case report on dramatic response of refractory panuveitis of Behcet disease to short-term therapy with Infliximab followed by cellcept

Behcet disease [BD] is a multisystem vasculitic syndrome with clinical triad of oral aphthus ulcer, genital ulcer, and eye involvement. Uveitis of BD may be particularly resistant to corticosteroids and immunosuppressants with a rapid progression to loss of vision in 10-25% of the cases. In recent years, Infliximab is a very useful drug for refractory eye involvement of BD and some studies recommend Cellcept for this reason. Here, we reported a 40 years old man with known BD, referred to our clinic with severe bilateral panuveitis. His eye involvement was refractory to conventional therapy in 15 months follow-up; then he was switched to Infliximab, in an attempt to control this disease. Infliximab [3mg/kg] was given at 0, 4, 8 weeks [three doses] together with Azathioprin. Very soon after the first infusion, we have found a remarkable ophthalmologic response. We have prescribed Cellcept after the third infusion and discontinued Azathioprin and Infliximab. 14 months after the last infusion, no significant changes were found in ophthalmologic examination. Our observation highlights a difference in the effect of Cellcept in panuveitis of BD

[Educational paper on osteoarthritis]

Osteoarthritis is the most common joint disease. The main pathologic manifestation of disease is local destruction of cartilage in diarthrodial joint. New bone formation in marginal surface in the joint is a sign progressive disease. Many systemic and local factors are introduced in initiate and progression of osteoarthritis include: age, sex, weight, race, genetic background, bone densitometry, sex hormones, endocrine and metabolic disease, nutrition status, major and frequent minor trauma to joint, occupational or exercise over stresses to joint, congenital or developmental defect in joint and previous infectious or inflammatory joint diseases. Early clinical manifestations often are intermittent mild pain in joint, frequently after joint use, mild stiffness with vague pain in periarthicular muscle. Diagnosis of osteoarthritis is simply with history, physical examination and X-Ray. At now there isn't definitive laboratory test for diagnosis. Overall osteoarthritis is destructive joint disease without cure, but we must be following the patients and don't leave them until complete cartilage destruction. Careful approach of physician with these patients can prevent more damage or at least delay it