Reumatologia最新文献

Introduction: Thoracic spine pain syndrome is far less common than lumbosacral or cervical pain. This pathology is often caused by work-related overload, especially sedentary work, lack of regular sport activities, and adopting incorrect postures. Thoracic spine pain may result, for instance, from degenerative joint lesions. In consequence, there is a reflex contraction of the soft, paraspinal tissues (muscles, fascia, ligaments). In this case, one of the treatment methods is spinal mesotherapy. The purpose of the present research was to evaluate the effectiveness and safety of thoracic spinal mesotherapy with collagen type I vs. lignocaine.

Material and methods: A retrospective analysis of the results of the treatment of patients with chronic thoracic back pain syndrome using mesotherapy was performed. A total of 130 patients (49 men and 81 women; mean age: 49 ±9 years) were divided into 2 groups: group A (n = 65), treated with collagen type I, and group B (n = 65), treated with lignocaine 1%. Mesotherapy was performed weekly over 5 weeks. Patients were assessed using the Visual Analogue Scale (VAS) and Laitinen scales before the therapy, after the therapy, and after a 3-month follow-up visit.

Results: A statistically significant improvement was observed after the use of thoracic spinal mesotherapy both with collagen type I and lignocaine, on the VAS and Laitinen scales, with the collagen treatment having better results at the 3-month follow-up visit. No adverse effects were observed after the procedures.

Conclusions: Spinal mesotherapy is an effective and safe method of treating chronic thoracic back pain syndrome using collagen type I and lignocaine. However, in an average observation, collagen mesotherapy seems to be more effective.

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease significantly impacting patients' quality of life (QoL) and necessitating complex, long-term treatment. This study aimed to assess the long-term therapeutic outcomes of biologic therapies in a real-world clinical setting, focusing on the achievement and maintenance of low disease activity (LDA) among RA patients, while also investigating factors influencing these outcomes.

Material and methods: A retrospective observational analysis was conducted on 190 RA patients receiving tumor necrosis factor α (TNF-α) or interleukin (IL)-6 inhibitors. Disease activity was evaluated using the Disease Activity Score 28 (DAS28) at baseline, 6 months, and 12 months. Based on the DAS28 with C-reactive protein (DAS28-CRP) values, the disease was categorized into 2 main groups: remission/low activity (target achieved) when the DAS28-CRP value was less than 3.2, and insufficient therapeutic response when the value exceeded 3.2.

Results: The study group consisted of 190 RA patients, predominantly women (85.8%), with a mean age of 58.7 years and a disease duration of 12.5 years. We found that 45.8% of patients achieved single-point LDA, with 39.5% sustaining this response after 12 months. Notably, comorbidities such as diabetes and smoking negatively affected the likelihood of maintaining LDA. Statistical analysis revealed that patients without diabetes had a significantly higher chance of retaining sustained LDA (OR = 0.100; p = 0.014).

Conclusions: These findings emphasize the need for personalized treatment approaches that consider comorbidities and lifestyle factors to enhance long-term therapeutic efficacy in RA management. Consequently, this study highlights the critical importance of ongoing monitoring and individualized strategies to improve outcomes and QoL for patients with RA.

Greater trochanter pain syndrome (GTPS) occurs in a large group of patients. This problem can affect patients of any age and is associated with a sedentary, overloading, and non-ergonomic lifestyle/work with a concomitant lack of regular physical activity. The literature to date describes the effectiveness of various therapies. Glucocorticosteroid injections and physical therapy are used. One of the new methods is injection collagen therapy using collagen type I (COL-I), a protein of porcine origin, which aims, among other things, to regenerate inflammation-changed tendon. Various repair mechanisms are activated, including the induction and proliferation of fibroblasts, as well as their migration to the pathological site. This is followed by stimulation and synthesis of COL-I, secretion, and maturation. Ultimately, a regenerative effect is achieved. This article aims to discuss the role of COL-I in the injectable treatment of GTPS as a new therapeutic approach.

Osteoarthritis (OA) is a chronic, progressive disease that affects bones and joint structures. Osteoarthritis is associated with joint pain, cartilage degradation, synovial inflammation, subchondral bone remodeling and osteophyte formation. It mainly impacts the knees, hips, hands, and lumbar spine. Despite its high prevalence, no current treatments can modify the course of OA, with most therapies focused on symptomatic relief. Non-pharmacological approaches such as weight management, exercise, and self-management programs are strongly recommended. Nonsteroidal anti-inflammatory drugs (NSAIDs), both topical and oral, are commonly used but pose risks with long-term use. In contrast, symptomatic slow-acting drugs for OA, such as glucosamine, chondroitin, and avocado-soybean unsaponifiables (ASU), offer a safer alternative, but their effects remain controversial. Newer therapies, including intra-articular glucocorticosteroids, hyaluronic acid, and centrally acting agents such as duloxetine, offer targeted relief. Emerging evidence suggests that ASU may help reduce pain and improve joint function, potentially lowering the need for NSAIDs, with minimal side effects.

Radiosynoviorthesis is a minimally invasive treatment for inflammatory joint disorders. It is an alternative to surgical synovectomy and is used when systemic treatment and intraarticular glucocorticosteroid injections have failed. This literature review summarizes the effectiveness of this method in various inflammatory joint disorders. A systematic literature search was performed in the PubMed, Embase, Web of Science and DOAJ databases. Depending on the type of inflammation and level of joint destruction, the effectiveness of therapy is 50-80%, up to even 90-100% in hemarthrosis. The present study demonstrates that the therapy is safe, with almost no side-effects. It provides long-term cost-effectiveness for patients due to its ambulatory characteristics, does not require rehabilitation, and leads to reduced use of other therapies. Moreover, it may be used as an independent type of therapy as well as a part of complex treatment. Given its benefits, the method should be considered by specialists of various fields.

This literature review provides a comprehensive overview of the use of complementary and alternative modalities for the treatment of autoimmune diseases, which pose a significant challenge in contemporary healthcare, often requiring long-term management with conventional therapies. It explores a diverse range of complementary and alternative therapies, including herbal remedies, dietary interventions, mind-body practices, and emerging therapies, in the context of the management of several autoimmune diseases, highlighting increased patient satisfaction, pain management and adaptation. The findings shed light on the evolving role of complementary and alternative medicine in addressing autoimmune diseases, emphasizing the importance of a holistic approach to patient care.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by joint inflammation, degradation of cartilage and bone, and potential systemic effects. This paper provides a comprehensive historical overview of RA treatment, tracing the evolution from ancient empirical methods to modern targeted therapies. Advancements in the understanding of RA's immunopathology have led to the development of conventional, biological, and targeted disease-modifying antirheumatic drugs, including tumor necrosis factor α inhibitors and Janus kinase inhibitors. These innovations have been pivotal in transforming RA management, allowing for more personalized and effective treatment strategies. The historical progression in RA treatment reflects a shift from symptomatic management to targeted interventions aimed at the underlying mechanisms of the disease. This shift has not only improved clinical outcomes but also enhanced the quality of life for those affected by RA, underscoring the importance of ongoing research and adaptation of therapeutic strategies.

Introduction: Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease that causes multi-organ inflammation and damage. Left untreated or inadequately managed, SLE can lead to severe organ dysfunction, disability, and reduced quality of life. In Poland, the absence of standardized, evidence-based clinical guidelines tailored to local resources and practices has created inconsistencies in SLE management. The purpose of these guidelines is to provide clear, evidence-based recommendations for the treatment and management of adult patients with SLE in the Polish healthcare system. These recommendations aim to align clinical practices with international standards, optimize treatment strategies, standardize patient care, and improve health outcomes while guiding healthcare policy.

Material and methods: The adaptation process follows the ADAPTE Collaboration guidelines, the GRADE methodology, and the Evidence to Decision (ETD) framework. An interdisciplinary Working Group (WG), comprising experienced rheumatologists, organ-specific specialists, young rheumatologists, and a patient representative, will develop the guidelines. Key steps will include: 1) creation of clinical questions using the PICO format; 2) systematic search of relevant international guidelines (EULAR, ACR) and national sources; 3) evaluation of identified guidelines using the AGREE II instrument to ensure methodological quality; 4) formulation of recommendations through consensus-based discussions, addressing clinical treatment, monitoring, and care organization.

Scope and implementation: The guidelines cover pharmacological interventions for SLE, including hydroxychloroquine, glucocorticosteroids, immunosuppressive drugs biologics. Specific focus areas include treatment of organ-specific manifestations, management during pregnancy, treatment of disease flares, maintenance therapy, monitoring, and comorbidity management. The finalized document will undergo external review and be published in both Polish (on the Polish Society for Rheumatology website) and English (in the journal Reumatologia) as open access. Implementation strategies will include dissemination through scientific journals, presentations at conferences.

Conclusions: These guidelines aim to provide a standardized framework for SLE management in Poland. By implementing evidence-based recommendations, they will support healthcare providers in improving patient outcomes, optimizing resource allocation, and addressing the unique challenges of SLE within the Polish healthcare system.

Introduction: Systemic lupus erythematosus (SLE) is a complex autoimmune disease influenced by genetic, environmental, and immunological factors. Variations in cytokine genes, including tumor necrosis factor α (TNF-α) and interleukin-10 (IL-10), have been implicated in SLE pathogenesis, but their associations remain uncertain owing to conflicting study results.

Material and methods: A systematic search of the Google Scholar, PubMed, and Embase databases was conducted to examine TNF-α (rs1800629) and IL-10 (rs1800896) polymorphisms in SLE. Eligible studies were selected based on specific inclusion criteria, and data were independently extracted. Quality assessment was performed using the Newcastle-Ottawa Scale, and the Hardy-Weinberg equilibrium was evaluated. Meta-analyses were conducted using Cochrane Rob Tool 2 and Review Manager version 5.4 to determine odds ratios and 95% confidence intervals.

Results: According to the meta-analysis, a significant association was found between SLE risk and TNF-α-308 G/A polymorphism in allelic, dominant, and heterozygote models. However, no association was found between homozygous and recessive models. Interleukin-10 polymorphisms were not significantly associated with SLE risk in any model. Ethnicity-specific analysis revealed a significant association between the TNF-α allele and SLE susceptibility in Asian populations but not in Caucasians.

Conclusions: This meta-analysis identified a strong correlation between the TNF-α-308 G/A polymorphism and SLE susceptibility, particularly in Asian populations. However, no association was found between IL-10 polymorphisms and SLE. More extensive studies with diverse populations are required to validate and enhance these findings.