Objective. Adult-onset Still's disease (AOSD) is frequently refractory to standard therapy. Tocilizumab (TCZ) has demonstrated efficacy in single cases and in small series of patients with AOSD. The aim of this multicenter study was to assess the efficacy of TCZ in patients with AOSD refractory to conventional treatment.Methods. This was a retrospective open-label study of TCZ treatment in 34 patients with AOSD who had experienced an inadequate response to corticosteroids and at least 1 standard synthetic immunosuppressive drug and also, in many cases, biologic agents.Results. The mean ؎ SD age of the patients (8 men and 26

Objective To estimate the incidence of hospitalisation due to varicella zoster virus (VZV) infection in patients treated with tumour necrosis factor (TNF) antagonists for infl ammatory rheumatic conditions and to compare it with the expected rate in the general population. Methods Secondary data analysis was performed of two large databases: (1) the national registry of rheumatic diseases patients treated with biological agents (BIOBADASER); and (2) the national hospital discharge database Conjunto Mínimo Básico de Datos al Alta Hospitalaria. Hospitalisations due to shingles or chickenpox were analysed. For each condition the incidence rate (IR) and the age and gender standardised IR per 100 000 person-years plus the standardised incidence ratio (SIR) and the standardised incidence difference (SID) were estimated. Results In patients exposed to TNF antagonists, the estimated IR of hospitalisation due to shingles was 32 cases per 100 000 patient-years (95% CI 14 to 78), the expected rate in the general population was 3.4 (95% CI 3.2 to 3.5), the SIR was 9 (95% CI 3 to 20) and the SID was 26 (95% CI 14 to 37). The estimated IR of hospitalisation due to chickenpox was 26 cases per 100 000 (95% CI 10 to 69), the expected rate was 1.9 (95% CI 1.8 to 2.0), the SIR was 19 (95% CI 5 to 47) and the SID 33 (95% CI 21 to 45). Conclusions Patients suffering rheumatic diseases exposed to TNF antagonists are hospitalised due to VZV infections signifi cantly more frequently than expected in the general population. Since the absolute IR of hospitalisations due to chickenpox and shingles is low in these patients, the implementation of risky preventive measures may not be justifi ed at present.

The use of microalgae as a production system has gained huge interest in recent years. Recent research has concentrated on single aspects, such as the microalgal cells or the photobioreactors. The design of sustainable, effective, and economic processes for microalgal products requires the integration of microalgal biology including strain selection and genetic engineering, process, and reactor design and integration into environmental mass and energy fluxes. This involves tools of biotechnology and process engineering. Several attempts of such integrated processes have been developed. This review groups the integration aspects into several degrees of integration with respect to the classical upstream, bioreaction, and downstream steps. The integration levels consider metabolic, process, environmental, and social integration. At the end, the following question remains: How far can microalgal biotechnology help to solve the problems of feed, food, and fuel supply and contribute to a better society? Overall, this review gives an overview of the different stages of integration in microalgal processes. It is a guide towards conceptual positioning and planning of microalgal plants. Furthermore, it is a decision guide to support microalgal technologies.

Optimal treatment for patients with RA failing on treatment with TNF antagonists may include RTX. This study suggests that the improvement in DAS28 is larger in patients treated with RTX than in those treated with monoclonal anti-TNF agents.

Perforating dermatoses are characterized by transepithelial elimination of dermal structures. We report a 61-year-old man with rheumatoid arthritis who developed a perforating folliculitis following the administration of two tumour necrosis factor (TNF)-alpha inhibitors, infliximab and etanercept. To our knowledge, no perforating disorders have been reported associated with these drugs. This report suggests, for the first time, a role for TNF-alpha in the pathogenesis of perforating folliculitis.