Infliximab in spondyloarthropathy associated with Crohn's disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations.

OBJECTIVE: To evaluate the efficacy and tolerability of anti-tumour necrosis factor alpha (TNFalpha) monoclonal antibody (infliximab) in the treatment of spondyloarthropathy (SpA) associated with active and inactive Crohn's disease (CD). METHODS: Twenty four patients with SpA associated with active or inactive CD (16 active, 8 quiescent) were treated with anti-TNFalpha monoclonal antibody (infliximab) with repeated infusions for a period of 12-18 months. The treatment aimed at ameliorating the general musculoskeletal and spinal pain, controlling peripheral arthritis and enthesitis, decreasing the BASDAI score, modifying acute phase reactants, and reducing CD activity. RESULTS: Infliximab improved both gastrointestinal (p<0.01) and overall articular symptoms (BASDAI, p<0.01; general musculoskeletal and spinal pain, p<0.01; peripheral arthritis, p<0.01) in patients with active CD. Additionally, infliximab effectively controlled not only axial involvement and peripheral arthritis but also enthesitis (p<0.01) and prevented inflammatory bowel disease reactivation in patients with inactive CD and low inflammatory markers. Amelioration of gut and musculoskeletal involvement persisted for up to 12 months. CONCLUSION: Infliximab may act on the inflammation of entheses and of periarticular structures, which usually does not cause a change in the haematological markers that are the main indicators of pain and joint ankylosis in SpA. Infliximab induces and maintains remission of CD while at the same time treating active and severe SpA, suggesting that it should be the preferred drug for the treatment of active and severe SpA associated with active or quiescent CD.

[Burning mouth syndrome. Clinical experience with 75 patients]. / Burning mouth syndrome. Esperienza clinica in 75 pazienti.

The burning mouth syndrome (BMS) is a very common disorder frequently seen in practical dentistry. It is a particular condition with a complex of strange burning sensation localized in the oral mucosa which is clinically normal. It is very important for the dentist to recognize and classify this particular syndrome in order to exclude other factors which can cause the same symptoms. On the basis of personal experience on 75 patients, the complex management of this particular group of patients has been evaluated to make a right diagnosis and a correct treatment.

[The effects of drugs on the oral cavity]. / Effetti delle droghe sul cavo orale.

As shown by the growing numbers of users attending the public drug addiction services, drug abuse is a phenomenon that is constantly spreading. It is important that dentists are aware of the oral problems linked to drug abuse. This study examines the general effects and oral implications of the illegal substances used by the majority of drug addicts. The main dental complications of cannabinoids are the increased incidence of squamous cell carcinomas of the oral cavity, the presence of xerostomia and severe gingivitis. Depending on how it is taken, cocaine may cause ischemic necrosis of the palate, inflammation, ulceration and gingival retraction, as well as an increased incidence of bruxism. Hallucinogens have few direct oral effects, but among these it is worth recalling xerostomia, increased bruxism and oral problems linked to malnutrition caused by ecstasy. Turning to the opioids, heroin is the drug primarily used by the majority of drug addicts. Its oral effects mainly take the form of dental decay, showing a particular form and extent linked either directly or indirectly to heroin use. This results in "typical" or "atypical" caries pathologies directly linked to the effects of heroin. Given the extent of this phenomenon, it is important that dentists are aware of the problems linked to drug abuse that they may have to treat.