Arthralgia with corticosteroids

Seven patients (17-22 years old) developed sjmptoms of arthralgia and arthritis after having taken minocycline 50-100 mg bd for 6-36 months for acne vulgaris (47). Increased titers of perinuclear ANCA were detected in all seven, five had fluorescent antinuclear antibodies, two had antihistone autoantibodies, and one had anticardiohpin antibodies. Symptoms resolved in five patients on withdrawal the other two were treated with corticosteroids and also achieved remissions. 

An antibody directed at the murine epitope of infliximab may develop in patients. A delayed infusion reaction, which occurs 1-2 weeks after infusion, develops in approximately 5% patients who are re-treated with infliximab. Delayed infusion reaction is more common in patients with circulating anti-infliximab antibodies (20-30% of those getting multiple infusions) than in those without the antibodies. These reactions consist of myalgia arthralgia fever rash urticaria and facial, hand, and lip edema. Delayed reactions respond to symptomatic treatment with antihistamines or corticosteroids. Positive antinuclear antibodies (ANA) and anti-dsDNA develop in a small number of patients. Development of a lupus-like syndrome has been reported that resolved after discontinuation of the drug. 

Two cases of serum sickness-like reactions have been reported in association with amfebutamone when used as an aid to smoking cessation (15,16). Both patients developed localized swellings of the fingers and hands, urticaria, and arthralgia. In both cases treatment with antihistamines and corticosteroids produced rapid relief of symptoms. 

In three other patients (two women, one man) a serum sickness-like reaction developed 6-21 days after the start of amfebutamone treatment (14). The symptoms, arthralgia, pruritus, and tongue swelling, abated within 2 weeks of treatment with oral corticosteroids. Serum sickness reactions to drugs are rare, and it will be important to find out whether amfebutamone carries an increased risk of this unusual reaction. 

Skin/respiratory - sarcoidosis A female patient with multiple sclerosis developed sarcoidosis 3 years after continuous therapy with IFNp. The patient presented witir low-grade fevers, dyspnoea on exertion, diffuse arthralgias and rash. Noncaseating granulomas and endobronchial biopsies of pulmonary lymph nodes contributed to the diagnosis of sarcoidosis. Withdrawal of IFNp combined with a course of corticosteroids and antirheumatic drug therapy led to resolution of the condition [60 ]. 

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