C. Cobilinschi, Flavia Dumitru, R. Ionescu, D. Opriș-Belinski
Nutrition has been identified as playing a significant role in inflammatory rheumatic conditions. Available recommendations for managing these diseases have recently included lifestyle changes as well as dietary advice as complementary to pharmacological treatments. This is a summary of the first dietary recommendations for patients suffering from rheumatic diseases, postulated by the French Society for Rheumatology. The work was performed by a group of multidisciplinary experts and it was based on a systematic literature review of available published data, also considering the quality of studies. The eight principles and nine recommendations issued target both joint and extra-articular effects of nutritional intervention. The recommendations state following a Mediterranean diet, supplementation of omega-3 polyunsaturated fatty acids. Restrictive-type diets like gluten-free, dairy-free, fasting or vitamins and trace elements supplementation are not recommended because of lack of scientifically proven benefit. The use of probiotics or spices have insufficient rationale to be recommended.
{"title":"Welcoming clinical nutrition in Rheumatology – summary of first dietary recommendations for patients with chronic inflammatory rheumatic conditions","authors":"C. Cobilinschi, Flavia Dumitru, R. Ionescu, D. Opriș-Belinski","doi":"10.37897/rjr.2022.1.3","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.3","url":null,"abstract":"Nutrition has been identified as playing a significant role in inflammatory rheumatic conditions. Available recommendations for managing these diseases have recently included lifestyle changes as well as dietary advice as complementary to pharmacological treatments. This is a summary of the first dietary recommendations for patients suffering from rheumatic diseases, postulated by the French Society for Rheumatology. The work was performed by a group of multidisciplinary experts and it was based on a systematic literature review of available published data, also considering the quality of studies. The eight principles and nine recommendations issued target both joint and extra-articular effects of nutritional intervention. The recommendations state following a Mediterranean diet, supplementation of omega-3 polyunsaturated fatty acids. Restrictive-type diets like gluten-free, dairy-free, fasting or vitamins and trace elements supplementation are not recommended because of lack of scientifically proven benefit. The use of probiotics or spices have insufficient rationale to be recommended.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45107892","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}
Objective: we aimed to estimate the long-term global cardiovascular risk (GCVR) in patients with psoriatic arthritis (PsA) and to identify factors correlated with this risk among traditional and non-traditional risk factors. Material and method: cross-sectional observational study enrolling 45 consecutive patients with PsA without known atherosclerotic disease or heart failure, attending an outpatient rheumatology department over 12 months. Disease-related parameters (clinical phenotype, inflammation tests, type of medication), traditional cardiovascular risk factors (smoking, obesity, dyslipidemia, hypertension, diabetes) and 10-year GCVR (Framingham Heart Study online platform) were collected in all patients according to a predefined protocol. Results: 57.77% of patients were female, with a mean age of 52.1 years; hypertension (46.66%), dyslipidemia and current smoking (20% each) were reported as main traditional cardiovascular risk factors in our cohort. 46.67% patients presented with high cardiovascular risk, 37.78% with intermediate risk, while only 15.55% with low risk. Framingham risk score correlated with coronary atherosclerosis, its sensitivity for the detection of CV risk factors being high (p<0.05). However, no statistically significant correlation was identified between moderate and elevated cardiovascular risk score and lipids, DAPSA score, pain severity and body mass index (p>0.05). Conclusion: Traditional cardiovascular risk factors were reported in a significant proportion of PsA patients, but cannot entirely explain the global cardiovascular risk; additionally, more than half of patients were stratified as having high or intermediate cardiovascular risk. Different factors could interfere with 10-year cardiovascular risk.
{"title":"Where borders meet: Psoriasic arthritis and the cardiovascular risk","authors":"Ana-Maria Doca, C. Pomîrleanu, C. Ancuța","doi":"10.37897/rjr.2022.1.7","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.7","url":null,"abstract":"Objective: we aimed to estimate the long-term global cardiovascular risk (GCVR) in patients with psoriatic arthritis (PsA) and to identify factors correlated with this risk among traditional and non-traditional risk factors. Material and method: cross-sectional observational study enrolling 45 consecutive patients with PsA without known atherosclerotic disease or heart failure, attending an outpatient rheumatology department over 12 months. Disease-related parameters (clinical phenotype, inflammation tests, type of medication), traditional cardiovascular risk factors (smoking, obesity, dyslipidemia, hypertension, diabetes) and 10-year GCVR (Framingham Heart Study online platform) were collected in all patients according to a predefined protocol. Results: 57.77% of patients were female, with a mean age of 52.1 years; hypertension (46.66%), dyslipidemia and current smoking (20% each) were reported as main traditional cardiovascular risk factors in our cohort. 46.67% patients presented with high cardiovascular risk, 37.78% with intermediate risk, while only 15.55% with low risk. Framingham risk score correlated with coronary atherosclerosis, its sensitivity for the detection of CV risk factors being high (p<0.05). However, no statistically significant correlation was identified between moderate and elevated cardiovascular risk score and lipids, DAPSA score, pain severity and body mass index (p>0.05). Conclusion: Traditional cardiovascular risk factors were reported in a significant proportion of PsA patients, but cannot entirely explain the global cardiovascular risk; additionally, more than half of patients were stratified as having high or intermediate cardiovascular risk. Different factors could interfere with 10-year cardiovascular risk.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43302697","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}
Ramona Georgiana Varse, N. Gică, R. Botezatu, G. Peltecu, A. Panaitescu
Hydroxychloroquine (HCQ) is an antimalarial drug containing a 4-aminoquinoline radical, with immunomodulatory, antioxidant, anti-inflammatory and vascular protective effects, which is widely used in the treatment of various rheumatological conditions and is also compatible with pregnancy. It is well known that hydroxychloroquine crosses the placental barrier and hence it can protect against adverse perinatal outcomes, such as congenital heart block in fetuses of anti-SSA/Ro positive mothers. When it is administered at daily doses inferior or equal to 400 mg, HCQ is not associated with augmented risk of perinatal morbidity and it has also been found to prevent disease flares among pregnant women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), improving maternal outcomes and being protective toward fetal health as well. However, the concerns about its safety in pregnancy are still present because studies on the risks of perinatal defects associated with HCQ administration arise sparse and have controversial results. The purpose of the current article is to make a review of the medical literature concerning the safety of HCQ in pregnancy. For this purpose, scientific research in online medical publications such as Elsevier, PubMed, and The Lancet, was conducted.
{"title":"Hydroxychloroquine - safety in pregnancy","authors":"Ramona Georgiana Varse, N. Gică, R. Botezatu, G. Peltecu, A. Panaitescu","doi":"10.37897/rjr.2022.1.1","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.1","url":null,"abstract":"Hydroxychloroquine (HCQ) is an antimalarial drug containing a 4-aminoquinoline radical, with immunomodulatory, antioxidant, anti-inflammatory and vascular protective effects, which is widely used in the treatment of various rheumatological conditions and is also compatible with pregnancy. It is well known that hydroxychloroquine crosses the placental barrier and hence it can protect against adverse perinatal outcomes, such as congenital heart block in fetuses of anti-SSA/Ro positive mothers. When it is administered at daily doses inferior or equal to 400 mg, HCQ is not associated with augmented risk of perinatal morbidity and it has also been found to prevent disease flares among pregnant women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), improving maternal outcomes and being protective toward fetal health as well. However, the concerns about its safety in pregnancy are still present because studies on the risks of perinatal defects associated with HCQ administration arise sparse and have controversial results. The purpose of the current article is to make a review of the medical literature concerning the safety of HCQ in pregnancy. For this purpose, scientific research in online medical publications such as Elsevier, PubMed, and The Lancet, was conducted.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48434918","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. Agache, C. Mogoșan, C. Popescu, S. Gabriel, C. Codreanu
Haemophagocytic lymphohistiocytosis (HLH) is an underrecognized hyperinflammatory condition with a high mortality, characterized by inappropriate survival of histiocytes and cytotoxic T cells (CTLs), leading to a cytokine storm, haemophagocytosis and multi-organ damage (1). The currently accepted terminology includes two forms of HLH: the primary or familial HLH (fHLH) and the secondary HLH (sHLH) (2). The sHLH associated with rheumatic conditions is known as macrophage activation syndrome (MAS). MAS can develop at any time during the evolution of the rheumatic diseases: at the beginning, during flare of the disease or during intercurrent infections – mostly with viral trigger. We present a case of MAS in an patient with adult-onset Still Disease. It is of great importance to be recognized in early stages, because if promptly treated it might respond well to combination therapy of glucocorticoids and IL1- blockers.
{"title":"Macrophage Activated Syndrome associated with Adult Onset Still Disease","authors":"M. Agache, C. Mogoșan, C. Popescu, S. Gabriel, C. Codreanu","doi":"10.37897/rjr.2022.1.8","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.8","url":null,"abstract":"Haemophagocytic lymphohistiocytosis (HLH) is an underrecognized hyperinflammatory condition with a high mortality, characterized by inappropriate survival of histiocytes and cytotoxic T cells (CTLs), leading to a cytokine storm, haemophagocytosis and multi-organ damage (1). The currently accepted terminology includes two forms of HLH: the primary or familial HLH (fHLH) and the secondary HLH (sHLH) (2). The sHLH associated with rheumatic conditions is known as macrophage activation syndrome (MAS). MAS can develop at any time during the evolution of the rheumatic diseases: at the beginning, during flare of the disease or during intercurrent infections – mostly with viral trigger. We present a case of MAS in an patient with adult-onset Still Disease. It is of great importance to be recognized in early stages, because if promptly treated it might respond well to combination therapy of glucocorticoids and IL1- blockers.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44577634","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}
R. Dumitrașcu, F. Vreju, A. Bărbulescu, Beatrice Andreea Trasca, R. Dascǎlu, Cristina Elena Gofiţă, P. Ciurea, Ș. Dinescu
The potential benefit gained from ultrasonography examination of the enthesis been extensively studied. Enthesitis plays a key role in pathogenesis of spondyloarthritis and thus, understanding the diagnostic and therapeutic implications has shaped the way clinicians view its importance in clinical practice. The development of high-quality imaging technologies offered a great opportunity to obtain more detailed analysis of the enthesis structure and also differentiate acute from chronic lesions. Several taskforce groups, including OMERACT, highlighted the diagnostic performance of ultrasonography for the detection of enthesitis. Panels of experts have also provided consensus-based definitions of elementary lesions in order to standardize the approach of US-defined enthesitis. Enthesitis is considered one of the main clinical domains in psoriatic arthritis patients and several trials have adopted its use as a potential outcome measure, although research carried out until now, still lacks uniformity between methods used to assess enthesitis. Multiple semiquantitative scoring systems of enthesitis using ultrasonography have been developed in the last two decades and these may provide a more standardized approach in future research.
{"title":"Enthesitis – a review on the ultrasonographic assessment","authors":"R. Dumitrașcu, F. Vreju, A. Bărbulescu, Beatrice Andreea Trasca, R. Dascǎlu, Cristina Elena Gofiţă, P. Ciurea, Ș. Dinescu","doi":"10.37897/rjr.2022.1.5","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.5","url":null,"abstract":"The potential benefit gained from ultrasonography examination of the enthesis been extensively studied. Enthesitis plays a key role in pathogenesis of spondyloarthritis and thus, understanding the diagnostic and therapeutic implications has shaped the way clinicians view its importance in clinical practice. The development of high-quality imaging technologies offered a great opportunity to obtain more detailed analysis of the enthesis structure and also differentiate acute from chronic lesions. Several taskforce groups, including OMERACT, highlighted the diagnostic performance of ultrasonography for the detection of enthesitis. Panels of experts have also provided consensus-based definitions of elementary lesions in order to standardize the approach of US-defined enthesitis. Enthesitis is considered one of the main clinical domains in psoriatic arthritis patients and several trials have adopted its use as a potential outcome measure, although research carried out until now, still lacks uniformity between methods used to assess enthesitis. Multiple semiquantitative scoring systems of enthesitis using ultrasonography have been developed in the last two decades and these may provide a more standardized approach in future research.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47529296","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. Stănescu, Marius Donici, I. Grăjdeanu, A. Simionescu
Improving the aged population’s health is a complex goal that requires a multifactorial approach and the knowledge of etiopathogenic factors. Osteoarthritis is the most common joint disease and the second leading cause of disability in people over the age of 50, which has a substantial economic impact and turns into a real social and public health problem. Although it manifested in less than 30% of the older population, pathological changes in the articular cartilage are founded in all deaths over 65 years. That is why we consider primary prophylaxis an important goal for the disease. This minireview presents etiological factors as genetic predisposition, age, body mass index, sex, bone density and the pathogenic degradation of articular cartilage. This includes two aspects of evolution, the progressive degradation of the articular cartilage and the reparative reaction of the subchondral bone. In conclusion, knowing these mechanisms are the first step in managing degenerative joint pathology.
{"title":"Influences in degenerative joint pathology","authors":"A. Stănescu, Marius Donici, I. Grăjdeanu, A. Simionescu","doi":"10.37897/rjr.2022.1.6","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.6","url":null,"abstract":"Improving the aged population’s health is a complex goal that requires a multifactorial approach and the knowledge of etiopathogenic factors. Osteoarthritis is the most common joint disease and the second leading cause of disability in people over the age of 50, which has a substantial economic impact and turns into a real social and public health problem. Although it manifested in less than 30% of the older population, pathological changes in the articular cartilage are founded in all deaths over 65 years. That is why we consider primary prophylaxis an important goal for the disease. This minireview presents etiological factors as genetic predisposition, age, body mass index, sex, bone density and the pathogenic degradation of articular cartilage. This includes two aspects of evolution, the progressive degradation of the articular cartilage and the reparative reaction of the subchondral bone. In conclusion, knowing these mechanisms are the first step in managing degenerative joint pathology.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48436683","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.A Badea, M. Bojincă, M. Milicescu, O. Vutcanu, A. Ilina
Background. Osteoporosis is a frequent comorbidity among patients with inflammatory rheumatic diseases, due to the impact of their therapies, the hish systemic inflammation and the large scale use of glucocorticoid treatment. Use of DXA and REMS. Dual X-ray Absorptiometry (DXA) is the “gold standard” for detecting patients with low bone mineral density (BMD), using Z and T scores to define the thresholds for diagnosis of osteopenia and osteoporosis, but this method has proven many disadvantages in time, especially in patients with inflammatory rheumatic diseases, those diagnosed with a disease in the spectrum of spondyloarthritides. Therefore, in the last years, a new method of evaluating bone mineral density (BMD) was developed and benefited from numerous efficiency studies: REMS (Radiofrequency Echographic Multi-Spectrometry). The basis of the method is its ability to identify and analyze native unfiltered ultrasound waves that reflect from the bone surface of the vertebra and femoral neck, the so-called echographic radiofrequency (RF) waves. The analysis of all RF waves spectra allows both a quantitative as well as a qualitative assessment of the bone, thus effectively obtaining estimates of bone resistance and evaluating fracture risk through indirect analysis of bone architecture. Conclusions. The studies concluded that REMS is a method at least as good as DXA in detecting patients with osteoporosis by applying the definitions of the World Health Organization (WHO), and also discovered many advantages of the REMS method, probably the biggest advantages being the ability of this ultrasound method of evaluating bone fragility independent of BMD by introducing the Fragility Score (FS) and the possibility of using the ultrasound method in identifying bone demineralization and fragility in pregnant women. Furthermore, numerous studies begin to recognize the usefulness of REMS in diagnosis and evolution of patients with osteoporosis and inflammatory rheumatic diseases. Discussions. A new concept that should be considered is the fact that REMS could potentially more accurately evaluate BMD and bone fragility through the FS in patients with diseases from the spectrum of spondyloarthritides(especially those with ankylosing spondylitis and psoriatic arthritis).
{"title":"Literature review of Radiofrequency Echographic Multi-Spectrometry (REMS) in the diagnosis of osteoporosis and bone fragility","authors":"I.A Badea, M. Bojincă, M. Milicescu, O. Vutcanu, A. Ilina","doi":"10.37897/rjr.2022.1.4","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.4","url":null,"abstract":"Background. Osteoporosis is a frequent comorbidity among patients with inflammatory rheumatic diseases, due to the impact of their therapies, the hish systemic inflammation and the large scale use of glucocorticoid treatment. Use of DXA and REMS. Dual X-ray Absorptiometry (DXA) is the “gold standard” for detecting patients with low bone mineral density (BMD), using Z and T scores to define the thresholds for diagnosis of osteopenia and osteoporosis, but this method has proven many disadvantages in time, especially in patients with inflammatory rheumatic diseases, those diagnosed with a disease in the spectrum of spondyloarthritides. Therefore, in the last years, a new method of evaluating bone mineral density (BMD) was developed and benefited from numerous efficiency studies: REMS (Radiofrequency Echographic Multi-Spectrometry). The basis of the method is its ability to identify and analyze native unfiltered ultrasound waves that reflect from the bone surface of the vertebra and femoral neck, the so-called echographic radiofrequency (RF) waves. The analysis of all RF waves spectra allows both a quantitative as well as a qualitative assessment of the bone, thus effectively obtaining estimates of bone resistance and evaluating fracture risk through indirect analysis of bone architecture. Conclusions. The studies concluded that REMS is a method at least as good as DXA in detecting patients with osteoporosis by applying the definitions of the World Health Organization (WHO), and also discovered many advantages of the REMS method, probably the biggest advantages being the ability of this ultrasound method of evaluating bone fragility independent of BMD by introducing the Fragility Score (FS) and the possibility of using the ultrasound method in identifying bone demineralization and fragility in pregnant women. Furthermore, numerous studies begin to recognize the usefulness of REMS in diagnosis and evolution of patients with osteoporosis and inflammatory rheumatic diseases. Discussions. A new concept that should be considered is the fact that REMS could potentially more accurately evaluate BMD and bone fragility through the FS in patients with diseases from the spectrum of spondyloarthritides(especially those with ankylosing spondylitis and psoriatic arthritis).","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43006063","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}
C. Avram, R. Drăgoi, M. Bojincă, H. Popoviciu, C. A. Avram
The most common types of crystal arthropathies are gout and calcium pyrophosphate deposition (CPPD) disease. Serum urate levels are influenced by a combination of genetic factors and the environment. There are studies estimating the heritability of urate ranging from 45% to 73%. Approximately 3% of the variance in serum urate level is explained by the locus SLC2A9. Among the Caucasian population, 10% of all gout cases may be largely attributable to locus ABCG2. Loss or reduction function of ABCG2 halves the kidney’s ability to secrete uric acid. Gain-of-function mutations in ENPP1 gene may be involved in the development of CPPD disease. Loss-of-function mutations in ANKH leads to excess calcium hydroxyapatite formation. Conclusions: There is reason to believe that studying susceptibility genes for the crystal arthropathies will contribute to our understanding of the complexity of inheritance of these disorders. At present many other genes involved in crystal arthropathies are being investigated, and we hope that soon, novel therapeutic targets will be found.
{"title":"Heritability of crystal related arthropathies","authors":"C. Avram, R. Drăgoi, M. Bojincă, H. Popoviciu, C. A. Avram","doi":"10.37897/rjr.2022.1.2","DOIUrl":"https://doi.org/10.37897/rjr.2022.1.2","url":null,"abstract":"The most common types of crystal arthropathies are gout and calcium pyrophosphate deposition (CPPD) disease. Serum urate levels are influenced by a combination of genetic factors and the environment. There are studies estimating the heritability of urate ranging from 45% to 73%. Approximately 3% of the variance in serum urate level is explained by the locus SLC2A9. Among the Caucasian population, 10% of all gout cases may be largely attributable to locus ABCG2. Loss or reduction function of ABCG2 halves the kidney’s ability to secrete uric acid. Gain-of-function mutations in ENPP1 gene may be involved in the development of CPPD disease. Loss-of-function mutations in ANKH leads to excess calcium hydroxyapatite formation. Conclusions: There is reason to believe that studying susceptibility genes for the crystal arthropathies will contribute to our understanding of the complexity of inheritance of these disorders. At present many other genes involved in crystal arthropathies are being investigated, and we hope that soon, novel therapeutic targets will be found.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42765780","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}
Systemic lupus erythematosus (SLE) is common in women of reproductive age and can have serious consequences on pregnancy outcomes. Recent updates in the clinical management of this condition have brought improvements for mothers affected and their babies. The aim of this general review is to offer the perspective of the maternal-fetal medicine specialist on the recent updates in clinical management of SLE in pregnancy and to bring into the attention of the rheumatology specialists the tools that obstetricians have nowadays in monitoring high-risk pregnancies.
{"title":"Clinical updates on systemic lupus erythematosus in pregnancy – the maternal-fetal medicine perspective","authors":"A. Panaitescu, G. Peltecu, N. Gică","doi":"10.37897/rjr.2021.4.3","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.3","url":null,"abstract":"Systemic lupus erythematosus (SLE) is common in women of reproductive age and can have serious consequences on pregnancy outcomes. Recent updates in the clinical management of this condition have brought improvements for mothers affected and their babies. The aim of this general review is to offer the perspective of the maternal-fetal medicine specialist on the recent updates in clinical management of SLE in pregnancy and to bring into the attention of the rheumatology specialists the tools that obstetricians have nowadays in monitoring high-risk pregnancies.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44281568","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. Simionescu, S. Daia-Iliescu, C. Cobilinschi, R. Ionescu, D. Opriș-Belinski
Impaired fertility is an important public health concern, especially in patients with immune-mediated rheumatic conditions. Frequency of infertility /subfertility vary among rheumatic diseases – higher in systemic lupus erythematosus or rheumatoid arthritis, than in other autoimmune diseases. Risk factors like age, nulliparity, disease activity or medication such as NSAIDs, corticosteroids, cyclophosphamide are mostly encountered. Treating a pregnant woman is a challenge: the well-being of mother and child has to be considered, as tight disease control before, during pregnancy and postpartum is mandatory to minimize adverse outcome risk. Safety of biological therapies during preconception, pregnancy, and postpartum is crucial, anti-TNFs being safe in early pregnancy, second, but not third trimester. Etanercept and certolizumab may be considered for use throughout pregnancy due to low rate of transplacental passage. Concerning the child, live-attenuated vaccines are to be avoided for the first 6 months of life due to persistence of biologics.
{"title":"Fertility and pregnancy outcomes in patients with immune-mediated rheumatic diseases","authors":"A. Simionescu, S. Daia-Iliescu, C. Cobilinschi, R. Ionescu, D. Opriș-Belinski","doi":"10.37897/rjr.2021.4.1","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.1","url":null,"abstract":"Impaired fertility is an important public health concern, especially in patients with immune-mediated rheumatic conditions. Frequency of infertility /subfertility vary among rheumatic diseases – higher in systemic lupus erythematosus or rheumatoid arthritis, than in other autoimmune diseases. Risk factors like age, nulliparity, disease activity or medication such as NSAIDs, corticosteroids, cyclophosphamide are mostly encountered. Treating a pregnant woman is a challenge: the well-being of mother and child has to be considered, as tight disease control before, during pregnancy and postpartum is mandatory to minimize adverse outcome risk. Safety of biological therapies during preconception, pregnancy, and postpartum is crucial, anti-TNFs being safe in early pregnancy, second, but not third trimester. Etanercept and certolizumab may be considered for use throughout pregnancy due to low rate of transplacental passage. Concerning the child, live-attenuated vaccines are to be avoided for the first 6 months of life due to persistence of biologics.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43795529","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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