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Objectives: The aim of this study was to evaluate annual direct medical costs of adult SLE patients with active autoantibody positive disease on medication in Germany., Methods: A multicentre, observational, retrospective European study with German sub-analysis was performed. Costs were assessed according to national tariffs., Results: 10 German centres included 77 patients. The mean (SD) annual direct medical costs of patients were € 3 452.21 (3 777.07), and were 3.4 times higher in severe than non-severe patients (€ 5 291.07 vs. 1 564.97; p<0.001). Cost of medication (€ 2 349.40) represented 68.1% of the total cost. Flares, especially severe flares, were identified as cost predictors. Each flare increased the annual total cost by € 2 164,01 (p<0,001)., Conclusion: The annual direct medical cost of SLE patients in Germany is linked to disease severity. Medical treatments and severe flares were identified as the cost predictors and drivers, respectively., (© Georg Thieme Verlag KG Stuttgart · New York.)

Over the last ten years various biologics have been introduced in the therapy of rheumatic diseases. The most successful approach so far has been the inhibition of TNF alpha, which is able to suppress systemic inflammation in an unprecedented manner. However, the early observation of newly developed antinuclear antibodies and some cases of drug-induced lupus has so far hampered the evaluation of this treatment option in larger clinical studies for collagen vascular diseases. Thus, ten years after treating the first RA patients with TNF alpha-Blockers we still only have reports of individual cases of patients with collagen vascular diseases treated with this principle. The following article reviews these single cases and summarizes the current knowledge about efficacy and safety of anti-TNF alpha-therapy for this indication.

History and Clinical Findings: A 47-year-old woman was admitted because of diarrhoea (3-5 stools daily) for 9 days, weakness for 3 weeks and painful wrist swelling, arthralgia and hyperesthesia over the medial aspect of the right thigh for 6 weeks. For 6 years she had been treated for asthma. Two operation had been performed for chronic sinusitis. ADMISSION FINDINGS AND INVESTIGATIONS: There was marked eosinophilia (5889/microliter) and thrombocytopenia (96,000/microliter), markedly increased serological inflammatory parameters and a raised total IgE level (134 IU/ml). The chest radiogram showed pulmonary infiltrates and bone marrow biopsy indicated eosinophilia. Echocardiography revealed a mass, 3 x 8 cm, in the ventral wall of the right ventricle with extension into the outflow tract., Diagnosis, Treatment and Course: These findings met the criteria of the American College of Rheumatology for Churg-Strauss syndrome (CSS). On methylprednisolone (1 mg/kg daily) the eosinophil and platelet counts became normal within 5 days and erythrocyte sedimentation rate and the level of C-reactive protein fell. Under cardiopulmonary bypass the tumour was removed, the tricuspid valve replaced, and the right ventricle reconstructed. Histology of the mass revealed it to be an organized thrombus., Conclusion: The relationship between the thrombus formation and CSS is unclear. Hypercoagulability connected with the inflammatory process may have played a part in the pathogenesis.