Intra-articular therapy with tumor necrosis factor-α antagonists: an update.

The aim of the study was to review from the present literature the intra-articular (IA) use of the TNF-blocking drugs. A total of 28 papers about this topic were found through a search in PubMed; the first publication's date was July 2003. These studies include a total of 214 patients affected by 12 different joint diseases that reported a total of 1046 intra-articular therapies carried out in 10 different joint sites. Infliximab and etanercept were the most widely used medications. The safety of this treatment clearly emerges from our analysis, while more difficult was the evaluation of its efficacy. Nevertheless we deduced an ideal patient profile that may better respond to the IA anti-TNF treatment.

Papular-purpuric gloves and socks syndrome due to parvovirus B19: a report of two simultaneous cases in cohabitant families.

The so-called papular-purpuric gloves and socks syndrome (PPGSS) is a condition characterized by acute onset of intense erythema, edema and petechiae with a typical localization on the hands and feet, besides mucosal lesions of the oral cavity. The syndrome has a favorable and self-limited course, requiring only a symptomatic therapy. In the 50% of the cases described in literature (ninety cases in 22 years), is documented an acute infection caused by parvovirus B19 and in only two cases the onset of PPGSS is reported among different members of the same family. The aim of the work is to describe two cases of PPGSS arisen during a short time period in two family members affected by an acute parvovirus B19 infection found by serum sampling. The peculiarity of the study was the infrequence of the syndrome and the rareness of the description of PPGSS in rheumatology. This syndrome is usually described in dermatology, but it is also interesting for the rheumatologist because it comes in differential diagnosis with various autoimmune diseases.

Incidence of influenza-like illness into a cohort of patients affected by chronic inflammatory rheumatism and treated with biological agents.

This study aimed to evaluate the incidence of influenza-like illness (ILI), from October 2009 to May 2010, in a group of patients suffering from chronic inflammatory rheumatism and treated with biological therapies. At the end of 2009-2010 influenza season, 159 patients under biological therapies answered to a questionnaire distributed 8 months before and were deeply interviewed. The group included 69 men and 90 women (mean age 47.6); forty-nine suffering from rheumatoid arthritis, 61 with psoriatic arthritis, 32 with ankylosing spondylitis and 17 with other spondyloarthritis; 146 patients were treated with anti-TNF-α, 7 with rituximab and 6 with abatacept; 128 patients assumed DMARDs and 72 patients assumed low dose of steroids. A case of ILI was identified by anamnestic findings and according to the case definitions commonly used in Europe. Seventeen percent of the considered population reported at least one episode of ILI during the monitoring period; none of the patients during the acute influenza attack suffered particularly severe symptoms and no one was hospitalized due to complications. Despite the diversity among the considered subgroups, the statistical analysis did not show any significant difference when incidence of ILI was considered for different disease, different biological agent and different association therapy. None of the examined variables resulted statistically significant concerning the relative risk evaluation. The incidence of ILI into a cohort of 159 patients treated with biological agents during the influenza season 2009-2010 resulted higher than the value reported in a wide sample of Italian population in the same period. However, the pandemic impact was not heavy among the studied patients, considering that no important complications or hospitalizations have been reported.

[Intra-articular therapy with infliximab in psoriatic arthritis: efficacy and safety in refractory monoarthritis]. / Terapia intra-articolare con infliximab nell'artrite psoriasica: valutazione di efficacia e tollerabilità nel trattamento della monoartrite refrattaria.

OBJECTIVE: To evaluate efficacy and safety of intra-articular therapy (IA) with infliximab (IFX), in patients with psoriatic arthritis (PsA) and refractory monoarthritis. METHODS: Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria) were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A), 3/5 with concomitant steroids, 4/5 with NSAID's. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare. RESULTS: At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist) was in remission after 2 injections (3 months of interval). In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention. CONCLUSIONS: Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening.

[Evaluation of the efficacy of orgotein in a series of patients with hydrarthrosis of the knee]. / Valutazione della efficacia della orgoteina in una casistica di idrartro del ginocchio.

A study was carried out to verify the efficacy of intra-articular orgotein in patients with different forms of hydrarthrosis of the knee. The results confirm the value of orgotein for the local treatment of osteoarthritic joint swellings. However in the presence of marked exudative synovitis processes (chronic primary polyarthritis), the use of orgotein is of limited value.

[Various forms of secondary lumbosciatic pain in children and adults]. / Su alcune lombosciatalgie secondarie dell'infanzia e dell'età adulta.

Reference is made to two personal cases in underscoring the fact that meralgia paraesthetica, though regarded as a form that displays a preference for adult males, must be considered as extended to subjects of all ages when a benign or malignant neoformation irritating the L2 root or its trunk is involved. Before classifying a case as idiopathic, therefore, one must rule out the possibility of intra-abdominal disease-usually malformative in young subjects, and benign or malignant in persons of all ages. Lastly, stress is laid on the fact that atypical lumbar and sciatic pain in the adult may be secondary to aneurysm of the abdominal aorta, the common iliacs and the hypogastric. Hence the need to look for such conditions symptomatologically.

[Duodenal absorption of calcium in rats treated with 25 OHD3, diphosphonates and synthetic anabolics]. / Etude de l'absorption duodénale du calcium chez des rats traités avec 25 OHD3, avec diphosphonates et avec anabolisants de synthése.

In this study the authors developed new technics of study of duodenal absorption of calcium in rats: atomic absorption spectrophotometry, and dialysis to equilibrium. We considered that the main factors necessary for evaluation of duodenal absorption of calcium are the serum calcium, the calcium and alkaline phosphatase present in the duodenal cells and the calcium-binding proteins. The authors demonstrate that these factors are highest in rats treated with 25 OHD3 and norandrostenolone decanoate, than in control rats. In rats treated with diphosphonate, on the contrary, they obtained a reduction in the values of calcium and alkaline phosphatase contained in the duodenal cells.

[Our experience with over 100 cases of carpal tunnel syndrome]. / Nostra esperienza su oltre cento casi di soggetti con sindrome del canale carpale.

Reference is made to personal experience with regard to the carpal tunnel syndrome. Attention is drawn to the importance of electromyography in the detection of median nerve deficiency, even in recent forms. The most suitable ways of treating the syndrome are also discussed.

[Rarefying osteopathy in rheumatology. Methods of evaluation and comparison of urinary hydroxyproline and serum proline iminopeptidase]. / Le osteopatie rarefacenti in reumatologia. Metodi di valutazione e confronto tra idrossiprolina urinaria eprolinoiminopeptidasi serica.

Serum proline iminopeptidase and (where possible) urinary hydroxyproline were determined in 214 subjects: normal subjects, subjects with chronic kidney disease, subjects with chronic liver disease, subjects with osteitis deformans, subjects with rheumatoid arthritis, and subjects with osteoporosis. The values of the two parameters fully corresponded. It is suggested, therefore, that proline iminopeptidase can be determined instead of hydroxyproline in cases where a primarily destructive bone disease in present.