Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of this autoimmune disease vary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Their appearance, as well as their severity are related to RA chronicity and resistance to therapy. The treatment consists of corticosteroids, NSAIDs and cytotoxic drugs, depending on the type of ocular manifestations and the patient's response to treatment.

The objective of this study is to determine and comparatively evaluate the effects of three different non-steroidal anti-inflammatory drugs on the levels of metalloproteinases MMP-1, MMP-3 and MMP-8, as well as on their tissue inhibitor TIMP-1, in patients suffering from idiopathic osteoarthritis. The effect of these drugs on the articular cartilage and the probable use of MMPs and TIMP-1 as markers of disease and treatment was also investigated. METHODS: Thirty-six patients with OA were selected and allocated to three groups on the basis of their disease location. All patients received anti-inflammatory treatment with special selective COX-2 inhibitors, i.e. celecoxib, meloxicam, aceclofenac. Each drug was given to every patient for three months following a randomized order of administration. Serum levels of MMP-1, MMP-3, MMP-8 and TIMP-1, and ratios MMP-1/TIMP-1, MMP-3/TIMP-1, MMP-8/TIMP-1 were measured before and after treatment. RESULTS: The use of aceclofenac resulted in no significant variation in either MMPs concentration and MMPs/TIMP-1 ratio. This outcome concerns the three groups and the 36 patients that form them. After all patients had received all three NSAIDs, MMPs and TIMP-1, these parameters were compared to their initial and final median values. A significant reduction in MMP-3 was found so in all OA patients as in the group of knee OA patients. CONCLUSIONS: 1. Of the MMPs studied, MMP-3 levels were found to be significantly reduced after NSAIDs treatment. Therefore, serum MMP-3 levels in OA patients could be proven to be a useful evaluating marker of treatment on the cartilage level. 2. No significant differences were observed among NSAIDs administered with regards to their effect on MMPs and TIMP-1 concentration.

Increased bone turnover and other less frequent comorbidities of hyperthyroidism, such as heart failure, have only rarely been reported in association with central hyperthyroidism due to a thyrotropin (TSH)-secreting pituitary adenoma (TSHoma). Treatment is highly empirical and relies on eliminating the tumor and the hyperthyroid state.We report here an unusual case of a 39-year-old man who was initially admitted for management of pleuritic chest pain and fever of unknown origin. Diagnostic work up confirmed pericarditis and pleural effusion both refractory to treatment. The patient had a previous history of persistently elevated levels of alkaline phosphatase (ALP), indicative of increased bone turnover. He had also initially been treated with thyroxine supplementation due to elevated TSH levels. During the diagnostic process a TSHoma was revealed. Thyroxine was discontinued, and resection of the pituitary tumor followed by treatment with a somatostatin analog led to complete recession of the effusions, normalization of ALP, and shrinkage of pituitary tumor.Accelerated bone metabolism and pericardial and pleural effusions attributed to a TSHoma may resolve after successful treatment of the tumor. The unexpected clinical course of this case highlights the need for careful long-term surveillance in patients with these rare pituitary adenomas.

No abstract

87.6% had received conventional synthetic (cs)DMARDs and 77.2% corticosteroids. During follow-up, golimumab was mostly (99.4%) administered in the 50mg oncemonthly dose, plus background csDMARDs. Improvements in EQ-5D-3L UK index scores from baseline to 3/6/12 months were: 0.2160.24, 0.2860.25, 0.3860.30, respectively (p,0.001, all comparisons). DAS28-ESR scores improved from baseline to 3/6/12 months; mean6sd scores were 5.460.9, 4.161.2, 3.761.2 and 3.261.1, respectively (p,0.001, all comparisons). Of patients attending the 12-month visit, 27.3% and 54.6% achieved DAS28-ESR,2.6 (remission) and DAS28-ESR#3.2 (low disease activity). Improvements were observed in HAQ-DI and WPAI scores from baseline to 3/6/12 months (p,0.001, all comparisons). Mean adherence rate to golimumab was 90.3%; non-significant difference in adherence rates for bDMARDnaïve vs. -experienced (p=0.152). Healthcare resources for RA-related reasons were utilised by .93.2% of pts. Conclusions: In real-world settings, patients with RA receiving golimumab over 12 months experienced significant improvements in QoL, physical function and work productivity/activity impairment.