Background: Therapy with tumour necrosis factor α (TNF) inhibitors can be associated with paradoxical reactions, namely the de novo development or flaring of conditions that usually respond to these therapeutic agents, such as arthritis, inflammatory bowel disease, sarcoidosis or psoriasis. They are considered a class effect of these drugs, and their incidence ranges from 1 to 5%, with paradoxical psoriasis (psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis and their combinations) being most frequently reported. Treatment of paradoxical psoriasis often requires withdrawal of the inducing drug and switching to another anti-TNF agent, but often this cannot avoid recurrence or persistence of the rash and/or loss of the therapeutic effect on the underlying condition. Case Report: We report on a 47-year-old woman who developed incapacitating palmoplantar pustulosis and psoriasis vulgaris flare with severe scalp and nail involvement after 5 months of treatment with adalimumab for psoriatic arthritis. Several treatments, including topical corticosteroids, photochemotherapy, ciclosporin, acitretin and etanercept 50 mg twice a day for 1 month, were ineffective or not tolerated. Treatment with ustekinumab 45 mg provided complete resolution of skin lesions with acceptable therapeutic control of the arthritis, with a follow-up duration of 16 months. Conclusion: A review of the reported cases suggests that this may be a therapeutic option in patients who develop paradoxical psoriasis while under treatment for arthritis or Crohn’s disease.

In this observational study, the absence of response, probably due to the low-dose scheme used, was the major cause of AZA withdrawal in our series of RA patients. TPMT genotyping may allow the use of high doses of AZA in patients with normal TPMT alleles to improve the efficacy of this immunosuppressive drug. Our data support the relationship between gastrointestinal intolerance and thiopurine metabolic imbalance.

• ▶ body composition • ▶ Cushing ' s syndrome • ▶ rheumatoid arthritis • ▶ glucocorticoids Body Composition After Endogenous (Cushing ' s Syndrome) and Exogenous (Rheumatoid Arthritis) Exposure to Glucocorticoids abolition of the normal male to female diff erence in visceral fat [5]. It has been assumed that resolution of hypercortisolism is followed by normalization of body composition; a decrease in fat mass has been reported in the early recovery after successful treatment of CS [6, 7]. However, patients who have suff ered from CS, often complain of central obesity, despite successful treatment, which may even have rendered them adrenal insuffi cient. Persistence of increased cardiovascular risk and carotid atherosclerosis has been reported in patients with CS after fi ve years of cure [8]. Moreover, there could be a relationship between cortisol and fasting glucose [9]. Rheumatoid arthritis (RA) is a chronic, systemic infl ammatory disorder that may aff ect many tissues and organs, but principally attacks the joints producing an infl ammatory synovitis that often progresses to destruction of the articular carti

Patients with loss of density present worse FVC and DLCO values. Prospective studies are warranted to determine whether NVC is useful for studying pulmonary function in SSc.