[Functional coma: case report and systematic review]. / Functioneel coma: casusbeschrijving en systematisch literatuuroverzicht.

We describe a case of a patient with a functional coma ,and give a systemic review of literature. Functional coma is an extremely rare disorder with only 21 described cases in the literature. The disease is linked to a conversion disorder or a dissociative disorder and is predominantly found in females. Predisposing factors are a history of sexual or physical abuse, psychiatric disorders, previous episodes of functional coma, and recent surgery with general anesthesia. Several clinical signs are suggestive for the diagnosis, however none of them is sufficiently sensitive or specific. Therefore, functional coma remains an exclusion diagnosis. Vital signs must be normal, just as a routine blood examination, an electroencephalogram and imaging of the central nervous system. The most important differential diagnosis are catatonia, factitious disorder, and malingering. Spontaneous recovery can be expected after a duration of about 45 minutes to 4 days.

Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16†weeks of treatment: the CareRA trial.

OBJECTIVES: To compare the efficacy and safety of intensive combination strategies with glucocorticoids (GCs) in the first 16 weeks (W) of early rheumatoid arthritis (eRA) treatment, focusing on high-risk patients, in the Care in early RA trial. METHODS: 400 disease-modifying antirheumatic drugs (DMARD)-naive patients with eRA were recruited and stratified into high risk or low risk according to classical prognostic markers. High-risk patients (n=290) were randomised to 1/3 treatment strategies: combination therapy for early rheumatoid arthritis (COBRA) Classic (methotrexate (MTX)+ sulfasalazine+60 mg prednisone tapered to 7.5 mg daily from W7), COBRA Slim (MTX+30 mg prednisone tapered to 5 mg from W6) and COBRA Avant-Garde (MTX+leflunomide+30 mg prednisone tapered to 5 mg from W6). Treatment modifications to target low-disease activity were mandatory from W8, if desirable and feasible according to the rheumatologist. The primary outcome was remission (28 joint disease activity score calculated with C-reactive protein <2.6) at W16 (intention-to-treat analysis). Secondary endpoints were good European League Against Rheumatism response, clinically meaningful health assessment questionnaire (HAQ) response and HAQ equal to zero. Adverse events (AEs) were registered. RESULTS: Data from 98 Classic, 98 Slim and 94 Avant-Garde patients were analysed. At W16, remission was reached in 70.4% Classic, 73.6% Slim and 68.1% Avant-Garde patients (p=0.713). Likewise, no significant differences were shown in other secondary endpoints. However, therapy-related AEs were reported in 61.2% of Classic, in 46.9% of Slim and in 69.1% of Avant-Garde patients (p=0.006). CONCLUSIONS: For high-risk eRA, MTX associated with a moderate step-down dose of GCs was as effective in inducing remission at W16 as DMARD combination therapies with moderate or high step-down GC doses and it showed a more favourable short-term safety profile. EUDRACT NUMBER: 2008-007225-39.

Progressive anterior vertebral body fusion, overgrowth and distinct craniofacial appearance.

In this report we describe the association of progressive anterior vertebral body fusion, generalized over-growth especially with large hands and feet and unusual thick skin and subcutaneous tissue of upper and lower limbs, and peculiar craniofacial appearance.

Double-blind placebo-controlled evaluation of levamisole in chronic rheumatoid arthritis.

Thirty-three out-patients with rheumatoid arthritis completed the study intended to compare under double-blind conditions, 50 mg levamisole tablets with placebo. Patients were given the double-blind medication at a dosage of one tablet t.i.d. for 3 months, and at a dosage of one tablet t.i.d., on 2 consecutive days every week for the next 3 months. Pain score, duration of morning stiffness, articular index and E. S. R. were recorded at the start of treatment, after 3 months of treatment and at the end of treatment. The levamisole patients made significantly better progress than did the placebo patients: for E.S.R. after 3 months of treatment, and for E.S.R., pain and morning stiffness by the end of treatment. Ten levamisole patients and 5 placebo patients reported adverse reactions. These were mainly gastrointestinal symptoms in the levamisole-treated patients.

Proximal interphalangeal arthroscintigraphy in rheumatoid arthritis.

Quantitative scintigraphy of proximal interphalangeal joints was performed by a reproducible method using 99m-Technetium in the hands of 40 normal controls and 20 patients with rheumatoid arthritis (RA). The range of the mean uptake varied considerably between proximal interphalangeal (PIP) joints in normal subjects. The mean uptake over PIP joints was not significantly different either between normal controls and RA patients, nor between those rheumatoid arthritis patients with and those without clinical signs of inflammation in the PIP joints. However, the variation in the PIP counts was significantly greater in the rheumatoid hands than in the normal hands. There was no clear correlation between the technetium uptake and the clinical parameters of inflammation in the PIP joints.

Diagnostic value of sacroiliac joint scintigraphy with 99m technetium pyrophosphate in sacroiliitis.

Using a quantitative method, scintigraphy of SI joints was performed by means of 99m technetium pyrophosphate in 21 patients with definite ankylosing spondylitis, in 17 control patients, and in 26 patients 'at risk', i.e. patients with complaints of back pain of the inflammatory type where on clinical grounds there was a possibility of sacroiliitis developing but with normal x-ray findings of the SI joints. Radioisotope uptake was higher in the ankylosing spondylitis group than in the other two groups, although the difference was not statistically significant with regard to the group 'at risk'. The high variance in the three groups considerably reduces the diagnostic value of the examination. In the ankylosing spondylitis group no correlation was found between radioisotope uptake and age, duration of disease, erythrocyte sedimentation rate, or radiological stage of scaroiliitis. Since the specificity and sensitivity of scintiscanning are lower than that of clinical and radiological diagnosis of the disease, we conclude that scintigraphy is not very helpful in the early diagnosis of sacroiliitis, at least by the techniques used here.