Reumatologia最新文献

Introduction: There is relative neglect of rheumatic and musculoskeletal diseases (RMDs) in sub-Saharan Africa (SSA). While hospital-based reports on RMDs abound, there is a paucity of population-based reports on these conditions which are otherwise recognized to cause functional disability and reduced quality of life in the affected individuals. Thus, the objective of this study is to determine the prevalence, diagnostic types, and predictors of musculoskeletal (MSK) pain in Agbowa, a peri-urban community in Lagos, South-West Nigeria.

Material and methods: This community-based survey utilized the World Health Organisation/International League of Association of Rheumatology Community Oriented Programme for the Control of Rheumatic Diseases (WHO/ILAR COPCORD) stage 1 model. All respondents had their profiles documented via modified COPCORD questionnaires. Pain intensity and functional disability were assessed by the Numerical Rating Scale (NRS) and Health Assessment Questionnaires Disability Index (HAQ-DI) respectively. The rheumatic and musculoskeletal diseases were classified using relevant validated criteria. Data obtained were analysed using SPSS Version 21.

Results: There were 3056 respondents who were predominantly female (59.2%). The period prevalence of MSK pain among the 3056 respondents was 58% (n = 1,773). There were significantly more females with MSK pain than males (62.8% vs. 37.2%, p = 0.001). Overall, 380 (12.4%) subjects had clinically diagnosed RMDs. The common RMDs in decreasing order were osteoarthritis (n = 185, 6.1%), chronic low back pain (n = 95, 3.1%) and soft tissue rheumatism (n = 52, 1.7%). The bivariate analysis showed that female sex, family history of MSK conditions, history of previous trauma, and some comorbidities were significantly associated with MSK pain. The median HAQ-DI was 0.6 (IQR 0.1-1.8) with significant disability (HAQ-DI ≥ 1) in 39.5% of the subjects.

Conclusions: The burden and impacts of these conditions are considerable. Thus, the government needs to devise programmes and policies to limit the effects of RMDs in such communities.

Introduction: Systemic sclerosis (SSc) is an autoimmune, connective tissue disorder of unknown etiology which causes vasculopathy and fibrosis. Raynaud's phenomenon (RP) is a common complication of SSc, which leads to ischemia and gangrenes. Treatment of RP is a clinical problem and often remains insufficient.This study aimed to evaluate the therapeutic efficacy of local injections of botulinum toxin type A (BTX-A) in improving the symptoms of Raynaud's phenomenon (RP) secondary to scleroderma.

Material and methods: This parallel single-blinded, placebo-controlled clinical trial enrolled 29 patients with scleroderma. Participants received BTX-A in the first, 2^nd, 3^rd, and 4^th dorsal web spaces and the base of the thumb and small finger of the non-dominant hand and 2.5 ml of sterile normal saline in the opposite hand. Pre-injection measurements and post-injection follow-up evaluations at months 1 and 4 were performed. We compared the outcomes using the paired Student's t-test.

Results: The change in pain severity between pre-injection and month 1 follow-up was significantly larger in the BTX-A group (p-value = 0.04). Between pre-injection and month 1 and month 4, the changes in the Raynaud's condition score (RCS) (p-value = 0.02, 0.004, respectively) and the number of Raynaud's attacks (p-value = 0.006, 0.001, respectively) were significantly greater in the BTX-A group. No significant difference was found in terms of paresthesia, skin thickening, upper extremity function, ulcer diameter, number of ulcers, or Raynaud's attack duration between the two groups (p-value > 0.05). In time, the decrease in pain severity, paresthesia, RCS, number of ulcers, and ulcer diameter, and the increase in upper extremity function were significantly greater in the BTX-A group as compared to the placebo group (p < 0.05).

Conclusions: Our study showed that local injection of BTX-A is safe and has beneficial therapeutic effects on RP and RP-related digital ulcers in SSc patients.

Hughes-Stovin syndrome is a rare disease characterized by thrombophlebitis associated with arterial or bronchial aneurysms. Even though it was described first in 1911, it is scarcely reported in the literature. Hughes-Stovin syndrome diagnosis is based on clinical manifestations as well as radiological findings. There are no validated criteria or specific laboratory findings to confirm the diagnosis. Computed tomography pulmonary angiography remains the gold standard for the diagnosis and follow-up of radiological findings, as they were recently described in a critical analysis of the largest cohort in the literature. The aim of this review is to draw attention to this rare but potentially fatal disease and to discuss its therapeutic options.

Introduction: Muscle enzymes are an indicator of ongoing muscle damage and disease activity in patients with idiopathic inflammatory myopathy. Although platelet-related parameters have been shown to be useful as markers of disease activity in autoimmune diseases, the relationship between platelet distribution width (PDW) and disease activity has not been previously studied in polymyositis. We aimed to determine the relationship between PDW and disease activity in patients with polymyositis.

Material and methods: Twenty-seven patients with polymyositis and thirty healthy controls were included in the study. Disease activity was evaluated using the myositis disease activity assessment Visual Analogue Scale (MYOACT) and the Myositis Intention to Treat Index (MITAX). The relationship between PDW and disease activity was evaluated using Pearson's or Spearman's correlation and reliability was assessed using correlation coefficients.

Results: The mean platelet volume (MPV) and plateletcrit (PCT) were significantly higher and PDW was significantly lower in patients with polymyositis compared to the control group. The mean PDW levels were lower in patients with constitutional symptoms and arthralgia/arthritis (p < 0.005). Although PDW levels were lower in patients with mechanical hand, lung involvement, or dysphagia compared to patients without, there was no statistically significant difference between them. Platelet distribution width was found to be negatively correlated with disease activity.

Conclusions: We found that PDW was negatively correlated with MYOACT and MITAX, widely used tools in assessing the disease activity of polymyositis. Based on this, PDW may be utilized as a non-invasive potential index to assess disease activity in patients with polymyositis.

Introduction: Spondyloarthropathies are a group of chronic inflammatory diseases with specific clinical symptoms in rheumatic diseases. These patients suffer from pain in the joints. Physicians have tried several ways to decrease the pain in these patients. This study aimed to evaluate the effect of intra-sacroiliac joint methylprednisolone injection under the guidance of ultrasonography in spondyloarthropathy patients.

Material and methods: In this randomized control trial we studied 60 patients with spondyloarthropathy (30 patients in the intervention group and 30 patients in the control group) from January 2020 to December 2020. The intervention group patients received 40 mg of intra-sacroiliac joint (SIJ) methylprednisolone injection at the beginning in addition to treatment with nonsteroidal anti-inflammatory drugs (inflammatory dose) and sulfasalazine (2 to 3 g/day). Patients' pain intensity and symptoms were assessed in the 2^nd, 4^th, 6^th, and 8^th weeks after glucocorticosteroid injection. Quantitative factors were compared by independent Student's t-test. Data analysis was performed using SPSS version 22.0 software. A p-value < 0.005 was considered significant.

Results: There were no statistically significant differences in Visual Analogue Scale (VAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) criteria and finger-to-floor (FTF) levels in the intervention and control groups. There were significant differences in VAS and BASDAI criteria and FTF levels 2 weeks after the injection, and this difference remained the same until the end of the 8^th week. The p-value was significant (p-value < 0.0001).

Conclusions: The sacroiliac joint methylprednisolone injection approach with ultrasound guidance seems to be effective in pain relief and function, and patient satisfaction scores. Additionally using the guidance of ultrasonography in this approach is without the risk of radiation exposure.

Introduction: Patients with rheumatic diseases may require costly treatment and continuous rehabilitation, which Internet collections may finance. We aimed to characterize medical crowdfunding campaigns for the needs of Polish people with rheumatic diseases.

Material and methods: We utilized data from the largest medical crowdfunding platform in Poland, Siepomaga.pl. All collections in the years 2009-2017 for the needs of people with rheumatic diseases were identified.

Results: Twenty-three of 2,656 collections were included (0.9%). Sixty-five and two percent of campaigns collected the financial target. The median amount of collected funds was 3,369 euros. Ten collections concerned conservative treatments (drug and/or rehabilitation), seven financed surgery, five supported the acquisition of medical equipment or its repair, and one aimed at facilitating a diagnostic consultation with a foreign specialist.

Conclusions: Polish patients with rheumatic diseases collect funds via medical crowdfunding, mostly for needs not covered by public healthcare or to obtain better health services in the private sector.

Introduction: Treatment of severe rheumatoid arthritis (RA) is currently based either on biological agents or Janus kinase/signal transducer and activator of transcription inhibitors, most often in combination with methotrexate (MTX).

Aim of the study: The aim of the study was to compare the effectiveness and side effects of bio- logic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic (ts) DMARDs treatment.

Material and methods: The analysis included 108 RA patients with active disease treated with MTX 25 mg per week. Eighty patients (group I) were treated with bDMARDs and 28 patients (group II) with JAK-STAT inhibitors. The duration of morning stiffness, pain on Visual Analogue Scale (VAS), 28-joints Disease Activity Score (DAS28) and Simplified Disease Activity Score (SDAI) were assessed. Classical radiographic images of patients' hands and feet using the Larsen and Dale's criteria were evaluated. The effects of treatment with bDMARDs and tsDMARDs were analyzed.

Results: All studied patients presented at least Larsen and Dale's stage 3 of X-ray changes typical for RA. There were no statistically significant differences in disease duration, ESR, CRP, DAS28 and SDAI values between studied groups. Patients from group II previously used higher numbers of bDMARDs than group I treated with bDMARDs. Low disease activity after treatment was achieved by all patients; therefore patients from group II (treated with tsDMARDs) achieved lower values of patients' global assessment on VAS.

Conclusions: The results of the present observational study indicated that treatment with JAK inhibitors is very promising. These drugs are not inferior in effectiveness to bDMARDs. It is important to monitor patients for thromboembolic events before and during JAK treatment.

Among the rheumatic diseases whose symptoms are more often associated with the possibility of cancer and other malignancies are systemic sclerosis, dermatomyositis and rheumatic polymyalgia. However, a differential diagnosis should be performed in each case of non-typical rheumatic disease and/or other neoplastic disease risk factors. The article's aim was based on a literature review of this subject and presentation own a case description and discussion about arthritis as a paraneoplastic syndrome. The conclusions of our analysis were as follows: more often paraneoplastic arthritis occurs in men, in ages higher than 50 years old, in patients who poorly respond to treatment of arthritis with polyarticular symmetrical involvement of the limbs, seronegative type of inflammatory joint disease. In this group of patients, complete remission after treatment of the primary tumor and recurrence of the symptoms in the presence of metastasis was observed.