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Richard F Howard,1 Tatjana Radic,2 Melanie Sohns,2 Mariëlle Eerdekens,2 Andrea Waßmuth2 1Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital and the GOS-UCL Institute of Child Health, London, UK; 2Grünenthal GmbH, Aachen, GermanyCorrespondence: Richard F HowardDepartment of Anaesthesia and Pain Medicine, Great Ormond Street Hospital and the GOS-UCL Institute of Child Health, London WC1N 3JH, UKTel +44 2078298865Email R.Howard@ucl.ac.ukPurpose: Investigation of the efficacy and safety of tapentadol prolonged release (PR) compared with morphine PR for long-term treatment of pain in children.Patients and Methods: Children aged 6 to < 18 years requiring long-term treatment with opioids were studied in a 12-month, 2-part, multi-center trial: Part 1, 14-day open-label, randomized, active-controlled, parallel group non-inferiority trial comparing twice daily tapentadol PR with morphine PR; Part 2, open-label treatment with tapentadol PR for up to 12 months or no treatment “safety observation period”. Pain intensity was rated with visual analogue scale or Faces Pain Scale-Revised, and non-inferiority was assessed by comparison of “treatment responders” (those completing the 14-day treatment period and showing pre-defined changes in pain rating) in each group.Results: Twenty-three of 48 centers enrolled 73 patients. In Part 1, 45 and 24 patients received tapentadol or morphine, respectively, of which 40 and 22 completed 14-day treatment. In Part 2, thirty-six and 58 patients entered the tapentadol PR or observation periods, respectively, with 20/36 completing at least 12 weeks of treatment; 10 of the 36 had received morphine in Part 1. Forty-four of the 58 patients in the safety observation period had received tapentadol. Tapentadol PR was non-inferior to morphine PR (lower limit of confidence interval above negative non-inferiority margin of − 0.2) in Part 1. Rates of adverse events were as expected with nausea (22.2%) and constipation (15.6%) in the tapentadol PR group, and with vomiting (33.3%), nausea and constipation (each 16.7%) in the morphine PR group. No new safety issues were identified; the safety profile of tapentadol over the 12 months treatment and observation periods was comparable to that established in subjects > 18 years old.Conclusion: Tapentadol PR was well tolerated and equivalent to morphine PR for both efficacy and safety in children (6 to < 18 years old) requiring long-term treatment with opioids.Keywords: tapentadol, analgesic, prolonged-release, pain, child, adolescent

Mustafa Q Albustani,1 Robert F Howard2 1Section of Medicine/Pediatrics, The University of Oklahoma College of Medicine, Tulsa, OK, USA; 2Division of Rheumatology, Utica Park Clinic, Tulsa, OK, USA Introduction: Wissler–Fanconi syndrome is a rare rheumatic syndrome that was first described during the 1940s in Europe. Since then, many papers have been written that cover all aspects of this syndrome, most of which are in French and German language, with only a very few in English (none of them recent). We report here a case that fulfils the criteria for Wissler–Fanconi syndrome. Under the more general descriptive umbrella of Wissler–Fanconi syndrome, our patient also fulfils the Modified Jones criteria, and the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis, and was interpreted by other internists and another rheumatologist as fulfilling the Yamaguchi criteria for adult onset Still’s disease. Case presentation: A middle-aged female presented to the emergency department with shortness of breath and chest pain associated with fever, polyarthritis, and had a chronic polymorphic rash on the back and lower extremities. Blood analysis showed highly elevated inflammatory markers and rheumatoid factor. After ruling out other possible deferential diagnoses and reviewing the medical literature, the patient was diagnosed with Wissler–Fanconi syndrome. A combination of nonsteroidal anti-inflammatory drugs and steroids achieved complete remission. Conclusion: This case report highlights the important differential diagnosis that may be included under the nomenclature of Wissler–Fanconi syndrome (subsepsis hyperergica). Features of Wissler–Fanconi syndrome can be found in a differential diagnosis that includes true sepsis, acute rheumatic fever, rheumatoid arthritis, and adult onset Still’s disease. Keywords: Wissler–Fanconi syndrome, adult Still’s disease, subsepsis hyperergica, subsepsis allergica&nbsp