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What is Raynaud’s disease? Raynaud’s disease is a disorder that affects the blood circulation, principally in the fingers and toes but sometimes in the ears, nipples, knees or nose.  It is characterised by a vasospasm – sudden constrictions of the blood vessels that considerably reduce the blood flow to the extremities – most often triggered by an exposure to cold but also by emotional stress. It can exist as an isolated  condition (primary Raynaud’s disease), in which case it is observed more frequently in women and people living in colder climates. The exact cause of primary Raynaud’s disease is not known.      Raynaud’s disease also occurs in men and women with autoimmune diseases, diseases of the conjunctive tissue and also other diseases, most notably:  Systemic scleroderma  Disseminated lupus erythematosis Sjögren’s disease  Rheumatoid polyarthritis  Polymyositis  Pulmonary hypertension Buerger’s disease (thromboangiitis obliterans) In these cases one speaks of secondary Raynaud’s disease. What are the risk factors?  Although we don’t know why certain persons develop Raynaud’s disease, certain risk factors are known:  Pre-existing connective tissue Autoimmune disease Smoking Repetitive pressure exercised on the hands, by using vibrating tools for example (electric tools)  Injuries or traumas Exposure to chemical products Side effects of certain medicines (beta blockers)  Etc. Symptoms and diagnosis There are some very frequent symptoms encountered in Raynaud’s disease patients but each patient can experience different symptoms. The fingers and toes turn white, then blue – generally after having been exposed to cold air or cold objects, or after having suffered stress – and then turn red when warmed up again. In serious cases, sores develop at the ends of the fingers or toes. In rare cases the fingers or toes can become infected or gangrenous, requiring amputation in the absence of treatment.  How to diagnose Raynaud’s disease ? Patients in our medical clinic are initially assessed by a rheumatologist and, depending on the severity, they can also be examined by a vascular specialist.  A large part of the diagnosis will focus on assessing the symptoms. In addition to a complete medical history and a medical examination, our team will generally order at least one type of blood test. A patient may also undergo a cold provocation test to highlight the colour changes in the hands or feet. With secondary Raynaud’s disease it is also important to identify - and treat- the underlying autoimmune disease that may be at the origin of the Raynaud’s disease (for example systemic sclerodermia: see the Erasmus Hospital’s systemic sclerodermia reference centre).  An examination by capillaroscopy is carried out. This non-invasive and painless examination makes it possible to visualise the capillaries in the nail bed. In the case of secondary Raynaud’s disease, as in the case of systemic sclerodermia, a reduction in the number of capillaries is observed as well as  the presence of dilated capillaries.       Treatment After an in-depth evaluation the team of doctors will draw up a treatment plan based on the type and extent of the disease, the general health status of the patient and the patient’s preferences.   Although there is no cure for Raynaud’s disease, it can normally be managed with appropriate treatment, such as:  Lifestyle changes: Limit exposure to the cold by dressing warmly: gloves, socks, scarf, hat and several layers  Stop smoking to improve circulation and your health in general Avoid the use of vibrating tools. Medical treatment Alpha blockers suppress the response of the sympathetic nervous system that leads to vasoconstriction (narrowing of the blood vessels)  Other medicines improve the blood flow to the fingers and toes by dilating the blood vessels. These include  calcium channel inhibitors and phosphodiesterase  inhibitors. Avoid using beta blockers, generally used for treating high blood pressure and that slow the heart rate and reduce the blood flow to extremities For patients who do not show a sufficient response to the aforementioned medicines there can be experimental medicine options - medicines that can be used in clinical trials. 

What is Sjögren’s disease?  Sjögren’s disease (also known as Sjögren’s syndrome) is a chronic autoimmune disease characterised by the infiltration of the salivary and lachrimal glands by immune system cells (lymphocytes). This disorder of the exocrine glands explains the appearance of dry syndrome characterised by dry eyes and mouth.  Sjögren’s disease is characterised by the dysfunctioning of the exocrine glands (one speaks of “exocrinopathy”), which is the cause of the dry eyes and mouth but also dryness of the nose, throat, bronchi, skin and vaginal mucosa. This generalised dryness is very debilitating, having a negative impact on quality of life and can be the source of local complications: dry keratoconjunctivitis, oral mycosa, infection of the salivary glands, etc. Sjögren’s disease is also a systemic autoimmune disease that can affect virtually all the organs. These so-called extraglandular manifestations can result from three different mechanisms: 1/ The appearance of a lymphocytic infiltration in other tissues than the exocrine glands (primary biliary cirrhosis, renal tubular impairment, bronchial damage) 2/ autoimmune  impairment linked to the presence of immune complexes or specific autoantibodies and 3/ an uncontrolled proliferation of chronically stimulated B lymphocytes (lymphocytic interstitial pneumonia, lymphoma). Epidemiology After rheumatoid arthritis,  Sjögren’s disease is the most common connective tissue disease with a prevalence of    0.1-0.6% in the general population. It is a disease that affects primarily women (9 women for 1 man), generally aged between 40 and 50. Its appearance around the time of the menopause in women and its relatively unspecific manifestations (dryness, pain, tiredness) explain why it is often late in being diagnosed.  Clinical manifestations The trio of dryness - tiredness - pain (Sicca Asthenia Polyalgia) The trio of dryness – tiredness – pain, known by some as SAP (Sicca-Asthenia-Polyalgia) syndrome, are the main complaints expressed by patients with Sjögren’s disease. As the disease appears in the exocrine glands, it is not surprising that almost 96% of patients present eye and mouth dryness that is often very debilitating. This dryness can be more general and affect the respiratory tracts (cough) and vaginal mucosa (intimate dryness in women). More than 50% of  Sjögren’s disease patients report tiredness as a symptom. Finally, almost 1 in 2 patients have chronic joint and muscular pain without any clear anatomical cause, making it similar to fibromyalgia syndrome. These “SAP” manifestations can be very debilitating, preventing the patient from working and considerably reducing the quality of life of patients with Sjögren’s syndrome. Extraglandular manifestations of autoimmune origin Although often reduced to its symptomatic trio as set out above,  Sjögren’s disease nevertheless remains a systemic rheumatological disease of autoimmune origin that can affect any organ of the body, sometimes very seriously. In regard to this dimension, it is close to its cousin: disseminated lupus erythematosus. Sjögren’s disease can thus manifest through a Raynaud phenomenon, constitutional manifestations (fever of unexplained origin, weight loss), glandular manifestations (major swelling of the  protid and submaxillary saliva glands), ganglionary manifestations (swollen glands known as adenopathies), joint manifestations (inflammatory pain with morning stiffness for more than 30 minutes, polyarthritis),   muscular manifestations (inflammatory myositis), neurological problems (polyneuropathies, brain vasculitis, symptoms miming  multiple sclerosis), bronchial lung damage or damage to lung tissue, kidney damage (proteinuria, renal failure, glomerular lesions, tubulointerstitial lesions complicated by tubular acidosis or osteomalacia), autoimmune haematological manifestations (anaemia, thrombocytopenia, leukopenia) and biological haematological manifestations (cryoglobulinemia, complement consumption, hypergammaglobulina). Non-Hodgkin’s lymphoma The intense activation of the immune system can lead to a major increase in B lymphocytes. If these lose their regulating mechanism, a B cell sub-population will continue to proliferate without limit: this is a cancer of the immune system, known as non-Hodgkin’s lymphoma. It is a complication found in between 5 and 10% of Sjögren’s disease patients. Generally slow to develop and quite discreet, it should be sought in the case of a chronic unilateral swelling of a salivary gland, adenopathies or an unexplained fever, for example. The rheumatologist may screen persons at risk of developing a lymphoma subsequent to  Sjögren’s disease by searching for clinical and biological anomalies reflecting the appearance of an excessive B-cell proliferation and monitor them more closely.  Diagnosis Due to its frequent non-specific manifestations  - tiredness, pain and dryness – and its systemic manifestations that can be polymorphous (neurological, kidney, lung, skin disorders, etc.) Sjögren’s disease can be complicated to diagnose.  In addition, there is not at present any single test that permits a diagnosis. The diagnosis is based on a set of clinical and biological arguments:  Subjective dryness of the eyes and mouth; Objectification of an impaired functioning of the salivary and lachrimal glands   - Establishing of damage to the surface of the eye by an ophthalmologist ; - Establishing of a reduced lachrimal flow by the Schirmer test; - Establishing of a reduced salivary flow by a sialometry; - Establishing of a malfunctioning of the salivary glands by a scintigraphy; - Establishing of MRI or ultrasound anomalies in the salivary glands. Lymphocytic Infiltration on a biopsy of accessory salivary glands; Establishment of anti-Ro/SSA and/or anti-La/SSB autoantibodies in the blood. Treatment There is not at present any curative treatment for Sjögren’s disease. Treatment is based on 3 dimensions: The dryness syndrome, tiredness and chronic pain (evaluated by the ESSPRI score) are treated on a  symptomatic and multidisciplinary basis in cooperation with the Departments of Ophthalmology and Physiotherapy and the Pain Clinic. The initial evaluation aims to exclude the involvement of certain manifestations systemic to tiredness and pain  (hypothyroidism, osteomalacia, lymphoma) as well as to identify persistent limiting factors (sleeping problems, depression, kinesiophobia, etc.) before proposing a multimodal treatment.  These interventions include prescribing artificial tears or saliva and the use of eye drops based on an autologous serum.  Pilocarpin is also a medication commonly prescribed to permit an increase in tear or saliva secretions. Sjögren’s disease is recognised as a “serious pathology” that brings the entitlement to 60 physiotherapy sessions a year. Following a diagnosis by your rheumatologist your mutual insurance company can also grant you monthly financial assistance to purchase eye drops and other medicines against dryness. Extraglandular manifestations of an autoimmune origin (evaluated with the aid of the ESSDAI score) can be present to very variable degrees. Depending on the organs affected and the seriousness of the inflammation, an immune suppression / immune modulator treatment may be prescribed by the rheumatologist: corticoids (Médrol), hydroxychloroquine (Plaquenil), méthotrexate, azathioprine, mycophenolate mofetil, rituximab or cyclophosphamide. Within our institution, the multidisciplinary treatment of complex systemic diseases   - of which Sjögren’s disease is one – is one of the missions  of the  MISIM (Immuno-Mediated Systemic Inflammatory Diseases) platform that includes rheumatologists, general internists, nephrologists, pneumologists, dermatologists... with a penchant for and expertise in autoimmune diseases. Sjögren’s  disease – apart from the intense activation of B lymphocytes – can be complicated in certain patients by a non-Hodgkin’s lymphoma (cancerous proliferation of the lymphocytes). This risk is the reason for at least an annual clinical and biological follow up in patients with Sjögren’s disease. If a lymphoma appears  in a patient being monitored for Sjögren’s disease, the patient will be monitored in cooperation with our hospital’s Department of Haematology.   

Primary immunodeficiencies unrelated to HIV, most of which are hereditary, are rarer and require a multidisciplinary approach provided by the various members of the team. These include, among others: common variable immunodeficiencies antipolysaccharide antibody deficiencies chronic granulomatous diseases predispositions to fungal, viral and mycobacterial infections The unit provides daily consultations to ensure prompt care and works closely with the infectious diseases clinic. Our centre is one of the few authorised reference centres (www.bpidg.be) eligible for reimbursement of antibody replacement therapies in this context.

How is hyper-eosinophilia treated when its cause has been identified? How is eosinophilia treated when its cause has been identified? If a classical cause of eosinophilia is found, it must be treated. For example, a parasitic infection will be treated with antiparasitic medication (often a very simple, well-tolerated, short course taken by mouth), a drug allergy will be treated by stopping the medication, and lung cancer will be treated with surgery, chemotherapy and/or radiotherapy. If the treatment is effective, the eosinophilia will disappear. A short course of cortisone may sometimes be added to lower the eosinophil count more rapidly, if the doctor considers that the eosinophils are causing concerning tissue damage. Treatment of rarer chronic inflammatory diseases is often based on cortisone and/or other immunosuppressive medicines (which reduce the immune response). Chronic eosinophilic leukaemia responds poorly to cortisone. However, in almost all cases, it responds extremely well to low doses of imatinib mesylate (Glivec). This is a highly specific treatment that directly targets the cellular defect responsible for the proliferation of eosinophils. This low-dose treatment is taken by mouth, is effective within a few days and is very well tolerated. Treatment of the other haematological diseases differs for each one and is beyond the scope of this summary. How is idiopathic hypereosinophilic syndrome treated? When hypereosinophilia remains unexplained despite an extensive work-up, it must nevertheless be treated to limit and prevent the damage it causes and, where possible, reverse it. The blood eosinophil count and clinical manifestations are used to determine whether the patient is responding to treatment. At the start of treatment, and for as long as the situation is not under control, medical check-ups are frequent in order to monitor several elements: the response to treatment, any treatment-related toxicity, and the progression of complications or the emergence of new complications of hypereosinophilia that may require additional symptomatic treatment (for example, heart failure requires medicines specifically intended to support cardiac function, in addition to treatment aimed at reducing the eosinophil count). Once the situation is under control, visits can gradually be scheduled less frequently. Treatment is started with corticosteroids (Medrol, or prednisolone capsules prepared by the pharmacist), which are effective in the majority of cases and act rapidly, within a few hours or days. Corticosteroids have numerous mechanisms of action; in particular, they accelerate eosinophil death and reduce the production of growth factors, including interleukin-5, by T lymphocytes. The side effects of corticosteroids are numerous and often well known to the general public: facial swelling, reduced muscle mass, the appearance of stretch marks and thinning of the skin, high blood pressure, diabetes, cataracts, glaucoma, gastric ulcer, bone demineralisation (osteoporosis), and increased susceptibility to certain infections, to mention the most common ones. 1. In the event of a response to corticosteroids If there is a good response to corticosteroids, the dose will be gradually reduced to the lowest dose that ensures disease control. This so-called “maintenance” dose will then be continued for at least several months. If corticosteroids are effective but the maintenance dose is high and/or causes significant side effects, second-line treatments will be used (known as “corticosteroid-sparing treatments”, as they make it possible to reduce the dose of corticosteroids needed to control the disease). The most commonly used agent is hydroxyurea (Hydrea), as it is easy to take (tablets taken by mouth) and prescribe (available on prescription from all pharmacies), and is free of charge in Belgium. This medicine, used to treat haematological diseases such as chronic myeloid leukaemia or essential thrombocythaemia (an abnormally high platelet count), works by reducing the production of blood cells in the bone marrow, including eosinophils. The main side effects are haematological toxicity, with an excessive decrease in white blood cells, red blood cells and/or platelets. Patients may also experience digestive intolerance, with abdominal discomfort, loss of appetite, nausea, diarrhoea and/or mouth ulcers. Interferon-alpha is also used to treat idiopathic hypereosinophilic syndrome. This treatment acts on eosinophils and T lymphocytes by “modulating” their functions. For example, it reduces the production of interleukin-5 by T lymphocytes without reducing immune defences. It belongs to a family of molecules that we naturally produce to fight certain viral infections, such as influenza. This agent is rarely prescribed in Belgium to treat hypereosinophilic syndrome because it is not reimbursed for this indication and costs several hundred euros per month. In addition, it is administered by subcutaneous injection several times a week, and the side effects are often poorly tolerated. Among these, a flu-like syndrome (with fever, chills, muscle pain and headaches) is the one most likely to lead to discontinuation of treatment. Some immunosuppressive medicines are sometimes tried to reduce the corticosteroid dose, but they are rarely effective and have numerous side effects: ciclosporin (Neoral), azathioprine (Imuran), cyclophosphamide (Endoxan). Mepolizumab (Nucala) is an agent that specifically targets interleukin-5 (it binds to this growth factor and neutralises its effects). It has recently been approved as a treatment for severe eosinophilic asthma that is not controlled by standard treatments. It proved to be an effective corticosteroid-sparing treatment for hypereosinophilic syndrome when administered intravenously once a month as part of a clinical study. However, it is not yet available to treat this disease because it has not been approved for this indication by the regulatory agencies (in particular, the Food and Drug Administration, or FDA, in North America; and the European Medicines Agency, or EMA, in Europe). It is currently available to treat hypereosinophilic syndrome only במסגרת a compassionate-use programme based on an individual case assessment, for patients with disease considered very severe (potentially life-threatening), for whom the conventional treatments mentioned above are ineffective and/or poorly tolerated. A new clinical study assessing the efficacy of subcutaneous mepolizumab administration in patients with hypereosinophilic syndrome is currently being prepared. 2. In the absence of a response to corticosteroids If the eosinophil count and symptoms do not respond, or respond only very partially, to corticosteroids, selecting an effective treatment may require several trials and changes of medicines over a period of several months, during which eosinophils may continue to cause damage. Close medical follow-up is essential during this period. The corticosteroid-sparing agents mentioned in the previous section may sometimes be effective, possibly in combination (for example, hydroxyurea and interferon-alpha). Rarely, some of these patients have an acquired genetic mutation that remains undetected (it is invisible using the techniques currently available to us) and that justifies a short trial (one month) of imatinib mesylate (Glivec). The recommended dose is higher than that used for chronic eosinophilic leukaemia and is therefore more often associated with side effects, including swelling of the legs and eyelids, fatigue, and bone marrow toxicity. Mepolizumab has never been tested in corticosteroid-resistant patients as part of a clinical study. However, it is available במסגרת the compassionate-use programme mentioned above, with patient eligibility determined individually after assessment of the medical file. Very rarely, a patient may not respond to any of the treatments mentioned above, while persistent hypereosinophilia continues to cause significant damage (to the heart, brain or blood vessels, for example) that threatens survival. The possibility of a stem cell transplant (formerly called a bone marrow transplant) from a healthy donor (either a close family member, where possible, or an unrelated donor) must then be discussed. This procedure consists of administering high-dose chemotherapy in the hope of killing all the abnormal cells in the bone marrow that are responsible for the hypereosinophilia. One consequence (unintended but unavoidable) of this treatment is that the other bone marrow cells needed to produce red blood cells, healthy white blood cells required to protect us against infections, and platelets will also be destroyed. It is then necessary to provide the patient with healthy cells (collected from a healthy donor), which will repopulate the bone marrow and enable it to produce new red blood cells, white blood cells and platelets. This procedure exposes the patient to the risk of numerous serious complications during the period before the donor cells have colonised the bone marrow, and will therefore be reserved for the most severe cases.

The term “systemic and autoimmune inflammatory diseases” encompasses a range of different conditions that share an abnormal and persistent activation of the immune system, leading to impaired function of several organs, tissues and/or systems. These include, in particular: Autoimmune diseases, such as systemic lupus erythematosus, Sjögren’s disease, scleroderma (or systemic sclerosis), and polymyositis Vasculitis, such as granulomatosis with polyangiitis (formerly Wegener’s disease), eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), giant-cell arteritis (also known as Horton’s disease), and Behçet’s disease Non-infectious granulomatous diseases, such as sarcoidosis Autoinflammatory diseases, such as familial Mediterranean fever and TRAPS And various other conditions, including IgG4-related disease and relapsing polychondritis. Since 2011, several departments at Erasme Hospital have pooled their clinical immunology expertise to create a transdisciplinary care platform for these conditions, known as the MISIM platform (for “Systemic and Immuno-Mediated Inflammatory Diseases”). Numerous medical specialists are involved in this unique platform. Transdisciplinary care is essential for identifying, monitoring and treating, in the most appropriate way, complications directly related to diseases that may affect different organs and tissues, as well as complications resulting from prolonged treatments. The departments actively involved in this platform include: Internal medicine Rheumatology Nephrology Pneumology Gastroenterology Neurology Dermatology Ophthalmology Cardiology The optimal management of chronic inflammatory diseases also often relies on specific blood tests, the interpretation of which can be challenging and may require discussion between laboratory specialists and clinicians. This is why an immunology laboratory specialist is also involved in the platform. The creation of a single platform for such diverse diseases is justified by a number of reasons related to the diseases themselves (the way they manifest and their complications) and to their management. Indeed, although each of these diseases has its own specific features, they share many common characteristics: In terms of manifestations and complications, there is considerable overlap between these diseases. For example, the lung inflammation that may occur in scleroderma or Sjögren’s disease is the same; it requires the same diagnostic tests and the same treatments. In terms of medical management, the approach is similar, particularly with regard to the investigations leading to the diagnosis, the types of medication prescribed, the prevention of treatment-related complications, and follow-up.

What is it about? Rheumatoid arthritis is a chronic and progressive inflammatory disease that affects many people in Belgium, most often at a young age. At Hôpital Erasme, this condition is treated by a specialized team within the Rheumatology department. The Early Arthritis Clinic Rheumatoid arthritis is the most common systemic autoimmune disease and affects approximately 0.5% of the population. If the disease is not correctly diagnosed and treated within the first months after the onset of symptoms, it can lead to irreversible joint damage. Early treatment of the disease can positively influence its course and thereby prevent disability.The HERA early arthritis clinic rapidly receives patients in whom inflammatory arthritis is suspected and uses advanced techniques to establish a diagnosis as quickly as possible. Tailored toolsThe traditional approach based on systematic history-taking and clinical examination is complemented by joint ultrasound, which can visualize intra-articular inflammation and detect joint erosions even before they become visible on X-rays.A blood test, performed by your general practitioner before the consultation or prescribed during the first visit, provides additional information to support the diagnosis. In addition, X-rays of the affected joints are performed in all patients.If necessary, a more in-depth examination using MRI is proposed to further clarify the cause of the pain. All of this information makes it possible to establish a diagnosis of polyarthritis within one week and to start the necessary treatment to relieve pain, control inflammation, and improve joint function.The clinic’s physicians then ensure effective treatment and close follow-up of the disease, and provide you with all necessary information regarding your condition. In parallel, the early arthritis clinic offers access to a specialized rheumatology nurse, a team of physiotherapists and occupational therapists specialized in rheumatoid arthritis, as well as rapid access to studies of new medications if needed. How to request a consultationYour general practitioner can use this form to refer you to the clinic; you will then be seen within 15 days. The Rheumatoid Arthritis Clinic What is rheumatoid arthritis?Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes pain, stiffness, and swelling (inflammation) of the joints. Joints that remain inflamed can become damaged and deformed, which may lead to disability. The synovial membrane can thicken, and the surrounding ligaments, cartilage, and bone may also be affected.Rheumatoid arthritis typically affects joints in a symmetrical pattern: if, for example, one hand is affected, the other is likely to be affected as well. Causes of rheumatoid arthritisThe exact cause of rheumatoid arthritis is unknown. It is an autoimmune disease, meaning that the patient’s immune system attacks its own healthy cells and tissues. This causes inflammation in the joints and surrounding tissues. Often, this inflammation is also systemic and may affect other organs such as the lungs and the heart.Heredity is a risk factor for developing rheumatoid arthritis, and smoking is also recognized as a factor that promotes its onset.The disease most commonly affects adults between 30 and 50 years of age, and more often women, but it can occur at any age and in both sexes. Symptoms of rheumatoid arthritisRA most commonly affects the hands, wrists, ankles, feet, knees, shoulders, and elbows. The onset of the disease may be gradual and slow or sudden and rapid. Each patient may experience different symptoms, including:PainJoint stiffness, especially in the morningJoint swellingReduced joint mobilityDifficulty with daily activities (opening a jar, buttoning a shirt, etc.)Difficulty grasping or pinching objectsFatigue and lack of energyOccasional feverThis list is not exhaustive, and these symptoms can also occur in other conditions. A medical consultation with a rheumatologist is necessary to establish a diagnosis. Diagnosis of rheumatoid arthritisThe initial diagnosis of RA is often challenging: symptoms are usually mild, and abnormalities in blood tests or X-rays may not yet be visible. The rheumatologist will perform a full medical history and a detailed clinical examination. Several diagnostic tests may be carried out:Bone X-raysJoint aspiration and synovial fluid analysis to detect infection, signs of inflammation, or crystalsBlood tests for inflammatory markers such as CRP, and diagnostic markers such as rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP)Joint ultrasound and MRI: specialized imaging studies to detect joint inflammation and damage to bone and cartilage. Duration of the diseaseMost people with polyarthritis face a chronic disease, often with alternating periods of severe pain (inflammatory flare-ups) and periods of symptom improvement. In rare cases, symptoms disappear completely, known as spontaneous remission. Fortunately, thanks to currently available treatments, most patients are able to return to a normal life, something that would be impossible without medical treatment. Treatments for rheumatoid arthritisTreatment is usually medication-based, but physiotherapy and a balanced approach between rest and physical activity can also help. At present, there is no cure for polyarthritis, but treatment helps control symptoms and prevent inflammatory flare-ups and disease-related damage.Treatment varies from person to person depending on disease severity, comorbidities, other medications, and patient preferences. The goal is to allow patients to maintain their lifestyle, reduce joint pain, and prevent permanent joint damage and disability.The mainstay of treatment consists of so-called DMARDs (disease-modifying antirheumatic drugs), which aim to control inflammation and prevent joint damage. These include classic drugs such as methotrexate, leflunomide, and sulfasalazine, as well as biological agents (anti-TNFα, anti-IL6, CTLA4 agonists, and rituximab) and small synthetic molecules (JAK inhibitors), which are second-line treatments.These medications are often combined with systemic anti-inflammatory drugs (NSAIDs and corticosteroids) and local treatments (intra-articular corticosteroid injections). These are needed as a “bridge” between the start of DMARD therapy and the time it takes for them to become effective, which can sometimes take several months. The Rheumatoid Arthritis Clinic At Hôpital Erasme, the rheumatoid arthritis team provides comprehensive care in a single location, ranging from medical imaging to physiotherapy, including treatment follow-up and pain management.

Presentation HIV infection is the most common cause of acquired immunodeficiency. Without treatment, this infection leads to AIDS, a fatal disease that can now be readily prevented through treatment supervised by a specialised team in this field. The AIDS Reference Centre and the Immunodeficiency Treatment Unit provide preventive and therapeutic care for patients suffering from different forms of immunodeficiency.   HIV seropositivity and AIDS HIV (human immunodeficiency virus) infection is the most common cause of acquired immunodeficiency. Without treatment, this infection leads to AIDS, a fatal disease that can now be easily prevented through treatment supervised by a specialised team. The Erasme Hospital reference centre provides: regular medical follow-up by specialist physicians in collaboration with your general practitioner free multidisciplinary care under an agreement with INAMI (nurses, sexologists, psychologists, dietitians, social workers, etc.) close collaboration with other medical disciplines (hepatology, dermatology, gynaecology, medically assisted reproduction, proctology, etc.) collaboration with various organisations active in the field of HIV (Plateforme prévention SIDA, Ex-Aequo, Aide Info SIDA, SIDA SOS, SIDA Sol, SIDAIDS Migrant, Sensoa, etc.) The reference centre also participates in numerous clinical studies. Screening and treatments Do you think you may have been exposed to HIV or other STIs? It is now possible to receive emergency preventive treatment that can significantly reduce the risk of contracting HIV. It is called Post-Exposure Prophylaxis (PEP), and you can access it 24/7. This treatment must be taken within 72 hours of a high-risk exposure. It is available during the day by appointment (02 555 7484) and at the Emergency Department at night and on weekends. Would you like to be screened for sexually transmitted infections? We offer immediate comprehensive screening for the most common STIs (chlamydia, gonorrhoea, hepatitis, syphilis and HIV). This screening is partially reimbursed by INAMI. Would you like to take PrEP? Pre-exposure prophylaxis has been shown to be effective in reducing the risk of acquiring HIV in specific situations. If you are already taking PrEP or would like follow-up in connection with future PrEP use, we offer specialised follow-up. More information: www.myprep.be.

Presentation The National Reference Centre for Congenital Infections is part of the network of National Reference Centres coordinated by Sciensano. Our specialties The NRL performs serological (confirmatory) and microbiological (PCR) analyses for the following conditions: cytomegalovirus (CMV), Toxoplasma gondii, rubella and parvovirus B19. It is accredited in accordance with the EN ISO 15189 standard. The NRL provides its expertise by advising clinicians and biologists on the diagnosis and prognosis of congenital infections. Contact National Reference Centre for Congenital InfectionsDr Marie-Luce DelforgeBrussels University Hospital: Erasme Hospital - ULBRoute de Lennik 808, 1070 BrusselsTel.: 02 555 66 81Email: marie-luce [dot] delforge [at] erasme [dot] ulb [dot] ac [dot] be (marie-luce[dot]delforge[at]hubruxelles[dot]be) Useful links Sciensano – National Reference Centre for Congenital Infections Compendium

What is Parkinson’s disease? Parkinson’s disease is a chronic, progressive and degenerative neurological disease. It primarily affects movement control, which may cause tremors, slowness of movement, muscle rigidity, and balance and postural disorders. Over time, the disease may also affect other functions, such as sleep, mood, attention, memory, or certain automatic functions of the body (for example, digestion or blood pressure). The disease is linked to the progressive destruction of neurons located in an area of the brain called the substantia nigra. These neurons produce dopamine, a chemical messenger essential for coordinating and controlling voluntary movements. The decrease in dopamine disrupts communication between the different areas of the brain involved in movement, which explains the onset of symptoms. Symptoms Motor symptomsThe best-known signs are:Tremors at rest,Slowness of movement (bradykinesia),Muscle rigidity,Balance and gait disturbances. Non-motor symptomsThe disease is also often accompanied by less visible symptoms:sleep disturbances,loss of smell,constipation,mood disorders (anxiety, depression),fatigue, pain, cognitive impairment.  Causes and risk factors The exact causes are not yet fully known, but several factors are involved:Genetic factors: certain rare genetic variations increase the risk.Environmental factors: exposure to certain chemicals (pesticides, heavy metals), certain solvents or head injuries could increase the risk.Advanced age: the disease is more common in older people, although cases in younger people also occur (before the age of 40).  Prevalence in Belgium The number of people living with Parkinson’s disease in Belgium is estimated at between 30,000 and 50,000, with approximately 2,000 to 3,000 new diagnoses each year. It is the second most common neurodegenerative disease in the country after Alzheimer’s disease. Medical care Screening and diagnosisThe diagnosis is clinical and is based on a careful neurological examination of the patient. There is no single blood test that confirms the disease, but certain tests (MRI, dopaminergic scintigraphy) can help to rule out other causes. The general practitioner often refers the patient to a specialised neurologist, who establishes the diagnosis and proposes an appropriate treatment plan.Symptomatic treatmentsAt present, there is no curative treatment, but several options can help manage the symptoms effectively:Dopaminergic medications, such as levodopa, which replace the dopamine lacking in the brain.Dopamine agonists and other classes of medication, used according to the symptoms and their progression.Medications that modulate the action or metabolism of dopamine:MAO inhibitors (MAOIs) and COMT inhibitors (COMTIs), which allow dopamine or levodopa to act for longer in the brain;Amantadine, which can improve certain motor symptoms and help reduce involuntary movements associated with treatment.Rehabilitation therapies (physiotherapy, occupational therapy, speech therapy) to maintain mobility, balance, speech and quality of life.Deep brain stimulation (DBS), offered to some people when medication no longer controls the symptoms sufficiently, by implanting electrodes in the brain. Your specialists at H.U.B. Brussels University Hospital has a clinic specialising in the diagnosis and management of movement disorders, including those caused by Parkinson’s disease (the Parkinson’s disease and Abnormal Movements Clinic). We offer personalised care focused on quality of life and the patient’s goals, including through a multidisciplinary approach that addresses both motor and non-motor aspects (cognition, sleep, pain, mood, independence, etc.). When necessary, we refer patients to advanced therapies and specialised care pathways. The H.U.B. Abnormal Movements Clinic team includes specialist physicians and multidisciplinary healthcare staff, including neurologists specialising in movement disorders, a physiotherapist, a speech therapist, neuropsychologists and a psychologist. Discover the Abnormal Movements Clinic Dr Frédéric Supiot, Director of the Abnormal Movements Clinic Position: Neurologist, Specialist in Abnormal Movements.Consultations for Parkinson’s disease, tremors, dystonias and other movement disorders.Principal investigator in clinical research (Enroll-HD Programme for Huntington’s disease)Administration of botulinum toxin injections for certain movement disorders, such as dystonias and hemispasm.Expertise in the implantation and programming of DBS (deep brain stimulation).Expertise in initiating, adjusting and monitoring patients receiving treatment with a Duodopa pump. Dr Virginie Destrebecq Role: Neurologist, Specialist in Abnormal Movements.Consultations for Parkinson’s disease, tremors, dystonias and other movement disorders, as well as degenerative disorders of the cerebellum (ataxia) and functional neurological disorders.Reference specialist for rare ataxias within the European Reference Network (ERN-RND)Principal investigator in clinical and translational research (on essential tremor).  Dr Vincent Leclercq Position: Neurologist, Specialist in abnormal movements.Provides consultations for Parkinson’s disease, tremors, dystonia and other movement disorders.Pays particular attention to non-motor symptoms (behavioural disorders, mood disorders, sexual dysfunction, urinary and digestive disorders, pain, …).Promotes a comprehensive approach, with referrals to neurological rehabilitation where necessary (physiotherapy, occupational therapy, speech therapy, neuropsychology, …).Performs DBS (deep brain stimulation) programming and botulinum toxin injections. Dr Alexandra Boogers Position: Neurologist, Specialist in Abnormal Movements.Consults patients with Parkinson’s disease, tremors, dystonia and other movement disorders.Expertise in the implantation and programming of DBS (deep brain stimulation).

A multidisciplinary specialist team for Multiple Sclerosis that places the patient at the centre of care to ensure a good quality of life Multiple sclerosis (MS) is a chronic neurological disease that mainly affects young adults. Being informed of the diagnosis profoundly disrupts the patient’s life, exposing them to sometimes disproportionate fears and many unanswered questions. However, nowadays, with prompt and effective care, the prognosis of this disease has improved significantly. The Clinical Neuroimmunology and Multiple Sclerosis Unit at Erasme Hospital works along several lines: Medical expertise The medical team ensures care based on the latest recommendations and closely follows scientific publications on inflammatory diseases of the central nervous system. Patients undergo physical and cognitive assessments using validated and reproducible tests. Patients have easy and rapid access to consultations, without delay, and the necessary additional examinations are organised at Erasme Hospital by the MS team. Treatment is chosen together with the patient after analysing the individual benefit–risk ratio. Communication Patients receive ongoing explanations about their disease and treatment. Dialogue is open and dynamic. Patients and their relatives receive support from a specialised nurse and learn to live with the diagnosis without restrictions. Personalised meetings and group meetings with other patients are offered. Physiotherapy Multidisciplinary care is available at the Centre for Outpatient Neurological Functional Rehabilitation. Annual assessments are carried out and regular follow-up is arranged to preserve patients’ abilities. The team also includes psychotherapists and occupational therapists. Psychological support The Centre for Outpatient Neurological Functional Rehabilitation also has a team of psychotherapists who are familiar with the challenges of multiple sclerosis and can provide occasional support. Patients can also take part in a monthly support group, where they can support one another and approach the disease differently. Administration Patients receive administrative support for every request submitted to their health insurance fund, employer, etc. Research The Neuroimmunology Unit participates in numerous clinical studies and contributes to fundamental research, with the aim of gaining a better understanding of the pathophysiological mechanisms of multiple sclerosis and other inflammatory diseases, making diagnosis more precise and faster, and providing effective, well-tolerated treatments.

Neurocognitive and behavioural disorders can cause anxiety, stress, depression, distress, disability and difficulties in everyday life. It is therefore important to provide help and support to patients suffering from such disorders and to those close to them. To assist these individuals, the Memory Unit at Erasme Hospital works along several lines: medical expertise, the quality of explanations provided, a range of services — neuropsychology, psychology, occupational therapy and speech therapy — and administrative support. Cognitive and behavioural disorders can cause anxiety, stress, depression, distress, disability and difficulties that may lead to a loss of independence, resulting in greater or lesser needs for help and support. Investigating these disorders requires active listening and an informed assessment of all remaining abilities and disabilities. In addition to the scientific rigour essential to all medical care, each approach is individualised and human-centred, enabling a systematic response to each person’s specific needs. Meeting the medical and paramedical teams, learning about the examinations required to establish a diagnosis, receiving the diagnosis and discussing therapeutic options are all stressful moments that can be difficult to manage and require dedicated time adapted to each individual. Thanks to our teamwork and close collaboration with the Geriatrics Department, such personalised and specific care pathways are possible. Our areas of work The Memory Unit at Erasme Hospital works along several lines: 1) Medical expertise: As part of the diagnosis and support of dementia syndromes, psychoeducation is offered to patients’ relatives when useful (ASAPP Project). The department, its doctors and its teams provide individually tailored medical care based on systematically updated scientific data. Patients are assessed in all areas — physical, cognitive, behavioural and social — using modern and reliable tests; Treatment is chosen together with the patient after analysing the individual benefits and risks; A care plan is also systematically proposed, with the possibility of rapid consultations after the diagnosis has been disclosed, if necessary; Patients have access to modern communication tools (telephone, email, fax, etc.), enabling them to communicate easily and without delay with their medical team; Psychoeducation is offered to patients’ relatives when useful; This psychoeducation programme, unique in Belgium, is supported by specific funding under Protocol 3 (INAMI), enabling art therapy sessions to be added for patients, as well as a home-support plan provided by a specialised nurse; Clinical study protocols involving both new therapeutic approaches and more fundamental research approaches are regularly offered to patients and their relatives if they wish to participate. Patients and their relatives always remain entirely free to decline participation. 2) Explanations: In addition to dynamic listening during each consultation, our teams formally meet twice a week to discuss each patient in greater detail; Consultations after the diagnosis has been disclosed are organised within the Geriatric Day Hospital, with which we work in very close collaboration; Psychoeducation and art therapy sessions are organised at the residential care home “Les Jardins de la Mémoire”, adjacent to the institution (792, route de Lennik). (ASAPP Project) 3) Neuropsychology, psychology, occupational therapy and speech therapy: Patients and those around them are accompanied and supported throughout their difficulties. Individualised meetings, as well as joint meetings with other patients, are also offered. 4) Administration: Patients receive administrative support for each request submitted to their health insurance fund, for their activities, etc. Download the leaflet for the ASAPP Project (Assistance and Support for Informal Carers and People with Alzheimer’s disease or a related condition) File depliant_asapp.pdf Training With the aim of promoting communication across the care network and continuity of care from the hospital to the home (including residential and nursing care homes), we offer an adapted psychoeducation training programme for professionals working with people affected by dementia syndromes (we also travel to residential and nursing care homes, in particular). In addition to providing explanations about dementia syndromes and their main symptoms, the overall objective is to encourage reflection on the best ways to care for and interact with people experiencing a loss of physical and psychological autonomy. This is therefore a theoretical but also interactive training programme: each participant is encouraged to bring the difficulties, questions and problems they encounter, so that we can reflect together on the best ways to respond to them (through discussions, exercises, role plays, etc.). The content of the training can be adapted, within certain limits, to meet participants’ needs.