OBJECTIVE: Atherosclerosis is a major complication of systemic lupus erythematosus (SLE) and is exacerbated by the disease itself, drug toxicity, and metabolic syndrome. Although belimumab (BEL) can ameliorate disease activity and reduce prednisolone (PSL) dose in SLE, its effect on metabolic profiles is obscure. We aimed to assess the effects of subcutaneous BEL on disease activity and metabolic profiles.
METHODS: A total of 106 patients with SLE who received subcutaneous BEL were included, and 76 patients who started BEL treatment at least 1 year prior were evaluated. Clinical information, including retention rate, disease activity, renal outcome, patient satisfaction, and metabolic profiles, were retrospectively analysed.
RESULTS: The retention rate of BEL was > 80% after 2 years, and ineffectiveness and pain were the major reasons for discontinuation of BEL treatment. Satisfaction with side effects was higher in the BEL group than that in the PSL group. Belimumab significantly improved disease activity, lupus nephritis, and PSL dosage, with a median reduction of 4 mg/day. These effects were observed in active disease and positive C1q-binding immune complex, and PSL reduction ≥ 5 mg was achievable in such cases. Patients with PSL reduction of ≥ 5 mg showed significantly lower blood low-density lipoprotein and triglyceride by 13 and 17 mg/dL, respectively, while those with PSL reduction of < 5 mg remained unaltered.
CONCLUSIONS: Subcutaneous BEL was effective in improving disease activity and proteinuria in patients with chronic disease while reducing PSL. Reduction in PSL by BEL also improved lipid status, which could synergistically reduce cardiovascular risk in SLE. Key Points • Significant reduction of disease activity, proteinuria, and prednisolone was observed in patients using subcutaneous belimumab. • Patient satisfaction was higher in terms of side effects in subcutaneous belimumab compared with prednisolone. • Reduction in prednisolone by belimumab contributed to the improvement of lipid status and would reduce the cardiovascular risk.

OBJECTIVE: Idiopathic recurrent pericarditis (IRP) is defined by recurring episodes of pericardial inflammation without a known cause. This study investigates the safety and efficacy of anakinra, an interleukin‑1 inhibitor, as a successful therapy for IRP in cases resistant to conventional treatment.
METHODS: A retrospective evaluation of patients treated at our autoinflammatory center between 2011 and 2023 was conducted. Patient files were examined for demographic, clinical, and treatment response data, including nonsteroid anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine. Monogenic autoinflammatory disease screening was performed for Mediterranean Fever (MEFV), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), mevalonate kinase (MVK), nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3), and nucleotide-binding oligomerization domain-containing protein 2 (NOD2). Patients who experienced multiple episodes of pericarditis were diagnosed with recurrent pericarditis. The study evaluated anakinra treatment in IRP patients unresponsive to conventional therapy.
RESULTS: The study included 21 participants, 9 (42.9%) female and 12 (57.1%) male. The average age of the participants was 43.1 ± 16.5 years. The MEFV mutation analysis revealed that 2 (9.5%) had a mutation in exon 10 and 4 (19.0%) had one in exon 2. Out of the 16 cases, 15 successfully discontinued steroid treatment. Four patients (19.0%) experienced injection site reactions. C‑reactive protein (CRP) levels were measured at an average of 196 ± 67.8 mg/l before and 2.6 ± 3.15 mg/l after anakinra treatment.
CONCLUSIONS: In conclusion, the study adds to the growing evidence for the efficacy of interleukin-1 inhibitors, such as anakinra, as a promising treatment modality for IRP in cases resistant to conventional treatment.
UNASSIGNED: ZIEL: Die idiopathische rezidivierende Perikarditis (IRP) ist charakterisiert durch rezidivierende Episoden perikardialer Entzündung ohne bekannte Ursache. In der vorliegenden Studie wurde die Sicherheit und Wirksamkeit von Anakinra, einem Interleukin-1-Inhibitor, als einer erfolgreichen Therapie der IRP in Fällen untersucht, die sich als refraktär auf die herkömmliche Behandlung erwiesen haben.
METHODS: Dazu wurde eine retrospektive Untersuchung von Patienten durchgeführt, die im Zentrum für Autoinflammation der Autoren zwischen 2011 und 2023 behandelt worden waren. Die Patientenakten wurden in Bezug auf demografische und klinische Daten sowie auf Daten zum Therapieansprechen hin untersucht, einschließlich nichtsteroidaler antientzündlicher Medikamente (NSAID), Kortikosteroide und Colchicin. Ein Screening auf monogene autoinflammatorische Erkrankungen wurde hinsichtlich MEFV, TRAPS, MVK, NLRP3 und NOD2 durchgeführt. Bei Patienten mit mehreren Perikarditisepisoden wurde die Diagnose einer rezidivierenden Perikarditis gestellt. In der Studie wurde die Behandlung mit Anakinra bei IRP-Patienten, die nicht auf die herkömmliche Therapie ansprachen, untersucht.
UNASSIGNED: In die Studie wurden 21 Teilnehmer einbezogen, 9 (42,9 %) weiblich und 12 (57,1 %) männlich. Das Durchschnittsalter der Teilnehmer betrug 43,1 ± 16,5 Jahre. Die MEFV-Mutationsanalyse ergab, dass 2 (9,5 %) Personen eine Mutation in Exon 10 und 4 (19,0 %) eine in Exon 2 aufwiesen. Von den 16 Fällen setzten 15 die Steroidtherapie erfolgreich ab. Bei 4 Patienten (19,0 %) kam es zu Reaktionen an der Injektionsstelle. Die Werte für C‑reaktives Protein (CRP) betrugen im Durchschnitt 196 ± 67,8 mg/l vor und 2,6 ± 3,15 mg/l nach Anakinratherapie.
UNASSIGNED: Diese Studie leistet also einen Beitrag zu der wachsenden Evidenz für die Wirksamkeit von Interleukin-1-Inhibitoren wie Anakinra als vielversprechender Behandlungsmodalität für IRP in Fällen, die refraktär auf die herkömmliche Therapie sind.

We report on the clinical management and outcome of an 11-year-old dog diagnosed with suspected refractory immune-mediated anemia (IMHA) and treated with equine placental extract supplementation.
The patient had received standard treatment with subcutaneous infusion of prednisone (2 mg/kg) and oral administration (1.3 mg/kg semel in die [sid]), with limited success as hematocrit (HCT) values continued to fall rapidly, and the patient continued to have severe symptoms of fatigue. The patient was then put on equine placental extract supplements, after which the patient\'s physical exhaustion was improved, and although the HCT level initially continued to fall, it eventually began to rise and remained near normal for approximately 2 years. A significant reduction in prednisone use was achieved with placental supplementation.
Equine placental supplementation may be useful as a new complementary therapy for suspected refractory IMHA.

One of the main reasons for continuous, persistent asthma is when there is a change in the structure of the airways and the Lung parenchyma. These persistent changes bring a much worse prognosis to asthmatic conditions and predispose the situation to severe asthmatic syndromes such as Churg-Strauss syndrome (CSS). CSS is an inflammation of systemic blood vessels and is a rare disorder that can be suspected in long-standing asthmatic patients. Leukotriene antagonists receptor antagonists (LTRA) have been used to treat asthma along with tapering steroids. But after the introduction of LTRA therapy in these patients suggests a causal relation between LTRA initiation and the development of CSS, or it is an unmasking of CSS as the dose of steroid tapers down with LTRA therapy. This review highlights the relationship between leukotriene antagonists and the pathogenesis of CSS. It summarizes the current literature regarding the development of CSS with the initiation of LTRA therapy on asthmatic patients. The literature on this topic was reviewed using different research/article searches, manual library searches, conference abstracts, and internet searches.

Adult-onset Still\'s disease (AOSD) is a systemic inflammatory disease characterized by rash, arthritis, and persistent spiking fever. The diagnosis and treatment of AOSD are challenging due to the lack of specific diagnostic criteria and little evidence of effective treatments. Here, we reported a case of an 18-year-old woman with a fever of unknown origin (FUO), evanescent rash (without the typical \"salmon-pink\" color), and systemic lymphadenopathy. Laboratory tests at hospital admission revealed marked hyperferritinemia of 12,100 ng/mL. AOSD was subsequently suspected. Additional anti-nuclear-antibody analysis for differential diagnosis was negative. The initiation treatment with high-dose prednisolone, tapered to half every week, was immediately started. The symptoms temporarily improved but relapsed during the tapering period. The prednisolone dose was increased again, and tocilizumab was introduced. Symptom remission and prednisolone dose reduction were subsequently achieved. Therefore, a medication tapering schedule and treatment replacement to inhibit the pathophysiology of AOSD need to be carefully considered. While a ferritin test is useful to diagnose AOSD based on the presence of FUO, there are AOSD patients without hyperferritinemia. Additionally, AOSD rash on Asian skin may not present with the typical \"salmon-pink\" color.