Parvovirus B19 and systemic sclerosis

marketing data collection from treated patients. This is being conducted in the U.S.A. by the various companies involved in biological immune modulators. Further information will undoubtedly become available over the next several years. The recent warnings from the manufacturers of infliximab (Remicade ) about the threefold increased risk of lymphoma and leukaemia in patients with rheumatoid arthritis and Crohn’s disease treated with Remicade should make those of us treating severe psoriasis cautious about our choices of treatments. A recent report showed that both methotrexate and, to a greater extent, antitumour necrosis factor therapy, increased lymphoma rates in patients with rheumatoid arthritis. I feel, however, that because of the chronicity and frequently varied therapeutic response of more severe psoriasis, we need as many treatment options as possible. I feel it is also important to explore combinations of many of the existing treatments that we utilize for more severe disease, with the biologicals. It is very important to note Dr Weller’s graph comparing ‡ 75% improvement in the Psoriasis Area and Severity Index with the different treatments. He shows that dithranol plus UVB at 3 weeks gives similar improvement to that obtained at 12 weeks with infliximab—a considerably more expensive and complex treatment given by intravenous infusion, with greater risks of side-effects.