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Author(s): Montse Janssen Bonás [sup.1], Janani Sundaresan [sup.2], Ruth G. M. Keijsers [sup.3], Eduard A. Struys [sup.2], Bas J. M. Peters [sup.4], Vivienne Kahlmann [sup.5], Marlies S. Wijsenbeek [sup.5], Maurits [...], Introduction Methotrexate (MTX), a folate antagonist, is often used as second-line treatment in patients with sarcoidosis. Effectiveness of MTX has large inter-patient variability and at present therapeutic drug monitoring (TDM) of MTX is not possible. Upon administration, MTX is actively transported into cells and metabolized to its active forms by adding glutamate residues forming MTXPG.sub.(n=1-5) resulting in enhanced cellular retention. In this study we address the question whether different MTXPG.sub.(n) concentrations in red blood cells (RBC) of patients with sarcoidosis after 3 months of MTX therapy correlate with response to treatment. Methods We retrospectively included patients with sarcoidosis that had started on MTX therapy and from whom blood samples and FDG-PET/CT were available 3 and 6-12 months after MTX initiation, respectively. FDG-uptake was measured by SUVmax in the heart, lungs and thoracic lymph nodes. Changes in SUVmax was used to determine anti-inflammatory response after 6-12 months of MTX therapy. MTXPG.sub.(n) concentrations were measured from whole blood RBC using an LC-MS/MS method. Pearson correlation coefficients were calculated to evaluate the relationship between changes in the SUVmax and MTXPG.sub.(n) concentrations. Results We included 42 sarcoidosis patients treated with MTX (15 mg/week); 31 with cardiac sarcoidosis and 11 with pulmonary sarcoidosis. In MTXPG.sub.3 and MTXPG.sub.4 a significant negative relation between the absolute changes in SUVmax and MTXPG.sub.(n) was found r = - 0.312 (n = 42, p = 0.047) for MTXPG.sub.3 and r = - 0.336 (n = 42, p = 0.031 for MTXPG.sub.4). The other MTXPG.sub.(n) did not correlate to changes in SUVmax. Conclusion These results suggest a relation between MTXPG.sub.(n) concentrations and the anti-inflammatory effect in patients with sarcoidosis. Further prospective validation is warranted, but if measuring MTXPG concentrations could predict treatment effect of MTX this would be a step in the direction of personalized medicine.

Author(s): Tarun Narang [1]; Apoorva Sharma [1]; Adhyatm Bhandari [1]; Sanjeev Handa [1]; Sunil Dogra (corresponding author) [1] Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening variant of psoriasis [...], Generalised pustular psoriasis(GPP) is a rare, potentially life-threatening variant of psoriasis with acute onset, widely spread pustular lesions on an inflamed base associated with a systemic inflammatory state. In the setting of the current COVID-19 pandemic, flares in pustular psoriasis have been reported, however these flares leading to mortality in SARS-CoV-2 infected patients is hitherto unreported. We present two cases of GPP flare following SARS-CoV-2 infection with fatal outcome. A 20 year old male, known case of GPP since 5 years presented with an exacerbation of his existing disease for 2 months. He had received methotrexate, cyclosporine, acitretin, apremilast, infliximab and secukinumab in the past. He was admitted and started on inj. methotrexate (subcutaneous) and cap. acitretin. During admission, he developed COVID-19 associated severe acute respiratory distress syndrome(ARDS). Despite timely intervention with life-saving measures, the patient could not be saved. The second case was a 52-year-old female, a case of GPP on treatment for the last 10 years, being maintained on cap. acitretin and cyclosporine. She also developed ARDS due to COVID infection. Despite being on acitretin for GPP and the appropriate management of severe COVID infection, her condition worsened and she expired within one day of admission. Both of our patients were not vaccinated against COVID-19. Awareness of potential risk of mortality in patients of GPP getting co-infected by COVID-19 is thus essential for dermatologists. Keywords: Generalised pustular psoriasis (GPP), flares, COVID-19, COVID-19 vaccination

ABSTRACT Scleroderma is a disease that affects the microvasculature and the connective tissue. These alterations produce fibrosis and blood vessel occlusion. Its cause is still unknown, although the exaggerated synthesis [...]

The study aims to evaluate and compare the efficacy of methotrexate withdrawal at 6 months as against 12 months in juvenile idiopathic arthritis (JIA) in remission. The results indicate that in case of such patients, there was not much difference in reduction in relapse rate in either of the cases.

A 37-year-old right-handed woman hospitalized for intermittent paresthesias, slurred speech, ataxia, and abnormalities on brain imaging is presented. The patient's neurologic symptoms resolved completely after treatment with two cycles of high-dose methotrexate on day 14 of each cycle followed by high-dose chemotherapy that consisted of thiotepa, busulfan, and cyclophosphamide and autologous stem-cell rescue.

The study attempts to establish the safety and efficacy of azathioprine or methotrexate as a form of maintenance therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The results indicate that both the agents are equally safe and effective as a form of maintenance therapy for ANCA-associated vasculitis such as Wegner's granulomatosis and microscopic polyangiitis.

Abstract A 62-year-old female presented with multiple keratoacanthomas of the palmar aspects of the hands, wrists, and proximal fingers. Surgery or radiation therapy would have caused significant impairment. A 30-day [...]

Methotrexate can be used instead of surgery to treat ectopic pregnancy. Ectopic pregnancy occurs when the embryo implants in the Fallopian tubes instead of of the uterus. Drug therapy can preserve the Fallopian tubes so the woman can attempt pregnancy again in the future.

High blood levels of chorionic gonadotropin may inhibit the action of the drug methotrexate in the treatment of tubal pregnancies. A tubal pregnancy occurs when the embryo implants in the Fallopian tube instead of the uterus. Methotrexate causes the embryo to be aborted or resorbed into the body. In a study of 350 women who received methotrexate to induce an abortion, 91% aborted the embryo. Those who did not had higher levels of chorionic gonadotropin, a hormone secreted during pregnancy.