Matrix metalloproteinases-3 baseline serum levels in early rheumatoid arthritis patients without initial radiographic changes: a two-year ultrasonographic study

Objective: To investigate the association of high baseline serum levels of metalloproteinases-3 [MMP-3] with structural damage to hand and feet joints, assessed by ultrasonography [US], in patients with early, treatment-naive rheumatoid arthritis [RA], without initial X-ray-visible erosions, during 24 months follow-up

Methods: Sixty-three early RA [European League Against Rheumatism/American College of Rheumatology 2010], disease-modifying anti-rheumatic drugs/glucocorticoid naive patients [mean age 53.4 +/-14.1] with symptom duration =

Results: Complete data were collected from 52 out of 63 patients. High baseline serum levels of MMP-3 [MMP-3-positive] were found in 46/63 patients. 122 bone erosions in total [1.9 bone erosions/patients] were detected by US at baseline visit and 213 erosions [4.3/patients] after 24 months. MMP-3 positive patients had significantly higher total number of erosions than MMP-3-negative [p = 0.039] and higher increase in size of bone erosions in the feet but not in the hand joints after follow-up [OR 4.82 [1.23-18.9], p = 0.024; OR 1.17 [0.320-4.26], p = 0.816 respectively]

Conclusion: After 2 years of follow-up, US assessment showed a higher number of new bone erosions in MMP-3-positive compared to MMP-3-negative patients with early RA and no visible initial radiographic changes. High baseline levels of MMP-3 predict significantly higher structural damage progression at the level of feet, but not at the level of hand joints

Fatal sulfasalazine-induced eosinophilic myocarditis in a patient with periodic fever syndrome

The aim of this paper is to report the first case of drug-induced eosinophilic myocarditis [EM] in a patient with hereditary periodic fever syndrome [PFS]. Case: A 28-year-old man with hyper-IgD syndrome, one of the PFS, developed a sulfasalazine-induced systemic hypersensitivity reaction complicated by EM. Thirteen days after sulfasalazine introduction, which had been given for arthritis, the patient developed fever, facial/neck edema, rash and cardiogenic shock, and died within 8 h. The autopsy revealed hemophagocytosis, while acute heart failure caused by necrotizing EM was established as the cause of death. This was a case of drug-induced EM in a patient with PFS that had an atypical presentation, rapid evolution and poor outcome