Reumatologia最新文献

Introduction: The aim was to examine biopsychosocial conditions of patients hospitalized in the rheumatology department of a university hospital.

Material and methods: Ninety-six patients (mean age: 53.14 ±16.83 years) receiving inpatient treatment at the rheumatology service of a university hospital were included. Chest circumference, manual muscle testing, general well-being (Visual Analogue Scale - VAS), the Fatigue Severity Scale, the Rivermead Mobility Index, the Beck Anxiety Inventory, and the Nottingham Health Profile were used for evaluation.

Results: The average number of days hospitalized was 15.57 ±15.11. Mean disease duration was 7.91 ±9.34 years. Respiratory rate per minute was 22.55 ±6.03. Chest circumference measurement at rest was 97.01 ±9.70 cm, inspiration was 99.71 ±9.67 cm, expiration was 94.10 ±13.91 cm. Quadriceps muscle strength (on a scale of 0-5) was 4.26 ±0.74 on the right and 4.16 ±0.76 on the left; biceps brachii muscle strength was 4.46 ±0.64 on the right and 4.39 ±0.78 on the left. The VAS score was 6.03 ±2.51; the Rivermead Mobility Index was 11.41 ±4.11; the Nottingham Health Profile total score was 39.18 ±22.44; the energy level sub-score was 52.89 ±37.06. History of previous hospitalization was found in 42 patients (43.8%). Five patients (5.2%) were at bed level, 4 patients (4.2%) were at sitting level, 7 patients (7.3%) were at standing level, and 80 patients (83.3%) were at walking level. Seventeen patients (17.7%) used assistive devices for mobilization. Sixty-one patients (63.5%) were fatigued, and 21 patients (21.9%) had moderate anxiety.

Conclusions: Inspiratory capacity of patients hospitalized in rheumatology service is low. Their respiratory rate is higher than the normal value. Their mobility and energy levels are at average values while fatigue and anxiety levels need to be considered. In addition to pharmacological treatments, we recommend that patients hospitalized in rheumatology service be supported by appropriate exercises provided by physiotherapists.

Systemic sclerosis (SSc) is a multi-organ, systemic connective tissue disease, which affects the lungs, heart, gastrointestinal tract, kidneys, skin, and musculoskeletal system. Musculoskeletal involvement is observed in 40-90% of patients with SSc. During the disease, any structure of the musculoskeletal system, such as bones, joints, tendon sheaths, tendons, and muscles, may be affected. The most common symptoms include joint pain, arthritis, tendinitis leading to tendon rupture, acro-osteolysis, calcinosis, myalgia, and myositis. Osteo-articular complications and changes in the soft tissues of the hand lead to finger contracture, which causes deterioration of the patients' quality of life and disability. To sum up, a more detailed understanding of the aetiology leading to progressive changes in the musculoskeletal system may contribute to the introduction of new therapeutic options, and thus improve the quality of life and reduce disability in patients with SSc.

Rapidly destructive coxopathy (RDC) is a rare type of coxarthritis marked by swift deterioration of the hip joint. Although its cause remains unclear, several pathophysiological mechanisms are proposed. To comprehensively analyze this poorly understood condition, a literature search was conducted focusing on associations of bilateral RDC and rheumatoid arthritis (RA). The problem of long-standing RA, bilateral RDC with a febrile episode that preceded a rapid decline in mobility and severe hip pain, with radiological assessment confirmed bilateral hip destruction, was presented. Rapidly destructive coxopathy, especially when linked to RA, poses diagnostic and therapeutic challenges. Our review confirmed by the clinical picture emphasizes the need for vigilance in RA patients with hip involvement and calls for further research to understand RDC's mechanisms and enhance clinical care.

Introduction: Glial cell derived neurotrophic factor (GDNF) has an important role in the pathogenetic mechanisms and clinical manifestations of rheumatoid arthritis (RA). Alexithymia is associated with a severe clinical course and worse prognosis, while the relationship between alexithymia and GDNF in RA patients has not been investigated before. The aims of the study were to investigate the GDNF level in blood plasma in RA patients depending on the presence of alexithymia and to evaluate the relationship of GDNF level with clinical manifestation and quality of life.

Material and methods: Fifteen men and 73 women with RA were examined using the Disease Activity Score with 28-joint count (DAS28) with erythrocyte sedimentation rate (ESR) index, the Simple Disease Activity Index (SDAI), the Rheumatoid Arthritis Clinical Disease Activity Index (CDAI), the Visual Analogue Scale (according to the assessment of the patient - VAS-P and the assessment of the doctor - VAS-D), the Health Assessment Questionnaire (HAQ), the Toronto Alexithymia Scale (TAS-20), the Disability Rating Index (DRI) and SF-36 indexes. Glial cell derived neurotrophic factor level in the blood plasma was determined by enzyme-linked immunosorbent assay (ELISA).

Results: Forty percent of RA patients had alexithymia. Glial cell derived neurotrophic factor level in the examined patients was 3.73 ±2.59 pg/ml, in patients with alexithymia 4.08 ±2.87 pg/ml, without alexithymia 3.48 ±2.37 pg/ml (p = 0.295). Patients with alexithymia had a higher erythrocyte sedimentation rate (ESR) and index scores than patients without alexithymia - ESR: 34.29 ±14.22 vs. 22.73 ±12.03 mm/h (p = 0.017), DAS28: 6.53 ±0.66 vs. 6.09 ±0.55 (p = 0.017), VAS-D: 7.19 ±0.81 vs. 6.53 ±0.83 (p = 0.020), HAQ: 1.78 ±0.58 vs. 1.51 ±0.54 (p = 0.040). Also they had worse SF-36 indicators - physical functioning: 39.52 ±13.78 vs. 51.00 ±14.90 (p = 0.019), role functioning due to physical condition: 30.95 ±20.77 vs. 46.67 ±24.76 (p = 0.041), physical component of health: 31.47 ±11.44 vs. 41.61 ±15.88 (p = 0.028). In patients with alexithymia, a correlation was found between the GDNF level and severity of pain according to VAS-P: r_S = 0.338, p = 0.044, and VAS-D: r_S = 0.446, p = 0.006.

Conclusions: Alexithymia was found in 40% of RA patients. Rheumatoid arthritis patients with alexithymia had a nonsignificantly higher GDNF level compared to patients without alexithymia. In RA patients with alexithymia, an association of GDNF level in the blood plasma with RA activity, loss of functional capacity and reduced quality of life was established. Alexithymia in RA patients is an important factor in the clinical manifestation of RA and modification of the pathophysiological role of GDNF.

Introduction: There is limited knowledge on cognitive performance in Behçet's disease (BD), the majority of which come from patients with neuro-Behçet's disease. However, the influence of BD on cognitive function in patients without neurological involvement is still not well understood.The aim of the study was to determine the frequency of cognitive involvement in BD patients without evident neuropsychiatric symptoms and to identify associated clinical variables in those patients.

Material and methods: Forty BD patients who fulfilled the diagnostic International Criteria for Behçet 's Disease (ICBD) without obvious neuropsychiatric manifestations were studied and compared with forty healthy controls matched for age, sex, and education. A comprehensive medical history, rheumatological, neurological, psychiatric, and psychometric assessment were applied for all patients. Behçet's disease Current Activity Form (BDCAF) was used to assess disease activity. For patients as well as controls, validated Arabic versions of the Wechsler Adult Intelligence Scale-Revised and Wechsler Memory Scale-Revised were used for assessment of cognitive function. Anxiety and depression were additionally assessed for both groups using the anxiety and depression subdivisions of the Arabic Version of Symptom Checklist 90 Revised.

Results: Cognitive impairment was identified in 37.5% of BD patients compared to none of the controls. Memory represents the cognitive domain most frequently affected. Cognitive involvement was significantly associated with current corticosteroid use and depression as measured by SCL-90-R. On the other hand, neither the activity of the disease nor the level of anxiety was associated with cognitive involvement.

Conclusions: Cognitive dysfunction is reported in BD patients distinctly and independently of clinically overt neurologic involvement. Prevalence of cognitive impairment in patients with BD is strikingly high at 37.5%, whereas the control group exhibited no such signs. Psychological assessment should be performed for every BD patient to reveal any cognitive involvement. It is highly recommended to encourage psychological intervention to prevent any further deterioration, especially in patients who are experiencing depression or currently using corticosteroids.

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects the joints, causing inflammation, pain, and potential joint damage. Patients with RA are at high risk of developing psychiatric morbidity; it is important to recognize these psychiatric manifestations. The relationship between psychiatric symptoms and RA is complex and can involve various factors, including the impact of chronic pain, inflammation, medications, and the overall burden of managing a chronic illness.Aim of the study was to systematically investigate and analyze the patterns and prevalence of psychiatric morbidity among individuals diagnosed with RA, with the aim of identifying common mental health conditions, understanding the interplay between RA and psychiatric disorders, and providing valuable insights for improved holistic patient care.

Material and methods: This was a prospective, observational cross-sectional study conducted over a period of three years in patients with RA. Psychiatric morbidity was assessed using International Classification of Diseases-10 criteria and Mini-Plus by dedicated psychiatrists. The diagnosis of RA was confirmed using the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) diagnostic criteria for RA and the disease activity was calculated by Disease Activity Score with 28-joint count (DAS28) using the calculator from the RheumaHelper application. The data were analyzed using SPSS, version 23.0.

Results: A total of 1,000 patients with RA were included in this study. Nearly two-thirds of the patients were female (64.8%). The majority of patients belonged to the age group of 41 to 54 years. Total 47.5% of the patients were unemployed, 27.0% were salaried, 19.0% were businessman, while 6.5% of the patients were students. More than half of the patients (53.2%) had moderate disease activity. Major depressive disorder was the most commonly observed comorbidity (41.0%), followed by somatoform disorder (28.5%), and generalized anxiety disorder was found in 13.5%. No psychiatric manifestations were found in 17% of studied individuals.

Conclusions: Psychiatric morbidity is associated with RA and there is a need for psychiatric services to be made available to these patients.

Introduction: The aim was to detect subclinical structural retinal abnormalities in optical coherence tomography (OCT) in ophthalmologically asymptomatic systemic lupus erythematosus (SLE) patients without signs of lupus retinopathy or drug toxicity in fundus examination and in OCT and to assess the relationship between OCT parameters and disease activity, therapy type and burden on other organs to demonstrate the utility of OCT in early retinal impairment in SLE patients.

Material and methods: Cross-sectional study. Thirty-three SLE patients (57 eyes) and 31 healthy individuals (56 eyes) were enrolled in the study. We excluded patients with evidence of lupus retinopathy or hydroxychloroquine (HCQ) toxicity on OCT or fundus examination to reveal any subclinical changes. All patients underwent full ophthalmologic examination in the slit lamp including best corrected visual acuity, tonometry, and OCT. The Kolmogorov-Smirnov distribution test was used to assess the normal distribution in quantitative values. The differences between the individual measured parameters in the groups were analyzed using the Mann-Whitney U test. Spearman's rank correlation test was used to assess the correlation between the measured parameters and quantitative clinical data.

Results: There was no difference in the OCT findings between SLE and healthy control groups. Among the study group a negative correlation was found between disease duration and age and retinal nerve fiber layer thickness in the inferior quadrant (p = 0.0063, p = 0.0036). No correlations were observed between examined retinal parameters and duration of hydroxychloroquine therapy, hydroxychloroquine as well as chloroquine cumulative dose and disease activity indices.

Conclusions: Optical coherence tomography is a widespread ophthalmic modality used for SLE retinopathy and HCQ toxicity screening. Our study did not demonstrate its clinical potency in diagnosis of subclinical retinal involvement. An optical coherence tomography device seems to be less sensitive in subclinical retinal impairment detection than optical coherence tomography angiography.

Polymyositis (PM) and dermatomyositis (DM) are rare idiopathic inflammatory myopathies (IIM). Myocardial involvement in patients with IIM is an unfavorable prognostic factor and one of the most common cause of mortality in this group of patients. The purpose of this review is to present current knowledge on cardiovascular manifestations observed in IIM. Data published in English until December 2021 were selected. Clinical symptoms suggesting cardiac involvement are non-specific and require a differential diagnosis in accordance with cardiological guidelines. Troponin I is specific to cardiac injury and should be preferred to other markers to evaluate the myocardium in IIM. Abnormalities in electrocardiography are common in IIM, especially non-specific changes of the ST-T segment. In standard echocardiography left ventricular diastolic dysfunction is reported frequently. New diagnostic technologies can reveal clinically silent myocardial abnormalities. However, the prognostic value of subclinical impairment of myocardial function require further studies.