Conspicuous synovial lymphatic capillaries in juvenile idiopathic arthritis synovitis with rice bodies

elty’s syndrome (FS) is defined by the coexistence of rheumatoid arthritis (RA), neutropenia, and spleno-megaly. The mechanisms underlying the neutropenia of FS may involve both cellular and humoral immunity, with a possible role of granulocyte-colony stimulating factor (G- CSF) antibodies. 1 Various disease modifying antirheumatic drugs have been used to treat FS, but with varying success 2 as this syndrome may arise in response to the excessive immune reaction found in RA. Interest has focused recently on a new biological tool in the treatment of RA, rituximab, a chimeric monoclonal antibody specific for human CD20 which targets B lymphocytes. 3 Accordingly, we investigated here the safety and of rituximab in two patients presenting with active RA and severe and refractory FS. s knowledge of the epidemiology of primary systemic vasculitides (PSV) is fragmentary, we attempted to investigate the incidence of temporal arteritis (TA), Takayasu’s arteritis (TAA), polyarteritis nodosa (PAN), Wegener’s granulomatosis (WG), Churg-Strauss syndrome (CSS), Henoch-Scho¨nlein purpura (HSP), and hypersensitivity vasculitis (HSV) in Vilnius according to the American College of Rheumatology (ACR) 1990 criteria and to compare the data with the results from selected European studies. 1 be the had to ( a ) have been diagnosed with systemic vasculitides in the 10 year period from 1990 to 1999 and ( b ) have resident in Vilnius at the time of diagnosis. Patients referred to Vilnius University the the patients’ registration books dermatology, a searched.Weapplied ACR 1990 criteria for the classification of PSV; steoporosis is a common feature of ankylosing spondylitis (AS), and vertebral fractures are an increasingly recognised complication. A cumulative fracture prevalence of between 9.5% and 18% has been reported, with a six- to eightfold relative increased risk of vertebral fracture. 1–3 Osteoporosis and new bone formation (syndesmophytosis) suggest that disordered bone turnover has a role in disease pathogenesis in AS. Bisphosphonates accumulate at sites of increased bone turnover, and inhibit bone resorption by inducing osteoclast apoptosis, 4 thereby improving bone density and reducing fracture rates. 5 Pulse pamidronate has recently been used with clinical efficacy in the treatment of AS. 6 7 Biochemical markers of bone turnover have been used to monitor response to treatment in postmenopausal osteoporosis. 8 The effect of bisphosphonate treatment on biochemical bone turnover markers has not previously been studied in AS. We aimed at studying the efficacy of pulse pamidronate treatment in severe AS, and at determining its effect on biochemical bone turnover markers.