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ID PMID Title PublicationDate abstract
21125170 Use of the abatacept in a patient with psoriatic arthritis. 2010 May Psoriatic arthritis (PA) is an inflammatory seronegative arthritis of unknown origin. Classically, PA has five clinical forms, and asymmetric oligoarthritis is the most common type. We describe the case of a patient with PA refractory to disease-modifying drugs, who developed drug-induced hepatitis after chemoprophylaxis with isoniazid, administered prior to the treatment with an anti-TNFα agent. Due to the risk of activating latent tuberculosis with the administration of anti-TNFα and hepatotoxicity onset caused by the TB treatment and based on the fact that the treatment of PA is similar to the treatment of rheumatoid arthritis, a decision was made to use the empirical treatment with abatacept. Approximately twenty days after the second infusion of the drug, the patient showed clinical improvement, resolution of the arthritis, almost complete disappearance of the skin lesions and improvement of anemia and inflammatory tests.
19605679 Cartilage oligomeric matrix protein in patients with juvenile idiopathic arthritis: relati 2009 Aug OBJECTIVE: Cartilage oligomeric matrix protein (COMP) has been identified as a prognostic marker of progressive joint destruction in rheumatoid arthritis. In this population based study we evaluated associations between plasma concentrations of COMP, disease activity, and growth velocity in patients with recent-onset juvenile idiopathic arthritis (JIA). COMP levels in JIA and healthy children were compared with those in healthy adults. Plasma levels of insulin-like growth factor I (IGF-1), which has been associated with COMP expression and growth velocity, were studied in parallel. METHODS: 87 patients with JIA entered the study, including oligoarticular JIA (n = 34), enthesitis-related arthritis (n = 8), polyarticular rheumatoid factor (RF)-positive JIA (n = 2), polyarticular RF-negative JIA (n = 27), systemic JIA (n = 6), and undifferentiated JIA (n = 10). Plasma levels of COMP were measured by ELISA and IGF-1 by a radioimmunoassay. RESULTS: Significantly higher COMP levels [mean 18.9 U/l (95% CI 17.3-20.5)] were found in healthy children compared with healthy adults [mean 10.7 U/l (95% CI 9.4-12.1)] (p < 0.0001). COMP levels in the JIA patients [mean 13.5 U/l (95% CI 12.4-14.7)] were significantly reduced compared to healthy children (p < 0.0001), and correlated negatively with C-reactive protein (CRP; r = -0.29, p = 0.01) and thrombocyte count (r = -0.28, p = 0.02). COMP levels in the JIA patients correlated positively with growth velocity (cm/yr) (r = 0.38, p = 0.0003) and growth velocity (SDS) (r = 0.29, p = 0.007). CONCLUSION: We found reduced COMP levels in children with JIA compared with healthy children. COMP levels in JIA correlated negatively with inflammatory activity as evaluated by CRP and the thrombocyte counts, and were associated with reduced growth rate.
19444549 Altered peptide ligands regulate type II collagen-induced arthritis in mice. 2009 We reported that peripheral blood mononuclear cells from HLA-DRB1*0101 Japanese patients with rheumatoid arthritis (RA) were highly reactive to 256-271 peptide of type II collagen (CII). Similar to RA, T cells reactive to CII (AA256-271) play a crucial role in the generation of arthritis in CII-induced arthritis mouse (I-A(q)). In the present study, we regulated the CII reactivity of T cells from CIA mouse with I-A(q) by altered peptide ligand (APL). Eight different APLs were designed and screened for their antagonistic activity using CII reactive cytokine production assay. Four APLs of CII 256-271 exhibited antagonistic activity in CII-reactive T cells. Moreover, intraperitoneally injected APL-5 (G262A) significantly suppressed CII-induced arthritis in mice, whereas the other three APLs did not. Compared with the control, APL-5 suppressed interleukin (IL)-17 production by T cells from CII-induced arthritis mice. These results suggest that CII APL is a potentially suitable therapeutic strategy for the control of RA.
21121214 Diabetes mellitus and renal tubular acidosis in primary Sjögren's syndrome. 2010 Jul Sjögren's syndrome is an autoimmune disease with multisystem involvement characterised by lymphocytic infiltration of exocrine glands resulting in keratoconjunctivitis sicca, xerostomia and bilateral parotid gland enlargement. Renal manifestation is characteristically chronic lymphocytic tubulointerstitial nephritis. Diabetes mellitus in Sjogren's syndrome has also been described in literature. In this article we discuss two cases of Sjogren's syndrome with diabetes mellitus and renal manifestations.
18810481 Selecting highly sensitive non-obese diabetic mice for improving the study of Sjögren's s 2009 Jan BACKGROUND: Non-obese diabetic (NOD) mice are a commonly used murine model for the study of Sjögren's syndrome. However, variations in susceptibility to the disease among the mice has often yielded less stable results. Based on the correlation between the pathological changes and the tear tests, we attempt to establish a simple screening procedure to assure the validity of experimental results by excluding those mice with poor susceptibility to dry eyes. METHODS: Seventy male NOD mice were recruited. The tear film break-up test (BUT) and the phenol red cotton thread test (CTT) were implemented while the mice were under anesthesia. The mice were divided into four groups (grades 1 to 4) based on their BUT readings, and four similar groups based on CTT measurements. Tear samples in each grade were collected for IL-1beta detection with ELISA. The lacrimal glands and conjunctiva of the mice were used to detect the levels of leucocyte common antigen (LCA). LCA-Positive staining was considered as the "gold standard" in the receiver operating characteristic curve (ROC curve) analysis. C57BL/6 mice were used as wild-type controls. RESULTS: There were 13 (18.57%), 43 (61.43%), 10 (14.29%) and 4 (5.71%) mice in grades 1, 2, 3 and 4 by BUT test, and 34 (48.57%), 15 (21.43%), 14 (20.00%) and 7 (10.00%) in grades 1, 2, 3 and 4 by CTT test respectively. Fifty-one out of the 70 mice (72.86%) were detected LCA-positive, and they were mainly in grades 1 and 2 of both the BUT and CCT grading systems. ELISA showed significant variances of IL-beta levels among the four groups (p < 0.01), with much lower IL-beta levels in group 3 and 4 when both BUT and CTT were used for grouping. The tear IL-beta level in the wild-type mice was similar to those of the grade 4 mice, using either BUT or CTT for grouping. The ROC curve analysis provided optimal cutting lines, which were 2 seconds in BUT readings and 4 mm/min in CTT measurements respectively. CONCLUSION: BUT and CTT tests are useful methods in screening high susceptible NOD mice. Cutting lines at BUT < or = 2 seconds and CTT < or = 4 mm/min provide a good balance between the assurance of susceptibility and the maximization of use of NOD mice for the study of Sjögren's syndrome.
20646416 [The diagnostic value of anti-SSA antibody in primary Sjögren's syndrome]. 2010 May OBJECTIVE: According to international classification criteria (2002) on Sjögren's syndrome, labial pathology was still considered as a major criterion for diagnosis. Standard labial biopsy was hard to be carried out in China. This study is to evaluate whether the invasive labial biopsy could be replaced by noninvasive detection of serum anti-SSA antibody. METHODS: 181 Chinese patients with the initial diagnosis of primary Sjögren's syndrome in Peking Union Medical College Hospital (PUMCH) were enrolled in Sjögren's International Collaborative Clinical Alliance (SICCA). All patients received standard labial biopsies (area of salivary gland tissue ≥ 4 mm²) and focal score (FS) of focal lymphatic sialadenitis were confirmed by pathologists from school of stomatology, University California of San Francisco (UCSF). Anti-SSA antibodies in sera of all patients were detected by double immunodiffusion (DID), Western blot in PUMCH and by enzyme-linked immunosorbent assay (ELISA) in central laboratory of SICCA. The correlation between labial pathological findings and serum anti-SSA antibody was studied by chi² test and the concordance was calculated by unweighted Kappa. RESULTS: (1) Bivariate analysis revealed strong associations of FS > 1 with the presence of anti-SSA antibody by DID (83.9% vs 42.0%, P < 0.0001). The accordance between FS and antibody detection by DID was fine with a kappa value of 0.432. However, there were 16.1% false-positive antibody reports and 42.0% false-negative antibody reports. (2) FS > 1 was strongly associated with the presence of anti-SSA antibody by Western blot (83.0% vs 51.7%, P < 0.0001). But the accordance between FS and antibody detection by Western blot was only fair with a kappa value of 0.316. There were 17.0% false-positive antibody reports and 51.7% false-negative antibody reports. (3) FS > 1 was strongly associated with the presence of anti-SSA antibody by ELISA (81.5% vs 38.6%, P < 0.0001). The accordance between FS and antibody detection by ELISA was fine with a kappa value of 0.427. There were 18.5% false-positive antibody reports and 38.6% false-negative antibody reports. CONCLUSION: In Sjögren's syndrome, labial biopsy with FS > 1 finding is strongly associated with anti-SSA antibody. Positive results of anti-SSA antibodies by DID or ELISA may indicate FS > 1, thus labial biopsy could relatively be avoided, negative results may need further standard labial biopsy procedure to confirm the diagnosis of Sjögren's syndrome.
20225049 Etanercept-refractory adult-onset Still's disease with thrombotic thrombocytopenic purpura 2010 Oct We report the case of a 69-year-old Japanese woman who presented with thrombotic thrombocytopenic purpura (TTP) which had manifested soon after the onset of adult-onset Still's disease (AOSD). Her disease was multi-drug resistant. She had undergone treatment with high-dose glucocorticoids, two courses of steroid pulse therapy, and cyclosporine A. The patient initially had a favorable response to the administration of etanercept (an anti-tumor necrosis factor agent) and glucocorticoids. However, her disease became refractory to etanercept after 6 months. Therefore, we administered tocilizumab (a humanized monoclonal anti-IL-6 receptor antibody) which dramatically improved the patient's refractory AOSD with TTP. This is the first report of an effective treatment for AOSD with TTP using the biological agents. Our report strongly suggests that biological agents, especially a humanized monoclonal anti-IL-6 receptor antibody, may be a new option for a safe and effective treatment of multi-drug-resistant AOSD and TTP associated with AOSD.
19882158 Interstitial inflammation in visceral organs is a pathologic feature of adult-onset Still' 2011 Jul The pathological features of adult-onset Still's disease remain unclear. An original case study of the histopathological changes in various organs of a patient with the disorder is presented. Interstitial inflammation was found in the heart, lung, liver, mucosa of total alimentary canal, and urinary bladder. Previous reports that involved the pathology of visceral organs are also reviewed.
20525741 Psychopathological and personality features in primary Sjogren's syndrome--associations wi 2010 Sep OBJECTIVES: To determine the spectrum of personality and psychopathology features of patients with primary SS (pSS) and explore whether they are linked to disease characteristics as well as the presence of autoantibodies (autoAbs) against neuropeptides. METHODS: Personality and psychopathological variables were determined in 103 pSS patients and 110 healthy controls (HCs). AutoAbs against hypothalamic and pituitary neuropeptides were measured by ELISA in 25 pSS patients and 25 HCs. Data analysis was performed by univariate and multivariate logistic regression models and by comparison with regression models. RESULTS: A higher number of pSS patients reported distinct personality traits (neuroticism, psychoticism and obsessiveness) and psychological distress compared with HCs. After adjustment for personality characteristics and demographics, only hypochondriasis was the main psychopathology feature associated with pSS, suggesting that psychopathological manifestations in the setting of pSS are primarily dependent on premorbid personality characteristics. Although no differences were detected between serum levels of neuropeptide autoAbs in pSS cases and controls, levels of autoAbs against alpha-melanocyte-stimulating hormone (alpha-MSH) correlated with anxiety scores in both groups examined but with higher intercept in pSS subjects. Significant correlations between anxiety score and autoAbs directed against oxytocin and vasopressin were also detected in the pSS patients. CONCLUSIONS: pSS patients exhibit a distinct pattern of personality traits and high levels of psychological distress compared with HCs, which seems to be determined by premorbid personality characteristics. Correlations between anxiety and alpha-MSH autoAbs suggest their potential involvement in anxiety development in both pSS and HCs.
20505281 Effects of cevimeline on the immunolocalization of aquaporin-5 and the ultrastructure of s 2009 Sjögren's syndrome (SS) is an autoimmune disorder whose main symptoms include xerostomia and dry eyes. It has been demonstrated that abnormal expression of aquaporin (AQP)-5 in the parotid and submandibular glands in SS model mice was corrected by cevimeline. In the present study, we orally administered cevimeline hydrochloride (cevimeline) to female MRL/l mice, which are widely used as a model for SS, to immunohistochemically investigate the localization of AQP-5 in the salivary glands. We also assessed the ultrastructure of acinar cells in the submandibular glands. AQP-5 was expressed in the apical and lateral cell membranes of acinar cells in the parotid and submandibular glands of normal mice, but not in the sublingual glands. In contrast, AQP-5 was expressed not only in the cell membranes in the apical domains but also in the cytoplasm in the SS model mice, indicating that the localization of AQP-5 was disordered in the SS model mice. After administration of cevimeline, AQP-5 was predominantly localized in the cellular apical domains of the acinar cells. Electron microscopy revealed that administration of cevimeline to the SS model mice and normal mice markedly reduced the number of secretory granules, increased the area of the rough endoplasmic reticulum, and expanded the intercellular gaps in the cells of the submandibular acini. Condensed vacuoles were also observed in the Golgi apparatuses, indicating that secondary enhancement of secretion and production of saliva had occurred. Consequently, the results of the present study demonstrate that the administration of cevimeline to the SS model mice increased salivary secretion in the submandibular glands. Furthermore, cevimeline transiently normalized the localization of AQP-5 expression in the parotid and submandibular glands.
21048389 [A case of primary Sjögren's syndrome complicated by chronic progressive myositis]. 2010 The patient was a 64-year-old woman with a nearly 20-year history of sicca symptoms, having been given a diagnosis of primary Sjögren's syndrome. Three years previously, she experienced difficulty in walking up a slope and had leg malaise, which insidiously progressed to an inability to go up and down stairs. This disability brought her to our hospital, where her muscle strength was examined by manual muscle testing, and she was found to have reduced muscle strength in proximal muscles like the thigh muscles and the neck flexor muscles. Blood studies revealed elevated ESR, increased serum IgG, mildly increased myogenic enzymes, and positive results for anti-SS-A and -SS-B antibodies. MRI scans disclosed extensive muscle atrophy as well as fatty degeneration in the thigh. A biopsy of the quadriceps femoris muscle provided a diagnosis of myositis based on the finding of muscle fibers of unequal size, nuclear centralization, and inflammatory cell infiltration into muscle fibers. CD4-positive lymphocytes were the predominant inflammatory cells. We diagnosed the case as myositis in primary Sjögren's syndrome based on the clinical course and laboratory findings. She recovered well with steroid medication. It is noteworthy that myositis associated with primary Sjögren's syndrome presents with mild symptoms and unremarkable laboratory data but may run a chronic progressive course.
20506202 Gene expression profile in the salivary glands of primary Sjögren's syndrome patients bef 2010 Aug OBJECTIVE: Primary Sjögren's syndrome (SS) is a complex disorder, in part due to B cell abnormalities. Although anti-B cell therapy is promising in primary SS, no treatment has yet been demonstrated to modify the disease course. This open-label study was undertaken to evaluate the efficacy of rituximab in primary SS and to investigate whether expression of specific genes is associated with efficacy of this treatment. METHODS: Fifteen patients with primary SS were treated in an open-label trial. Salivary gland biopsy specimens were obtained, and total RNA was extracted and amplified. Microarray analysis with the Affymetrix Human Genome U133 Plus 2.0 Array was used to analyze >54,000 transcripts, and potential pathways were identified. RESULTS: With gene expression data obtained before treatment, patients could be correctly classified in terms of whether they would be responders or nonresponders to rituximab. Gene pathway analysis demonstrated that the B cell signaling pathway was the most profoundly differentially expressed before treatment in the responders compared with nonresponders. Subclassification of patients based on the level of infiltration also demonstrated differential expression of genes belonging to the interferon (IFN) pathway between responders and nonresponders. Furthermore, unsupervised analysis based on gene expression modification before and after treatment allowed identification of 8 genes that were differentially expressed between responders and nonresponders, with the difference remaining significant after Bonferroni correction. CONCLUSION: Our results demonstrate the ability to elaborate a set of genes predictive of rituximab efficacy and highlight the importance of studying the differential expression of B cell and IFN pathway signaling molecules in relation to the response to anti-CD20 treatment. A randomized controlled study is currently ongoing to confirm these results.
20138793 Increased serum vitamin B12 levels are associated with adult-onset Still's disease with re 2010 Mar BACKGROUND: Adult-onset Still's disease (AOSD) can be complicated by reactive macrophage activation syndrome (rMAS). The objective of this study was to evaluate vitamin B(12) values in AOSD with and without rMAS. METHODS: All patients' files with AOSD in one center were retrospectively reviewed. Hemophagocytosis was defined as phagocytosis of various hematopoietic cells by macrophages. Clinical data including fever, rash, sore throat, arthritis, lymphadenopathy were recorded. Laboratory tests included complete blood count, serum ferritin, transaminases, serum triglyceride and vitamin B(12) level. The control group was selected from our AOSD pool who had AOSD without rMAS. RESULTS: Seven patients (5 female) had AOSD with rMAS. Median age at the diagnosis of rMAS was 32 (range, 27-37) and median follow-up duration after rMAS diagnosis was 18 months (range, 2-60). All of the patients with rMAS had fever, sore throat, rash, arthritis, anemia and hyperferritenemia. Five of seven patients had hepatosplenomegaly and lymphadenopathy. Four of seven patients had normal or low leucocyte count, three of seven patients had increased triglyceride level. The patients with AOSD and rMAS mean+/-standard deviation (S.D.) vitamin B(12) levels were significantly higher than without rMAS (1903+/-960 vs 542+/-328pg/ml, p=0.001). The specificity (75%) of increased vitamin B(12) level was high and sensitivity (100%) was excellent. CONCLUSION: Elevated vitamin B(12) levels seems to be a good marker for diagnostic marker in AOSD when complicated with rMAS.
20054701 Annular erythema associated with Sjögren's syndrome: review of the literature on the mana 2010 Apr Annular erythema has been recognized to be a specific, cutaneous manifestation associated with Sjögren's syndrome. Based on a search of the literature up to 2007, annular erythema with Sjögren's syndrome (AESS) preferentially occurs in Asian but not in Western populations. However, the precise clinical course and standard regimen for the management of AESS have remained obscure, primarily because of its rare occurrence in Western populations and the fact that most Asian cases are isolated reports. In this study, 28 cases of AESS from our department and 92 cases distilled from the literature were enrolled in a retrospective study to evaluate the clinical characteristics and most desirable management of this skin manifestation in Sjögren's syndrome. We found that 75% of all cases with AESS were positive for both anti-SSA and anti-SSB antibodies. Multiple therapeutic options are available to treat AESS, including oral steroids. Several anti-malaria drugs or tacrolimus ointment have also been reported to be effective against AESS. AESS is a distinct clinical entity, and a small dose of prednisolone (approx. 10 mg) is sufficient to control diseases activity, except in some cases with systemic manifestations, and this treatment has a more rapid clinical effect than topical steroids.
20374376 Pulmonary amyloidosis in Sjögren's syndrome: a rare diagnosis for nodular lung lesions. 2009 Dec Lung involvement in Sjögren's syndrome (SS) can affect trachea, bronchus, small airways, pleura and may cause interstitial lung injury. It may also be associated with malignancies, particularly non-Hodgkin's lymphoma, which is a well-recognized complication of this disease. Here we describe the occurrence of localized amyloidosis presenting as pulmonary nodules in a patient with newly diagnosed SS. We highlight this rare occurrence as a diagnostic possibility that should be considered in the evaluation of pulmonary involvement in this disease.
19900977 Sjogren's syndrome-onset lupus patients have distinctive clinical manifestations and benig 2010 Feb The objective of this study was to investigate the clinical characteristics and prognosis of Sjögren's syndrome-onset systemic lupus erythematosus (SS/SLE) patients. Medical charts of 41 consecutive SS/SLE inpatients admitted to Peking Union Medical College Hospital (PUMCH) from February 1998 to February 2008 were systematically reviewed, including demographic data, clinical features, laboratory findings, treatment as well as outcomes. Two hundred and fourteen cases were randomly selected as controls from 2331 SLE-only inpatients treated in PUMCH at the same time period. There were significant differences between SS/SLE and SLE-only patients in the following manifestations (p < 0.05): (1) sex ratio (F/M) (41/0 versus 184/30), age (42.8 +/- 41.0 years versus 31.8 +/- 31.0 years), disease duration (113.8 +/- 84.0 months versus 44.9 +/- 18.0 months); (2) clinical features, xerostomia (85.4% versus 6.1%), xerophthalmia (75.6% versus 2.3%), renal tubular acidosis (21.9% versus 0%), interstitial lung disease (12.2% versus 2.8%), facial rash (9.8% versus 46.3%), nephrotic syndrome (7.3% versus 31.3%), central nervous system involvement (4.9% versus 19.6%); (3) laboratory findings, ESR (64.6+/-75.0mm/h versus 46.5+/-34.0mm/h), C4 (14.8 +/- 12.2 g/dl versus 12.0 +/- 10.9 g/dl), IgG elevation (56.4% versus 29.9%) and IgA elevation (38.5% versus 20.4%), RF, anti-SSA and anti-SSB positive rates (70.8% versus 20.3%, 82.9% versus 43.4% and 39.0% versus 7.9%); (4) SLEDAI score (8.0 +/- 8.0 versus 10.2 +/- 10.0), glucocorticoid treatment (methylprednisolone bolus/1-2 mg kg(-1) day(-1) prednisone/<1 mg kg(-1) day(-1) prednisone) (8/26/7 versus 91/102/21), and importantly, rate of death and/or severe irreversible organ failure (2.4% versus 14.9%). SS/SLE patients were followed up for 33.0 +/- 34.0 months, 40 cases remained stable at a low dose of corticosteroid. In conclusion, different from SLE-only patients, SS/SLE patients have distinctive clinical manifestations and benign prognosis that require less vigorous treatment with glucocorticoids and/or immunosuppressants.
20618099 Reversal of premature ovarian failure in a patient with Sjögren syndrome using an elimina 2010 Jul BACKGROUND: Premature ovarian failure is diagnosed with a picture of amenorrhea, elevated follicle-stimulating hormone (FSH), and age under 40 years. Twenty percent (20%) of patients with premature ovarian failure have a concomitant autoimmune disease. Cases of premature ovarian failure associated with Sjögren syndrome have been reported in the literature. PATIENT AND METHOD: We report a case of a 42-year-old white woman with Sjögren syndrome and premature ovarian failure who underwent a reversal of her premature ovarian failure and restoration of normal menses using an elimination diet protocol. The patient was diagnosed with her rheumatological condition in 2005 and started on disease-modifying antirheumatoid drugs, which were taken intermittently due to a concern over medication side-effects. Her menses became irregular at the time of initial diagnosis and finally ceased in 2006, with a dramatic elevation in her FSH, indicative of autoimmune-induced premature ovarian failure. In March 2009, she commenced an elimination diet protocol, eliminating gluten, beef, eggs, dairy products, nightshade vegetables, refined sugars, and citrus fruit for 4 months. RESULTS: Her repeat laboratory tests after 4 months showed a drop in FSH from 88 to 6.5 and a drop in erythrocyte sedimentation rate from 40 to 16. Her menses also resumed and her rheumatological symptoms significantly improved. CONCLUSIONS: It is hypothesized that the restoration of normal menses was caused by reduced inflammation in the ovarian tissue and supports the hypothesis that the gut immune system can influence autoimmune disease and inflammation.
20215986 Prolonged remission of a demyelinating neuropathy in a patient with lymphoma and Sjögren' 2010 Mar Chronic acquired demyelinating polyneuropathies may be refractory to conventional therapy including corticosteroids, plasma exchange, and intravenous immunoglobulin (Ig) or require long-term immunotherapy to maintain remission. Use of alternative approaches such as Rituximab, an anti-CD20 antibody, in the treatment of demyelinating polyneuropathy, unrelated to IgM gammopathy and myelin-associated glycoprotein antibodies, has been the subject of only a few case reports. We report the case of a 79-year-old woman with a distal acquired demyelinating polyneuropathy in the context of Sjögren's syndrome, IgG paraproteinemia, and occult lymphoma who has had an excellent and durable response to Rituximab therapy.
20156928 Calcinosis cutis and Sjögren's syndrome. 2010 May Cutaneous calcinosis can be classified into four types: dystrophic, metastatic, idiopathic and iatrogenic. Dystrophic calcification constitutes the most frequent variant and is associated with a large number of illnesses, among which are included some collagen diseases such as CREST syndrome, scleroderma, dermatomyositis and lupus erythematosus. We present a case of dystrophic calcinosis cutis, affecting the fingertip of a woman with a 10-year history of primary Sjögren's syndrome (SS). She has been receiving diltiazem as a treatment for the last 15 months, resulting in the partial resolution of the lesions. We emphasize the fact that the presence of calcinosis cutis has not been described previously in patients with SS, and that diltiazem has partially improved our patient's cutaneous lesions.
21199465 Psoriatic arthritis: a systematic review. 2010 Oct Psoriatic arthritis is an inflammatory rheumatic disorder of unknown etiology occurring in patients with psoriasis. The Classification Criteria for Psoriatic Arthritis study group has recently developed a validated set of classification criteria for psoriatic arthritis with a sensitivity of 91.4% and a specificity of 98.7%. Three main clinical patterns have been identified: oligoarticular (≤ 4 involved joints) or polyarticular (≥ 5 involved joints) peripheral disease and axial disease with or without associated peripheral arthritis. In this context distal interphalangeal arthritis and arthritis mutilans may occur. According to other reports, also in our centre, asymmetric oligoarthritis is the most frequent pattern at onset. Axial disease has been estimated between 5% and 36% of patients. It is characterized by an irregular involvement of the axial skeleton with a predilection for the cervical spine. Recurrent episodes of enthesitis and dactylitis represent a hallmark of psoriatic arthritis. In around 20% of cases distal extremity swelling with pitting edema of the hands or feet is observed. Unilateral acute iridocyclitis, usually recurrent in alternate fashion, is the most frequent extra-articular manifestation, and accelerated atherosclerosis is the prominent comorbidity. The clinical course of peripheral and axial psoriatic arthritis is usually less severe than rheumatoid arthritis and ankylosing spondylitis, respectively. Local corticosteroid injections and non-steroidal anti-inflammatory drugs are recommended in milder forms. Sulphasalazine and methotrexate are effective in peripheral psoriatic arthritis. Recent studies have provided evidence on the efficacy of anti-tumor necrosis factor-α drugs to control symptoms and to slow or arrest radiological disease progression.