Search

Introduction Patients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively affects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear. Objective To evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infiltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction. Methods We performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confirmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient’s baseline status. The pre-post differences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann–Whitney test. Results Using our protocol, we recorded a rapid and significant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with significant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear. Conclusions Our multidisciplinary therapeutic protocol enabled a very significant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary. Key Points• Multidisciplinary evaluation of patients with RA is advisable because it improves the treatment management in cases of inflammatory activity and structural abnormalities of the foot.• Comprising orthopedic-podiatric treatment (heel, splints, and suitable footwear) and infiltrations, in terms of clinical, ultrasound, and functional recovery of the foot tendons.• The therapy protocol we propose led to a significant improvement in pain relief and functional recovery.

IntroductionConventional or biologic disease-modifying anti-rheumatic drugs (DMARDs) are the mainstay of treatment for systemic autoimmune disease (SAD). Infectious complications are a major concern in their use.ObjectiveTo evaluate the clinical benefit of sublingual mucosal polybacterial vaccines (MV130 and MV140), used to prevent recurrent respiratory and urinary tract infections, in patients with SAD and secondary recurrent infections following conventional or biologic DMARDs.MethodsAn observational study in SAD patients with recurrent respiratory tract infections (RRTI) and/or recurrent urinary tract infections (RUTI) was carried out. All patients underwent mucosal (sublingual) vaccination with MV130 for RRTI or with MV140 for RUTI daily for 3 months. Clinical evaluation was assessed during 12 months of follow-up after the first dose, i.e., 3 months under treatment and 9 months once discontinued, and compared with the previous year.ResultsForty-one out of 55 patients completed 1-year follow-up. All patients were on either conventional or biologic DMARDs. A significant decrease in the frequency of RUTI (pS. pneumoniaeIgA and IgG antibodies following MV130 vaccination.ConclusionsSublingual polybacterial vaccines prevent recurrent infections in patients with SAD under treatment with immunosuppressant therapies, supporting a broad non-specific anti-infectious effect in these patients.

Objective To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. Methods Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. Results A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. Conclusions These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.

Resumen Objetivo Establecer recomendaciones, basadas en la evidencia, sobre el uso de la ecografia (US) y la resonancia magnetica en pacientes con espondiloartritis, incluyendo la artritis psoriasica, y en la artritis idiopatica juvenil. Metodos Las recomendaciones se consensuaron mediante metodologia basada en grupos nominales. Un grupo de expertos (15 reumatologos y 3 radiologos) definio el alcance, los usuarios, los apartados, las posibles recomendaciones y las revisiones sistematicas a realizar (se utilizaron y actualizaron las revisiones de documentos de consenso de EULAR), y se asignaron tareas. Los expertos delimitaron los apartados y redactaron las recomendaciones. El nivel de evidencia y el grado de recomendacion se establecieron utilizando el sistema del Centre for Evidence Based Medicine de Oxford, y el grado de acuerdo mediante Delphi a 2 rondas. Las recomendaciones se votaron segun una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiendose el acuerdo como una puntuacion ≥ 7 por al menos el 70% de los participantes. El documento fue revisado por los expertos y el proyecto estuvo coordinado por un metodologo experto. Resultados Se emitieron 12 recomendaciones sobre la validez de la US y la resonancia magnetica para la deteccion de actividad y dano estructural, capacidad diagnostica, predictora (de progresion de dano estructural, brote de la enfermedad, respuesta al tratamiento, etc.), utilidad en la evaluacion y monitorizacion del tratamiento, y uso de la US como guia (para infiltraciones, biopsias, etc.) en pacientes con espondiloartritis y artritis idiopatica juvenil. Conclusiones Se presentan unas recomendaciones utiles para el manejo de la US y la resonancia magnetica por los clinicos en pacientes con espondiloartritis y artritis idiopatica juvenil.

Background Measurement of vaccine response may be used as a diagnostic tool to aid determination of antibody deficiency. The IgG response to pneumococcal polysaccharide vaccination (PPV) is currently used to assess T cell independent responses, however additional polysaccharide vaccines are under evaluation. In patients with rheumatic diseases (RD) treatment regimens can result in immunosuppression and subsequently secondary immune deficiency (SID). Objectives To measure the IgG response to Typhi Vi vaccination (TV) in RD patients presenting with antibody deficiency. To correlate immunosuppression with TV responses, as well as TV responses to clinical presentations, B cells and total IgG. Further, we interpret the responses in combination with the responses to PPV. Methods 35 RD patients were referred for immunological evaluation at Hospital Clinico San Carlos, Madrid, Spain. The responses to TV and PPV were measured using commercial human anti-Salmonella Typhi Vi IgG and pneumococcal capsular polysaccharide (PCP) IgG ELISAs kits. A TV responder was defined as achieving ≥32 IU/mL (lower limit of the normal range), a PCP IgG responder (>50 mg/L), B cells were measured by flow cytometry (responder ≥6.6%) and total IgG by nephelometric assay (responder ≥600 mg/dL). For all measurements (+) indicates a responder and (-) indicates a non-responder. Results A greater percentage of TV- patients previously received non-biological treatment (79% vs 43%), specifically steroid treatments (68% vs 28%) and biological treatments (particularly CD20 and TNF alpha targets; 46% vs 14%). At presentation, TV non-responsiveness was associated with a higher frequency of upper respiratory tract infections (75% vs 57%), serious bacterial infections (21% vs 14%) and required slightly higher antibiotic usage (93% vs 71%). Stratification of the RD patients using the response the TV and PPV identified four groups of activity: TV+/PCP+, TV-/PCP+, TV+/PCP- and TV-/PCP-. In the presence of a normal response to PPV, the failure to respond to TV (TV-/PCP+) correlated with a higher frequency of previous non-biological treatment (84% vs 43%), biological treatment (47% vs 14%), steroids treatment (68% vs 29%) and were currently undergoing treatment (84% vs 29%, p=0.01) compared those who responded to TV (TV+/PCP+). At presentation TV-/PCP +patients had a greater incidence of upper respiratory tract infections (74% vs 57%), serious bacterial infections (16% vs 14%) and antibiotic usage (95% vs 71%). Non-responders to both vaccinations (TV-/PCP-) had a higher incidence of serious bacterial infections (25% vs 16%) and pneumonia (50% vs 32%) when compared to the TV+/PCP- group. When correlated with B cell number, 58% of B cells had a concentration of TV antibodies Conclusions The response to TV correlated with underlying disease treatment and immunological presentation. Assessing the response to two polysaccharide vaccinations, TV and PPV, may provide a greater understanding of the T cell independent pathway and provide more clinical information for the clinician. Disclosure of Interest L. Williams Employee of: The Binding Site Group Ltd, G. Candelas: None declared, C. Tange Employee of: The Binding Site Group Ltd, J. Ochoa-Grullon: None declared, P. Macarron: None declared, C. Morado: None declared, K. Llano: None declared, C. Martinez-Prada: None declared, A. Rodriguez de la Pena: None declared, B. Fernandez: None declared, J.-A. Jover: None declared, S. Harding Employee of: The Binding Site Group Ltd, S. Sanchez-Ramon: None declared, A. Parker Employee of: The Binding Site Group Ltd

Background Disease-modifying antirheumatic drugs (DMARDs) and new biologicals have improved the prognosis of systemic autoimmune diseases (SAD), but reciprocally increase the risk of recurrent respiratory tract (RRTI) and urinary tract (RUTI) infections. Given the rising of antibiotic resistance, the search for new strategies for the prevention of recurrent infections is a priority. Objectives The purpose of this study was to evaluate the clinical benefit of the sublingual polybacterial vaccines on infections9 rates in SAD patients. Methods A retrospective observational study on a cohort of SAD patients on active inmunosuppression with RRTI and RUTI was conducted. Patients were treated with multibacterial sublingual vaccine formulations either for RRTI (Staphylococcus spp., S. pneumoniae, K. pneumoniae, M. catarrhalis, H. influenzae)3 or/and RUTI (K. pneumoniae, E. coli, E. faecalis, P. vulgaris)4 (Bactek/Uromune®, Inmunotek SL Madrid, Spain) for 3-months period and clinical follow-up at 6- and 12-months. We monitored the frequency of infections, the intensity and severity of infections during follow-up. Immunological evaluation was performed, including: Serum immunoglobulin levels, IgG subclasses, specific antibodies9 production: anti-pneumococcal, anti-Typhi polysaccharide and anti-tetanus toxoid antibodies, and B and T cell phenotype. Results A total of 50 patients were evaluated, and 34 were eligible at 12-months.The mean age of the patients was 58±13 years, 31 women (91.17%) and 3 men (8.82%), 44.11% (n=15) with rheumatoid arthritis (RA), 23.52% (n=8) with systemic lupus erythematosus (SLE), 8.82% (n=3) mixed connective tissue disease, 2.94% (n=1) ankylosing spondylitis, 2.94% ( n=1) sacroileitis, 2,94% (n=1) psoriatic arthritis, 2,94% (n=1) SLE/RA, 2.94% (n=1) discoid LE/Sjogren, 2.94% (n=1) adult onset Still disease, 2,94% (n=1) sarcoidosis, 2.94% (n=1) SLE-like. All patients showed a significant decrease in RRTI (3.15±2.66 vs 0.46±1.07, p Conclusions Mucosal vaccination in immunosuppressed patients due to SAD with recurrent infections resulted in lower rates of RRTIs and RUTIs with subsequent improvement in their quality of life. Our preliminary results need to be validated in controlled trials. References G. Avila, A. Alonso, A. Pluma, C. Diaz, R. Juvernau, M. Lupez Lasanta, S. Marsal. FRI0252 Risk Analysis for Recurrent Infectionsduring Biological Therapy in Chronic Inflammatory Arthritis. Ann Rheum Dis 2014;73:474–475 doi:10.1136/annrheumdis-2014-eular.5736. Sanchez-Ramόn S, de Diego RP, Dieli-Crimi R, Subiza JL. Extending the clinical horizons of mucosal bacterial vaccines: current evidence and future prospects. Curr Drug Targets. 2014;15(12):1132–43. Disclosure of Interest None declared

Objective To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). Methods Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. Results A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. Conclusions These recommendations will help clinicians use US and MRI in RA patients.

The objective of this study is to identify risk factors for permanent work disability (PWD) related to musculoskeletal disorders (MSDs). This is a secondary data analysis of a randomized controlled intervention study in Temporary Work Disability (TWD) due to MSDs. The association of PWD (claim submission and status recognition) with baseline clinical, sociodemographic, work-related administrative and occupational factors was analyzed by Cox proportional hazards models. Of 3,311 patients with TWD, 47 submitted a PWD claim, of whom 32 achieved PWD status. The main alleged causes of the PWD were back pain, sciatica, and inflammatory diseases. The following factors were independently associated with an increased probability of PWD claim submission: age (odds ratio (OR) 5.1), being woman (OR 2.1), self-employment (OR 3.4), unemployment (OR 13.8), previous musculoskeletal surgery (OR 16), repeated TWD (OR 3.4), sitting (OR 2.8), and raising arms frequently (OR 3.1). Patients with inflammatory disease were more likely to file PWD claims (OR 10.4) while tendonitis was associated with lower probability (OR 0.3). The sociodemographic factors that better predicted PWD status recognition were age (OR 5.7), low educational level (OR 4.2), previous musculoskeletal surgery (OR 14.9), unemployment (OR 17.6), sitting (OR 2.6), and raising arms frequently (OR 2.7). Inflammatory diseases were the diagnoses associated with a higher rate of PWD status recognition (OR 6.1). Inflammatory diseases have a high chronic disability potential in active workers. Sociodemographic, work-related, occupational factors, and other clinical factors, some of which are modifiable, may explain the development of long-term work disability related to MSDs.

Objetivo Describir la incidencia y las caracteristicas de la infeccion por Mycobacterium tuberculosis en pacientes con enfermedades autoinmunes. Pacientes y metodos Se identificaron los casos nuevos de tuberculosis desde 1991 a 2000 en pacientes con enfermedad autoinmune a partir de la base de datos del servicio; se calculo el tiempo total de seguimiento como la diferencia entre la primera y la ultima visita. El tiempo de tratamiento con farmacos inmunosupresores se obtuvo en pacientes con artritis reumatoide de una base de datos orientada al seguimiento longitudinal de estos pacientes. Se calculo la densidad de incidencia como el cociente entre la frecuencia absoluta de casos y la suma de los periodos individuales de riesgo en cada subgrupo. Resultados Se identificaron 15 casos de tuberculosis en 3.634 pacientes en riesgo seguidos durante un periodo acumulado de 9.795 anos (incidencia global: 153 por 100.000 pacientes-ano). Catorce pacientes estaban recibiendo farmacos modificadores de la enfermedad y once corticosteroides en el momento del diagnostico. La localizacion de la infeccion tuberculosa fue pulmonar en el 33,3% de los casos. La incidencia por farmacos en pacientes con artritis reumatoide fue de 143 por 100.000 pacientes-ano con metotrexato, 2.703 por 100.000 pacientes-ano con azatioprina, 7.692 por 1.000 pacientes-ano con ciclofosfamida y 4.878 por 100.000 pacientes-ano con anti-TNFα. Conclusiones La densidad de incidencia de tuberculosis esta aumentada en nuestra poblacion comparado con la de la poblacion general, existiendo una mayor frecuencia de afectacion extrapulmonar. La densidad de incidencia es variable en pacientes con artritis reumatoide en funcion de los farmacos utilizados.

Objective The aim of this study was to describe the incidence rate (IR) of adverse drug reactions (ADRs) in daily clinical practice, related to disease-modifying antirheumatic drugs (DMARDs) and biologic agents (BA) in rheumatoid arthritis (RA) patients, and to analyze factors causing discontinuation due to ADRs. Methods This was a prospective observational study (October 2010 to October 2011). RA patients who were attended in our hospital taking DMARDs or BA during the study period were included. ADRs were injuries related to these drugs and registered with a software system in routine visits. ADRs could be mild (lowering dosage), moderate (drug discontinuation), or severe (hospital admission). The IR of ADR per 100 patient-years was estimated using survival techniques. Cox regression models (HR; 95% confidence interval) were used to explore factors associated with discontinuation due to ADRs. Results In total, 1202 patients were analyzed, with 158 ADRs (IR = 15.2). Of all ADRs, 80.4% required drug discontinuation (IR = 12.2). Age, less disease and therapy duration, taking corticoids, and combined therapy versus monotherapy (HR = 3; 95% CI: 2.0–4.4) were the factors independently associated to discontinuation due to ADRs. We did not find statistical differences between the different monotherapy regimens. Regarding combinations, Methotrexate + BA had the lowest risk of discontinuation compared to the rest (HR = 0.24; 95% CI: 0.09–0.6). Conclusions We have estimated the incidence of ADRs related to DMARDs/BA in real-life conditions. We confirm the role of combined therapy in the development of discontinuations due to ADRs, except for BA + MTX, which did not show an increase of toxicity compared to monotherapy. This combination seems to be safer than others.

Background Over a decade has passed since the introduction of biologic therapies for autoimmune diseases. The use of biologic therapies as an adjuvant to disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of systemic autoimmune diseases is rapidly expanding, due the efficacy and safety profiles of these drugs, and the better understanding of the targets of altered immune regulation. However, infections complications after biologicals are major concerns in their use. Objectives The aim of this study is to evaluate the clinical benefit of new personalized polybacterial sublingual vaccines in patients with systemic autoimmune disease and recurrent infections. Methods An observational study in a cohort of patients with systemic autoimmune disease and recurrent respiratory tract infections (RRTI) (3 or more episodes of upper respiratory tract infection or at least 1 pneumonia episode per year) and recurrent urinary tract infections (RUTI) (3 or more UTIs per year) was carried out. All patients underwent immunization with sublingual polyvalent preparation (Bactek®, ImmunoteK S.L. Madrid, Spain) for RRTI (Staphylococcus spp., S. pneumoniae, K. pneumoniae, B. catarrhalis, H. influenzae) and RUTI (K. pneumonia, E. coli, E. faecalis, P. vulgaris). Immunological evaluation was performed at baseline and at 6- and 12-mo., including serum immunoglobulins, IgG subclasses, specific antibodies production and B and T cell subsets counts. Results Twenty-three patients (mean age, 55.52±15.69, 21 women and 2 men) were studied: rheumatoid arthritis (RA) (n=11, 47%), SLE (n=5, 22%), MCTD (n=3, 13%), psoriatic arthritis (n=1, 4.%), SLE/RA (n=1, 4%), DLE/Sjogren (n=1, 4%), cryoglobulinemia II (n=1, 4%) and Sjogren syndrome (n=1, 4%). All patients presented a decrease in RRTI and RUTI frequency at 6-mo of vaccine: RRTI decreased from 4.81±2.04 to 0.75±1.29 and RUTI from 4.56±1.59 to 0.22±0.44. An episode of pneumonia in two patients. Nine out of 23 patients (39%) showed alterations of the humoral immune response at baseline: hypogammaglobulinemia (n=6, 26%) and IgG2 subclass deficiency (n=3, 13%). Eleven of 23 (47%) disclosed a defect on specific antibody production to polysaccharide and protein stimuli, 7 (30%) with normal Ig serum levels and 5 (21%) with hypogammaglobulinemia. At baseline, 21 were on DMARDs (metotrexate in 12, 52%). The most used biologicals were anti-TNF-α monoclonal antibodies (n=9, 39%) followed by anti-CD20 (n=8, 34%) and tocilizumab (n=4, 17%). Conclusions Vaccination in immunosuppressed patients with systemic autoimmune disease and recurrent infections is a commonly missed opportunity. There is an urgent need to develop alternative strategies to prevent the overuse of antibiotics in what is called the post-antibiotic era. Our preliminary results seem to be promising in these patients, reducing the infections rates, avoiding chronic use of antibiotics and subsequent resistance and adverse effects. Disclosure of Interest None declared

OBJECTIVES To assess the reliability of the automated radio frequency (RF)-based US measurement of carotid intima-media thickness (IMT) performed by rheumatologists and to evaluate the variability between this method and the conventional B-mode US measurement of carotid IMT in RA patients. METHODS Twelve rheumatologists measured in two blinded rounds the IMT of both common carotid arteries (CCAs) of seven RA patients with an automated RF-based method. At each round, a cardiologist measured both CCA-IMTs of the patients using an automated B-mode method. Inter-observer reliability for RF-based IMT measurements was evaluated by the intra-class correlation coefficient (ICC). Intra-observer reliability for RF-based IMT measurements was assessed using the root mean square coefficient of variation (RMS-CV), Bland-Altman method and ICC. Agreement between the two US methods was evaluated by the Bland-Altman method, ICC and RMS-CV. RESULTS Inter-observer ICCs for the RF-based CCA-IMT measurements were 0.85 (95% CI 0.69, 0.94) for the first round, and 0.77 (95% CI 0.55, 0.91) for the second round. RMS-CVs for the RF-based CCA-IMT measurements varied from 5.6 to 11.7%. The mean intra-observer ICC for the RF-based CCA-IMT measurements was 0.61 (95% CI 0.46, 0.71). In the Bland-Altman analysis for agreement between RF-based and B-mode CCA-IMT measurements, the mean difference varied from -0.6 to -19.7 μm. Inter-method ICCs varied from 0.57 to 0.83 for 11 rheumatologists. Inter-method RMS-CVs varied from 11.3 to 13.7%. CONCLUSIONS Our results suggest that automated RF-based CCA-IMT measurement performed by rheumatologists can be a reliable method for assessing cardiovascular risk in RA patients.

To analyze sociodemographic and clinic-associated factors of patients with rheumatoid arthritis (RA) undergoing any orthopedic surgery (AOS) and total joint replacement (TJR) in Spain.A retrospective medical record review was performed in a probabilistic sample of 1379 RA patients from 46 centers distributed in 16 of 19 regions in Spain. Sociodemographic and clinical features, use of drugs, and arthritis-related joint surgeries were recorded following a standardized protocol. Gross domestic product (GDP) data were obtained from the National Statistical Index.Of 1379 patients, a total of 358 (26%) underwent one or more joint surgeries, and 194 (14%) had a TJR. The median time to first orthopedic procedure was 12.5 years from presentation of RA and the estimated rate was 5.6 surgeries per 100 person-years. The rate of AOS was increased in women, patients with RA with extraarticular complications, with longterm RA (10 yrs), with functional grade III-IV, and with persistent inflammatory disease. The risk factors for undergoing a TJR were longterm RA, functional grade III-IV, and extraarticular complications. Patients from regions with higher GDP per capita were more likely to undergo a procedure.Clinical variables reflecting disease activity and severity are predictors of orthopedic surgery, but geographic and socioeconomic variables were also independently associated with the rate of orthopedic surgery.

Background There is a group of patients with non-infectious posterior uveitis (PU) who are refractory to corticosteroid or immunosuppressive (IS) regimens. The important role played by TNF-a in experimental uveitis models, and the efficacy shown by the various anti-TNF-a agents in autoimmune diseases have been reported. Objectives To demonstrate the usefulness of infliximab in the treatment of non-infectious PU. Methods Open, non-controlled trial, including 7 patients with corticosteroid-refractory PU who were receiving one or more of the following IS agents for a minimum of 2 years: CsA, AZA, MTX. Treatment was administered on a compassionate use basis, after EC approval at our institution and patient informed consent. All IS agents except MTX were discontinued one month prior to the start of treatment. Prednisone dose was adjusted to 0.5 mg/kg/day and decreased by 5 mg/day every week in the absence of posterior pole inflammation. Three doses of 5 mg/kg infliximab were administered IV at weeks 0, 2, and 6. Visits including a full ophthalmological assessment took place at weeks 1, 3, 4, 5, 7, 8, and 12; fluorescein angiographies (FAG) and retinograms were performed at baseline and week 16. Results No adverse effects, and no ocular or systemic exacerbations were observed. Final prednisone dose was = or Conclusion In this preliminary open trial, infliximab treatment appears to be a useful option in the short term for the management of refractory PU patients with retinal vasculitis.