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The introduction of cytokine-targeted therapies has significantly improved the treatment options of rheumatic diseases; however, some patients are also refractory to these treatment measures. The B cells play a central role in the pathogenesis of many rheumatic diseases and B-cell targeted therapies are a promising option as second-line medication for treating patients with a refractory disease course. Randomized controlled trials analyzing the efficacy of B-cell directed therapies for childhood rheumatic diseases have not yet been performed. The use of the B-cell depleting antibody rituximab showed positive results in non-controlled case series of juvenile systemic lupus erythematosus (SLE) patients. Patients with a refractory disease course of oligoarticular or polyarticular juvenile idiopathic arthritis might also benefit from B-cell depletion using rituximab. The B cell-targeting therapies for the treatment of childhood rheumatic diseases should be initiated and closely supervised by a pediatric rheumatologist.

From a clinical point of view scleroderma is classified as either localized scleroderma or systemic scleroderma. However, as this didactic separation does not always reflect the clinical picture in patients, various groups have attempted to make new classification methods. This current review focuses on the clinical presentation in this respect, recently developed aspects of etiology and molecular pathogenesis in addition to modern aspects of therapeutic strategies.

Borrelia burgdorferi is the causative agent of Lyme borreliosis (LB). Clinical manifestations of LB include chronic inflammatory disorders of skin, central nervous system, and joints. Although LB is infectious and B. burgdorferi is highly susceptible to antibiotic treatment, about 10% of cases of Lyme arthritis are refractory. Possible pathogenetic mechanisms might be persistent antigenic stimulation or autoimmunity or a combination. Thus persistent inflammation due to LB might be a useful model for chronic inflammatory joint diseases including rheumatoid arthritis or juvenile idiopathic arthritis.