Rheumatoid arthritis: new developments in biologic therapy.

With the development of biologic agents our therapeutic approach to rheumatoid arthritis (RA) and inflammatory diseases in general, has dramatically changed within the last few years. Biologic technically means a substance as the product of biologic system and functionally as an agent that targets specific biologic molecule. Recently a number of endogenous antigens have been identified and these are known to activate CD4+ T cells leading to production of cytokines [interleukin (IL)-1, IL-6] and tumour necrosis factor (TNF)-alpha and immunoglobulins like rheumatoid factor and expression of osteoprotegerin ligands that stimulate osteogenesis leading to joint distruction. Rheumatologists and other practitioners are facing a remarkable wave of new therapies for RA like infliximab, adalimumab, atlizumab, etanercept, anakinra, prosorbacolumn, anti-IL-6 agents, IL-10 and inferferon-r. To date combination therapy of methotrexate plus a single biologic has been widely studied with synergistic effect. Etanercept and infliximab are two biologics available in India.

Reflex Sympathetic Dystrophy Syndrome

Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndome Type-I (CRPS-I), a disease of unknown prevalance, complicates any minor trauma, stroke, myocardial infection, colle’s fracture, peripheral nerve injury and in one-fourth of cases without any precipitant factor. An awareness of RSD and the injuries, illnesses and drugs that can provoke it is the first step to learn for an early treatment and better outcome. Here we present a neglected case of RSD following minor trauma who presented to us after 6-7 months of onset of disease. Delay in treatment resulted in partial recovery of the patient.