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Summary: Background: Thyroid eye disease (TED) is an autoimmune inflammatory disease that can be disfiguring and potentially sight threatening. Suppression of inflammation in active disease can reduce the risk of visual loss and limit long‐term sequelae. Current management involves inflammation suppression using glucocorticoids. The aim of this study was to evaluate the efficacy of early disease intervention with targeted immunomodulatory therapy to alter disease course. This paper reports the efficacy of low‐dose rituximab in reducing clinical activity in TED in a small population. Methods: A retrospective audit of consecutive patients with active TED managed primarily with a 100 mg rituximab infusion. Further glucocorticoid or steroid‐sparing agents were prescribed if clinically indicated. Clinical activity score, VISA overall severity score and Oxford Quality of Life score were recorded at each visit as well as TSH receptor antibody levels (TRAb), B cell subsets and adverse reactions. Results: Twelve patients had mean follow‐up of 6.3 months. Clinical activity scores significantly decreased (mean score 5.08 to 1.58; P < 0.001), VISA overall severity scores reduced by 50% from 12 to 6, P < 0.001 and the mean cumulative dose of IV methylprednisolone was 2.3 g. 100 mg rituximab induced significant CD19+ B cell depletion (n = 8, P < 0.001). There was no significant reduction in serum TRAb (n = 8, P = 0.06). A transient infusion‐related rash was the only adverse effect, n = 4. QoL scores did not differ markedly before and after treatment. Conclusion: Low‐dose rituximab is an efficacious, well‐tolerated and safe treatment for active TED; reducing disease activity and allowing reduced administration of systemic steroid. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis B surface antigen (HBsAg) is an important serological marker for diagnosis of hepatitis B virus (HBV) infection. Commercial kits for detection of HBsAg emphasize confirmation by neutralization assays. In this study, we have standardized an ‘in-house’ neutralization test for HBsAg confirmation. Methods: Among 6684 HBsAg-positive samples, 615 were subjected to an ‘in-house’ HBsAg neutralization test (NT). Of these, 91 (100%) high-reactive samples (optical density [OD] 1.000–3.000) and 286 (93%) of 289 low-reactive samples (OD < 1.000) were neutralized, and 235 (100%) grey-zone reactive samples were ‘in-house’ NT negative. Eighty-four samples of varying reactivities that were tested by the ‘in-house’ NT were compared with a commercial NT (AxSYM, Abbott). Results: The ‘in-house’ NT showed an excellent agreement ( κ = 0.83, P < 0.001) with the commercial confirmatory assay. The sensitivity, specificity, positive and negative predictive values were 90%, 94%, 96% and 87%, respectively. Conclusion: The enzyme immunoassay-based ‘in-house’ HBsAg neutralization assay is a feasible alternative to the commercial HBsAg confirmatory assay. This technique is easily adaptable, cost-effective and reliable for the confirmation of HBsAg in a low resource setting, enhancing the overall quality of HBsAg screening. [ABSTRACT FROM AUTHOR]

Abstract: Back pain in children is common, affecting around 25%. The incidence in adolescence is higher, with girls more commonly affected. Epidemiological studies demonstrate associations with weight of backpacks and access to school lockers. There is a strong association with psychosocial factors and disability. An algorithm for the evaluation of the disorder is described. Those individuals with ‘red flags’, i.e. night pain, constant pain of recent onset and constitutional upset, need further investigation. MRI scanning is the most valuable imaging tool. A definite cause for the pain is only found in 22%. Rehabilitation with physiotherapy and back education schools are the mainstay of treatment. [Copyright &y& Elsevier]

Background: We set out in this study to demonstrate the adverse effect profile of methotrexate when used in the treatment of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in a district general hospital population, and to investigate the effect of alcohol consumption in these patients. Methods: A prospective evaluation of 550 RA patients and 69 PsA patients was undertaken, controlling for confounding factors. Systematically randomised patients were further analysed regarding alcohol consumption. A transaminase level of three times the upper limit of normal on two or more occasions was taken to indicate hepatic injury. Results: Gastrointestinal disturbance was the predominant adverse effect in RA patients (9.8%); hepatic disturbance was the most frequent in PsA patients (14.5%). Both groups had hepatic enzyme elevation; PsA patients were at significantly greater risk of elevated transaminases than RA patients (14.5% vs 7.5%, respectively, χ2 = 4.017). Alcohol consumption did not correlate with hepatic injury (mean 5.15 vs 6.6 alcohol units/week consumed by RA and PsA patients, respectively). Conclusion: Our data show methotrexate-treated PsA patients have a higher incidence of hepatotoxicity compared with methotrexate-treated patients with RA. It is proposed that psoriatic patients may be inherently more susceptible to methotrexate hepatotoxicity than are rheumatoid patients. [ABSTRACT FROM AUTHOR]

Examines the danazol treatment for systemic lupus erythematosus. Details on the history of a 43 year old woman with systemic lupus erythematosus; Description of hyperglucagonaemia in relation to the treatment with danazol; Characteristics of danazol.