Severe infliximab-induced psoriasis treated with adalimumab switching.

BACKGROUND: Antitumor necrosis factor (anti-TNF) agents are a well-established treatment for various medical conditions, including psoriasis and psoriatic arthritis. However, anti-TNF agents may themselves induce psoriasis in some patients. METHODS: The authors report two cases of patients with severe and refractory infliximab-induced psoriasis. RESULTS: The patients had good clinical responses after switching to another TNF blocker. CONCLUSION: For severe cases, infliximab withdrawal combined with conventional immunosuppressive psoriasis drugs or with adalimumab may be a therapeutic option.

Optic neuritis after infliximab therapy.

Demyelinating diseases were described in patients receiving anti-TNF agents. Optic neuritis (ON) induced by TNF blockers was already described in 22 cases in the literature. In this article, the authors report a 53-year-old woman with refractory rheumatoid arthritis that developed neuritis optica after the fourth dose of infliximab and had a good outcome after anti-TNF withdrawal, associated with glucocorticoid treatment. In addition, the previous cases of ON induced by anti-TNF agents were reviewed.

Psoriatic arthritis.

Psoriatic arthritis (PsA) is a chronic inflammatory spondyloarthritis that occurs in combination with psoriasis. The exact prevalence of PsA is unknown, and its pathogenesis has not yet been fully elucidated. Genetic, environmental, and immunologic factors have all been implicated. The appearance of arthritis might precede, succeed or occur concomitant with skin lesions. PsA is sometimes considered a benign form of arthritis, but it affects patient quality of life and also causes functional impairment. Up to 20% of affected patients exhibit extremely destructive and disfiguring forms of the disease, and PsA is associated with increased mortality. The treatment of PsA aims to provide relief from signs and symptoms of the disease, prevent structural damage to joints, improve patient quality of life and decrease mortality. The choice of treatment depends on the severity of clinical presentation. The use of immunobiological agents is restricted to cases that do not respond to conservative treatment.

Still's Disease and Recurrent Complex Regional Pain Syndrome Type-I: The First Description.

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder characterized by neuropathic pain associated with local edema and changes suggestive of autonomic involvement such as altered sweating, skin color, and skin temperature of the affected region. CRPS was described associated with several diseases, such as trauma, psychiatric conditions, and cancer. However, no case associated with Still's disease has been previously described. In this paper, the authors describe the first case of CRPS associated with Still's disease.

[Livedo reticular: classification, causes and differential diagnoses]. / Livedo reticular: classificação, causas e diagnósticos diferenciais.

Livedo reticularis (LR) is a common finding and results from a physiological vasospastic response to cold or systemic disease, characterized by a pattern of cyanotic discoloration, or erythematous-cyanotic aspect. LR can be congenital or acquired. Among the acquired LR stand out from the physiological or cutis marmorata, the idiopathic, the induced vasospastic, those due to intravascular diseases or even in the wall of the vessels. This article reviews several clinical features, differential diagnosis and various causes of livedo.