Reumatologia最新文献

Introduction: Osteoarthritis (OA) is a worldwide, disabling condition, more prevalent in older people. Although anxiety and depression disorders are common in OA and may affect compliance with treatment, both disorders are still underrecognized and undertreated. The present study aimed to screen for anxiety and depression among patients with primary knee OA, and to study the relationship between Hospital Anxiety and Depression Scale (HADS) score and different disease parameters.

Material and methods: Fifty patients fulfilling primary knee OA classification criteria were recruited for the study, and 50 age- and sex-matched healthy individuals served as a control group. Medical history was taken, clinical examination was done, and pain intensity was assessed using the Visual Analogue Scale. The 6-minute walk test was used for functional status assessment, and plain X-ray knees were scored according to the Kellgren and Lawrence classification system. Participants completed the HADS questionnaire.

Results: Twenty-nine patients were female (58%) and 21 were male (42%). The mean HADS score was significantly higher in OA patients than controls (p = 0.001). The mean HADS-A (Anxiety) score was statistically significantly higher in OA patients than controls (p < 0.001). Anxiety was more frequent in patients (44%) than in controls (10%) (p < 0.001). In regression analysis, female sex could be considered as a predictor for each of HADS-A and HADS-D (Depression) (β: 0.4, 0.3; t: 3.28, 2.2; p = 0.002, 0.03; CI: 1.3-5.6, 0.2-4.4), respectively, while knee giving way was considered as a predictor for HADS-A (β: 0.34, t: 2.8, p = 0.007, CI: 0.96-5.87).

Conclusions: The results of the present study showed that anxiety level rather than depression was significantly higher in patients with primary knee OA than in controls. Female sex could be considered as a predictor for each of HADS-A and HADS-D, while knee giving way was considered as a predictor for HADS-A.

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.

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: 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: Eosinophilic granulomatosis with polyangiitis (EGPA) is characterized by eosinophilic granulomatous vasculitis. Typical symptoms include late-onset bronchial asthma and blood and tissue eosinophilia. In addition to these characteristic symptoms, EGPA can affect important organs such as the skin, kidneys, heart, sinuses, gastrointestinal tract, and nervous system. Given the variability of the clinical presentation, EGPA is challenging to diagnose. Furthermore, EGPA often occurs in phases, with clinical manifestations and pathological findings varying depending on the affected anatomic site and stage of disease.

Material and methods: The authors reviewed the SCOPUS, MEDLINE, and PubMed medical databases to prepare an overview of the clinical manifestations and diagnosis for EGPA.

Results: This comprehensive review examines the current knowledge on the clinical course of EGPA, diagnostic options and prognostic factors.

Conclusions: We highlight the diverse organ involvement observed in EGPA, particularly in association with eosinophilic and vasculitic manifestations. Our findings underscore the importance of anti-neutrophil cytoplasm antibody status as a potential key factor influencing disease presentation.

Introduction: Amyloidosis is a heterogeneous group of conditions associated with tissue deposition of insoluble abnormal proteins that damage vital organs. Early diagnosis, when the deposits are minimal, determines the prognosis and requires histological confirmation. The commonly adopted gold standard technique is alkaline Congo red (ACR) staining, though its sensitivity is limited. There is a need for a simple and inexpensive screening method offering a better chance of detecting minimal amyloid deposits. The aim of this study was to compare amyloid detectability with ACR and phenol Congo red (PHCR) staining techniques for early detection of minimal deposits.

Material and methods: We assessed 452 tissue specimens (including adipose tissue, gastrointestinal mucosa, labial salivary gland, myocardium, and bone marrow) from 425 patients with clinically suspected systemic or local amyloidosis, which had been sent to the Pathology Laboratory of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. Adjacent sections from each specimen were stained with ACR and PHCR. If amyloid was detected, immunohistochemical typing was conducted. The consistency of the two staining methods was expressed as Cohen's κ coefficient.

Results: A total of 169 tissue specimens (37%) yielded positive readings, with 93 cases ACR(+) and PHCR(+); 75 cases ACR(-) and PHCR(+), and 1 case ACR(+) and PHCR(-). The percentage agreement between the staining methods was 83%, with the Cohen's κ coefficient value of 0.60 (95% CI: 0.52-0.69), which corresponds to moderate agreement according to Fleiss. Additional immunohistochemical amyloid typing, conducted in ACR(-) and PHCR(+) specimens, yielded conclusive results in 82% of cases.

Conclusions: The use of PHCR staining as a screening method in suspected amyloidosis improves amyloid (light chain, transthyretin, and amyloid A protein) detectability in various tissues. The PHCR staining specificity should be verified via electron microscopy and/or mass spectrometry.

Introduction: Psoriatic arthritis (PsA) is a heterogeneous disease with various manifestations such as dactylitis, enthesitis, spondylitis, and skin involvement. Minimal disease activity (MDA) has been successfully used in daily clinical practice and is considered a reasonable treatment target in patients with PsA. In this study, we aimed to evaluate the MDA status and associated factors in patients with PsA in our tertiary referral clinic.

Material and methods: This cross-sectional study included patients who met the CASPAR classification criteria and had at least 6 months of follow-up data between 2001 and 2021. Patients who met at least 5 of 7 criteria (tender joint count ≤ 1/68, swollen joint count ≤ 1/66, Psoriasis Area Severity Index [PASI] ≤ 1, Visual Analogue Scale [VAS] ≤ 15, patient global VAS ≤ 20, Health Assessment Questionnaire-Disability Index [HAQ-DI] ≤ 0.5, and enthesitis number ≤ 1) were considered to achieve MDA.

Results: Data from 172 patients (61% female) were analyzed and included in the study. While most patients had polyarticular involvement (33.7%), mono-oligoarthritis was present in 30.2%, mixed type in 26.2%, isolated distal interphalangeal arthritis in 5.8%, isolated spondylitis in 2.9%, and arthritis mutilans in 1.2%. Overall, 95 (55.2%) of the patients were observed at MDA, which was lower in tumor necrosis factor inhibitor (TNFi) users compared to only conventional synthetic disease-modifying antirheumatic drug users. In univariate analysis, MDA was associated with higher patient age, longer psoriasis duration, late-onset PsA, and continued use of first TNFi. In multivariate analysis, higher patient age, late-onset PsA, and higher continuation rate of first TNFi were associated with MDA.

Conclusions: In the study, more than half of our patients achieved MDA status. A higher MDA rate was associated with a higher continuation rate at first-line TNFi treatment. The relatively large population who could not reach MDA status in our study indicates an unmet need for monitoring and treatment of PsA.