Letters to the editor / Joint Bone Spine 76 (2009) 570–576 571 Table 1 Total cholesterol, HDL-cholesterol and triglyceride levels. September 2004 February 2007 June 2007 September 2007 January 2008 March 2008 June 2008 Triglyceride (mmol/L), [Normal value 0.68–1.88 mmol/L] Total cholesterol (mmol/L), [Normal value 3.9–5.2 mmol/L] HDL (mmol/L), [Normal value 0.75–1.85 mmol/L] 5.73 11.76 9.75 17.81 20.60 5.25 4.92 4.6 7.6 6.1 6.9 6.7 2.7 2.5 0.58 0.63 0.68 0.66 0.53 0.51 0.50 apy we have no plausible explanation for the abnormal lipid profile. The results obtained after etanercept treatment in our patient illustrate the complexity of effects of TNF superfamily on lipid metabolism. Research on the effects of anti-TNF therapy on lipid profile is scarce and encompasses only case reports and small studies which are either too small or too brief. Further long term prospective studies are needed, firstly to confirm the modulation of lipoprotein plasma concentrations with anti-TNF therapy, and secondly to identify which anti-TNF formulation has a more pro-atherogenic effect. Muhammad Haroon ∗ Rheumatology Specialist Registrar, Waterford Regional Hospital, Waterford, Republic of Ireland Joe Devlin Consultant Rheumatologist, Waterford Regional Hospital, Waterford, Republic of Ireland ∗ Corresponding author. Tel.: +353 863911237; fax: +353 51848838. E-mail address: mharoon301@hotmail.com (M. Haroon) 5 January 2009 Available online 19 March 2009 References doi:10.1016/j.jbspin.2009.01.002 [1] Sattar N, McCarey DW, Capell H, et al. Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation 2003;108:2957–63. [2] Allanore Y, Kahan A, Sellam J, et al. Effects of repeated infliximab therapy on serum lipid profile in patients with refractory rheumatoid arthritis. Clin Chim Acta 2006;365:143–8. [3] Popa C, van den Hoogen FH, Radstake TR, et al. Modulation of lipoprotein plasma concentrations during long-term anti-TNF therapy in patients with active rheumatoid arthritis. Ann Rheum Dis 2007;66:1503–7. [4] Popa C, Netea MG, Radstake T, et al. Influence of anti-tumor necrosis factor therapy on cardiovascular risk factors in patients with active rheumatoid arthritis. Ann Rheum Dis 2005;64:303–5. [5] Garcês SP, Parreira Santos MJ, Vinagre FMR, et al. Anti-tumour necrosis factor agents and lipid profile: a class effect? Ann Rheum Dis 2008;67:895–6. [6] Scheryer SA, Vick CM, LeBouef RC. Loss of lymphotoxin-␣ but not tumor necrosis factor-␣ reduces atherosclerosis in mice. J Biol Chem 2002;277:12364–8. [7] Vahlquist C, Michaelsson G, Vessby B. Serum lipoproteins in middle-aged men with psoriasis. Acta Derm Venereol 1987;67:12–5. [8] Uyanik BS, Ari Z, Onur E, et al. Serum lipids and apolipoproteins in patients with psoriasis. Clin Chem Lab Med 2002;40:65–8. [9] Skoczyñska AH, Turczyn B, Barancewicz-Losek M, et al. High-density lipoprotein cholesterol in patients with psoriatic arthritis. J Eur Acad Dermatol Venereol 2003;17:362–3. [10] Rocha-Pereira P, Santos-Silva A, Rebelo I, et al. Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease. Clin Chim Acta 2001;303:33–9. [11] Antoniou C, Dessinioti C, Katsambas A, et al. Elevated triglyceride and cholesterol levels after intravenous antitumour necrosis factor-alpha therapy in a patient with psoriatic arthritis and psoriasis vulgaris. Br J Dermatol 2007;156:1090–1. [12] Stinco G, Piccirillo F, Patrone P. Hypertriglyceridaemia during treatment with adalimumab in psoriatic arthritis. Br J Dermatol 2007;157: 1273–4. Role for the central motor system in fibromyalgia: Pain resolution after pontine infarction Keywords: Fibromyalgia; tem,modification Pontine Infarction; Central Motor Sys- A 50-year-old woman was diagnosed with fibromyalgia in 2002 upon evaluation for diffuse muscle pain, chronic fatigue, headaches and sleep disturbances. Several investigations were performed, with normal findings. Her treatment consisted of pregabalin 125 mg, clonazepam 0.5 mg and dosulepin 50 mg/day. On June 11, 2008, she experienced the sudden onset of left hemiplegia without sensory loss. Computed tomography of the brain showed an infarction in the right side of the pons along the pyramidal tract (Fig. 1). Magnetic resonance imaging was contraindicated by a history of claustrophobia. On June 23 2008, she was admitted to the rehabilitation unit. The Toulouse motor scale (TMS) score [1] was 80/100 and the functional independence measure (FIM) was 87/126. During her stay, findings were normal from three separate assessments of sensitivity to touch, prick, temperature, joint position and movement. At discharge from the rehabilitation unit after 2 months, the TMS score was 95/100 and the FIM was 125/126. She had persistent pyramidal tract signs on the left with myotatic hyperreflexia, ankle clonus and mild exertional spasticity. After the pontine infarction, the muscle pain resolved completely in the left half of the body despite the excellent level of motor function recovery and the muscular efforts required by the rehabilitation program. The muscle pain persisted on the right. 572 Letters to the editor / Joint Bone Spine 76 (2009) 570–576 References [1] Roques CF, Felez A, Marque P, et al. Bilan de la motricité volontaire et de la spasticité du sujet hémiplégique vasculaire adulte. Eléments de validation du bilan moteur de Toulouse (BMT). Ann Readapt Med Phys 1997;40:147–58. [2] Ablin J, Neumann L, Buskila D. Pathogenesis of fibromyalgia – a review. Joint Bone Spine 2008;75:273–9. [3] Lidbeck J. Central hyperexcitability in chronic musculoskeletal pain: a conceptual breakthrough with multiple clinical implications. Pain Res Manag 2002;7:81–92. [4] Staud R, Rodriguez ME. Mechanisms of disease: pain in fibromyalgia syndrome. Nat Clin Pract Rheumatol 2006;2:90–8. [5] McCabe CS, Cohen H, Blake DR. Somaesthetic disturbances in fibromyalgia are exaggerated by sensory-motor conflict: implications for chronicity of the disease? Rheumatology 2007;46:1587–92. [6] Jegede AB, Gilbert C, Tulkin SR. Muscle characteristics of persons with fibromyalgia syndrome. NeuroRehabilitation 2008;23:217–30. [7] Pierrynowski M, Tiidus P, Galea V. Women with fibromyalgia walk with an altered muscle synergy. Gait Posture 2005;22:210–8. Fig. 1. Computed tomography, axial section through the pons: infarction seen as a hypodense zone in the right part of the pontine protuberance, at the site occupied by the pyramidal tract. Philippe Noël ∗ Jean Mathieu Mohamed Yahla Centre de rééducation et de réadaptation fonctionnelles « Le Bourbonnais », 7, rue de la Roche, 71140 Bourbon-Lancy, France ∗ Corresponding author. She returned to work on October 8, 2008. On November 15, her neurological evaluation was unchanged compared to the previous visit. On the right, pressure on eight of nine fibromyalgia points caused pain and flinching; whereas, on the left six points were slightly tender (discomfort without flinching). At the arms, the blood pressure cuff caused pain (visual analog scale pain score of 5/10) at 170 mmHg on the right and 220 mmHg on the left; corresponding figures at the legs were 120 and 220 mmHg. The pathophysiology of fibromyalgia is complex and multiple factors are probably involved. A role for the central nervous system has been documented by studies showing central pain sensitization and hyperexcitability [2–4]. Recent data suggest impaired sensorimotor control or abnormalities in the motor system [5–7]. Our case-report supports a role for the central motor system. The infarction visualized by computed tomography seemed confined to the pyramidal tract, with no involvement of sensory pathways. The patient had isolated motor deficits. Thus, the resolution of the muscle pain on the paralyzed side was unexpected, as sensory function remained normal. Neither the spasticity nor the substantial muscular exertion required by the rehabilitation program exacerbated the muscle pain. Our case-report supports a role for a functional abnormality in motor control, which may be either primary or secondary to defective sensorimotor control. This functional abnormality may increase motor activity above the level required to maintain posture or to perform a movement, resulting in chronic muscular overload and in fatigue. The pyramidal tract involvement in our patient may have lowered this abnormally high level of central motor activity, leading to resolution of the muscle pain in the left side of the body. E-mail address: philippe.noel@ugecam-bfc.cnamts.fr (P. Noël) 21 January 2009 Available online 29 September 2009 doi:10.1016/j.jbspin.2009.01.012 Intravenous immune globulins to treat eosinophilic fasciitis: A case report Keywords: Eosinophilic fasciitis; Shulman syndrome; Eosinophilia; Immunoglobulins 1. Introduction Eosinophilic fasciitis or Shulman’s syndrome was first described in 1974 as a syndrome of diffuse fasciitis with high peripheral eosinophil counts [1]. This rare condition usually responds to glucocorticoid therapy. In patients with glucocorticoid-resistant or dependent disease, immunosuppressant therapy may be considered. We report the case of a glucocorticoid-dependent patient who experienced a partial response to methotrexate therapy followed by a full response to intravenous immune globulin (IVIg) therapy. 2. Case report A 39-year-old male was admitted for swelling and induration of the hands and feet with severe functional impairment. He