After introduction of infliximab for the treatment of rheumatoid arthritis (RA), there have been many reports of patients developing asymptomatic higher rate of antinuclear antibodies and anti-dsDNA antibodies than in non-infliximab-treated patients. However, only five clinical drug-induced lupus (DIL) cases have been documented following treatment with infliximab, in RA and in Crohn's diseases. We report a case of a 69-year-old female with a 5 year history of RA, whowas successfully treated with low-dose methotrexate (MTX) and infliximab (initially 3 mg/kg and from the fourth infusion 5 mg/kg) for 23 weeks. Before the sixth infusion, she was diagnosed with DIL by both clinical features (fever > 38 degrees C, recurrence of active synovitis, myalgia, erythematous rash and general malaise) and laboratory findings (antinuclear antibodies 1:160, anti-double-stranded DNA positive by ELISA assay, decreased serum complement C3 andC4, hypergammaglobulinaemia, increased erythrocyte sedimentation rate). After discontinuation of treatment and therapy with oral prednisone, lupus resolved within 8 weeks.
Paget's disease of bone (originally named osteitis deformans) is a common disorder of unknown etiology, affecting approximately 3% to 4% of the population older than 40 years of age. The disease typically involves a single bone (monostotic) or a few
Background Methotrexate has been recognised as one of the main therapeutic agents used in rheumatoid arthritis (RA). However some of the adverse effects of low-dose methotrexate therapy and in particular pancytopenia have caused major concern. Objectives The aim was to describe our experience of long-term follow up of patients with RA treated with low-dose methotrexate, in particular in reference to the appearance of pancytopenia. Methods During the last 14 years 528 RA patients were treated with methotrexate 7.5-15 mg/week by the Rheumatology Department. These patients were followed up by the Rheumatology Department and they had a complete laboratory evaluation and clinical examination in regular intervals. Results In 528 RA patients treated with low-dose methotrexate therapy over a period of 14 years 4 cases of aplastic anaemia were diagnosed (0.76%). In these patients the white cell count, platelet count, haemoglobin and haematocrit values decreased.
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