Therapy resistant idiopathic scleredema: an underlying pathology not always present

WOS: 000365587100008PubMed ID: 27708956Scleredema is a rare connective tissue disorder of unknown pathogenesis. Three types of scleredema have been described, based on its association with postinfection, monoclonal gammopathy and diabetes mellitus. We report herein a case of scleredema which the diagnosis didn't get specified. The patient was followed regularly for 13 years and did not respond to various combinations of immuno-suppressants and psoralen plus ultraviolet A therapy. Treatment of scleredema is quite difficult and of limited success. At present, there is no proved treatment for this disease

Very Low Dose Methotrexate-Induced Rheumatoid Nodules Localized in Buttocks and Palmar Aspects of Phalanges: Case Report

WOS: 000298720200040Rheumatoid nodules are the most common extra-articular lesions. They usually occur in rheumatoid factor positive patients and indicate activity and severity of the disease. These nodules characteristically occur subcutaneously on extensor surfaces over the elbows or other bony prominences. They may be overlooked if they occur in sites other than well-known areas. We present a case with rheumatoid arthritis (RA) who developed multiple subcutaneous, histologically-proven rheumatoid nodules in both buttocks as well as on palmar aspects of phalanges after 3.5 years of very low-dose weekly methotrexate (MTX) treatment. These nodules occurred abruptly while there was not active arthritis in any joint. MIX-induced large nodules may occur even with very low doses of MTX, in atypical localizations such as both buttocks

Saliva levels of caspase-1, TNF-?, and IFN-? in primary Sjögren’s syndrome: oral mucosal abnormalities revisited

Background/aim: Abnormalities in oral mucosal immunity contribute to complex pathogenesis of primary Sjögren’s syndrome (pSjS). We aimed to measure saliva and serum levels of caspase-1, tumor necrosis factor-alpha (TNF-?) and interferon gamma (IFN-?) in patients with pSjS. Materials and methods: We studied 43 pSjS patients fulfilling the AECG criteria and 30 age/sex-matched healthy controls, as well as 39 rheumatoid arthritis (RA) patients as a disease control group. ESSDAI scores were less than seven in all patients with pSjS, indicating low disease activity. Quantitative analyses were made in serum and whole saliva samples. the statistical analysis was performed using SPSS 19.0. Results: While no significant difference was found in serum measurements, saliva levels of TNF-? and caspase-1 were significantly higher in pSjS patients versus healthy controls when using the Mann–Whitney U test. on the other hand, in the pSjS group, saliva levels of TNF-? and caspase-1 were also significantly higher compared to the RA group using Student’s t-test. in the pSjS group, those parameters did not show any correlation with disease duration, seropositivity, and smoking. Conclusion: Despite low disease activity, saliva TNF-? and caspase-1 levels were found to be significantly higher in the pSjS group, which may suggest a possible advantage of local anticytokine treatments in selected cases