[The pathogenesis of inflammatory bowel disease is only partly understood; various environmental and host factors (e.g., genetic, epithelial, immune and non-immune) are involved. It is a multifactorial polygenic disease probably with genetic heterogeneity; some genes confer susceptibility to IBD in general, while others specifically increase the risk of ulcerative colitis or Crohn's disease or affect location (localized or extensive) and/or behaviour (e.g., mild, severe, aggressive). This review presents recent advances in the genetics of inflammatory bowel disease including chromosome segments newly recognized to be involved in inflammatory bowel disease as well as the role of NOD2/CARD15, SLC22A4/A5 and DLG5. The increasing genetic information provides, for the time being, a better understanding of the pathogenesis of the disease thus setting a basis for potential targets for therapeutic intervention. In the future, however, genetics may also help in refining the diagnosis or predicting disease course.]

[The research of pathomechanism of rheumatoid arthritis resulted in remarkable pragmatic results beyond the important theoretical knowledge. These observations led to the development of new effective agents, which were named as biological therapy and introduced in clinical praxis. The key factor of pathomechanism of rheumatoid arthritis is the proinflammatoric citokin TNF-α. It can be found on the top of the inflammation cascade where regulates many other inflammatory mediators and also plays an important role in the defence against infections and tumours. The author describes the TNF-α blocking agents used in clinical practice, their chemical and pharmacological feature, as well as their mode of action and the consequence of inhibition of TNF-α. He reviews the main results of the major clinical tests with infliximab, etanercet, and adalimumab. The results of these clinical studies demonstrate that the TNF-α blocking therapy gives clinical improvement in case of therapy resistant patients, decreases the number of swollen and tender joints, the pain, ESR and CRP, decreases the radiological progression, furthermore improves the quality of life. There are also some data about the favourable impacts observed during the early arthritis treatment. The TNF-α blocking therapy can be used effectively and safely in rheumatoid arthritis. In most cases the infusion reaction and the injection site reaction are not reasons for withdrawal from the study. The sideeffects, however, developed in increasing numbers during widespread applications. Among these the most important ones are the opportunist infection and the tuberculosis. In addition the sporadic occurrence of lupus-like symptoms, demyelinating disease, and aplastic anemia were reported. The fundamental requirements of the safety of the biological therapy are the professional indication and the careful monitoring during the treatment, the principle of which has been already prepared by the Professional College of the Rheumatology and Physiotherapy based on the international experience.]

[PURPOSE - The aim of this paper is to demonstrate morphological changes of Crohn’s disease observed by CT enteroclysis and also to evaluate the role of the method in the diagnosis and the follow up of patients with known or suspected Crohn’s disease. PATIENTS AND METHODS - We evaluated retrospectively 50 typical cases who were examined earlier. Crohns’s disease was diagnosed in 42 patients before CT enteroclysis. Histological confirmation was available in 36 cases after colonoscopy and in six cases after surgery. In eight patients had a high suspicion of the disease, histological examination was not performed. CT enteroclysis findings were read by two radiologist independently and results were compared. RESULTS - CT enteroclysis showed typical signs of Crohn’s disease in all patients. Different degree of wall thickening was seen in all cases, pathological enhancement of small bowel wall (in cases 35), multilayered appearance (n=29), fibrofatty proliferation (n=33), enlarged lymph nodes (n=37), entero-enteric fistula (n=6), entero-cutan fistula n (=5), mesenteric abscess (n=5) was found. CONCLUSION - CT enteroclysis is an accurate method to detect mural and extramural abnormalities in patients with Crohn’s disease. CT enteroclysis proved highly accurate in detecting small bowel involvement and it also provides an estimation of clinical activity of the disease. CT enetroclysis can be considered as the first imaging method in patients with clinical signs of Crohn’s diseases and also in the follow up of patients with known disease.]

[INTRODUCTION - Perianal manifestations of Crohn’s disease are common. Treatment of advanced complications like strictures and incontinence may require a radical surgical intervention. We present a case of an extremely rare manifestation of Crohn’s disease. The disease localized exclusively to the anal canal for more than twenty years was complicated by an extensive perianal septic lesion. Besides our own surgical strategy, we discuss in detail other therapeutic options for perianal septic complications of Crohn’s disease. CASE REPORT - During 16 years of disease course the perianal process of the 34 year old female patient caused sphincter destruction and incontinence, and furthermore resulted in a chronic septic state by fistulous tracts involving the whole perineo-gluteal region. Following rectal extirpation, we performed a radical excision and a reconstructive operation using musculo- cutaneous/fascio-cutaneous advancement flaps. The final result of multiple operations of two years’ duration was functionally and aesthetically excellent. CONCLUSION - Fistulous tracts of perianal Crohn’s disease destructing widely their surroundings can only be cured by the radical excision of involved tissues. Extremely large consequent defects can also be covered with proper functional results by methods applying healthy tissues of good loadability i.e. musculocutaneous/ fascio-cutaneous advancement flaps.]

[The development of anti-TNF-α agents represents a great advance in the treatment of inflammatory joint diseases. Adalimumab is the first fully human, recombinant IgG1 monoclonal antibody that blocks the interaction of TNF with the p55 and p75 cell surface TNF receptors, thereby neutralising the activity of this cytokine. In well designed, placebocontrolled trials adalimumab significantly reduced symptoms, improved quality of life, and reduced radiologically evident joint damage in patients with rheumatoid athritis, ankylosing spondylitis and psoriatic arhritis. The drug was generally well tolerated, and the follow up studies confirmed, that the incidence of serious adverse events was similar to that generally seen in patients not receiving anti-TNF agents. This review summarises the recent available data related to the efficacy and safety of adalimumab in inflammatory joint diseases.]