M. Dună, D. Predețeanu, F. Berghea, M. Abobului, V. Vlad, A. Balanescu, D. Opriș-Belinski, C. Constantinescu, A. Borangiu, L. Groșeanu, I. Saulescu, M. Negru, S. Daia, D. Mazilu, R. Ionescu, B. Pharmacy
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which deposit within tissues and fix complement leading to systemic inflammation (1). Is a heterogeneous disease with a continuum of disease activity. Some patients can have predominant skin and joint involvement, whereas others can present with organ-threatening diseases such as nephritis, cardiac involvement or even neurologic manifestations. Relatives of patients with SLE appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable (2,3).
{"title":"General characteristics and familial aggregation in patients with systemic lupus erythematosus","authors":"M. Dună, D. Predețeanu, F. Berghea, M. Abobului, V. Vlad, A. Balanescu, D. Opriș-Belinski, C. Constantinescu, A. Borangiu, L. Groșeanu, I. Saulescu, M. Negru, S. Daia, D. Mazilu, R. Ionescu, B. Pharmacy","doi":"10.37897/rjr.2018.3.5","DOIUrl":"https://doi.org/10.37897/rjr.2018.3.5","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which deposit within tissues and fix complement leading to systemic inflammation (1). Is a heterogeneous disease with a continuum of disease activity. Some patients can have predominant skin and joint involvement, whereas others can present with organ-threatening diseases such as nephritis, cardiac involvement or even neurologic manifestations. Relatives of patients with SLE appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable (2,3).","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46506859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoporosis and periodontal disease are two diseases that affect millions of people worldwide. The common element is represented by bone loss. Periodontal disease consists of a set of inflammatory and/or degenerative changes concerning the periodontium, that evolve in the first phase with the loss of the connection between the superficial periodontium and the tooth, and subsequently with the damage of the profound periodontium. Recent studies in the literature show that osteoporosis, by lowering systemic bone mineral density and alveolar bone, can create a favorable framework for the progression of the periodontal impairment. This paper aims to present the main epigenetic changes related to micro-RNA from the two pathologies, focusing on the common elements that they share.
{"title":"Influence of sistemic osteoporosis on periodontal health: epigenetic micro-RNA resemblances","authors":"Dan Piperea-Șianu, Ș. Cristea, B. Pharmacy","doi":"10.37897/rjr.2018.3.2","DOIUrl":"https://doi.org/10.37897/rjr.2018.3.2","url":null,"abstract":"Osteoporosis and periodontal disease are two diseases that affect millions of people worldwide. The common element is represented by bone loss. Periodontal disease consists of a set of inflammatory and/or degenerative changes concerning the periodontium, that evolve in the first phase with the loss of the connection between the superficial periodontium and the tooth, and subsequently with the damage of the profound periodontium. Recent studies in the literature show that osteoporosis, by lowering systemic bone mineral density and alveolar bone, can create a favorable framework for the progression of the periodontal impairment. This paper aims to present the main epigenetic changes related to micro-RNA from the two pathologies, focusing on the common elements that they share.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45236639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Caraba, Roxana Saulescu, V. Crișan, D. Predețeanu
In the presence of lupus nephritis, the pregnancy remains a challenging problem, requiring a multidisciplinary monitoring. Such pregnancies are considered as high risk similar to those with maternal and fetal potential complications. Thus, these pregnancies must be planned, after a multidisciplinary evaluation, performed by obstetrician, rheumatologist and nephrologist. Inactive disease for at least 6 months before conception, absence of hypertension, heavy proteinuria or important renal dysfunction are associated with good maternal-fetal outcomes. Lupus nephritis flare and preeclampsia may occur, associating a poor prognosis. Therapeutic regimens must be adapted, taking into account the teratogenic effects of the drugs.
{"title":"Lupus nephritis and pregnancy. The rheumatologist’s opinion","authors":"A. Caraba, Roxana Saulescu, V. Crișan, D. Predețeanu","doi":"10.37897/rjr.2018.3.1","DOIUrl":"https://doi.org/10.37897/rjr.2018.3.1","url":null,"abstract":"In the presence of lupus nephritis, the pregnancy remains a challenging problem, requiring a multidisciplinary monitoring. Such pregnancies are considered as high risk similar to those with maternal and fetal potential complications. Thus, these pregnancies must be planned, after a multidisciplinary evaluation, performed by obstetrician, rheumatologist and nephrologist. Inactive disease for at least 6 months before conception, absence of hypertension, heavy proteinuria or important renal dysfunction are associated with good maternal-fetal outcomes. Lupus nephritis flare and preeclampsia may occur, associating a poor prognosis. Therapeutic regimens must be adapted, taking into account the teratogenic effects of the drugs.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43605055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Nicolau, Pitesti Cmi Dr. Nicolau Mihaela-Ana, R. Ionescu, B. Pharmacy
Objectives. The purpose of this study is to underline the benefits of the complex, multimodal therapy, composed of the pharmacological and non-pharmacological treatment of patients suffering from osteoarthritis (OA) with different localizations, namely pain and functioning relief and the increase of the quality of life. Methods. The study included 246 patients with osteoarthritis diagnosed at the clinical examination and confirmed by radiological investigations. All the patients were pharmacologically treated and 127 of them also followed non-pharmacological treatment consisting of a recuperation program kinesiotherapy and electrotherapy. Results. Patients who achieved a significant decrease in pain were those treated with multimodal therapy (pharmacologically, kinesiotherapy and electrotherapy) 27.3%, followed by patients treated only pharmacologically 20%, and patients treated pharmacologically plus kinesiotherapy (without electrotherapy) 10.7%. Patients who achieved moderate improvement in 2 out of 3 (pain, function / mobility, global assessment), according to OARSI also responded to treatment, that means 85.7% who combined pharmacological treatment and kinesiotherapy (without electrotherapy) and only 67% subjects who received only pharmacological treatment. Conclusions. Our findings demonstrate that multimodal therapy, which consists of the combination of pharmacological and non-pharmacological treatment, brings important benefits to the management of patients with OA.
{"title":"Benefits of multimodal therapy for patients with osteoarthritis","authors":"M. Nicolau, Pitesti Cmi Dr. Nicolau Mihaela-Ana, R. Ionescu, B. Pharmacy","doi":"10.37897/rjr.2018.3.4","DOIUrl":"https://doi.org/10.37897/rjr.2018.3.4","url":null,"abstract":"Objectives. The purpose of this study is to underline the benefits of the complex, multimodal therapy, composed of the pharmacological and non-pharmacological treatment of patients suffering from osteoarthritis (OA) with different localizations, namely pain and functioning relief and the increase of the quality of life. Methods. The study included 246 patients with osteoarthritis diagnosed at the clinical examination and confirmed by radiological investigations. All the patients were pharmacologically treated and 127 of them also followed non-pharmacological treatment consisting of a recuperation program kinesiotherapy and electrotherapy. Results. Patients who achieved a significant decrease in pain were those treated with multimodal therapy (pharmacologically, kinesiotherapy and electrotherapy) 27.3%, followed by patients treated only pharmacologically 20%, and patients treated pharmacologically plus kinesiotherapy (without electrotherapy) 10.7%. Patients who achieved moderate improvement in 2 out of 3 (pain, function / mobility, global assessment), according to OARSI also responded to treatment, that means 85.7% who combined pharmacological treatment and kinesiotherapy (without electrotherapy) and only 67% subjects who received only pharmacological treatment. Conclusions. Our findings demonstrate that multimodal therapy, which consists of the combination of pharmacological and non-pharmacological treatment, brings important benefits to the management of patients with OA.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43189154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. D. Tudorancea, Romania Pharmacy Craiova, P. Ciurea, C. D. Pârvănescu, S. Firulescu, C. Bogdan, E. Vintilă, R. Dumitrașcu, C. Ene, C. Criveanu, Florentin Vreju Ananu, Ș. Dinescu
Inflammatory myopathies, include polymyositis, dermatomyositis, inclusion body myositis and necrotising myopathy, but their diagnosis requires a comprehensive differential, in order to optimise treatment and to have the best outcome. One of the most controversial diagnosis in this situation is drug related myotoxicity, since the symptoms may vary significantly, but usually include muscle weakness and myalgia accompanied by elevated creatine kinase serum levels Patient background. We report a case of a 70 year-old patient, treated with statins, with onset of symptoms since one year with tolerable myalgia, accompanied by mild muscle weakness shortly after and progressive worsening in the last couple of months. Interruption of statins was recommended based on current symptoms and elevated muscle enzymes: creatine kinase (CK) x3 fold and aspartate aminotransferase (AST) x2 fold normal range. Investigations. Autoimmunity panel including anti-nuclear and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies was negative. The needle EMG was abnormal, with diffuse fibrillation potentials in almost all investigated sites, both in the proximal and distal muscles. Complex repetitive discharges were also observed in most muscles tested. Existence of clear myogenic signs on needle EMG revealed the probable cause for the clinical presentation as being myogenic in nature. Discussion. Statin-induced myopathy (SIM) is typically self-limited showing remission in the following weeks or months after statin cessation. Although EMG studies support the presence of typical myopathy features in SIM, it cannot point-out specific changes attributed to a statin-related dysfunction. Patient outcome was favorable on hospital discharge. On a two week check-up, she reported improvement in muscle strength, range of motion and remitted myalgia. Repeated blood work showed a descending trend in both CK and AST, with values in normal range. Conclusions. The clinical case, the whole algorithm of clinical evaluation and paraclinical tests that lead to final diagnosis and the literature review, highlight the importance of an exhaustive approach. Electrophysiology tests offer important aid to the physician in the approach of patients with an underlying toxic myopathy in initial diagnosis, follow-up and biopsy yield if necessary.
{"title":"Differential diagnosis between statin myotoxicity and inflammatory myositis – case presentation","authors":"A. D. Tudorancea, Romania Pharmacy Craiova, P. Ciurea, C. D. Pârvănescu, S. Firulescu, C. Bogdan, E. Vintilă, R. Dumitrașcu, C. Ene, C. Criveanu, Florentin Vreju Ananu, Ș. Dinescu","doi":"10.37897/rjr.2018.3.6","DOIUrl":"https://doi.org/10.37897/rjr.2018.3.6","url":null,"abstract":"Inflammatory myopathies, include polymyositis, dermatomyositis, inclusion body myositis and necrotising myopathy, but their diagnosis requires a comprehensive differential, in order to optimise treatment and to have the best outcome. One of the most controversial diagnosis in this situation is drug related myotoxicity, since the symptoms may vary significantly, but usually include muscle weakness and myalgia accompanied by elevated creatine kinase serum levels Patient background. We report a case of a 70 year-old patient, treated with statins, with onset of symptoms since one year with tolerable myalgia, accompanied by mild muscle weakness shortly after and progressive worsening in the last couple of months. Interruption of statins was recommended based on current symptoms and elevated muscle enzymes: creatine kinase (CK) x3 fold and aspartate aminotransferase (AST) x2 fold normal range. Investigations. Autoimmunity panel including anti-nuclear and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies was negative. The needle EMG was abnormal, with diffuse fibrillation potentials in almost all investigated sites, both in the proximal and distal muscles. Complex repetitive discharges were also observed in most muscles tested. Existence of clear myogenic signs on needle EMG revealed the probable cause for the clinical presentation as being myogenic in nature. Discussion. Statin-induced myopathy (SIM) is typically self-limited showing remission in the following weeks or months after statin cessation. Although EMG studies support the presence of typical myopathy features in SIM, it cannot point-out specific changes attributed to a statin-related dysfunction. Patient outcome was favorable on hospital discharge. On a two week check-up, she reported improvement in muscle strength, range of motion and remitted myalgia. Repeated blood work showed a descending trend in both CK and AST, with values in normal range. Conclusions. The clinical case, the whole algorithm of clinical evaluation and paraclinical tests that lead to final diagnosis and the literature review, highlight the importance of an exhaustive approach. Electrophysiology tests offer important aid to the physician in the approach of patients with an underlying toxic myopathy in initial diagnosis, follow-up and biopsy yield if necessary.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47013021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Pompilian, L. E. Stoichitoiu, S. Caraiola, P. Bălănescu, R. Ionescu
Sarcoidosis is an inflammatory disease of unknown etiology, characterized by non-caseating epithelioid granulomas. Neurological involvement appears in 5-10% of cases, most frequently leading to involvement of the cranial nerves, the hypothalamus and the pituitary gland (1-3). We hereby present the case of an 82 year old woman with neurosarcoidosis who presented with severe symptomatic hyponatremia. An 82 year old woman presented to our clinic with fatigue, drowsiness, bradylalia, bradypsychia, all developed in the context of severe hyponatremia. She has been diagnosed with sarcoidosis in 2004 on the basis of histopathological examination. She has been treated with corticosteroids from 2004 until 2007; in 2007 the treatment has been stopped at the patient’s initiative. Clinical examination revealed normal cardiac and pulmonary data; there were no signs of focal neurological involvement. Lab tests showed low levels of ACTH, fT4 and an inadequate normal level of TSH, which raised the suspicion of hypopituitarism. The moderately elevated level of prolactin together with the imaging appearance (enlarged sella turcica on X-ray examination and an expansive process in the sellar and suprasellar regions on computed tomography examination) suggest that hypothalamic-pituitary insufficiency is the more accurate diagnosis. Given the background of untreated pulmonary sarcoidosis, in the absence of another sustainable etiology, we have assigned to sarcoidosis the hypothalamic-pituitary insufficiency. The outcome was good with corticosteroids in moderate dose and thyroid replacement therapy.
{"title":"Severe hyponatremia revealing neurosarcoidosis","authors":"V. Pompilian, L. E. Stoichitoiu, S. Caraiola, P. Bălănescu, R. Ionescu","doi":"10.37897/rjr.2018.2.7","DOIUrl":"https://doi.org/10.37897/rjr.2018.2.7","url":null,"abstract":"Sarcoidosis is an inflammatory disease of unknown etiology, characterized by non-caseating epithelioid granulomas. Neurological involvement appears in 5-10% of cases, most frequently leading to involvement of the cranial nerves, the hypothalamus and the pituitary gland (1-3). We hereby present the case of an 82 year old woman with neurosarcoidosis who presented with severe symptomatic hyponatremia. An 82 year old woman presented to our clinic with fatigue, drowsiness, bradylalia, bradypsychia, all developed in the context of severe hyponatremia. She has been diagnosed with sarcoidosis in 2004 on the basis of histopathological examination. She has been treated with corticosteroids from 2004 until 2007; in 2007 the treatment has been stopped at the patient’s initiative. Clinical examination revealed normal cardiac and pulmonary data; there were no signs of focal neurological involvement. Lab tests showed low levels of ACTH, fT4 and an inadequate normal level of TSH, which raised the suspicion of hypopituitarism. The moderately elevated level of prolactin together with the imaging appearance (enlarged sella turcica on X-ray examination and an expansive process in the sellar and suprasellar regions on computed tomography examination) suggest that hypothalamic-pituitary insufficiency is the more accurate diagnosis. Given the background of untreated pulmonary sarcoidosis, in the absence of another sustainable etiology, we have assigned to sarcoidosis the hypothalamic-pituitary insufficiency. The outcome was good with corticosteroids in moderate dose and thyroid replacement therapy.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47949680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Ticu, M. Balea, C. Badea, A. Gheorghe, Ruxandra Pătraşcu
The overlap syndromes are a diverse group of conditions that usually have characteristic features of at least two well-defined rheumatic diseases occurring together. We present the case of a 32-year-old patient who sequentially develops manifestations of systemic lupus erythematosus and systemic sclerosis. The first manifestation of the disease was the pleural effusion and, over time, the patient associated various other complications which influenced the diagnostic course. Digital ulcerations associated to scleroderma have evolved into ischemic necrosis lesions, requiring amputation. This case is a clinically suggestive example of the complexity of autoimmune diseases, of associations between pathologies and unexpected evolutions, requiring constant and long-term follow-up of the patients.
{"title":"Scleroderma – lupus overlap syndrome: case report","authors":"G. Ticu, M. Balea, C. Badea, A. Gheorghe, Ruxandra Pătraşcu","doi":"10.37897/rjr.2018.2.6","DOIUrl":"https://doi.org/10.37897/rjr.2018.2.6","url":null,"abstract":"The overlap syndromes are a diverse group of conditions that usually have characteristic features of at least two well-defined rheumatic diseases occurring together. We present the case of a 32-year-old patient who sequentially develops manifestations of systemic lupus erythematosus and systemic sclerosis. The first manifestation of the disease was the pleural effusion and, over time, the patient associated various other complications which influenced the diagnostic course. Digital ulcerations associated to scleroderma have evolved into ischemic necrosis lesions, requiring amputation. This case is a clinically suggestive example of the complexity of autoimmune diseases, of associations between pathologies and unexpected evolutions, requiring constant and long-term follow-up of the patients.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46500569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health represents both a personal and social asset different valued by individuals and populations. Personal education, previous experience, sex, income or housing variables contribute to a higher or lower prioritization of health care. Different actors interfere their forces and interests in this area: industry is interested in profit, administration is interested in a healthier and productive population, politicians are interested in accomplishing their agenda, patients want to pay less and receive more benefits etc. As European Union is still very inhomogeneous in terms of wealth, education or previous experience with health sector is clear that a large pool of differences could observed among EU28 countries. Objectives. In this paper we are analyzing EU official statistical data to understand these differences and find practical conclusions for what Romanian health system intend to be. Methods. Analyses of EU statistics public available in Eurostat directory. Results. We analyzed how developed and what are the outcomes of EU health sector with a focus on Romania and rheumatology field. Discussions and conclusions. There is no a clear link between different components of health sector and the way these are financed and the outcome.
{"title":"Financial constrains in the health sector: Romanian place in European perspective with a focus on rheumatic disease","authors":"F. Berghea, B. Pharmacy","doi":"10.37897/rjr.2018.2.1","DOIUrl":"https://doi.org/10.37897/rjr.2018.2.1","url":null,"abstract":"Health represents both a personal and social asset different valued by individuals and populations. Personal education, previous experience, sex, income or housing variables contribute to a higher or lower prioritization of health care. Different actors interfere their forces and interests in this area: industry is interested in profit, administration is interested in a healthier and productive population, politicians are interested in accomplishing their agenda, patients want to pay less and receive more benefits etc. As European Union is still very inhomogeneous in terms of wealth, education or previous experience with health sector is clear that a large pool of differences could observed among EU28 countries. Objectives. In this paper we are analyzing EU official statistical data to understand these differences and find practical conclusions for what Romanian health system intend to be. Methods. Analyses of EU statistics public available in Eurostat directory. Results. We analyzed how developed and what are the outcomes of EU health sector with a focus on Romania and rheumatology field. Discussions and conclusions. There is no a clear link between different components of health sector and the way these are financed and the outcome.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47651483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Vele, C. Pharmacy, L. Damian, S. Simon, I. Felea, L. Muntean, I. Filipescu, M. Tămaș, C. Pamfil, S. Rednic
Background. Calcium pyrophosphate deposition disease results from the deposition of calcium pyrophosphate crystals and needs to fulfil McCarty criteria for diagnosis. Chondrocalcinosis is defined as cartilage and fibrocartilage calcification identified by imaging or histological examination. The presence of calcium-containing crystals in synovial fluid is associated strongly with the degenerative joint disease, but the exact mechanism remains to be elucidated. Objectives. To compare the clinical and radiographic characteristics in patients with and without chondrocalcinosis. Material and methods. One hundred and forty-three patients, 86 with chondrocalcinosis and 57 controls with primary osteoarthritis were consecutively enrolled in this case-control, transversal, prospective study performed in the Rheumatology Department, Emergency Clinical County Hospital Cluj-Napoca, Romania, between January 2015 and January 2018. A subgroup of 39 patients fulfilled McCarty criteria for calcium pyrophosphate deposition (CPPD) disease. Demographic data, clinical data, laboratory data, knee radiographs, knee ultrasound, were recorded in both groups. Kellgren-Lawrence score was graded in all patients at the knee level. Results. The patients with chondrocalcinosis had higher tender joint count (3.1±6.8 versus 1.9±0.1, p<0.05), swollen joint count (1.37±0.9 versus 0.28±0.3, p<0.05), visual analogue scale for pain (7.72±1.28 versus 6.5±3.5, p<0.05). Kellgren-Lawrence score at the knee level was higher in the chondrocalcinosis group (p<0.05) comparing to controls, but not when comparing the CPPD group with the chondrocalcinosis group. Osteoarthritis was associated with chondrocalcinosis when compared to controls and with definite CPPD when comparing to chondrocalcinosis subgroup. Conclusions. Chondrocalcinosis was associated with pain, arthritis and higher Kellgren-Lawrence score than the controls.
{"title":"Clinical and radiographic findings in patients with chondrocalcinosis","authors":"P. Vele, C. Pharmacy, L. Damian, S. Simon, I. Felea, L. Muntean, I. Filipescu, M. Tămaș, C. Pamfil, S. Rednic","doi":"10.37897/rjr.2018.2.4","DOIUrl":"https://doi.org/10.37897/rjr.2018.2.4","url":null,"abstract":"Background. Calcium pyrophosphate deposition disease results from the deposition of calcium pyrophosphate crystals and needs to fulfil McCarty criteria for diagnosis. Chondrocalcinosis is defined as cartilage and fibrocartilage calcification identified by imaging or histological examination. The presence of calcium-containing crystals in synovial fluid is associated strongly with the degenerative joint disease, but the exact mechanism remains to be elucidated. Objectives. To compare the clinical and radiographic characteristics in patients with and without chondrocalcinosis. Material and methods. One hundred and forty-three patients, 86 with chondrocalcinosis and 57 controls with primary osteoarthritis were consecutively enrolled in this case-control, transversal, prospective study performed in the Rheumatology Department, Emergency Clinical County Hospital Cluj-Napoca, Romania, between January 2015 and January 2018. A subgroup of 39 patients fulfilled McCarty criteria for calcium pyrophosphate deposition (CPPD) disease. Demographic data, clinical data, laboratory data, knee radiographs, knee ultrasound, were recorded in both groups. Kellgren-Lawrence score was graded in all patients at the knee level. Results. The patients with chondrocalcinosis had higher tender joint count (3.1±6.8 versus 1.9±0.1, p<0.05), swollen joint count (1.37±0.9 versus 0.28±0.3, p<0.05), visual analogue scale for pain (7.72±1.28 versus 6.5±3.5, p<0.05). Kellgren-Lawrence score at the knee level was higher in the chondrocalcinosis group (p<0.05) comparing to controls, but not when comparing the CPPD group with the chondrocalcinosis group. Osteoarthritis was associated with chondrocalcinosis when compared to controls and with definite CPPD when comparing to chondrocalcinosis subgroup. Conclusions. Chondrocalcinosis was associated with pain, arthritis and higher Kellgren-Lawrence score than the controls.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48575260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Ghib, C. Pharmacy, M. Tămaș, L. Muntean, S. Rednic
The objectives of this study where to validate the ”joint criteria” for fibromyalgia (FM) diagnosis represented by the difference between tender joint count (TJC) and swollen joint count (SJC) in rheumatoid arthritis (RA) patients undergoing biological treatment and examine clinical and ultrasound parameters in patients with and without FM. Patients and methods. RA patients on biological treatment were included during one month. ROC analysis was used to determine whether the ”joint criteria” could differentiate between patients with associated FM and those without. The disease activity score in 28 joints (DAS28) was calculated and ultrasound (US) examination was performed using the 7 joint score. Results. 39 patients were included. The ”joint criteria” had a sensitivity of 85% and specificity of 87% for FM diagnosis for a difference of ≥ 6 between TJC and SJC. Nine (23%) patients were diagnosed with FM using these criteria. Patients with RA-FM had higher values compared to RA for the DAS28 (5.1 vs 3.3, p= 0.01), TJC (12 vs 3, p < 0.001) and patient global assessment (PGA) (58 vs 41, p < 0.001), but similar values for SJC (1 vs 2, p=0.6), erythrocyte sedimentation rate (ESR) (27 vs 22, p= 0.21), C reactive protein (CRP) (8.6 vs 8.4, p= 0.6) and ultrasound parameters (Gray Scale synovitis 2.6 vs 3.8, p= 0.9; Power Doppler synovitis, 1.2 vs 1.6, p= 0.5; Gray Scale Tenosynovitis 0.4 vs 0.3, p=0.3; Power Doppler Tenosynovitis, 0.3 vs 0.2, p=0.08). Discussions. Our findings confirm previous published data on RA-FM diagnosis and disease characteristics on a sample of RA patients on biological treatment. The ”joint criteria” is a feasible tool and could easily identify patients with RA and FM in order to improve disease management. Conclusions. A difference of ≥ 6 between TJC and SJC is diagnostic of FM in RA patients. Patients that satisfy this criteria have higher DAS28 scores, TJC, PGA but similar SJC, ESR, CRP and US scores compared to RA patients without FM.
本研究的目的是验证接受生物治疗的类风湿性关节炎（RA）患者纤维肌痛（FM）诊断的“关节标准”，即软关节计数（TJC）和肿胀关节计数（SJC）之间的差异，并检查FM患者和非FM患者的临床和超声参数。患者和方法。接受生物治疗的RA患者包括在一个月内。ROC分析用于确定“联合标准”是否可以区分伴有FM的患者和无FM的患者。计算28个关节的疾病活动性评分（DAS28），并使用7个关节评分进行超声（US）检查。后果包括39名患者。对于TJC和SJC之间≥6的差异，“联合标准”对FM诊断的敏感性为85%，特异性为87%。使用这些标准，9名（23%）患者被诊断为FM。与RA相比，RA-FM患者的DAS28（5.1 vs 3.3，p=0.01）、TJC（12 vs 3，p<0.001）和患者整体评估（PGA）（58 vs 41，p<001）的值更高，但SJC（1 vs 2，p=0.6）、血沉（ESR）（27 vs 22，p=0.21）的值相似，C反应蛋白（CRP）（8.6 vs 8.4，p=0.6）和超声参数（灰度滑膜炎2.6 vs 3.8，p=0.9；功率多普勒滑膜炎1.2 vs 1.6，p=0.5；灰度Tenosynovitis 0.4 vs 0.3，p=0.3；功率多普勒Tenosynovatis 0.3 vs 0.2，p=0.08）。讨论。我们的研究结果证实了先前发表的关于生物学治疗的RA患者样本的RA-FM诊断和疾病特征的数据。“联合标准”是一种可行的工具，可以很容易地识别RA和FM患者，以改善疾病管理。结论。TJC和SJC之间的差异≥6是RA患者FM的诊断。与没有FM的RA患者相比，满足该标准的患者具有更高的DAS28评分、TJC、PGA，但SJC、ESR、CRP和US评分相似。
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