Apremilast demonstrated clinical improvements in PsA for up to 52 weeks, including signs and symptoms, physical function, and psoriasis. No new safety signals were observed. ClinicalTrials.gov identifier: NCT01212757.

Clinical assessment (disease activity, severity, and extraarticular manifestations) of 101 rheumatoid arthritis patients was correlated with several laboratory tests, including 5 immune complex assays: the bovine conglutinin, 125I–C1q binding, monoclonal rheumatoid factor inhibition, Raji cell, and staphylococci binding assays. Elevated disease activity indices were most closely associated with the presence of immune complexes detected by the 125I–C1q and staphylococci binding assays. There were significant but weak correlations between the level of disease activity and the level of immune complexes as measured by the bovine conglutinin, 125I–C1q binding, Raji cell, and staphylococci binding assays. Articular disease severity, as measured by anatomic stage, was best discriminated by the bovine conglutinin, monoclonal rheumatoid factor inhibition, and staphylococci binding assays. Extraarticular manifestations were best discriminated by the Raji cell and staphylococci binding assays. We concluded that the sensitivity, specificity, predictive value, and overlap of the associations were not sufficient to warrant their wide use for the diagnosis and management of rheumatoid arthritis in individual patients. Conversely, the 125I–C1q and staphylococci binding assays were as good as the erythrocyte sedimentation rate and the IgG rheumatoid factor test (the 2 best tests of many examined) in assessing disease activity. Further prospective studies with these assays will determine their usefulness in following rheumatoid arthritis for a prolonged period.

Lesions of the aorta and its main branches have rarely been described in systemic lupus erythematosus (SLE) (1,2). Arteriolar and postcapillary venular lesions predominate. The vasculitis of both large and small caliber vessels is thought to be caused by endothelial cell injury secondary to immune complex deposition ( 3 ) . The following patient with undiagnosed active SLE had left hand digital ischemia, and her left arm arterial pulses were absent due to thrombosis of the subclavian and brachial arteries.Case report. A 1Pyear-old black woman was admitted to Emory University Hospital. She complained of bilateral angioedema of the hands and digital cyanosis on the left. Three days before admission she developed facial edema and was given Benadryl by her physician, without relief. On the evening of admission she developed numbness and cyanosis of her left hand. She had a history of alopecia, anemia, and a documented weight loss of 20 pounds over 3 months.Physical examination revealed a lethargic young woman with stable vital signs, severe left hand pain, bilateral periorbital edema, chemotic conjuctivae, and malar hyperpigmentation. Multiple white plaques (0.5-1 .O cm in diameter) covered the tongue, oral mucous membranes, and mucosa of the external nares. Enlarged, bilateral, movable, nontender lymph nodes were present in the supraclavicular, axillary, and posterior cervical areas. Pulmonary auscultation indicated the presence of bilateral pleural effusions.Findings from a cardiovascular examination were normal, except for absent left brachial, radial, and ulnar pulses. All other arterial pulses were strongly palpable. The abdomen was distended, with hypoactive bowel sounds and shifting dullness, but there was no evidence of hepatosplenomegaly. The results of pelvic, rectal, and neurologic examinations were normal. Her admission white blood cell (WBC) count was 17,500/mm3 with a monocytosis (12%). She had a Westergren erythrocyte sedimentation rate (ESR) of 87 mm/hour, and an albumin of 2.4 gm/dl. The chest roentgenogram demonstrated bilateral pleural effusions and bibasilar linear atelectasis with interstitial infiltrates present in both lower lobes. A kidneyureter-bladder roentgenogram of the abdomen revealed ascites. The results of the electrocardiogram, urinalysis, thyroid function studies, and all chemical, hematologic, and clotting studies (including prothrombin and partial thromboplastin times) were normal.Thoracentesis and abdominal paracentesis were nondiagnostic. Cultures and cytologic examinations of both body fluids, as well as the pleural biopsy, were negative. All cultures were sterile except those from the oral and nasal plaques, which grew Candida albicans. The patient was treated with oral and topical ately distal to the juxtaposition of the subclavian artery over the first rib (Figure 1). There was no evidence of occlusion or narrowing proximally. Oblique views of the aortic arch including the left upper arm showed abrupt occlusion of the brachial artery in its distal third with arterial collater...