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Even thought there were two new events of TB and HBV reactivation after etanercept treatment, incidence of overall infection seemed to be increased after infliximab treatment. The infectious screening and monitoring with high index of suspicion as well as the pre-emptive treatment are still important whenever either etanercept or infliximab is started.

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IntroductionThe diverse spectrum of focal or diffuse, central and peripheral nervous system involvement in neuropsychiatric systemic lupus erythematosus (NPSLE), its inconsistent relationship with overall disease activity as it continues to remain a leading cause of morbidity and mortality in SLE makes its diagnosis extremely challenging. In 1999, the American College of Rheumatology (ACR) proposed criteria that include 19 case definitions for NPSLE.PurposeWe reviewed all patients with the diagnosis of NPSLE at the Mayo Clinic, over a 25-year period to better understand the pattern of presentation of NPSLE and prevalence with frequency distribution of every criterion as defined by the ACR.MethodsWe retrospectively reviewed 117 patients with presumed NPSLE presenting at the Mayo Clinic, Rochester, from 1976 to 2001. Twenty-seven records that failed to meet ACR diagnostic criteria or did not have a confirmed nervous system involvement were excluded. Abstracted data included general demographics, clinical presentation, duration of SLE, blood tests, imaging studies, electroencephalography (EEG) and mortality.Summary of ResultsMajority were women (n = 77), Caucasian (88.9%) with a mean age of 37.6 years (range: 11 to 70 yrs) at presentation. Twenty-six developed NPSLE prior to demonstrable SLE symptoms and 12 developed it concurrently. Twenty-four of them died with a median survival of 168 months. Seizure was the most common presentation (38.9%), followed by cerebrovascular accidents and cognitive impairment (31.1%). Interestingly, we identified 3 patients who presented with features of parkinsonism as demonstrated by cogwheel rigidity, bradykinesia, dysphonia, and gait disturbance.ConclusionWe believe that this study is among the largest population sample in the United States of this rare but devastating illness. Review of literature reveals that most studies performed so far involve small sample populations and are predominantly case reports. Central nervous system involvement was much more frequent than peripheral nervous system. We unearth a hitherto undescribed and novel presentation of NPSLE and suggest that it be added to the current ACR case definitions.

IntroductionFull Text on the Net bias (FUTON Bias) is the “tendency to peruse what is more readily available on the Internet.” This innate tendency to pick the “low-hanging fruit of convenience” greatly enhances the odds that a FUTON article will be read or cited. By the same token, invisible research, defined as not readily accessible on-line, may possibly be ignored or overlooked and therefore disregarded.PurposeWe sought to determine if there was any effect on the increase in impact factor (IF) of immunology journals which were available FUTON and whether going on-line affected the IF.MethodsA comprehensive search was made to identify all rheumatology and immunology journals worldwide using MEDLINE, PubMed, and EMBASE databases and several search engines. The on-line status of these journals in MEDLINE (as FUTON, abstracts only, and no abstracts or citations) was ascertained. Impact factors for all available journals from 1990 to 2003 were abstracted. Journals that went on-line in the first half of the Internet era (prior to 1998), as opposed to those that went on-line later, were compared using sign rank and rank sum tests.Summary of ResultsIn general impact factors have increased with the availability of the World Wide Web. As expected the “prior to 1998 era” journals (n = 69) tended to have higher mean impact factors than the post 1998 era journals (n = 58) available as FUTON (2.994 ± 0.793 vs. 0.1.392 ± 0.0.195). Interestingly while FUTON and “abstract only” journals continued to improve their impact factors every year after they went on-line those that had only references or citations without abstracts failed to improve their impact factors. Also “abstract only” journals failed to catch up with the impact factors of their peer journals available as FUTON (p<0.007 year 1 to p<0.01 year 4).ConclusionThis suggests that although the Internet has increased awareness of the existence of a journal, those allowing FUTON access are likely to make substantial leaps in their impact factors and continue to outstrip their peers who fail to provide such access. Also, barrier free access will threaten journals that insist on subscription who need to recognize the looming threat of becoming obscure. The FUTON bias like the “Tower of Babel” bias influences visibility of research and limits consideration of relevant medical literature impeding the progress of evidence based medicine.