Chronic inducible urticaria (CIndU) is a subgroup of chronic urticaria which can cause severe quality of life impairment by their refractory forms. The recommended treatment approach in CindU is the same as that for chronic spontaneous urticaria (CSU). However, CIndU seem to be more resistant to standard doses of H1 antihistamines (AHs) and higher doses of AHs are required for symptom control. Omalizumab, a recombinant anti-IgE antibody, effectively treats CSU. Nevertheless, there is not enough evidence in patients with CIndU, especially in AHs resistant cases. This study analyzed 2 severe cases of CIndU (cold urticaria and symptomatic dermographism) with completely different response to omalizumab. We describe 2 patients with 2 subtypes of CIndU: one with severe cold urticaria (including anaphylaxis) and the other with severe extensive symptomatic dermographysm. In both cases, we performed complete positive and differential diagnostic work-up. Management strategies included first line and second line symptomatic therapy, but with no success in either case. Avoidance of eliciting triggers was difficult to achieve (occupational reasons). We decided to start omalizumab treatment, 300 mg every 4 weeks for 6 months. The cold urticaria patient gained complete symptom relief 10 days after the first dose of omalizumab; the quality of life improved substantially with no side effects of the treatment. The urticaria factitia patient showed no benefit of the add-on 5 months treatment with omalizumab. He refused the 6th dose of omalizumab due to the lack of response, and also cyclosporine, but he showed some benefits of oral corticosteroids. Although many clinical studies support the use of omalizumab in the treatment of patients with CIndU, we certainly need more data for prediction of a good clinical response.

No abstract

Background and objectivesDisease activity in spondylarthritis (SpA) is widely evaluated through disease activity scores such as BASDAI, ASDAS and PtGA, with no proven superiority between them. The aim of this study was to subdivide patients with anti-TNF therapy according to their disease status indicated by scores in order to evaluate group characteristics with further assessment on the quality of each activity indicator.Materials and methodsWe included 100 SpA patients under anti-TNF therapy (32 infliximab, 33 adalimumab, 35 etanercept). We collected demographic, clinical (BASDAI, ASDAS, PtGA) and laboratory (ESR, CRP) data. Statistical analysis was performed with SPSS 20.0.ResultsWe evaluated disease activity for the entire study group based on conventional scores: BASDAI, ASDAS-CRP, ASDAS-ESR, acute phase reactants and PtGA.When used as an external criterion PtGA showed that 12% of patients had active disease while 88% were classified as low disease activity (PtGA < 5). Mean ASDAS-CRP/ESR in the active group were 3.39/3.24. Mean BASDAI score in the high activity group was 5.66.We showed that both ASDAS scores had good discriminating capacities, with similar values when using the SMD (ASDAS-CRP and ASDAS-ESR – SMD 2.00). In our study group, based on PtGA, BASDAI outperformed ASDAS scores with a SMD of 3.33.We used ROC curves of the disease activity scores by using the PtGA ≥ 5 as variable of high disease activity state. For ASDAS-CRP, ASDAS-ESR and BASDAI the AUCs (area under curve) were 0.89 (P = 0.05), 0.88 (P < 0.001), and 0.99 (P = 0.009), respectively. For CRP and ESR the AUCs were 0.81 and 0.79 (P = 0.001, P = 0.003). This shows the high accuracy of the three scores in assessing SpA activity.When dividing patients according to BASDAI score (4 as cut-off), 14% showed a more active disease than the rest of 86% who had low disease activity. Mean ASDAS scores in the first group were 3.31 and 3.16, respectively.BASDAI correlated to both ASDAS scores (r = 0.65 and 0.71, P < 0.001) and PtGA stronger to BASDAI(r = 0.912, P < 0.01) than ASDAS(r = 0.67 and 0.71, P < 0.01).ConclusionWe proved that disease activity scores have good discriminatory power and that BASDAI and ASDAS perform similarly in assessing and investigating SpA patients. BASDAI outperformed ASDAS when using PtGA as criterion.

No abstract

No abstract