[Obesity and autoimmunity : Adipose tissue as an immune organ?] / Adipositas und Autoimmunität : Fettgewebe als Immunorgan?

Adipose tissue possesses crucial immunological features in the development of comorbidities of obesity. Complex interactions between the metabolic system and cells of the immune system are the cause but are not fully understood. Autoimmune diseases might therefore be influenced by obesity. Epidemiological studies provide evidence of only a modest association between obesity and the development of rheumatoid arthritis and psoriatic arthritis. In obesity the course of inflammatory rheumatic diseases is aggravated, as subjectively measured by activity parameters; however, laboratory parameters show no differences and radiographic examinations reveal less bone destruction in obesity. Furthermore, there are indications for a poorer response to treatment especially with infliximab in patients with an increased body mass index (BMI). Weight loss has a positive effect on the course of joint diseases. Due to deficits in the currently available studies there is insufficient evidence to recommend individualization of treatment decisions based on the BMI.

[Differential diagnosis of sternoclavicular arthritis]. / Differenzialdiagnose der Sternoclaviculararthritis.

A 47-year-old male patient presented with a 6-month history of a painful swelling in the region of the right sternoclavicular joint together with fatigue. Initial investigations including X-rays of the sternoclavicular joint did not reveal any pathological conditions. Eventually, a CT scan revealed marked joint destruction, pulmonary condensation, and enlargement of the adrenal glands. Subsequent procedures, such as joint fluid aspiration and bronchoalveolar lavage, proved to be positive for Mycobacterium tuberculosis. After initiation of a standard combination therapy (four tuberculostatic drugs) the general condition of the patient stabilized and he was discharged from hospital after 4 weeks.