Clinical characteristics of importance to outcome in patients with axial spondyloarthritis: protocol for a prospective descriptive and exploratory cohort study.

INTRODUCTION: Spondyloarthritis (SpA) is a heterogeneous spectrum of rheumatic diseases with either predominantly axial inflammatory symptoms of the spine and sacroiliac joints or predominantly peripheral arthritis. The two main entities of axial SpA (axSpA) are ankylosing spondylitis or non-radiographic axSpA (nr-axSpA). Tumour necrosis factor-α inhibitors have revolutionised the treatment of patients with axSpA who failed to respond to non-steroidal anti-inflammatory drugs and physical therapy. Chronic pain is common in patients with SpA and may still persist despite the lack of signs of inflammation. This has led researchers to hypothesise that central pain sensitisation may play a role in the generation of chronic pain in SpA. The painDETECT Questionnaire (PDQ) is a screening tool developed to detect neuropathic pain components. The primary objective is to explore the prognostic value of the PDQ regarding treatment response in patients with axSpA 3 months after initiating a biological agent. Secondary aim is to evaluate the impact of extra-articular manifestations, comorbidities and patient-reported outcomes and elucidate if these factors influence treatment response. METHOD AND ANALYSIS: We will include 60 participants (≥18 years of age) diagnosed with axSpA independent of main entity, who initiate or switch treatment of a biologic. Data will be collected at baseline and at endpoint following Danish clinical practice (≥3 months) of treatment with biologics. We will explore whether the PDQ and other phenotypical patient characteristics are prognostically important for response to biological therapy according to established response criteria like 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (50%) and Ankylosing Spondylitis Disease Activity Score. ETHICS AND DISSEMINATION: The study is approved by the Region of Southern Denmark's Ethics committee (S-20160094) and has been designed in cooperation with patient representatives. The study is registered at clinicaltrials.gov (NCT02948608, pre-results). Dissemination will occur through publication(s) in international peer-reviewed journal(s).

Inadvertent yellow fever vaccination of a patient with Crohn's disease treated with infliximab and methotrexate.

We present a case of a 56-year-old woman with Crohn's disease, treated with methotrexate and infliximab, who inadvertently received yellow fever vaccination (YFV) prior to a journey to Tanzania. She was not previously vaccinated against YF. YFV contains live-attenuated virus, and is contraindicated in patients treated with immunosuppressive drugs. Following vaccination, the patient fell ill with influenza-like illness. Elevated transaminase levels and YF viremia were detected. Despite being immunocompromised, the patient did not develop more severe adverse effects. Neutralising antibodies to YF virus were detected on day 14 following vaccination and remained protective at least 10 months after vaccination. Limited data is available on outcomes of YFV in patients receiving immunosuppressive therapy, including biologics, and we report this case as a reminder of vigilance of vaccine recommendations in this population.

[Photodynamic therapy of cholangiocarcinomas]. / Fotodynamisk terapi ved kolangiokarcinom.

Cholangiocarcinomas (CC) account for approximately 3% of all gastrointestinal cancers with an incidence of about three per 100,000. 70% of CC are perihilar lesions and can be classified according to the Bismuth-Corlette system. At the time of dia-gnosis less than 30% are candidates for complete resection. For nonresectable CC median survival is 4-6 months. Since biliary obstruction is the most common cause of death, biliary stenting has been the standard palliative therapy. Several studies have confirmed that administering photodynamic therapy to perihilar CC improves quality of life and increases median survival time.

[Photodynamic therapy of a cholangiocarcinoma in an 80-year-old man]. / Fotodynamisk behandling af kolangiokarcinom hos 80-årig.

70% of cholangiocarcinomas (CC) are perihilar lesions. At the time of diagnosis few are candidates for complete resection, and the standard palliative therapy has been biliary stenting. Studies have shown that photodynamic therapy (PDT) improves survival time. In this case report we describe an 80-year-old man with rheumatoid arthritis and perihilar CC classified as Bismuth-Corlette type II who successfully underwent PDT as the first patient in Denmark. The treatment was well tolerated with no phototoxic skin reaction, and a subsequent endoscopic retrograde cholangiopancreatography showed reduction of tumour.