Gavril Gheorghievici, C. Stoica, B. Mitoiu, Anatoli Covaleov, A. Luchian
Total knee arthroplasty is a frequently met replacement procedure for patients with degenerative knee disease. The main purpose of the intervention is to provide pain relief and to promote range of motion and joint stability for patients in which conservative options such as pharmacological treatment or physical therapy can’t accomplish any more an adequate symptom alleviation. Most guidelines regarding the first stage of the rehabilitation process recommend early mobilization in order to gain as quickly as possible functional independence, and also to promote muscle strength and coordination. This should be done from the first day post surgery, depending on the patients compliance. In the subacute stage, the emphasis is put on maintaining a progression of the weight-bearing status, and promoting normal walking without the use of an assistive device. Patient education will be focused on changes that need to be made in a domestic environment and also modifications regarding social and professional activities. The third phase of the rehabilitation process focuses on limb symmetry and equal weight bearing which represent absolute objectives that need to be obtained. Balance exercises will include progression from bilateral to unilateral, and integration of unstable surfaces if possible associated with cardiovascular training. This phase of the rehabilitation process is considered to be completed once all realistic functional goals are achieved.
{"title":"Adapted rehabilitation protocols for knee arthroplasty - Systematic review of the literature","authors":"Gavril Gheorghievici, C. Stoica, B. Mitoiu, Anatoli Covaleov, A. Luchian","doi":"10.37897/rjr.2023.1.1","DOIUrl":"https://doi.org/10.37897/rjr.2023.1.1","url":null,"abstract":"Total knee arthroplasty is a frequently met replacement procedure for patients with degenerative knee disease. The main purpose of the intervention is to provide pain relief and to promote range of motion and joint stability for patients in which conservative options such as pharmacological treatment or physical therapy can’t accomplish any more an adequate symptom alleviation. Most guidelines regarding the first stage of the rehabilitation process recommend early mobilization in order to gain as quickly as possible functional independence, and also to promote muscle strength and coordination. This should be done from the first day post surgery, depending on the patients compliance. In the subacute stage, the emphasis is put on maintaining a progression of the weight-bearing status, and promoting normal walking without the use of an assistive device. Patient education will be focused on changes that need to be made in a domestic environment and also modifications regarding social and professional activities. The third phase of the rehabilitation process focuses on limb symmetry and equal weight bearing which represent absolute objectives that need to be obtained. Balance exercises will include progression from bilateral to unilateral, and integration of unstable surfaces if possible associated with cardiovascular training. This phase of the rehabilitation process is considered to be completed once all realistic functional goals are achieved.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47125271","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}
Teodora Baciu, Stefan Neculai Nica, S. Daia-Iliescu, A. Borangiu, Claudia Cobilinski, D. Opriș-Belinski, R. Ionescu, I. Saulescu
Cutaneous disease is one of the most frequent manifestations of systemic lupus erythematosus (SLE), being classified as LE-specific and LE-nonspecific. LE-specific skin lesions are divided into acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). The association with systemic involvement varies between each clinical subtype, with non-specific lesions being more frequent associated with active SLE than cutaneous specific lesions. The treatment consists of topical agents (glucocorticoids, topical calcineurin inhibitors) as well as systemic therapies (glucocorticoids, hydroxychloroquine, quinacrine, methotrexate, retinoids, dapsone, mycophenolate mofetil or even biologics). In the presence of strictly cutaneous involvement, periodic patient follow-up and monitoring for the progression to systemic disease remains an important mission for the dermatologist and the rheumatologist.
{"title":"Skin involvement in systemic lupus erythematosus: a review article","authors":"Teodora Baciu, Stefan Neculai Nica, S. Daia-Iliescu, A. Borangiu, Claudia Cobilinski, D. Opriș-Belinski, R. Ionescu, I. Saulescu","doi":"10.37897/rjr.2023.1.2","DOIUrl":"https://doi.org/10.37897/rjr.2023.1.2","url":null,"abstract":"Cutaneous disease is one of the most frequent manifestations of systemic lupus erythematosus (SLE), being classified as LE-specific and LE-nonspecific. LE-specific skin lesions are divided into acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). The association with systemic involvement varies between each clinical subtype, with non-specific lesions being more frequent associated with active SLE than cutaneous specific lesions. The treatment consists of topical agents (glucocorticoids, topical calcineurin inhibitors) as well as systemic therapies (glucocorticoids, hydroxychloroquine, quinacrine, methotrexate, retinoids, dapsone, mycophenolate mofetil or even biologics). In the presence of strictly cutaneous involvement, periodic patient follow-up and monitoring for the progression to systemic disease remains an important mission for the dermatologist and the rheumatologist.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70159367","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}
Mihaela Dragusin, B. Dumitrescu, I. Miler, N. Petre, Virginia Chiţu, C. Popescu, C. Codreanu
Systemic lupus erythematosus (SLE) is the prototype of autoimmune diseases with multiorgan involvement, most commonly targeting the skin, joints and kidneys. The existence and type of renal involvement influence the prognosis and this information may be crucial when it comes to establishing the optimal therapy. We present the case of a patient with SLE with skin involvement (vasculitis), joint manifestations and immunological markers remitted under synthetic remissive treatment but with severe renal damage diagnosed at the renal biopsy as a glomerulosclerosis type focal segmental podocytopathy (FSGS) collapsing variant associated with a possible ultrastructural defect of the glomerular basement membrane in the context of the disease with a severe prognosis.
{"title":"Systemic lupus erythematosus – the discrepancy between renal impairment and clinical and immunological manifestations","authors":"Mihaela Dragusin, B. Dumitrescu, I. Miler, N. Petre, Virginia Chiţu, C. Popescu, C. Codreanu","doi":"10.37897/rjr.2023.1.5","DOIUrl":"https://doi.org/10.37897/rjr.2023.1.5","url":null,"abstract":"Systemic lupus erythematosus (SLE) is the prototype of autoimmune diseases with multiorgan involvement, most commonly targeting the skin, joints and kidneys. The existence and type of renal involvement influence the prognosis and this information may be crucial when it comes to establishing the optimal therapy. We present the case of a patient with SLE with skin involvement (vasculitis), joint manifestations and immunological markers remitted under synthetic remissive treatment but with severe renal damage diagnosed at the renal biopsy as a glomerulosclerosis type focal segmental podocytopathy (FSGS) collapsing variant associated with a possible ultrastructural defect of the glomerular basement membrane in the context of the disease with a severe prognosis.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44238841","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}
Ioan-Teodor Dragoi, A. Burlui, L. Macovei, P. Richter, E. Rezus
Hydroxychloroquine (HCQ) is an antimalarial used in the treatment of patients with systemic lupus erythematosus (SLE). HCQ has a good safety profile and favorable results in terms of controlling clinical manifestations in SLE. In addition to known side effects such as retinal toxicity and neuromusculopathy, prolongation of the QT interval is mentioned in multiple studies. The QT interval can be prolonged due to comorbidities, medication or dyselectrolytemia. QT corrected interval (QTc) durations greater than 470ms for women and greater than 450ms for men are prolonged according to the European Medicines Agency (EMA). QTc interval duration greater than 500ms predisposes to Torsades des Pointes (TdP), a cause of sudden death. The aim of the present work was to present a case of a SLE patient who was treated with HCQ for over 20 years and who showed a prolongation of the QT interval on the electrocardiogram (ECG).
{"title":"Prolongation of the QT interval under treatment with hydroxychloroquine in a patient with systemic lupus erythematosus: A case report","authors":"Ioan-Teodor Dragoi, A. Burlui, L. Macovei, P. Richter, E. Rezus","doi":"10.37897/rjr.2022.4.1","DOIUrl":"https://doi.org/10.37897/rjr.2022.4.1","url":null,"abstract":"Hydroxychloroquine (HCQ) is an antimalarial used in the treatment of patients with systemic lupus erythematosus (SLE). HCQ has a good safety profile and favorable results in terms of controlling clinical manifestations in SLE. In addition to known side effects such as retinal toxicity and neuromusculopathy, prolongation of the QT interval is mentioned in multiple studies. The QT interval can be prolonged due to comorbidities, medication or dyselectrolytemia. QT corrected interval (QTc) durations greater than 470ms for women and greater than 450ms for men are prolonged according to the European Medicines Agency (EMA). QTc interval duration greater than 500ms predisposes to Torsades des Pointes (TdP), a cause of sudden death. The aim of the present work was to present a case of a SLE patient who was treated with HCQ for over 20 years and who showed a prolongation of the QT interval on the electrocardiogram (ECG).","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41315110","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}
Sofian Nachawati, I. Stoica, R. Popescu, Gavril Gheorghievici, Theodor Moldoveanu, E. Haritinian
Isolated lesser tuberosity fracture avulsion without an associated posterior shoulder dislocation or in the context of a three- or four-part proximal humerus fracture are extremely rare, with an estimated incidence rate of only 0.46 persons per 100,000. Diagnosis remains challenging, often leading to delayed treatment. In contrast with fractures of the greater tuberosity, there are no displacement guidelines to assist the surgeon in treatment decision-making for lesser tuberosity fractures. The aim of this study was to highlight diagnostic features as well as surgical treatment. We present a case of a 54-year-old male with an isolated lesser tuberosity fracture avulsion. We performed open reduction and osteosynthesis of the lesser tuberosity fragment with suture anchors and transosseous sutures. At 11-month follow-up the patient was able to normally perform his daily living and professional activities, had full, painless range of motion of the affected shoulder and regained almost full strength.
{"title":"Isolated avulsion fracture of the lesser tuberosity of the humerus","authors":"Sofian Nachawati, I. Stoica, R. Popescu, Gavril Gheorghievici, Theodor Moldoveanu, E. Haritinian","doi":"10.37897/rjr.2022.4.3","DOIUrl":"https://doi.org/10.37897/rjr.2022.4.3","url":null,"abstract":"Isolated lesser tuberosity fracture avulsion without an associated posterior shoulder dislocation or in the context of a three- or four-part proximal humerus fracture are extremely rare, with an estimated incidence rate of only 0.46 persons per 100,000. Diagnosis remains challenging, often leading to delayed treatment. In contrast with fractures of the greater tuberosity, there are no displacement guidelines to assist the surgeon in treatment decision-making for lesser tuberosity fractures. The aim of this study was to highlight diagnostic features as well as surgical treatment. We present a case of a 54-year-old male with an isolated lesser tuberosity fracture avulsion. We performed open reduction and osteosynthesis of the lesser tuberosity fragment with suture anchors and transosseous sutures. At 11-month follow-up the patient was able to normally perform his daily living and professional activities, had full, painless range of motion of the affected shoulder and regained almost full strength.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47944532","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}
Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only one had a markedly improved elbow function with a 90° arc of motion; elbow stiffness had recurred in the other two patients. Of the 5 patients who underwent total elbow arthroplasty, 3 were lost to follow-up; the other 2 patients had a stable elbow, with a fair arc of motion of 60° and 70° respectively, both with a flexion contracture of 20°. Complications included 2 superficial infections, which healed following conservative treatment, and one fracture following remodeling of a malunited distal fracture of the humerus. In the treatment of the posttraumatic stiffness of the elbow, the arthrolysis and the arthroplasty are indicated in dependence on the existent (extrinsic or intrinsic) lesions and on their severity.
{"title":"Open arthrolysis versus arthroplasty in the treatment of posttraumatic elbow stiffness","authors":"D. Antonescu, D. Schiopu, I. Stoica","doi":"10.37897/rjr.2022.4.6","DOIUrl":"https://doi.org/10.37897/rjr.2022.4.6","url":null,"abstract":"Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only one had a markedly improved elbow function with a 90° arc of motion; elbow stiffness had recurred in the other two patients. Of the 5 patients who underwent total elbow arthroplasty, 3 were lost to follow-up; the other 2 patients had a stable elbow, with a fair arc of motion of 60° and 70° respectively, both with a flexion contracture of 20°. Complications included 2 superficial infections, which healed following conservative treatment, and one fracture following remodeling of a malunited distal fracture of the humerus. In the treatment of the posttraumatic stiffness of the elbow, the arthrolysis and the arthroplasty are indicated in dependence on the existent (extrinsic or intrinsic) lesions and on their severity.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45521670","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}
I. Dinu, M. Abobului, F. Berghea, C. Cobilinschi, Cristiana Prefac, D. Opriș-Belinski, A. Balanescu
Osteomyelitis pubis (OP) is a rare type of infection involving the pubic bones that often poses diagnostic and consecutive therapeutic problems. The infection can be mono or polymicrobial, bacterial, mycotic or bacillary with Staphylococcus aureus being the most common infectious agent involved. OP is generally seen in immune-suppressed patients of oncologic and diabetic population or in pediatric and geriatric subjects. The main symptom is represented by local pain with radiation to thighs which in later stages is accompanied by general non-specific symptoms such as malaise, fever and loss of appetite. The specificity-lacking initial presentation often leads to diagnostic delays which furthermore decrease the effectiveness of drug therapy, leading to higher chances of bone and joint destruction. Initial therapy consists of empirical antibiotherapy that should cover Staph. aureus; depending on culture results, the scheme should be changed accordingly. Moreover, symptomatic treatment of pain and inflammation consisting of NSAIDs, small dose glucocorticoids and minor opioids should be considered. Selected cases may benefit from surgical intervention when improvement or remission is considered improbable under drug therapy or when severe bony destructions are present.
{"title":"“50 shades of groin pain” in an unusual case of osteomyelitis pubis following surgery","authors":"I. Dinu, M. Abobului, F. Berghea, C. Cobilinschi, Cristiana Prefac, D. Opriș-Belinski, A. Balanescu","doi":"10.37897/rjr.2022.4.2","DOIUrl":"https://doi.org/10.37897/rjr.2022.4.2","url":null,"abstract":"Osteomyelitis pubis (OP) is a rare type of infection involving the pubic bones that often poses diagnostic and consecutive therapeutic problems. The infection can be mono or polymicrobial, bacterial, mycotic or bacillary with Staphylococcus aureus being the most common infectious agent involved. OP is generally seen in immune-suppressed patients of oncologic and diabetic population or in pediatric and geriatric subjects. The main symptom is represented by local pain with radiation to thighs which in later stages is accompanied by general non-specific symptoms such as malaise, fever and loss of appetite. The specificity-lacking initial presentation often leads to diagnostic delays which furthermore decrease the effectiveness of drug therapy, leading to higher chances of bone and joint destruction. Initial therapy consists of empirical antibiotherapy that should cover Staph. aureus; depending on culture results, the scheme should be changed accordingly. Moreover, symptomatic treatment of pain and inflammation consisting of NSAIDs, small dose glucocorticoids and minor opioids should be considered. Selected cases may benefit from surgical intervention when improvement or remission is considered improbable under drug therapy or when severe bony destructions are present.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48642629","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}
Maria-Luciana Loghinoaia, A. Burlui, A. Cardoneanu, I. Bratoiu, E. Rezus
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a considerable global effect, posing notable challenges for clinicians, the pandemic becoming one of the most imperative international health emergencies lately. Among other more frequent manifestations, SARS-CoV-2 disease may also give rise to skeletal muscle involvement. Viral-induced skeletal muscle involvement is a potentially severe manifestation of COVID-19 (Coronavirus Disease 2019) and may be either acute, or in the context of “long-COVID”. The present review aimed to illustrate few aspects about pathomechanisms, clinical and paraclinical frames, and treatment options for SARS-CoV-2-induced muscle involvement. Notably, it has been stated that SARS-CoV-2 may have the ability to invade muscle myocytes directly, the disease having a variety of clinical manifestations, from myalgia and muscle weakness to rhabdomyolysis. Nevertheless, it is also important to take into account that most of patients with severe forms receiving mechanical ventilation for more than one week may have complications such as CIM (critical illness myopathy) and/or CIP (critical illness polyneuropathy) that may be clinically similar to SARS-CoV-2-induced myositis, yet may be differentiated paraclinically from it. Additionally, it was hypothesized that SARS-CoV-2 infection may constitute a trigger for autoimmune diseases such as polymyositis/ dermatomyositis. Presently, there are no diagnosis criteria and no specific therapeutic strategy for SARS-CoV-2-induced myositis.
{"title":"SARS-CoV-2-induced myopathy: Clinical aspects, paraclinical changes, and therapeutic options","authors":"Maria-Luciana Loghinoaia, A. Burlui, A. Cardoneanu, I. Bratoiu, E. Rezus","doi":"10.37897/rjr.2022.4.5","DOIUrl":"https://doi.org/10.37897/rjr.2022.4.5","url":null,"abstract":"The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a considerable global effect, posing notable challenges for clinicians, the pandemic becoming one of the most imperative international health emergencies lately. Among other more frequent manifestations, SARS-CoV-2 disease may also give rise to skeletal muscle involvement. Viral-induced skeletal muscle involvement is a potentially severe manifestation of COVID-19 (Coronavirus Disease 2019) and may be either acute, or in the context of “long-COVID”. The present review aimed to illustrate few aspects about pathomechanisms, clinical and paraclinical frames, and treatment options for SARS-CoV-2-induced muscle involvement. Notably, it has been stated that SARS-CoV-2 may have the ability to invade muscle myocytes directly, the disease having a variety of clinical manifestations, from myalgia and muscle weakness to rhabdomyolysis. Nevertheless, it is also important to take into account that most of patients with severe forms receiving mechanical ventilation for more than one week may have complications such as CIM (critical illness myopathy) and/or CIP (critical illness polyneuropathy) that may be clinically similar to SARS-CoV-2-induced myositis, yet may be differentiated paraclinically from it. Additionally, it was hypothesized that SARS-CoV-2 infection may constitute a trigger for autoimmune diseases such as polymyositis/ dermatomyositis. Presently, there are no diagnosis criteria and no specific therapeutic strategy for SARS-CoV-2-induced myositis.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48533890","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}
E. Jugănaru, C. Cobilinschi, C. Constantinescu, P. Hoara, C. Iosif, F. Mehic, A. Balanescu
Adult-onset polymyositis (PM) belongs to the idiopathic inflammatory myopathy (IIM) group and manifests with proximal muscle weakness, elevated muscle enzymes and positive myositis- specific antibodies. The subset of autoantibodies can indicate a higher risk for cancer association. An 82-year-old diabetic patient, with multiple cardio-vascular comorbidities, was hospitalized for muscle weakness of the upper girdle, dysphagia and dysphonia, accompanied by elevated serum muscle enzymes. Muscle biopsy showed an inflammatory infiltrate while immunological assays found positive ANA and anti-NXP2 antibodies. The diagnosis of PM was established, thus a screening for underlying neoplasia was required. Upper endoscopy visualized an area of ectopic mucosa in the esophagogastric junction and the biopsy confirmed a squamous cell carcinoma in situ. Patient had favorable muscle outcome under methylprednisolone pulse therapy. It is worth noting that polymyositis is more rarely associated with cancers as compared to dermatomyositis (DM). In conclusion, the type of antibodies identified in myositis can represent an alarm signal for oncologic screening, making possible an early diagnosis and efficient treatment of a hidden tumor.
{"title":"“Playing detective” in a case of paraneoplastic polymyositis","authors":"E. Jugănaru, C. Cobilinschi, C. Constantinescu, P. Hoara, C. Iosif, F. Mehic, A. Balanescu","doi":"10.37897/rjr.2022.4.4","DOIUrl":"https://doi.org/10.37897/rjr.2022.4.4","url":null,"abstract":"Adult-onset polymyositis (PM) belongs to the idiopathic inflammatory myopathy (IIM) group and manifests with proximal muscle weakness, elevated muscle enzymes and positive myositis- specific antibodies. The subset of autoantibodies can indicate a higher risk for cancer association. An 82-year-old diabetic patient, with multiple cardio-vascular comorbidities, was hospitalized for muscle weakness of the upper girdle, dysphagia and dysphonia, accompanied by elevated serum muscle enzymes. Muscle biopsy showed an inflammatory infiltrate while immunological assays found positive ANA and anti-NXP2 antibodies. The diagnosis of PM was established, thus a screening for underlying neoplasia was required. Upper endoscopy visualized an area of ectopic mucosa in the esophagogastric junction and the biopsy confirmed a squamous cell carcinoma in situ. Patient had favorable muscle outcome under methylprednisolone pulse therapy. It is worth noting that polymyositis is more rarely associated with cancers as compared to dermatomyositis (DM). In conclusion, the type of antibodies identified in myositis can represent an alarm signal for oncologic screening, making possible an early diagnosis and efficient treatment of a hidden tumor.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44062175","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}
Ana-Maria Doca, Andreea Odobasu, Andreea Hortolomei, M. Russu, A. Popescu, C. Pomîrleanu, G. Strugariu, C. Ancuța
Introduction. Spondyloarthritis (SpA) represent a heterogeneous group of chronic inflammatory conditions sharing clinical, genetic, imaging and therapeutic features. Objectives. To analyze the clinical and biological characteristics, disease activity and functional impact in non-radiographic axial SpA (nr-axSpA) versus ankylosing spondylitis (AS). Material and method. Cross-sectional observational 12 months study on 46 patients with axial SpA; disease related parameters (clinical, biological, activity and functionality indices) and treatment options were compared in disease categories (nr-axSpA and AS). Outcomes. AS was diagnosed in 73.9%, and nr-axSpA in 26.1% cases. The majority of patients with nr-axSpA were women (72% vs 28%), with a younger age at onset (35.2±9.5 years vs 41±0.6 years) and a shorter time to diagnosis (3±0.5 vs 5.5±3.2 years). C-reactive protein levels were significantly higher in AS compared to nr-axSpA (2.2±0.5 vs 1.28±0.7)(p<0.05). However, there were no significant differences between activity (ASDAS-CRP: 3.4±1.2 vs 3.2±0.9; BASDAI: 5.8±1.3 vs 5.6±1.1) and functionality measures (BASFI: 5.8±1.4 vs 5.7±1.2) in (p >0.05) in AS vs nr-axSpA. Conclusions. Although nr-axSpA occurs frequently in women and may present with lower CRP levels, there are similar trends in disease activity and functional outcomes in both disease categories of the ax-SpA spectrum. Both nr-axSpA and AS patients experience high disease burden.
介绍脊椎关节炎（SpA）是一组具有临床、遗传、影像学和治疗特征的异质性慢性炎症疾病。目标。分析非放射学轴性SpA（nr-ax-SpA）与强直性脊柱炎（AS）的临床和生物学特征、疾病活动性和功能影响。材料和方法。46例轴性SpA患者12个月的横断面观察研究；在疾病类别（nr-axSpA和AS）中比较疾病相关参数（临床、生物学、活性和功能指数）和治疗方案。结果。AS诊断率为73.9%，nr-axSpA诊断率为26.1%。大多数nr-axSpA患者为女性（72%对28%），发病年龄较小（35.2±9.5岁对41±0.6岁），诊断时间较短（3±0.5对5.5±3.2岁）。AS组的C反应蛋白水平显著高于nr-axSpA组（2.2±0.5 vs 1.28±0.7）（p0.05）。结论。尽管nr-ax-SpA在女性中经常发生，并且可能表现出较低的CRP水平，但在ax-SpA谱的两种疾病类别中，疾病活动性和功能结果的趋势相似。nr-axSpA和AS患者都有较高的疾病负担。
{"title":"Disease activity and functional outcomes in non-radiographic spondyloarthritis versus ankylosing spondylitis – preliminary results","authors":"Ana-Maria Doca, Andreea Odobasu, Andreea Hortolomei, M. Russu, A. Popescu, C. Pomîrleanu, G. Strugariu, C. Ancuța","doi":"10.37897/rjr.2022.3.8","DOIUrl":"https://doi.org/10.37897/rjr.2022.3.8","url":null,"abstract":"Introduction. Spondyloarthritis (SpA) represent a heterogeneous group of chronic inflammatory conditions sharing clinical, genetic, imaging and therapeutic features. Objectives. To analyze the clinical and biological characteristics, disease activity and functional impact in non-radiographic axial SpA (nr-axSpA) versus ankylosing spondylitis (AS). Material and method. Cross-sectional observational 12 months study on 46 patients with axial SpA; disease related parameters (clinical, biological, activity and functionality indices) and treatment options were compared in disease categories (nr-axSpA and AS). Outcomes. AS was diagnosed in 73.9%, and nr-axSpA in 26.1% cases. The majority of patients with nr-axSpA were women (72% vs 28%), with a younger age at onset (35.2±9.5 years vs 41±0.6 years) and a shorter time to diagnosis (3±0.5 vs 5.5±3.2 years). C-reactive protein levels were significantly higher in AS compared to nr-axSpA (2.2±0.5 vs 1.28±0.7)(p<0.05). However, there were no significant differences between activity (ASDAS-CRP: 3.4±1.2 vs 3.2±0.9; BASDAI: 5.8±1.3 vs 5.6±1.1) and functionality measures (BASFI: 5.8±1.4 vs 5.7±1.2) in (p >0.05) in AS vs nr-axSpA. Conclusions. Although nr-axSpA occurs frequently in women and may present with lower CRP levels, there are similar trends in disease activity and functional outcomes in both disease categories of the ax-SpA spectrum. Both nr-axSpA and AS patients experience high disease burden.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44251111","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}
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