Reumatologia最新文献

Introduction: Low back pain (LBP) is a prevalent musculoskeletal condition that poses significant public health challenges. However, its epidemiology in Sub-Saharan Africa, especially in rural settings, remains largely unexplored. This study aimed to determine the epidemiology of LBP in a Nigerian Teaching Hospital.

Material and methods: This was a retrospective review of the records of all LBP cases seen at the rheumatology clinic from 2018 to 2022 in a Teaching Hospital in South-South Nigeria. The sociodemographic and clinical data, including disability scores, was extracted from the patients' medical records. The data was analyzed using IBM SPSS version 25, and the level of significance was set at p < 0.05.

Results: Among 1,580 patients, 319 (20.2%) reported LBP. The mean age was 59.51 ±10.21, and the peak age incidence was 51-60 years. Low back pain was more prevalent in females (61.4%). Work-related factors (47.3%) such as heavy lifting (26.3%), prolonged sitting (19.4%), and poor posture (27.9%) were the prominent risk factors. Sedentary behavior (11.5%) and obesity (16.9%) contributed. Common clinical manifestations included difficulty standing or bending (73%), walking difficulties (67.7%), sleep disturbances (51.4%), and radicular pain (45.8%). Common etiologies were spondylosis (66.5%), spondylolisthesis (22.3%), disc prolapse (19.4%), spinal canal stenosis (15.4%), muscle spasm (12.2%), and tuberculous spondylitis (9.7%). Acute and chronic LBP constituted 12.2% and 79.9% of cases, respectively. In terms of disability, 33.5% had minimal, 44.5% had moderate, 15.4% had severe, and 6.6% had crippling disabilities.

Conclusions: Mechanical causes were the most implicated in LBP. Work-related factors and lifestyle choices contribute to the occurrence of LBP. Adjusting posture and lifestyle modification reduces LBP risk. Understanding its epidemiology is crucial for optimizing care and implementing preventive strategies.

Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive disorder that was first described in 2014. It is a monogenic disease that is caused by loss-of-function variants in the ADA2 gene. Deficiency of adenosine deaminase 2 involves small- and medium-sized vessels and its clinical presentations include polyarteritis nodosa (PAN)-like features such as livedoid rash, early-onset stroke, hypogammaglobulinemia, hematological abnormalities, and systemic inflammation. Early diagnosis and treatment of DADA2 are crucial as the clinical features could be potentially life-threatening but might be treatable. The first-line treatment of choice in DADA2 is tumor necrosis factor α inhibitors. We aimed to provide an overview of the known pathophysiology, clinical presentations, diagnosis, and treatment of DADA2. A clearer knowledge of DADA2 may help to better diagnose, manage, and improve the clinical outcome of DADA2 patients. However, further studies are required to investigate the genotype-phenotype associations and exact pathophysiology of DADA2.

Many medical conditions affect the skeletal system and constitute independent risk factors for fractures. The action of thyroid hormones is necessary to maintain adequate development, mineralization, and bone strength. Untreated hyperthyroidism can lead to a decrease in bone mineral density (BMD), osteoporosis, and pathological fractures. In hypothyroidism, the changes in the quality of bone structure lead to an increase in the frequency of fractures. Excessive body weight negatively impacts fracture risk, increases the risk of osteoarthritis and accelerates the development of rheumatoid arthritis and osteoporosis. Type 1 and type 2 diabetes are associated with an increased risk of bone fractures despite different etiopathogenesis due to the duration of the disease and the pro-inflammatory state, the incorporation of advanced glycation end products (AGEs) into the bone matrix, and microvascular disorders. This study summarizes the current literature on the influence of thyroid dysfunction, obesity, and diabetes on the skeletal system.

Primary hyperparathyroidism (PHPT) is a frequent endocrine disease which mainly affects the skeletal system and kidney. Some of its signs and symptoms are similar to those seen in rheumatic diseases such as rheumatoid arthritis, Sjögren's disease, fibromyalgia, polymyalgia rheumatica, gout or systemic lupus erythematosus. Coexistence of primary hyperparathyroidism with those pathologies potentiate their effects on muscles, bones and joints, increasing the risk of complications such as osteoporosis and fractures. Therefore, rheumatologists should be familiar with symptoms and diagnostic criteria of PHPT and consider it in the differential diagnosis of rheumatic diseases. In 2022 the Fifth International Workshop guidelines on the PHPT evaluation and management were published. They are based on a profound analysis of advances in research concerning multiple fields, that include genetics, outcomes and new imaging modalities of PHPT. They have led to revision of previous renal indications for parathyroidectomy in PHPT. There is also more evidence for the other recommendations regarding evaluation of the disease. This article summarizes the most relevant elements of these recommendations and refers them to Polish realities. I focus on the symptoms of primary hyperparathyroidism and its diagnosis as I consider these areas to be the most important for non-endocrinologists.

Introduction: The aim was to study the red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) as inflammatory markers and their correlation with clinical disease activity parameters in patients with rheumatoid arthritis (RA).

Material and methods: This observational cross-sectional study included 100 randomly selected patients with RA. Disease Activity Score with 28-joint counts and erythrocyte sedimentation rate (DAS28-ESR) was taken as a marker of disease activity. The diagnostic value of NLR and RDW in RA was assessed.

Results: The majority (51%) of cases showed mild disease activity. The mean NLR in cases was 3.88 ±2.59. Mean RDW was 16.25 ±2.49%. Neutrophil-lymphocyte ratio significantly correlated with ESR (p = 0.026), severity of pain (p = 0.013), osteoporosis (p = 0.014) and radiographic joint erosions (p = 0.048), but not with DAS28-ESR (p > 0.05) and C-reactive protein (CRP) (p > 0.05). Red cell distribution width showed a significant correlation only with NLR (p = 0.009). The positive predictive values of NLR and RDW for disease activity were 93.3% and 90% and the negative predictive values were 20% and 16.7% respectively. For NLR, the area under the curve (AUC) was 0.78 (p = 0.001) and at a cut-off value of 1.63, the diagnostic sensitivity was 97.7% and specificity 50%. For RDW, the AUC was 0.43 (p = 0.40) and at a cut-off value of 14.52, the diagnostic sensitivity was 70.5% and specificity 41.7%. The sensitivity and specificity of NLR were higher than those of RDW. A significant difference was seen between the AUC of NLR and RDW (p = 0.02).

Conclusions: Neutrophil-lymphocyte ratio is a valuable inflammatory marker in patients with RA, but RDW is not useful in this regard.

Introduction: Kawasaki disease (KD) is a systemic vasculitis, seen mostly in children. Epidemiology of KD is dependent on geographical location and seasonality. Although many years have passed since the first report of KD, multiple related factors are still unknown.

Material and methods: We investigated the clinical, paraclinical, and therapeutic aspects of KD in Kerman, Iran by performing a retrospective, descriptive, cross-sectional study on all children hospitalized due to KD between 2007 and 2020.

Results: A total of 340 patients with mean ±SD age of 29.83 ±22.55 months participated in the study. Most of our patients were two to five years old. The male : female ratio was ~ 1.4 : 1. A few of our patients had a family history of KD or vasculitis (0.3%, 1.7%). Typical KD was more common by a large margin (316 patients with typical KD). More than half of our patients had a duration of hospitalization of under ten days. All of our patients were febrile. Hand/foot and lip/mouth changes were the second and third most common clinical findings in more than 60% of our patients. Other manifestations were conjunctivitis in 40%, skin rashes in 34.8%, gastrointestinal manifestations in 33.9%, and lymphadenopathy in 25.3%. Echocardiography revealed abnormalities in 78.6% of the participants; coronary artery aneurysm (CAA) was the most frequent (22.5%) and follow-up echocardiography revealed that all of them regressed within 6 months after treatment. The two laboratory tests with the highest ratio of abnormality were erythrocyte sedimentation rate (95%) and hemoglobin (83.3%). C-reactive protein and liver function tests were also abnormal in most patients. All of our patients received intravenous immunoglobulin and acetylsalicylic acid.

Conclusions: Kawasaki disease must be considered in every febrile child, especially those with risk factors, because timely diagnosis and treatment are essential to prevent complications. Health policies should focus on appropriate diagnosis and treatment to prevent the occurrence of sequelae.

VEXAS syndrome is an adult-onset autoinflammatory disease associated with hematologic symptoms. The disease affects primarily males, and leads to death of a significant proportion of the patients. VEXAS syndrome is caused by a somatic mutation of the UBA1 gene in hematopoietic progenitor cells. The clinical picture of the syndrome consists of a number of organ manifestations including those akin to rheumatic diseases, arthritis, myalgia, vasculitis and chondritis.

Introduction: There are nearly 240 million children living with disabilities worldwide - 1 in 10 of all children. The Polish disability certification system is characterized by a significant level of complexity. At the same time the Social Insurance Institution (ZUS), Agricultural Social Insurance Fund (KRUS) and poviat/city disability adjudication teams, voivodeship disability adjudication teams/councils, the Ministry of Family and Social Policy supervising poviat and voivodeship teams/councils issue different certificates. The system is complemented by the appeals to the court which resolve complaints against the decisions of voivodship teams. Children are considered individuals under 16 years of age. They can get a disability certificate if necessary. The aim of the study was to investigate the characteristics of children obtaining a disability certificate due to diseases of the locomotor system in Lublin within the last 16 years.

Material and methods: The authors asked the Municipal Disability Adjudication Council in Lublin to provide data on the number of disability certificates issued for children up to 16 years of age in the years 2006-2021.The data used for the analysis come from the electronic system that collects and processes them according to the assumed patterns.

Results: In the years 2006-2021 the Municipal Disability Adjudication Council in Lublin issued 9,929 disability certificates for children up to 16 years of age. The total number of certificates issued because of musculoskeletal disorders was 1,085 (mean 68/year). Majority of the recipients were 8-16 years old. There were 524 girls (mean 32.75/year) and 561 boys (mean 35.06/year).

Conclusions: In children musculoskeletal problems are in the third position after diseases of the respiratory tract and developmental disorders as the reason for obtaining a disability certificate in Lublin. Comparing this data with others, it can be concluded that the situation is similar to data from developed countries.