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SUMMARY To investigate whether tumour necrosis factor α (TNFα) plays a role in the pathogenesis of hepatitis C virus-associated mixed cryoglobulinaemia (HCV-MC), we measured soluble TNFα and its soluble p55 (sTNFR1) and p75 (sTNFR2) receptors in the serum of patients with HCV-MC. TNFα, sTNFR1 and sTNFR2 were measured in the serum of 32 patients with HCV-MC, 18 patients with hepatitis C without MC (HCV) and 18 healthy volunteers, using specific immunoassays. Correlations between clinical and biological parameters and the concentrations of TNFα and sTNFRs were established by studying detailed clinical records of the 32 HCV-MC patients. Although higher, TNFα levels were not significantly different in HCV-MC patients compared with healthy or HCV controls. sTNFR1 and sTNFR2, however, were significantly higher in HCV-MC compared with controls or with HCV patients, and higher concentrations of sTNFR1 and sTNFR2 were observed in patients with severe visceral vasculitis, compared with patients with limited purpura. sTNFR1 concentrations positively correlated with fibrinogen levels but TNFα, sTNFR1 and sTNFR2 did not correlate with other biological parameters such as rheumatoid factor concentrations, CH50 or C4 values. These data suggest a role for TNFα in the pathogenesis of the immune complex-mediated vasculitis associated with HCV-MC. [ABSTRACT FROM AUTHOR]

This French National Diagnostic and Care Protocol (NDPC) includes both pediatric and adult patients with non-infectious chronic uveitis (NICU) or non-infectious recurrent uveitis (NIRU). NICU is defined as uveitis that persists for at least 3 months or with frequent relapses occurring less than 3 months after cessation of treatment. NIRU is repeated episodes of uveitis separated by periods of inactivity of at least 3 months in the absence of treatment. Some of these NICU and NIRU are isolated. Others are associated with diseases that may affect various organs, such as uveitis associated with certain types of juvenile idiopathic arthritis, adult spondyloarthropathies or systemic diseases in children and adults such as Behçet's disease, granulomatoses or multiple sclerosis. The differential diagnoses of pseudo-uveitis, sometimes related to neoplasia, and uveitis of infectious origin are discussed, as well as the different forms of uveitis according to their main anatomical location (anterior, intermediate, posterior or panuveitis). We also describe the symptoms, known physiopathological mechanisms, useful complementary ophthalmological and extra-ophthalmological examinations, therapeutic management, monitoring and useful information on the risks associated with the disease or treatment. Finally, this protocol presents more general information on the care pathway, the professionals involved, patient associations, adaptations in the school or professional environment and other measures that may be implemented to manage the repercussions of these chronic diseases. Because local or systemic corticosteroids are usually necessary, these treatments and the risks associated with their prolonged use are the subject of particular attention and specific recommendations. The same information is provided for systemic immunomodulatory treatments, immunosuppressive drugs, sometimes including anti-TNFα antibodies or other biotherapies. Certain particularly important recommendations for patient management are highlighted in summary tables. [ABSTRACT FROM AUTHOR]

Les infections sont responsables de morbimortalité des patients souffrant d'artérite à cellules géantes (ACG). Le but de ce travail était double : l'identification de facteurs prédisposant au risque infectieux et la description des patients hospitalisés pour une infection survenant pendant la période de traitement de l'ACG. Nous avons mené une étude rétrospective monocentrique chez les patients ACG en comparant les patients hospitalisés pour infection avec des patients sans infection. L'analyse a porté sur 21/144 (14,6 %) patients ayant présenté 26 infections (cas), auxquels 42 témoins ont été appariés sur le sexe, l'âge et l'année du diagnostic d'ACG Les deux groupes étaient similaires en dehors d'une sérite au diagnostic plus fréquente chez les cas (15 % vs 0 %, p = 0,03). Les rechutes d'ACG étaient moins fréquentes chez les cas (23,8 % vs 50,0 %, p = 0,041). Une hypogammaglobulinémie était présente lors de l'infection. Plus de la moitié des infections (53,8 %) survenaient la première année du suivi sous une posologie moyenne de 15 mg/jour de prednisone. Les infections étaient surtout pulmonaires (46,2 %) et cutanées (26,9 %). Des facteurs associés au risque infectieux ont été identifiés. Ce travail préliminaire monocentrique va se poursuivre par une étude nationale multicentrique. Infections are associated with morbimortality of patients with giant cell arteritis (GCA). The aim of this work was twofold: the identification of factors predisposing to the risk of infection and the description of patients hospitalized with an infection occurring during the treatment period of CAG. A monocentric retrospective study was conducted in GCA patients, comparing patients hospitalized for infection with patients without infection. The analysis included 21/144 (14.6%) patients with 26 infections (cases) and 42 control matched on sex, age, and diagnosis of GCA. Both groups were similar except for a higher frequency of seritis in cases (15% vs. 0%, p = 0.03). Relapses of GCA were less common in cases (23.8% vs 50.0%, p = 0.041). Hypogammaglobulinemia was present during infection. More than half of the infections (53.8%) occurred in the first year of follow-up with an average dose of 15 mg/day of corticosteroids. Infections were mainly pulmonary (46.2%) and cutaneous (26.9%). Factors associated with infectious risk were identified. This preliminary monocentric work will continue with a national multicentre study. [ABSTRACT FROM AUTHOR]

Résumé La sclérite est une maladie inflammatoire de la sclère, tunique externe blanche de l’œil sur laquelle s’insèrent les muscles oculomoteurs. Elle peut être associée à une maladie systémique jusqu’à une fois sur trois. Ces maladies associées sont majoritairement la polyarthrite rhumatoïde, les vascularites systémiques, principalement la granulomatose avec polyangéite et les spondylarthrites. Avant d’évoquer une telle étiologie, il convient d’éliminer une cause infectieuse, principalement herpétique, probablement sous-estimée. La classification des sclérites est clinique. On distingue des sclérites antérieures et des sclérites postérieures. Les sclérites antérieures sont diffuses ou nodulaires, généralement de bon pronostic. Les sclérites antérieures nécrosantes avec inflammation sont souvent associées à une maladie auto-immune, les sclérites nécrosantes sans inflammation s’observent au cours des polyarthrites rhumatoïdes évoluées. Le traitement des sclérites associées aux maladies systémiques nécessite une collaboration étroite entre internistes et ophtalmologistes pour décider de l’utilisation d’une corticothérapie associée ou non à des immunosuppresseurs ou des biothérapies. Scleritis is an inflammatory disease of the sclera; outer tunic of the eye on which the oculomotor muscles are inserted. It can be associated with a systemic disease up to one time out of 3. These associated diseases are mainly rheumatoid arthritis, vasculitis, including granulomatosis with polyangiitis in the first line and spondyloarthropathies. Before mentioning such an etiology, it is necessary to eliminate an infectious cause, mainly herpetic, which is regularly underestimated. The classification of scleritis is clinical. We distinguish between anterior scleritis and posterior scleritis. Anterior scleritis is diffuse or nodular, usually of good prognosis. Anterior necrotizing scleritis with inflammation is often associated with an autoimmune disease, necrotizing scleritis without inflammation usually reflects advanced rheumatoid arthritis. The treatment of these conditions requires close collaboration between internists and ophthalmologists to decide on the use of corticosteroid therapy with or without immunosuppressors or biotherapies. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: . Lupus enteritis is a rare manifestation of systemic lupus erythematosus. The clinical manifestations are variable including abdominal pain, diarrhea, nausea and vomiting. Lupus enteritis is thought to be related to vasculitis. Case reports: . We report here three new cases. All three patients aged of 45, 24 and 43 years (two females and one male) were admitted for abdominal pain, vomiting and diarrhea, and fulfilled the ACR criteria of systemic lupus erythematosus. The diagnosis of lupus enteritis was retained on the CT scan findings and the favorable outcome on corticosteroids after infectious etiologies were excluded. Conclusion: . Lupus enteritis is thought to be one of the most common causes of acute abdominal pain in systemic lupus erythematosus. The diagnosis is based on clinical, radiological and biological findings. A good response to corticosteroids is usually reported. [Copyright &y& Elsevier]