Introduction: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints associated with HLA B27 antigen and with the predominance of the male gender (with an average between 20 and 30 years old). Case presentation A 48 years old male patient was admitted to our clinic, having a long history regarding this disease since he was 16. This patient has switched 3 therapies with anti TNF alpha agents until now, and we hope to obtain a good response for a long time. During the treatment with Etanercept he presented an acute anterior uveitis which had a good response to therapy. Conclusion: The ankylosing spondylitis management is complicated when we have the possibility to choose only three anti TNF alpha agents. If a patient does not respond to the first or second agent we are constrained to follow the last one. Therefore the principal problem regarding this special case is that the patient is non responder at the last agent. So the question that arises is witch will be the next therapy for this patient? INTRODUCTION Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints – asymmetric. Its major characteristic is the early damage of the sacroiliac joint, ascending to ankylosis. The incidence is increased for males between 20 and 30 years old, thus most of the patients are associating a HLA B27 antigen. The existence of cardiovascular risk due to inflammatory rheumatic diseases for decades but the real significance and therapy designed to control this risk has been recently evaluated. is known Systemic inflammatory rheumatic diseases accelerates atherosclerosis and inflammation because of destabilizes plaque of atheroma, contributing to an increased frequency of fatal cardiovascular events such as myocardial heart attacks and strokes. The ankylosing spondylitis cardiovascular events include: aortic damage (dilatation/hypertrophy), nerve impulse conduction disorders, accelerated atherosclerosis. heart muscle insufficiency, pericarditis, and Anti TNF-alpha therapy leads to a decrease of the disease activity score the nonspecific inflammatory syndrome. (BASDAI) and also The anti TNF approved drugs which are currently in clinical practice are: 1 Carol Davila Central University Emergency Military Hospital, Bucharest 39
Behcet's disease is a rare and poorly understood condition with multiple systemic manifestations. The disease causes inflammation in blood vessels throughout the body which leads to numerous symptoms that may appear and disappear unpredictable. Case presentation A 33 year old woman was admitted (interned) to our clinic. Her family medical history reveals – multiple strokes (father) and autoimmune thyroiditis (sister). The onset of her symptomatology was in 2013 and it consisted of fever (39-40 Celsius degrees) sicca syndrome and persistent headaches, recurrent oral and genital ulcerations. An important event is essential to be mentioned -the patients has suffered an episode of upper gastrointestinal bleeding (hemoglobin has dropped to 2.5g/dl which has led to cardiac arrestresuscitated). The lab tests showed: C3 hypocomplementemia, Anti-centromere antibodies (-), anti-b2gp1 antibody (+), lupus anticoagulant (+), U1RNP(-). We started to administrate cyclophosphamide to the patient, thus his condition has improved after the 2nd dose. At the 12-month evaluation we were able to see a significant clinical and biological improvement. Conclusions In order to be able to talk about “evidence based medicine” for the management of Bechet’s disease, a large number of clinical trials is required to provide to the attending physicians the necessary data for diagnosis and treatment.
