CD25 blockade for refractory polymyositis

We report a patient with refractory PM treated with the high-affinity interleukin-2 receptor (CD25) blocker basiliximab

Treatment of inflammatory myopathies

The idiopathic inflammatory myopathies (IIM) dermatomyositis (DM) and polymyositis (PM) are chronic diseases affecting the striated muscles with variable involvement of other organs. Glucocorticoids are considered the cornerstone of treatment, but some patients require adjunctive immunosuppressive agents because of insufficient response to glucocorticoids, flares upon glucocorticoid tapering, or glucocorticoid-related adverse events. Areas covered: The aim of this article was to review (PubMed search until February 2018) the evidence on established and new therapies derived from randomized controlled trials (RCTs) on adult DM and PM. In addition, key data from open-label trials, case reports, and abstracts were included where data from RCT were lacking. Expert commentary: Numerous synthetic and biological immunosuppressive agents are currently available to treat the IIM, sometimes in combination. The choice of the specific medication in the individual patient depends upon the disease phenotype and patient's characteristics. Exercise improves muscle performance without causing disease flares and should be an integral part of the treatment of the IIM. Prompt diagnosis and treatment can lead to better outcome

Systemic vasculitis: state of the art and emerging concepts

Systemic vasculitis: state of the art and emerging concept

Improving therapeutic options for patients with giant cell arteritis

Glucocorticoids remain the mainstay of treatment of giant cell arteritis. The aim of this review is to establish the optimal schedule of glucocorticoid administration, and to ascertain which other treatments may be used as glucocorticoid-sparing agents

Comment on: Rituximab therapy for takayasu arteritis: A seven patients experience and a review of the literature: Reply

Comment on: Rituximab therapy for Takayasu arteritis: a seven patients experience and a review of the literature: repl

Chronic periaortitis: a large-vessel vasculitis?

Chronic periaortitis is characterized by a fibro-inflammatory process spreading from the abdominal aorta and the iliac arteries. Originally, chronic periaortitis was considered a localized inflammatory response to severe aortic atherosclerosis. However, subsequent studies have shown that chronic periaortitis may also involve other arteries and present with features of auto-immune diseases. This article reviews the issue of large-vessel involvement in chronic periaortitis and its implications in the pathogenesis and nosography of the disease

The Role of Tumor Necrosis Factor-\u3b1 Blockers in Psoriatic Disease. Therapeutic Options in Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting peripheral and axial joints, usually associated with psoriasis (PsO) and involving various systems and organs (eye inflammation, such as uveitis; and involvement of nail and enthesis), and it usually requires a multidisciplinary treatment approach. Tumor necrosis factor-\u3b1 (TNF-\u3b1) is overexpressed in psoriatic synovium and skin plaques and its selective inhibition by anti-TNF-\u3b1 agents has been demonstrated to reduce TNF-\u3b1 levels in the articular environment, reversing the synovial hyperproliferative phenotype. Studies performed on anti-TNF-\u3b1 agents in PsA demonstrated that they are able to reduce neutrophil and macrophage infiltration as well as vascular cell adhesion protein 1 expression with ensuing synovial thickness normalization. The efficacy of anti-TNF-\u3b1 agents for all PsA manifestations (peripheral arthritis, axial involvement, enthesopathy, and skin disease) suggests that anti-TNF-\u3b1 efficacy might be related to the ability to influence angiogenesis and osteoclastogenesis, reduce synovial inflammation, and slow radiological disease progression. This review describes the role of anti-TNF-\u3b1 in each manifestation of PsA

Biologics in vasculitides: Where do we stand, where do we go from now?

Biological agents represent a valid therapeutic option in patients with severe and/or relapsing vasculitis. Over the last years, some of these agents have become an established therapy (such as RTX in AAV or IFX for ocular BD), and some appear to hold promise to become so. In addition, there are a number of drugs in the pipeline that may contribute to further improve the prognosis of vasculitis. As the range of medications available for vasculitis widens, the need will also increase to define the best treatment schemes as well as to identify those patients that may benefit most from biological agents

Tocilizumab for severe refractory neuro-Beh\ue7et: three cases IL-6 blockade in neuro-Beh\ue7et

Objectives: To describe the response to IL-6 blockade [tocilizumab (TCZ)] in three patients affected by highly refractory neuro-Behcet disease (NBD). Methods: Three patients who had failed synthetic immunosuppressants and TNF-alpha antagonists combined with glucocorticoids received TCZ after obtaining their informed consent. Two patients underwent TCZ infusions at 8 mg/kg every 4 weeks for a mean period of 24 months, while in one patient, the frequency of TCZ infusions was increased to every other week after 21 months due to a disease flare. Concomitant therapy with synthetic agents and low-to-medium dose glucocorticoids was continued. Clinical and imaging findings were assessed before and after the onset of TCZ therapy. Results: In all our patients, a very short time lag between the onset of treatment with TCZ and the clinical response was observed. A partial response occurred in two patients and a nearly complete response in one. Some loss of efficacy occurred after 18 months in one patient, but there was again a significant improvement when the interval between the infusions was shortened. TCZ was overall well tolerated and no serious adverse events occurred. In two patients, the prednisone dose could successfully be tapered to about 20 mg/day, while in another patient glucocorticoids could safely be withdrawn. Brain MRI remained virtually unchanged in all patients. Conclusions: Although TCZ has not yet been included among the medications recommended for the treatment of NBD, our data suggest that it may be considered for patients with refractory NBD

Usefulness of PET in recognizing and managing vasculitides

PURPOSE OF REVIEW: The aim of this article was to review the recent contributions to the scoring methods of PET in vasculitis as well as to its role in the diagnostic work-up. RECENT FINDINGS: Both visual and semiquantitative scoring methods can be used to interpret PET scans. PET has been shown to be both sensitive and specific in the diagnosis of large-vessel vasculitis. In addition, it also has a role in predicting vascular complications. SUMMARY: There is a need to better standardize the scoring methods used to interpret PET scans. In clinical practice, PET is useful to diagnose untreated individuals with suspected large-vessel vasculitis and contributes to identify patients at risk for vascular complications