TNFα inhibitor biosimilars associated with alopecia areata. Case-based review.

Alopecia areata (AA) is a common non-scaring hair loss associated with many inflammatory and autoimmune disorders. Anti-tumor necrosis factor alpha (TNFα) therapy is used to treat many chronic inflammatory disorders and has been proven to be effective and relatively safe. However, several immune-mediated skin reactions have been described with the use of TNFα inhibitors, among them AA. In this report, we describe two patients, a 32-year-old woman with ankylosing spondylitis and a 48-year-old man with rheumatoid arthritis who were both treated with SB4 (Benepali®), an etanercept biosimilar, and developed AA, 6 and 12 months respectively after the initiation of TNFα blocker biosimilar. These, are the first two cases of AA development during TNFα inhibitors biosimilar. Thus, physicians when dealing with patients treated with these agents, should be aware of possible immune skin reactions, among them AA. To this end, a close follow-up and monitoring is mandatory.

Occupational mimics of rheumatoid arthritis: hair dye-induced arthritis.

Hair dye (HD) and its component para-phenylenediamine (PPD) are commonly used to enhance beauty and youth. HD is associated with allergic contact reactions and the development of autoimmune phenomena. A 28-year-old woman presented to us complaining of pain and swelling affecting the small joints of the hands bilaterally lasting for 7 weeks. Laboratory evaluation was remarkable only for an increase of acute-phase reactants, while the rest of laboratory tests including serological tests for viruses, as well as immunological tests were negative or within normal limits. She noticed a close correlation between the onset of symmetrical polyarthritis and the use of HD product. Thus, after excluding other possibilities of inflammatory arthritides, the diagnosis of HD-induced arthritis was made. The patient was treated with naproxen, and after 3 weeks, she had a complete clinical response with decrease of acute-phase reactants. Thus, we review and discuss the relevant literature of cases related with the use of HD and arthritis development. This is the first described case of HD-induced arthritis. Physicians must be aware and recognize these symptoms and signs of patients exposed to HD and treat them appropriately.

Impact of nasal continuous positive airway pressure on heart rhythm in patients with obstructive sleep apnea/hypopnea syndrome.

AIM: A high incidence of nocturnal cardiac rhythm disturbances among patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) has been described in some reports. We wished to examine the prevalence of arrhythmias in OSAHS patients and, in particular, to assess the impact of nasal continuous positive airway pressure (nCPAP) therapy. METHODS: Three hundred thirty-seven patients with suspected OSAHS; 261 men (77.4%) and 76 women (22.6%); 154 accepted to participate in a second polysomnographic check. RESULTS: Mean age was 53.28±13.6 years. Mean Body Mass Index (BMI) 32.89±6.1 kg/m2. Found statistical significance between patients with normal-mild apnea/hypopnea index (AHI) and moderate to severe AHI (P<0.01). Also, found statistical significance between patients without and with the use of nCPAP (P<0.01). During periods of stable SpO2 there were no apparent oscillations on heart rate. CONCLUSION: We demonstrated that the impact of nCPAP in patients suffering from OSAHS and heart arrhythmias is positive, helping those patients to have a better quality sleep and probably less cardiovascular risk in a long-term use of the nCPAP apparatus. Males are more prone to OSAHS and to develop tachycardias and bradycardias.

Gastroesophageal reflux disease: epidemiological data, symptomatology and risk factors.

BACKGROUND: Patients with gastroesophageal reflux disease (GERD), present a typical symptomatology with heartburn and regurgitations in about 80%. OBJECTIVE: This study will assess the prevalence of gastroesophageal reflux disease and some demographic features of the study group. It will also be assessed the sensitivity and specificity of GERD Questionnaire and the risk factors of the disease. MATERIAL AND METHODS: For the current study 426 patients were selected who were admitted to a tertiary gastroenterology-hepatology hospital in Athens, Greece, complaining about having the common symptoms of GERD (heartburn and regurgitations). The study period was January 2008-March 2011. Positive diagnosis has been based on personal history, clinical examination and by upper gastrointestinal endoscopy. RESULTS: Of 426 patients, 20 were excluded from the study. 150 (36.9%) were women and 256 (63.1%) men. The mean patient age was 48.77 years with SD 14.32 years. The age group with the highest frequency of GERD was the 40-59 years including 196 (48.3%) patients and also the group between 20-39 years including 111 (27.3%) patients. 60 (14.8%) patients were not diagnosed with GERD after following an upper gastrointestinal endoscopy. CONCLUSIONS: The M:F ratio for patients with Barrett esophagus is 5:1. The sensitivity for the diagnosis of GERD using questions about the typical symptoms (regurgitation, heartburn) is about 72.6%. Although, the prevalence of GERD is higher in males than females, the prevalence of esophagitis and GEFV grade between sexes in not statistically significant. On the other hand, there is a strong statistical significance between sex and grade of HH presence (p < 0.05).