C. Cobilinschi, C. Cobilinschi, A. Constantinescu, R. Ionescu, D. Opriș-Belinski
Dermatomyositis (DM) is a rare autoimmune disorder defined by weakness of the striated muscles and a distinctive skin rash. Dysphagia is a serious symptom that can be difficult to manage, severely impacting quality of life and long-term survival. The aim of this report is to highlight a case of an anti-NXP-2 positive DM with severe dysphagia refractory to multiple therapies, including steroids, cyclophosphamide and intravenous immunoglobulins. Anti-NXP-2 autoantibodies indicate a specific disease phenotype adding severe muscle weakness, dysphagia, peripheral edema and underlying malignancy.
{"title":"Complete, refractory dysphagia in a dermatomyositis patient with positive anti-NXP-2 antibodies","authors":"C. Cobilinschi, C. Cobilinschi, A. Constantinescu, R. Ionescu, D. Opriș-Belinski","doi":"10.37897/rjr.2021.4.7","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.7","url":null,"abstract":"Dermatomyositis (DM) is a rare autoimmune disorder defined by weakness of the striated muscles and a distinctive skin rash. Dysphagia is a serious symptom that can be difficult to manage, severely impacting quality of life and long-term survival. The aim of this report is to highlight a case of an anti-NXP-2 positive DM with severe dysphagia refractory to multiple therapies, including steroids, cyclophosphamide and intravenous immunoglobulins. Anti-NXP-2 autoantibodies indicate a specific disease phenotype adding severe muscle weakness, dysphagia, peripheral edema and underlying malignancy.","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":"47318470","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. Richter, A. Cardoneanu, L. Macovei, A. Burlui, E. Rezus
Alkaptonuria is a rare disorder, an autosomal recessive condition with genetic determinism and hereditary transmission, having a prevalence of 1 per 1 million population in USA. The pathogenesis includes the deficiency of the homogentisate 1,2-dioxygenase (HGD) enzyme, an intermediary enzyme in phenylalanine and tyrosine catabolism. Mutations in HGD gene leads to deficient levels of functional HGD and an excess of homogentisic acid (HGA). Although HGA is rapidly excreted by the kidneys, it slowly accumulates in various tissues. Due to HGA oxidase deficiency, HGA turns into melanin-like pigment which determines: alkaptonuria, accumulation in the connective tissues, in the joints, or can make cardiovascular and genitourinary deposits. The chronic accumulation of HGA destroys the affected tissue, leading to the characteristic black-blue color and to clinical symptoms of alkaptonuria. The aim of this paper is to investigate the particularities of rheumatic manifestations in a rare metabolic disease and to support the correct diagnosis. A 58-year-old male patient was admitted to our clinic in 2019 for bilateral knee and left shoulder pain. In 2008 he was diagnosed with polyarticular ochronosis having dorsal and lumbar pain, mixed scapulohumeral pain, lumbar intervertebral disk calcifications; at that time, a diagnosis of ankylosing spondylitis or Forestier disease was excluded. At the current admission, the patient has been thoroughly reassessed to obtain a proper diagnosis and to determine the severity of the disease. The ochronotic axial damage caused important differential diagnosis problems with ankylosing spondylitis. Pigment deposition in the eyes, ears and skin does not cause problems to patients, but cardiovascular and genitourinary deposition leads to important complications. Kinetotherapy and NSAIDs are beneficial for pain symptoms. There is no specific medication for stopping the disease progression. Conclusions. Ochronosis is a rare disease which can cause a lot of problems regarding a proper diagnosis and treatment. When differential diagnosis with AS is difficult, the HLA-B27 genotyping is recommended. Final diagnosis is based on qualitative and quantitative urinary tests. The treatment includes only symptomatic drugs such as NSAIDs and kinetotherapy to improve joint mobility and muscle toning.
{"title":"Ochronosis – a rare metabolic disease","authors":"P. Richter, A. Cardoneanu, L. Macovei, A. Burlui, E. Rezus","doi":"10.37897/rjr.2021.4.6","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.6","url":null,"abstract":"Alkaptonuria is a rare disorder, an autosomal recessive condition with genetic determinism and hereditary transmission, having a prevalence of 1 per 1 million population in USA. The pathogenesis includes the deficiency of the homogentisate 1,2-dioxygenase (HGD) enzyme, an intermediary enzyme in phenylalanine and tyrosine catabolism. Mutations in HGD gene leads to deficient levels of functional HGD and an excess of homogentisic acid (HGA). Although HGA is rapidly excreted by the kidneys, it slowly accumulates in various tissues. Due to HGA oxidase deficiency, HGA turns into melanin-like pigment which determines: alkaptonuria, accumulation in the connective tissues, in the joints, or can make cardiovascular and genitourinary deposits. The chronic accumulation of HGA destroys the affected tissue, leading to the characteristic black-blue color and to clinical symptoms of alkaptonuria. The aim of this paper is to investigate the particularities of rheumatic manifestations in a rare metabolic disease and to support the correct diagnosis. A 58-year-old male patient was admitted to our clinic in 2019 for bilateral knee and left shoulder pain. In 2008 he was diagnosed with polyarticular ochronosis having dorsal and lumbar pain, mixed scapulohumeral pain, lumbar intervertebral disk calcifications; at that time, a diagnosis of ankylosing spondylitis or Forestier disease was excluded. At the current admission, the patient has been thoroughly reassessed to obtain a proper diagnosis and to determine the severity of the disease. The ochronotic axial damage caused important differential diagnosis problems with ankylosing spondylitis. Pigment deposition in the eyes, ears and skin does not cause problems to patients, but cardiovascular and genitourinary deposition leads to important complications. Kinetotherapy and NSAIDs are beneficial for pain symptoms. There is no specific medication for stopping the disease progression. Conclusions. Ochronosis is a rare disease which can cause a lot of problems regarding a proper diagnosis and treatment. When differential diagnosis with AS is difficult, the HLA-B27 genotyping is recommended. Final diagnosis is based on qualitative and quantitative urinary tests. The treatment includes only symptomatic drugs such as NSAIDs and kinetotherapy to improve joint mobility and muscle toning.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41325150","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. Cobilinschi, C. Cobilinschi, A. Constantinescu, Adel Abu Abid, R. Ionescu, D. Opriș-Belinski
Objective. The spondyloarthritis group comprises chronic inflammatory conditions that share clinical, genetic and radiographic features. The impact of comorbidities on disease activity is not entirely known. The aim of this study is to identify the frequency and management of comorbidities in SpA patients. Materials and methods. A six-month retrospective study included 235 SpA patients for whom demographic, disease data and associated comorbidities were collected, according to EULAR’s designated categories. Statistical analysis was performed using Microsoft Excel. Results. 71% were males, with a mean age of 42.3, suffering from SpA for more than 15 years. 60% patients were overweight or obese, 25% had been diagnosed with hypertension, 28% were smokers. 18% suffered from dyslipidemia and 9% had type II diabetes. 16% had hepatitis B while 2% had C viral infection, 14% had previous mild to moderate urinary or pulmonary infections. Osteoporosis was confirmed in 6% and malignancies in 2.5% cases. Conclusions. The most frequently encountered comorbidities were cardio-vascular events, followed by gastro-intestinal disorders. SpA patients require early comorbidity detection with the aid of their rheumatologist and a multidisciplinary care to avoid additional disease burden.
{"title":"Managing comorbidities in spondyloarthritis patients – to what extent do rheumatologists carry the burden?","authors":"C. Cobilinschi, C. Cobilinschi, A. Constantinescu, Adel Abu Abid, R. Ionescu, D. Opriș-Belinski","doi":"10.37897/rjr.2021.4.4","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.4","url":null,"abstract":"Objective. The spondyloarthritis group comprises chronic inflammatory conditions that share clinical, genetic and radiographic features. The impact of comorbidities on disease activity is not entirely known. The aim of this study is to identify the frequency and management of comorbidities in SpA patients. Materials and methods. A six-month retrospective study included 235 SpA patients for whom demographic, disease data and associated comorbidities were collected, according to EULAR’s designated categories. Statistical analysis was performed using Microsoft Excel. Results. 71% were males, with a mean age of 42.3, suffering from SpA for more than 15 years. 60% patients were overweight or obese, 25% had been diagnosed with hypertension, 28% were smokers. 18% suffered from dyslipidemia and 9% had type II diabetes. 16% had hepatitis B while 2% had C viral infection, 14% had previous mild to moderate urinary or pulmonary infections. Osteoporosis was confirmed in 6% and malignancies in 2.5% cases. Conclusions. The most frequently encountered comorbidities were cardio-vascular events, followed by gastro-intestinal disorders. SpA patients require early comorbidity detection with the aid of their rheumatologist and a multidisciplinary care to avoid additional disease burden.","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":"45894453","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}
Anti-Ro antibodies are detected frequently in the general population, but more so in patients with autoimmune conditions as Sjögren’s syndrome and systemic lupus erythematous (SLE). During pregnancy, anti-Ro antibodies can cross the placenta by hijacking physiological mechanisms and can have deleterious effects on the fetus. Administration of hydroxychloroquine (HCQ) to pregnant women with documented anti-Ro antibodies has been shown to prevent congenital heart block (CHB). Serial fetal ultrasound scans and echocardiograms are controversial in pregnant women with anti-Ro antibodies. When complete CHB is diagnosed, this is irreversible and can lead to fetal heart failure, hydrops, and death. After delivery, babies with complete CHB require pacemaker. In the presence of maternal anti-Ro antibodies, there is a high risk of recurrence of CHB for future pregnancies, if there is a previously affected child. Adequate counselling and prophylactic treatment with HCQ should be encouraged.
{"title":"Management of fetal congenital heart block in pregnancies with anti-Ro antibodies","authors":"A. Panaitescu, G. Peltecu, N. Gică","doi":"10.37897/rjr.2021.4.2","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.2","url":null,"abstract":"Anti-Ro antibodies are detected frequently in the general population, but more so in patients with autoimmune conditions as Sjögren’s syndrome and systemic lupus erythematous (SLE). During pregnancy, anti-Ro antibodies can cross the placenta by hijacking physiological mechanisms and can have deleterious effects on the fetus. Administration of hydroxychloroquine (HCQ) to pregnant women with documented anti-Ro antibodies has been shown to prevent congenital heart block (CHB). Serial fetal ultrasound scans and echocardiograms are controversial in pregnant women with anti-Ro antibodies. When complete CHB is diagnosed, this is irreversible and can lead to fetal heart failure, hydrops, and death. After delivery, babies with complete CHB require pacemaker. In the presence of maternal anti-Ro antibodies, there is a high risk of recurrence of CHB for future pregnancies, if there is a previously affected child. Adequate counselling and prophylactic treatment with HCQ should be encouraged.","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":"47790632","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. Macovei, A. Burlui, A. Cardoneanu, Claudia Dragomir, Georgiana Murgu, D. Florea, E. Rezus
Aim. The present study aimed primarily to assess COVID-19 (Coronavirus Disease 2019) course and management in unvaccinated patients with rheumatoid arthritis (RA). Secondary objectives included an analysis of the impact of RA disease activity, age, comorbidities, and DMARD treatment on COVID-19 course. Materials and methods. We performed a prospective observational study on RA patients in the 1st Rheumatology Clinic of the Clinical Rehabilitation Hospital between February and July 2021. The criteria for inclusion in the study cohort were: confirmed RA diagnosis and SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection confirmed by rapid antigen test and/or RT-PCR (Real-Time Polymerase Chain Reaction) during hospitalization in our department. We excluded the patients who were vaccinated against SARS-CoV-2 and those with incomplete data regarding COVID-19 clinical features and management. Demographic characteristics, DAS28 (Disease Activity Score 28) and the treatment prior to SARS-CoV-2 infection, as well as the patients’ comorbidities were taken from the subjects’ charts completed on presentation in the 1st Rheumatology Clinic. COVID-19-related data were collected from the patients’ release forms from specialized departments. Results. The study group included 28 unvaccinated patients with RA who tested positive for SARS-CoV-2. All patients over 65 years of age were symptomatic for COVID-19. Moreover, this subgroup had an increased risk of pneumonia (p = 0.047) and a 217% risk increase for desaturation. Comorbid type 2 diabetes mellitus was associated with COVID-19 pneumonia (p = 0.048). Women needed less antiaggregant and anticoagulant medication (p = 0.029), antitussives (p = 0.014) and oxygen therapy (p = 0.044) compared to men. Patients with comorbid heart failure, valvulopathies and cardiac ischemia were more likely to require antiaggregant or anticoagulant medication during hospitalization for COVID-19 (p = 0.003, p = 0.013, and p < 0.001). DAS28 ≥ 5.1 prior to infection was associated with Tocilizumab therapy for COVID-19 pneumonia, results approaching statistical significance in this respect. Conclusions. In the present study group, we found significant associations between COVID-19-related changes and advanced age, as well as certain comorbidities. Large comprehensive longitudinal studies may provide a more accurate representation of COVID-19 outcomes in unvaccinated patients with RA.
{"title":"Clinical profile and management of COVID-19 in unvaccinated patients with rheumatoid arthritis: A single-center study","authors":"L. Macovei, A. Burlui, A. Cardoneanu, Claudia Dragomir, Georgiana Murgu, D. Florea, E. Rezus","doi":"10.37897/rjr.2021.4.5","DOIUrl":"https://doi.org/10.37897/rjr.2021.4.5","url":null,"abstract":"Aim. The present study aimed primarily to assess COVID-19 (Coronavirus Disease 2019) course and management in unvaccinated patients with rheumatoid arthritis (RA). Secondary objectives included an analysis of the impact of RA disease activity, age, comorbidities, and DMARD treatment on COVID-19 course. Materials and methods. We performed a prospective observational study on RA patients in the 1st Rheumatology Clinic of the Clinical Rehabilitation Hospital between February and July 2021. The criteria for inclusion in the study cohort were: confirmed RA diagnosis and SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection confirmed by rapid antigen test and/or RT-PCR (Real-Time Polymerase Chain Reaction) during hospitalization in our department. We excluded the patients who were vaccinated against SARS-CoV-2 and those with incomplete data regarding COVID-19 clinical features and management. Demographic characteristics, DAS28 (Disease Activity Score 28) and the treatment prior to SARS-CoV-2 infection, as well as the patients’ comorbidities were taken from the subjects’ charts completed on presentation in the 1st Rheumatology Clinic. COVID-19-related data were collected from the patients’ release forms from specialized departments. Results. The study group included 28 unvaccinated patients with RA who tested positive for SARS-CoV-2. All patients over 65 years of age were symptomatic for COVID-19. Moreover, this subgroup had an increased risk of pneumonia (p = 0.047) and a 217% risk increase for desaturation. Comorbid type 2 diabetes mellitus was associated with COVID-19 pneumonia (p = 0.048). Women needed less antiaggregant and anticoagulant medication (p = 0.029), antitussives (p = 0.014) and oxygen therapy (p = 0.044) compared to men. Patients with comorbid heart failure, valvulopathies and cardiac ischemia were more likely to require antiaggregant or anticoagulant medication during hospitalization for COVID-19 (p = 0.003, p = 0.013, and p < 0.001). DAS28 ≥ 5.1 prior to infection was associated with Tocilizumab therapy for COVID-19 pneumonia, results approaching statistical significance in this respect. Conclusions. In the present study group, we found significant associations between COVID-19-related changes and advanced age, as well as certain comorbidities. Large comprehensive longitudinal studies may provide a more accurate representation of COVID-19 outcomes in unvaccinated patients with RA.","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":"42487799","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}
Objectives. We want to present the evolution of a lot of patients, previously diagnosed with psoriatic arthritis, who last spring went through a difficult period due to infection with the new coronavirus. After healing from COVID-19, the patients had returned to the hospital after a period of 4-6 months, to follow a rehabilitation treatment, the majority of the accusations being those related to psoriatic arthritis, with close follow-up of these patients in connection with the treatment applied. Material and methods. The patients were evaluated at hospitalization (biological inflammatory markers like CRP and ESR), pain scale, DAPSA score, PASI and the quality of life score (DLQI and QOL scale), after which they followed different rehabilitation treatments for a period of 21 days. After 3 months of completing this treatment they were re-evaluated. Patients diagnosed with psoriatic arthritis who do not have documentation to suggest SARS-CoV-2 infection (antibodies/ previous RT-PCR positive tests) were not included in the study. Outcomes. There were some significant differences in terms of the initial score at hospitalization and that performed after rehabilitation treatment. Most of the indices performed had lower values at reassessment (pain scale score, DAPSA, PASI, DLQI and even lower values of CRP and ESR), thus resulting in an important step in terms of the beneficial effects of rehabilitation therapy, both for patients with psoriatic arthritis and for post-COVID-19 recovery. The most important change was observed in the score for quality of life. Conclusions. The inclusion of rehabilitation therapy in patients with psoriatic arthritis should be a step that each patient should take. Its effects are long-term, with periods of pain decreasing in frequency and intensity, thus changing the quality of life of these patients. The mental, social and emotional impact of COVID-19 on people who have gone through the disease can be changed in a good way, also following a rehabilitation therapy.
{"title":"Rehabilitation therapy in patients with psoriatic arthritis after SARS-CoV-2 infection","authors":"Diana Maghiar, N. Paşcalău, L. Lazăr","doi":"10.37897/rjr.2021.3.4.","DOIUrl":"https://doi.org/10.37897/rjr.2021.3.4.","url":null,"abstract":"Objectives. We want to present the evolution of a lot of patients, previously diagnosed with psoriatic arthritis, who last spring went through a difficult period due to infection with the new coronavirus. After healing from COVID-19, the patients had returned to the hospital after a period of 4-6 months, to follow a rehabilitation treatment, the majority of the accusations being those related to psoriatic arthritis, with close follow-up of these patients in connection with the treatment applied. Material and methods. The patients were evaluated at hospitalization (biological inflammatory markers like CRP and ESR), pain scale, DAPSA score, PASI and the quality of life score (DLQI and QOL scale), after which they followed different rehabilitation treatments for a period of 21 days. After 3 months of completing this treatment they were re-evaluated. Patients diagnosed with psoriatic arthritis who do not have documentation to suggest SARS-CoV-2 infection (antibodies/ previous RT-PCR positive tests) were not included in the study. Outcomes. There were some significant differences in terms of the initial score at hospitalization and that performed after rehabilitation treatment. Most of the indices performed had lower values at reassessment (pain scale score, DAPSA, PASI, DLQI and even lower values of CRP and ESR), thus resulting in an important step in terms of the beneficial effects of rehabilitation therapy, both for patients with psoriatic arthritis and for post-COVID-19 recovery. The most important change was observed in the score for quality of life. Conclusions. The inclusion of rehabilitation therapy in patients with psoriatic arthritis should be a step that each patient should take. Its effects are long-term, with periods of pain decreasing in frequency and intensity, thus changing the quality of life of these patients. The mental, social and emotional impact of COVID-19 on people who have gone through the disease can be changed in a good way, also following a rehabilitation therapy.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43932361","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. Ionescu, M. Agache, C. Popescu, L. Enache, C. Mogoșan, C. Codreanu
Background. There is a time sensitive window of opportunity in rheumatoid arthritis (RA) in which therapeutic intervention is more effective, the disease being more susceptible to the immunomodulatory effects of the remissive medication. The goal is to prevent osteo-articular damage, which causes severe functional deficit, and to raise the chance to lead the disease in remission. Evolution towards RA represents a multi-step process. In other medical fields prevention has the same important role as treatment, so could we in the future switch again the therapeutic paradigm in RA, from early treatment to prevention of RA, by treating patients with high risk of developing disease? Initiating treatment in the pre-RA phases could potentially lead to a better immune modulation or even preventing disease development by acting on less mature pathogenic processes. Treating in the initial symptomatic phase of the disease could potentially be more effective in reducing disease persistence and the development of structural lesions. The clinically suspect arthralgia (CSA) definition offers a support of clinical parameters for future longitudinal studies, where together with para clinical parameters, laboratory studies and imagistic studies, could lead to the development of imminent RA classification criteria. Currently there are more ongoing studies that have the primary objective to prove this concept with different subpopulations and treatments, but most of them have inclusion criteria based on the presence of autoantibodies. The publication of this trials results in the next decade will help to better understand the efficacy of therapeutic intervention with the scope of preventing chronic arthritis and what subset of patients at risk to treat. There are no recommendations for management of CSA, but current practice is symptomatic treatment with nonsteroidal anti-inflammatory drugs, pain relievers and of course monitoring.
{"title":"Clinically suspect arthralgia – are we going towards a new shift in the therapeutic paradigm of rheumatoid arthritis?","authors":"C. Ionescu, M. Agache, C. Popescu, L. Enache, C. Mogoșan, C. Codreanu","doi":"10.37897/rjr.2021.3.2","DOIUrl":"https://doi.org/10.37897/rjr.2021.3.2","url":null,"abstract":"Background. There is a time sensitive window of opportunity in rheumatoid arthritis (RA) in which therapeutic intervention is more effective, the disease being more susceptible to the immunomodulatory effects of the remissive medication. The goal is to prevent osteo-articular damage, which causes severe functional deficit, and to raise the chance to lead the disease in remission. Evolution towards RA represents a multi-step process. In other medical fields prevention has the same important role as treatment, so could we in the future switch again the therapeutic paradigm in RA, from early treatment to prevention of RA, by treating patients with high risk of developing disease? Initiating treatment in the pre-RA phases could potentially lead to a better immune modulation or even preventing disease development by acting on less mature pathogenic processes. Treating in the initial symptomatic phase of the disease could potentially be more effective in reducing disease persistence and the development of structural lesions. The clinically suspect arthralgia (CSA) definition offers a support of clinical parameters for future longitudinal studies, where together with para clinical parameters, laboratory studies and imagistic studies, could lead to the development of imminent RA classification criteria. Currently there are more ongoing studies that have the primary objective to prove this concept with different subpopulations and treatments, but most of them have inclusion criteria based on the presence of autoantibodies. The publication of this trials results in the next decade will help to better understand the efficacy of therapeutic intervention with the scope of preventing chronic arthritis and what subset of patients at risk to treat. There are no recommendations for management of CSA, but current practice is symptomatic treatment with nonsteroidal anti-inflammatory drugs, pain relievers and of course monitoring.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43945196","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 sclerosis is a complex autoimmune disorder marked by heterogeneous clinical manifestations and variable disease course. We present the case of a patient with diffuse cutaneous systemic sclerosis with anti-PM/Scl antibodies and associated calcinosis cutis. Currently, there is no uniformly effective therapy for calcinosis, but in the present case study combined therapy (calcium channel blocker, colchicine, bisphosphonate and minocycline) showed a good outcome with significant clinical improvement. Calcinosis in patients with systemic sclerosis is relatively common and it represents a challenge that requires appropriate management.
{"title":"Systemic sclerosis – metamorphosis of a life","authors":"A. Stanciu, L. Groșeanu, R. Ionescu","doi":"10.37897/rjr.2021.3.5","DOIUrl":"https://doi.org/10.37897/rjr.2021.3.5","url":null,"abstract":"Systemic sclerosis is a complex autoimmune disorder marked by heterogeneous clinical manifestations and variable disease course. We present the case of a patient with diffuse cutaneous systemic sclerosis with anti-PM/Scl antibodies and associated calcinosis cutis. Currently, there is no uniformly effective therapy for calcinosis, but in the present case study combined therapy (calcium channel blocker, colchicine, bisphosphonate and minocycline) showed a good outcome with significant clinical improvement. Calcinosis in patients with systemic sclerosis is relatively common and it represents a challenge that requires appropriate management.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47103488","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. Constantinescu, C. Cobilinschi, Elena Grădinaru, I. Saulescu, R. Ionescu
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, characterized by multiorgan involvement, most commonly targeting the skin, joints and kidneys. Late-onset disease occurs in patients over the age of 50 and represents a diagnostic challenge, as it is less frequently encountered and it may exhibit a more unusual clinical and paraclinical picture. The aim of this paper is to highlight two cases of SLE diagnosed in female patients of considerably advanced ages, 81 and 72 years respectively, in order to enhance physician awareness with regard to this distinct disease subtype.
{"title":"Features of late-onset systemic lupus erythematosus","authors":"A. Constantinescu, C. Cobilinschi, Elena Grădinaru, I. Saulescu, R. Ionescu","doi":"10.37897/rjr.2021.3.6","DOIUrl":"https://doi.org/10.37897/rjr.2021.3.6","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, characterized by multiorgan involvement, most commonly targeting the skin, joints and kidneys. Late-onset disease occurs in patients over the age of 50 and represents a diagnostic challenge, as it is less frequently encountered and it may exhibit a more unusual clinical and paraclinical picture. The aim of this paper is to highlight two cases of SLE diagnosed in female patients of considerably advanced ages, 81 and 72 years respectively, in order to enhance physician awareness with regard to this distinct disease subtype.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48979116","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}
We describe the case of a 63-year-old nonsmoker woman, with a long history of active seropositive rheumatoid arthritis, failure to multiple disease-modifying antirheumatic drugs due to both loss of efficacy and adverse drug reaction. She was exposed to silicon dust some years ago and has many pulmonary nodules, revealed by imaging studies as multiple cavitary lung nodules. Her initial pathological samples were negative for any infections and treatment against tuberculosis and anti-fungal therapy did not improve the appearance of the nodules. After an extensive reevaluation of pulmonary nodules, the Baricitinib treatment was started.
{"title":"Active rheumatoid arthritis with multiple pulmonary nodules failure to multiple remissive therapy: Which is the solution?","authors":"I. Filipescu, M. Man, S. Rednic","doi":"10.37897/rjr.2021.3.7","DOIUrl":"https://doi.org/10.37897/rjr.2021.3.7","url":null,"abstract":"We describe the case of a 63-year-old nonsmoker woman, with a long history of active seropositive rheumatoid arthritis, failure to multiple disease-modifying antirheumatic drugs due to both loss of efficacy and adverse drug reaction. She was exposed to silicon dust some years ago and has many pulmonary nodules, revealed by imaging studies as multiple cavitary lung nodules. Her initial pathological samples were negative for any infections and treatment against tuberculosis and anti-fungal therapy did not improve the appearance of the nodules. After an extensive reevaluation of pulmonary nodules, the Baricitinib treatment was started.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46471473","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：