[Infectious complications of biologic therapy in patients with rheumatoid arthritis]

[Differential diagnosis of inflammatory arthritis of the hip joint]

The differential diagnosis of inflammatory arthritis of the hip covers a broad spectrum and includes in particular crystal arthropathies and systemic rheumatic diseases. The clinical examination of joint effusion of the hip may be difficult but diagnostic ultrasound should support an early diagnosis. Radiographs remain essential in the initial diagnostic evaluation but may be of limited value in early stages of the disease. Magnet resonance imaging may be helpful in addition for the detection of early arthritis.Basic laboratory diagnostics include blood count, determination of C-reactive protein level and erythrocyte sedimentation rate. If septic arthritis is suspected blood cultures should be taken. Joint aspiration should be attempted in all cases and especially in monoarthritis. Synovial fluid analysis includes white cell count, differential count, examination for crystals and microbiological diagnostics including direct stains and cultures. The most important differential diagnoses of inflammatory arthritis of the hip joint in adults are osteoarthritis, crystal arthropathies and systemic rheumatic diseases, such as spondyloarthritis.

[Biologicals 2012]

Therapy with biologicals for the management of rheumatic diseases has improved treatment options and dramatically increased expectations of patients and doctors. Remission is a reasonable therapeutic aim, as well as inhibition of progression of structural damage. In 2012, five TNF-α inhibitors and four other biologicals targeted against Il-1, IL-6, B-lymphocytes and cell-cell interaction, have become available. Safety data for biological therapy are reassuring, based on a large amount of study data and data collected from national registries. The most important side-effect is a slightly increased tendency to infections (up to doubled in the first treatment year, depending on other factors such as previous infections and comorbidities). An increased risk for cancer (with the exception of preliminary data supporting a possible increase of skin cancer) has not been observed for patients treated with anti-TNF-α. Screening for tuberculosis as well as completing of vaccinations is necessary before starting treatment.

[Immune reconstitution syndrome]

The immune reconstitution inflammatory syndrome (IRIS) represents a heterogeneous group of conditions. Whilst they typically present in HIV-infected patients with advanced immunodeficiency, IRIS have also been described in HIV-negative patients with immune reconstitution due to other causes of immunosuppression. Frequently IRIS results from an immune response against underlying infection (pathogen-associated IRIS). However, IRIS might become evident during immune reconstitution without an underlying pathogen such as a sarcoid-like illness or an autoimmune thyropathy. Here we report on the epidemiology and risk factors of IRIS along with diagnosis and management of this clinically important inflammatory syndrome.