AimTo determine the prevalence of American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) classification criteria among systemic lupus erythematosus (SLE) patients; to determine disease activity and severity; and to investigate the correlation of classification criteria with disease activity, and of disease activity and damage index with disease duration.MethodsWe performed a cross-sectional study on 110 SLE patients from the Division of Rheumatology and Clinical Immunology, University Hospital Centre Rijeka, Croatia in the period from September to December 2013 and determined disease duration and the total number of ACR and SLICC classification criteria. Disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) index and organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index.ResultsThe number of SLICC classification criteria met per patient was significantly higher than the number of ACR criteria (7 [IQR 6-8] vs 5 [IQR 4-6], P < 0.001). Moderate correlations were detected between the number of SLICC classification criteria and disease activity index, both in case of active (r = 0.48, P = 0.003) and inactive disease (r = 0.43, P < 0.001). We neither found a correlation between the number of ACR criteria and disease activity nor between disease activity and disease duration. However, there was a good correlation between SLICC/ACR damage index and disease duration (r = 0.63, P < 0.001).ConclusionNew SLICC classification criteria correlate with disease activity because they capture more manifestations also included in the SLEDAI index. Patients with longer disease duration had a larger damage index score.

Adult-onset Still's disease is a rare systemic inflammatory disease of unknown aetiology characterised by typical symptoms including daily high spiking fever, evanescent salmon-pink rash, sore throat, arthritis/arthralgias and polyserositis. The laboratory findings usually show neutrophilic leucocytosis, seronegativity and raised serum transaminases. We describe six typical cases. All of them had serum ferritin above 5,000 µg/L. Although there are few theories about the origin of the high ferritin level, an extremely high serum ferritin above 5,000 µg/L should be the main diagnostic tool of adult-onset Still's disease.

Anti-tumour necrosis factor (TNF) monoclonal antibodies have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis (RA). However, due to increased risk of opportunistic infections, patients receiving anti-TNF therapy should be closely monitored for serious infections. Here, we describe a case of acute Salmonella enteritidis infection of a joint arthroplasty that previously was functioning well, in a patient receiving infliximab treatment for RA. After prolonged antimicrobial chemotherapy and interrupted infliximab treatment, reimplantation of a new prosthesis was successfully performed two years after Salmonella septic arthritis. Therefore, because of the possibility of extraintestinal salmonellosis, screening for fecal colonization could be advisable in patients undergoing anti-TNF treatment. Moreover, we emphasize the importance of appropriate counselling of these patients concerning food hygiene.

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Cilj: Prikazati pacijenta s bolesti povezanom s imunoglobulinom G4 (engl. immunoglobulin G4-related disease; IgG4-RD) te dijagnostičke izazove vezane uz ovu bolest, kao i terapijske mogućnosti s naglaskom na liječenje rituksimabom. Prikaz slučaja: Šezdesetogodišnji pacijent primljen je na hospitalnu obradu nakon pregleda u gastroenterološkoj ambulanti u koju je zaprimljen zbog neredovite stolice, slabosti i gubitka 20 kg unutar dva mjeseca. U statusu je ustanovljena lezija desnog ličnog živca, ptoza, lagoftalmus i otežano gutanje. Obradom su potvrđene lezije desnog oculomotoriusa, facialisa i trigeminusa, a otorinolaringološkim pregledom utvrđena je pareza desne glasnice. Laboratorijski nalazi pokazali su anemiju i povišene upalne pokazatelje. Ultrazvukom otkrivena lezija jetre definirana je kao hemangiom. Kompjutorizirana tomografija (engl. computed tomography; CT) i magnetska rezonancija (MR) mozga pokazale su hipertrofični pahimeningitis u području srednje i stražnje lubanjske jame, uz desni tentorij, kavernozni sinus, Meckelovu jamu i gornju orbitalnu fisuru. CT aortografija pokazala je aortitis infrarenalne aorte. Serumska razina IgG4 protutijela bila je povišena te su zadovoljeni kriteriji za moguću dijagnozu IgG4-RD i započeta je terapija metilprednizolonom. Iduće je godine ponovno hospitaliziran radi reevaluacije bolesti. MR mozga pokazao je dobru regresiju hipertrofičnog tkiva dure, ali CT aortografija nepotpunu regresiju bolesti te su upalni pokazatelji i dalje bili visoki. Uvedena je terapija rituksimabom koja je dovela do remisije. Zaključak: IgG4-RD je rijetka i složena bolest koja često oponaša druge i predstavlja velik dijagnostički izazov, stoga bi poznavanje ove bolesti uvelike pridonijelo njezinom ranom otkrivanju i boljim terapijskim ishodima. Iako su glukokortikoidi standardna terapija, često ne daju željene rezultate, a inovativna terapija rituksimabom pokazuje odličnu učinkovitost.