Rapid and deep control of inflammation in rheumatoid arthritis with infliximab and its correlation with acute-phase reactants

Rheumatoid arthritis (RA) is a chronic inflammatory disease with predominant joint involvement and possible systemic compromise, which leads to a handicapped status and poor quality of life. An optimal approach to treat RA requires early and intensive intervention with close monitoring of treatment response. Tumor necrosis factor (TNF) blockers are recommended in cases of active RA after the unsuccessful use of effective disease-modifying antirheumatic drugs (DMARDs); even adding them to treatment or replacing these drugs. Anti-TNF therapies have been demonstrated to reduce significant joint damage and to relieve symptoms during a prolonged time (see Scott and Kingsley, 2006). The efficacy of infliximab in an open-label trial is summarized with respect to speed of onset of action, durability of response, and its correlation between clinical and laboratory parameters. Safety for long-term treatment is also summarized. We studied 105 RA patients with more than 3 years' history of disease during 24 months on i.v. infliximab (75 completed study). We evaluated ACR responses at base line, and at 1, 6, 12, 16, 52, 77, and 104 weeks. Morning stiffness, swollen and tender joints, HAQ, SF-36% (PCS/MCS), polymerase chain reaction (PCR), erythrosedimentation rate (ESR), transaminases, rheumatoid factor (RF) levels, hemogram, and adverse events profile were all assessed. The treatment offered rapid and sustained clinical improvements as revealed by ACR responses and marked changes in the parameters previously described. Important changes were made in functional status and acute-phase reactants. Finally, infliximab was considered well tolerated and did not affect the safety profile of this trial.

New scoring system using tumor markers in diagnosing patients with moderate pericardial effusions

We performed diagnostic and therapeutic pericardiostomy with drainage and biopsy in 51 patients with moderate to large pericardial effusions of different etiologies from August 1991 to July 1995. Patients were divided into 4 groups (group 1, tuberculous pericarditis; group 2, suspected tuberculous pericarditis; group 3, acute pericarditis; group 4, malignancy). The pericardial fluid adenosine deaminase level in tuberculosis (87 +/- 10 U/l) was significantly higher than that in malignancy or acute pericarditis (21 +/- 4 U/l, 23 +/- 7 U/l, respectively) (P = 0.0001). The mean pericardial fluid carcinoembryonic antigen level (1.8 +/- 0.3 ng/ml) in benign disease was significantly lower than that (170.7 +/- 46.4 ng/ml) in malignant disease (P = 0.0001). Follow-up study has been done. With a new scoring system (each score 1 for adenosine deaminase > or = 40 U/l, or carcinoembryonic antigen < or = 5 ng/ml) in 25 patients since November 1993, we could diagnose 5 among 7 patients (71%) with tuberculosis, 11 among 13 patients (85%) with malignancy (adenosine deaminase < or = 40 U/l, or carcinoembryonic antigen > or = 5 ng/ml) and 5 among 5 patients (100%) with acute pericarditis (adenosine deaminase < or = 40 U/l, or carcinoembryonic antigen < or = 5 ng/ml), respectively. Our long-term follow-up study suggests that with the new scoring system we can decrease complications or avoid unnecessary procedures or treatments of patients.

Comparative study of the biotype, hemolysin-producing capability and antibiogram of the aquatic and the clinical strains of Aeromonas hydrophila

One hundred and seventy-two Aeromonas hydrophila strains were isolated from aquatic hosts including fish, turtle, frogs, shellfish and water itself. The aquatic organisms were compared with 45 clinical strains with regard to biotype, hemolysin, and antibiogram. The carrier rate of A. hydrophila in the aquatic environment was 61.7%. Of the aquatic strains 51% were hemolysin producers, equivalent to a capability for producing enterotoxin. The hemolysin-producing capability of aquatic strains was not significantly different from that of the clinical strains. The main code numbers or biotypes of aquatic strains were 3265 (29.4%), 3065 (17.5%), 7065 (9.6%), 7265, 3225 (each 8.5%). The main code number or biotypes of clinical strains were 3265 (36.1%), 3065 (9.8%), 7261 (6.6%), 2265, 3261 and 6241 (each 4.9%). Analysis of the antibiotic susceptibility pattern of both aquatic and clinical A. hydrophila strains using the microbroth dilution method showed that there is no significant difference in antibiotic susceptibility. Most aquatic and clinical strains were highly susceptible to tobramycin, gentamicin, amikacin, cefuroxime, piperacillin, cefotaxime and cefoperazone. Most strains of aquatic A. hydrophila were highly susceptible to cefamandole and chloramphenicol; however, clinical strains were only moderately susceptible to the same drugs. Most aquatic and clinical strains were highly resistant to ampicillin, and moderately resistant to sulbenicillin. Clinical strains were moderately resistant to cephapirin; however, aquatic strains were moderately susceptible to cephapirin. Based on the above findings, we may considered aquatic environment be, at least partially, the source of clinical strains. Furthermore, biotypes of aquatic A. hydrophila do not correspond to antibiogram or hemolysin-producing patterns.