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WHAT IS KNOWN AND OBJECTIVE: Kaposi's sarcoma (KS) is a malignant neoplasm caused by HHV-8, a pathogen that leads to endothelial cell transformation when host defences are weakened. CASE DESCRIPTION: Here we report the first case of KS during treatment with abatacept, a biologic agent targeting T-cell costimulation. The patient was a 64-year-old female with rheumatoid arthritis who developed multiple firm, purple-reddish nodules on the dorsal aspect of the right hand. Histological examination confirmed KS. WHAT IS NEW AND CONCLUSION: Although a direct causal relationship between KS development and abatacept treatment cannot be proved, we hypothesize a role for costimulation blockade.

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Whenever hypertrophic osteoarthropathy is diagnosed, it is imperative to search for the underlying pathology. The disorder is usually associated with a primary pulmonary lesion and periostitis and paresthesias of the lower extremities. Recognizing and understanding the primary pathology is essential to the effective treatment of secondary hypertrophic osteoarthropathy.

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RS3PE Syndrome is an inflammatory disease which affects mainly males and responds, rapidly, to low dose steroids. We describe the concurrence of RS3PE, poorly responsive to low dose steroids, and endometrial adenocarcinoma. In this patient, clinical and laboratory signs of RS3PE disappeared after total hysterectomy. Patients with RS3PE, poorly responsive to low dose steroids, need an accurate clinical and laboratory evaluation before considering the disease as idiopathic.

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The aim of the present study was to evaluate the frequency of hypertension in a group of extremely old persons: 73 centenarians resident in Calabria were studied, aged 100-110 years, (mean age 102.95 +/- 2.0), 54 women (73.9%) and 19 men (26.1%), in the period January 1st and April 30th, 1994. All the centenarians were visited at their homes. Hypertensive centenarians were 14 (19.1%), women 12 (85.7%) and men 2 (14.3%). Even if blood pressure progressively increases with age, we have not found it in centenarians. The lesser frequency of hypertension in centenarians certainly depends on genetic and constitutional factors, but also their way of life and alimentary habits (decreased sodium intake, increase of calcium and potassium intake), as we have proven in a recent work, could be determinant. Moreover, the presence of hypertensive centenarians might mean that hypertension does not prevent to reach an age by far above the average, if it is the only risk factor.

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The differential diagnosis between polymyalgia rheumatica (PMR) and elderly onset rheumatoid arthritis (EORA) in PMR-like presentation may represent several problems at the beginning of the disease, since the patterns of these pathologies may show largely overlapping areas. In this study we examined clinical and laboratory features of 21 patients with PMR and 22 patients with EORA PMR-like presentation, to identify eventual differences between the 2 diseases. EORA PMR-like presentation occurred more frequently in males (14 men and 8 women) than PMR (6 men and 15 women) (p = 0.046). In EORA PMR-like presentation we observed higher levels of gamma-globulins (p = 0,003), immunoglobulins IgC (p =0.004), IgA (p = 0.002) and IgM (p = 0.014) than in PMR. Fever (p = 0.022), asthenia (p = 0.007) and the contemporary involvement of the shoulder and pelvic girdle (p = 0.0054) were more frequent in PMR patients than EORA PMR-like presentation patients. Moreover, the involvement of the shoulder girdle only (p =0.0054) and arthritis of the peripheral joints (p = 0.045) were more frequent in EORA PMR-like presentation than in PMR patients. The results of this preliminary study revealed different clinical and laboratory features that may offer additional help in differential diagnosis at onset of the 2 diseases.

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The Authors provide an update on benign edematous polysynovitis in the elderly and propose clinical and laboratory criteria for a correct diagnosis. They also propose the use of the term "polysynovitis" rather than polyarthritis, as they think it describes the histopathological findings of the disease better. Finally, they attempt to correctly distinguish RS3PE syndrome from polymyalgia rheumatica, rheumatoid arthritis and chondrocalcinosis.

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On the basis of their own and other researchers' knowledge, the authors describe the clinical and laboratory characteristics of benign edematous polysynovitis in the elderly. They suggest that the term polysynovitis should be used in preference to polyarthritis since it gives a better idea anatomic and pathological characteristics of RS3PE syndrome.

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