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Thanks to the better understanding of the physiopathological mechanisms in action in rheumatoid arthritis (RA), new therapeutic weapons have appeared, which have dramatically modified our approach of the disease. These so-called "biological" therapies antagonize the action of the cytokine at the top of the cascade which maintains the synovial inflammation, and leads to the joint destruction, i.e. the Tissue Necrosis Factor alpha (TNF alpha). Several controlled clinical studies have clearly demonstrated their short and middle term efficacy and safety profile, and they will soon become at the Belgian clinicians disposal. They have a rapid and dramatic effect on the signs and symptoms of RA and they slow down the radiologic progression. Some questions remain unresolved concerning their place in the general therapeutic strategy against RA, due to the uncertainties of their use in the long run, and to their cost.

We have followed a case of Mixed Connective Tissue Disease (M.C.T.D.) during 5 years. A progressive pulmonary hypertension inducing cor pulmonary failure terminated in a fatal issue. The prognosis of M.C.T.D. previously considered good is sometimes more severe in spite of immunosuppressive therapy.

The clinical and biochemical side-effects of diuretics administered without potassium supplement were monitored during one year in 58 hypertensive out-patients. The only changes observed were a moderate rise in triglycerides (correlated with weight increase) and in blood glucose. Blood urea, creatinine, potassium, calcium, uric acid and cholesterol remained unchanged. The objections raised against the use of diuretics as anti-hypertensive agents, such as the need for close surveillance of biochemical values and the fear that the beneficial effects on blood pressure would be upset by an increase in other cardiovascular risk factors (some of which are still highly controversial), therefore appear to be unfounded.

The authors report a case of apical pulmonary fibrosis associated with rheumatoid arthritis. The pulmonary lesions were clearly different from the classical features of pleuro-pulmonary disease in rheumatoid arthritis. They were identical to those described in ankylosing spondylitis. A review of the literature reveals recent report on ten similar cases. The authors discuss a possible relationship with bronchiolitis obliterans.