Our results indicate that the use of TNFi therapy appeared to be as safe as traditional DMARDs in treatment of rheumatoid arthritis patients and long-term follow-up with careful examination is essential to pick up any abnormal ADEs.

Hemodialysis (HD) patients have greater morbidity and mortality when they have a central venous catheter (CVC) rather than an arteriovenous fistula (AVF) access. Inflammation associated with dialysis catheter use and resultant higher C-reactive protein (CRP) levels could have an independent adverse effect on patient outcomes. In this prospective study, we investigated whether HD catheters induce inflammation independent of infection. We compared the mean levels of the inflammatory marker (CRP) in 67 patients on maintenance HD using noninfected catheters with 86 HD patients using AVFs at Prince Salman Center for Kidney Diseases, Saudi Arabia (KSA), and Jahra Hospital, Kuwait, who met our inclusion criteria. C-reactive protein levels were measured every 2 months over a period of 6 months using immunoturbidimetric assay. One hundred fifty-three patients on maintenance HD for more than 6 months were included in the study, with mean age of 52.19 ± 16.06 years; 66% were males and 34% were females. Serial levels of mean CRP were statistically and significantly higher in group with noninfected catheters (1.33, 1.24, and 1.10 mg/dL) compared to those with AVFs (0.65, 0.59, and 0.68 mg/dL) with P value of 0.000. In our study, we found no relation between CRP level and age, sex, hemoglobin, albumin, calcium, phosphorus, and iPTH level in both groups. Hemodialysis patients with a catheter have a heightened state of inflammation independent of infection, and thus our study supports the avoidance of catheters and a timely conversion to AVFs with catheter removal.

Central venous catheters are associated with infection and resultant higher C-reactive protein levels (CRP), suggesting that catheters may be an important determinant of increased inflammatory response. The increased levels of markers such as CRP are associated with increased risk of premature death and hospitalization in end stage renal disease (ESRD) patients on regular hemodialysis (HD). In this prospective study the mean levels of the inflammatory marker CRP were measured every 2 months over a period of 6 months by using immunoturbidimetric assay in 70 ESRD patients on maintenance HD at Prince Salman Center For Kidney Diseases (PSCKD) who met our inclusion criteria, comparing those dialyzed using a non-infected catheter (35 patients) to those using arteriovenous fistulas (35 patients). Seventy ESRD patients who had been on maintenance HD for more than 6 months were included in the study, with a mean age of 50.09 ± 15.61 years, 80% were males and 20% were females. Serial levels of mean CRP were statistically significantly higher in the group with non-infected catheters (0.83, 0.82, 0.94 mg/dL) compared with those with arteriovenous fistula (0.31, 0.38 and 0.34 mg/dL) with P-values of 0.000, 0.023 and 0.001, respectively. In our study we found no relationship between CRP level and age, sex, hemoglobin albumin, calcium, phosphorus and intact parathyroid hormone level in both groups. Our study shows that catheters might contribute to increased inflammation independent of infection, and support the avoidance of catheters and a timely conversion to fistulas with catheter removal.

No abstract

The classical clinical picture of antiphospholipid antibody syndrome (APS) is characterized by venous and arterial thrombosis, fetal losses and thrombocytopenia in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disorder or secondary to a connective tissue disease, most frequently systemic lupus erythematosus. Central nervous system involvement is one of the most prominent clinical manifestations of APS, and includes thrombotic events, psychiatric features and a variety of other non-thrombotic neurological syndromes. We present a 9-year-old Saudi girl who developed psychotic illness without thrombotic manifestations. Autoantibodies against cardiolipin were persistent and strongly positive while antinuclear antibodies and antibodies against double-stranded DNA was absent. Her brain computed tomography, magnetic resonance imaging, magnetic resonance arteriography and magnetic resonance venography all were normal. There was no evidence of infection, drug intake or connective tissue disorders, So a diagnosis of primary APS was likely. Starting on antipsychotics only was unsatisfactory and marked improvement occurred after combined treatment with antidepressants (imipramine 10 mg and risperdal 0.2 mg, both once daily), small-dose aspirin (100 mg) and hydroycloroquine (100 mg) both once daily. Unfortunately aspirin was stopped by the family and 5 months later she developed right axillary vein thrombosis. This case presented psychotic illness. Investigations revealed the presence of anticardiolipin antibodies without a thromboembolic picture, mimicking Hughes syndrome but not fulfilling the criteria needed for the diagnosis. Thus, psychosis should be appreciated as a presenting symptom for primary APS and combined treatment with antipsychotics, aspirin and antimalarials is recommended.