Case

The first patient was a 42-year-old female, with a 20-year disease duration, who presented with severe orogenital ulcerations, oligoarthritis, and low-grade fever. During the past years her orogenital ulcerations responded only to moderate-to-high doses of steroids, which had resulted in severe, steroid-induced osteoporosis. Any attempt in the past to reduce the daily dose of methylprednisolone below 8 mg using cyclosporine A and/or azathioprine was unsuccessful. At the initiation of infliximab treatment, which was decided mainly to treat severe genital ulcers, she was on methylprednisolone 0.2 mg/kgr/day and colchicine.

Infliximab (Remicade®) was administrated intravenously at a dose of 5 mg/kg at day 1, day 30, and every 8 weeks therafter. To date she has completed 20 months of continuous treatment. The acute response to infliximab treatment was the resolution of all symptoms within 10 days. Infliximab proved to be efficacious in the long term; ulcerations have not appeared and no episodes of arthritis and fever have occurred ever since the second infusion. Moreover, methylprednisolone was rapidly tapered and for the last 18 months the patient was receiving, in addition to infliximab, 3 mg/day of methylprednisolone only. Up to the present day no adverse events have been noted. Interestingly, during the following 9 months after the initiation of infliximab, the patient developed moderate titres of serum antinuclear antibodies, which were negative at baseline, as well as low titres of anti-dsDNA antibodies. During the subsequent 11 months of follow-up no clinical signs suggestive of systemic lupus erythematosus were ever noted, despite continuous treatment.

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