Patients initiated on adalimumab therapy should be closely monitored for the development of exacerbation of psoriasis. Clinicians should be aware of this rare adverse effect of this anti-TNF drug.

A 50-year-old woman was referred to our emergency room because of urticaria. Eleven days after etanercept therapy was started, the patient developed an urticarial rash of the trunk and face. A diagnosis of generalized urticaria was made. Etanercept treatment was suspended. Treatment was started with methylprednisolone and dexchlorpheniramine. The patient's condition improved and she was discharged. In this case, the most probable cause of urticaria was considered to be etanercept because of the temporal relationship between exposure to the drug and the onset of symptoms. The adverse reaction could be considered probable. Although the overall risk of skin adverse events associated with etanercept appears low, clinicians should be aware of this reaction.

Patients initiated on etanercept therapy should be closely monitored for the development of tuberculosis and other infections. During treatment, all febrile or novel illnesses should be evaluated promptly. If clinical evaluation leads to the suspicion of tuberculosis and other infections associated with etanercept, it should be discontinued immediately.

No abstract

Background The role of the nursing consultation in rheumatology is becoming more prevalent, especially in patient monitoring, reducing the burden of care of rheumatologists in many cases where in-person consultation with the rheumatologist is not required. Objectives To analyze the usefulness of telephone consultation to nursing staff to resolve doubts and/or health incidents to rheumatic patients and to assess the involvement of physicians on it. Methods We collected clinical data for the period between June 2012 and January 2013 of all telephone consultation received in the nursing department: clinical and laboratory data, number of calls, characteristics of the proposed consultation and its resolution, and involvement of the rheumatologist in consultations. Results We registered 122 telephone consultations, in which 77% of cases the nursing staff resolved the consultation (72% of them require the nurse consultant support by the rheumatologist) and in 88.5% of all consultations have required an additional call from the nursing. From the 23% of the queries unresolved by nurses (n=28), 19 cases required telephone consultation with the patient’s rheumatologist, and 7 cases were derived to an in-person appointment with the doctor (5 cases the rheumatologist, 1 to Emergency door and 1 to Primary Care). Patients who performed telephone consultations are mostly diagnosed as rheumatoid arthritis (40.2%), ankylosing spondylitis (13.1%) and systemic lupus erythematous (9.8%). 49.2% of the patients were treated with methotrexate, and 35.3% received biologic therapy. Consultations by patients are for different reasons, but the 22.9% of consultations were supply problems in medication, 19.7% were disease outbreaks and 9.8% to check analytical results. Conclusions Telephone consultation to nurse staff contributes greatly to answer questions from patients about disease outbreaks, as well as problems in treatment and/or analytical results, without the presence of the rheumatologist. It also prevents unnecessary movement of patients, reducing the number of telephone consultations and medical attendance, and helping manage health hospital resources effectively. Disclosure of Interest None Declared