L. Groșeanu, A. Petre, A. Balanescu, V. Bojinca, D. Opriș-Belinski, F. Berghea, I. Saulescu, D. Mazilu, Sanziana Daia Iliescu, A. Borangiu, C. Constantinescu, C. Cobilinschi, M. Negru, M. Abobului, R. Ionescu
Introduction. The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results have often been observed. Material and method. We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096 . We looked at sex influence on disease characteristics at baseline and then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival. Results. 173 patients with SSc were available for the baseline analyses. In the longitudinal analysis after a mean follow-up of 3.5(±0.65) years, male sex was associated with a higher risk of scleroderma renal crisis (OR:9.45 (1.49 to 59.69); p = 0.004), digital contractures (OR:8.2 (3.1 to 21.9); p < 0.001), arrhythmias (OR: 3.37 (1.36 to 8.34); p = 0.006), pulmonary fibrosis (OR: 3.56, (1.51 to 8.41); p = 0.003), pulmonary hypertension (OR: 3.01 (1.19 to 7.59); p = 0.016), severe vascular involvement (OR:2.86, (1.22 to 6.73); p = 0.013) and low ventricular ejection fraction (OR: 2.84, (1.2 to 6.73); p = 0.014). Males had significantly reduced survival time after diagnosis (p = 0.004). The most frequent causes of death were scleroderma renal crisis in males and pulmonary hypertension in females. Conclusions. Although more common in women, SSc appears as strikingly more severe in men. Our results demonstrate a higher risk of severe organ involvement and poor prognosis in men. These results raise the point of including sex in the management and the decision-making process.
{"title":"Gender differences in organ involvement and survival in systemic sclerosis – experience of a EUSTAR center","authors":"L. Groșeanu, A. Petre, A. Balanescu, V. Bojinca, D. Opriș-Belinski, F. Berghea, I. Saulescu, D. Mazilu, Sanziana Daia Iliescu, A. Borangiu, C. Constantinescu, C. Cobilinschi, M. Negru, M. Abobului, R. Ionescu","doi":"10.37897/rjr.2021.2.4","DOIUrl":"https://doi.org/10.37897/rjr.2021.2.4","url":null,"abstract":"Introduction. The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results have often been observed. Material and method. We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096 . We looked at sex influence on disease characteristics at baseline and then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival. Results. 173 patients with SSc were available for the baseline analyses. In the longitudinal analysis after a mean follow-up of 3.5(±0.65) years, male sex was associated with a higher risk of scleroderma renal crisis (OR:9.45 (1.49 to 59.69); p = 0.004), digital contractures (OR:8.2 (3.1 to 21.9); p < 0.001), arrhythmias (OR: 3.37 (1.36 to 8.34); p = 0.006), pulmonary fibrosis (OR: 3.56, (1.51 to 8.41); p = 0.003), pulmonary hypertension (OR: 3.01 (1.19 to 7.59); p = 0.016), severe vascular involvement (OR:2.86, (1.22 to 6.73); p = 0.013) and low ventricular ejection fraction (OR: 2.84, (1.2 to 6.73); p = 0.014). Males had significantly reduced survival time after diagnosis (p = 0.004). The most frequent causes of death were scleroderma renal crisis in males and pulmonary hypertension in females. Conclusions. Although more common in women, SSc appears as strikingly more severe in men. Our results demonstrate a higher risk of severe organ involvement and poor prognosis in men. These results raise the point of including sex in the management and the decision-making process.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46017433","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 chronic connective tissue disease characterized by multi-organ involvement but the main clinical changes occur in the hands, secondary to skin, joint and microvascular damage. Therefore the hand received a special attention for imaging and especially for ultrasound evaluation. In rheumatology US become an extension of the clinical examination and particularly in systemic sclerosis it has been proven to help with a better assessment of the skin, blood vessels, joints and tendons involvement. This evolution was allowed by permanent improvement of technology along with expanding the range of ultrasound applications which happened especially in past decade.
{"title":"Ultrasound of the hand in systemic sclerosis","authors":"H. Popov, M. Tămaș, C. Pamfil, S. Rednic","doi":"10.37897/rjr.2021.2.2","DOIUrl":"https://doi.org/10.37897/rjr.2021.2.2","url":null,"abstract":"Systemic sclerosis is a chronic connective tissue disease characterized by multi-organ involvement but the main clinical changes occur in the hands, secondary to skin, joint and microvascular damage. Therefore the hand received a special attention for imaging and especially for ultrasound evaluation. In rheumatology US become an extension of the clinical examination and particularly in systemic sclerosis it has been proven to help with a better assessment of the skin, blood vessels, joints and tendons involvement. This evolution was allowed by permanent improvement of technology along with expanding the range of ultrasound applications which happened especially in past decade.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45387124","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, R. Ionescu, D. Opriș-Belinski
Systemic sclerosis is a chronic autoimmune disorder characterized by multiorgan involvement, most notably of the skin through fibrosis and vasculopathy. One of its most feared complications requiring rapid intervention is scleroderma renal crisis, as it can be fatal in the absence of prompt treatment. A 34-year old woman presents with a history of acute renal failure and malignant hypertension occurring one month postpartum and no other scleroderma feature in the following 5 years. Eventually, skin, heart and lung involvement is observed, positive anti-ARN III polymerase antibodies and suggestive capillaroscopic findings. Immunosuppressive therapy with mycophenolate mofetil is initiated and later switched to off-label Rituximab, with significant improvement of disease manifestations. Regular patient monitoring for novel symptom occurrence and appropriate treatment adjustment is essential for optimal management of scleroderma.
{"title":"Scleroderma renal crisis as the sole presenting feature of systemic sclerosis in a postpartum woman","authors":"C. Cobilinschi, C. Cobilinschi, A. Constantinescu, R. Ionescu, D. Opriș-Belinski","doi":"10.37897/rjr.2021.2.6","DOIUrl":"https://doi.org/10.37897/rjr.2021.2.6","url":null,"abstract":"Systemic sclerosis is a chronic autoimmune disorder characterized by multiorgan involvement, most notably of the skin through fibrosis and vasculopathy. One of its most feared complications requiring rapid intervention is scleroderma renal crisis, as it can be fatal in the absence of prompt treatment. A 34-year old woman presents with a history of acute renal failure and malignant hypertension occurring one month postpartum and no other scleroderma feature in the following 5 years. Eventually, skin, heart and lung involvement is observed, positive anti-ARN III polymerase antibodies and suggestive capillaroscopic findings. Immunosuppressive therapy with mycophenolate mofetil is initiated and later switched to off-label Rituximab, with significant improvement of disease manifestations. Regular patient monitoring for novel symptom occurrence and appropriate treatment adjustment is essential for optimal management of scleroderma.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48116189","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}
Irina Andrada Craciun, Relu Liviu Craciun, S. Daia-Iliescu, R. Ionescu
Introduction. Treat-to-target concept in spondyloarthritis (SpA) is a highly disputed subject. Up to the present, there is no evaluation score that integrates the clinical and laboratory/imaging results for defining remission in SpA. This issue generates the need of identifying predictive factors of remission in SpA patients. Aim. The aim of this study is to assess the effectiveness of the biological treatment upon naïve patients versus switchers and to identify some difficulties in achieving remission. Material and method. 65 patients with SpA were enrolled in this retrospective study, using data from multiple-choice forms and medical reports from University Hospitals in Romania, between 2019-2021. Results. 65 patients with SpA, in treatment with one biological disease-modifying antirheumatic drug (bDMARD) were available for the baseline analysis. They were distributed into 3 groups, whether they changed the biological therapy: group 1 – naïve patients, group 2 – first-time switchers and group 3 – more than one-time switchers. BASDAI and ASDAS were calculated at baseline, 24 and 52 weeks for the 3 groups. The scores were higher for the switchers and the highest in the 3rd group. Retention time of the first bDMARD was compared between groups and between the biological therapies. Conclusions. Results showed that the best treatment response, as well as effectiveness, is reached by the naïve patients group. Greater retention time rate for the first bDMARD is associated with a greater chance of achieving remission.
{"title":"Naïve vs. switchers differences in treatment effectiveness in spondyloarthritis","authors":"Irina Andrada Craciun, Relu Liviu Craciun, S. Daia-Iliescu, R. Ionescu","doi":"10.37897/rjr.2021.2.5","DOIUrl":"https://doi.org/10.37897/rjr.2021.2.5","url":null,"abstract":"Introduction. Treat-to-target concept in spondyloarthritis (SpA) is a highly disputed subject. Up to the present, there is no evaluation score that integrates the clinical and laboratory/imaging results for defining remission in SpA. This issue generates the need of identifying predictive factors of remission in SpA patients. Aim. The aim of this study is to assess the effectiveness of the biological treatment upon naïve patients versus switchers and to identify some difficulties in achieving remission. Material and method. 65 patients with SpA were enrolled in this retrospective study, using data from multiple-choice forms and medical reports from University Hospitals in Romania, between 2019-2021. Results. 65 patients with SpA, in treatment with one biological disease-modifying antirheumatic drug (bDMARD) were available for the baseline analysis. They were distributed into 3 groups, whether they changed the biological therapy: group 1 – naïve patients, group 2 – first-time switchers and group 3 – more than one-time switchers. BASDAI and ASDAS were calculated at baseline, 24 and 52 weeks for the 3 groups. The scores were higher for the switchers and the highest in the 3rd group. Retention time of the first bDMARD was compared between groups and between the biological therapies. Conclusions. Results showed that the best treatment response, as well as effectiveness, is reached by the naïve patients group. Greater retention time rate for the first bDMARD is associated with a greater chance of achieving remission.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43495355","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}
Claudia Dragomir, A. Burlui, Geanina-Florica Popescu, Ioan-Teodor Dragoi, A. Cardoneanu, L. Macovei, E. Rezus
Since the first case was reported to the World Health Organization (in late December 2019 in Wuhan, Hubei Province, China), by mid-June 2021, there have been 175,541,600 confirmed cases of COVID-19 globally, including 3,798,361 reported deaths. Many of those infected with SARS-CoV-2 have an asymptomatic form of the disease or mild flu-like symptoms. In another category of patients, the disease may be more aggressive, with a severe form that can lead to acute respiratory distress syndrome (ARDS), respiratory failure, and even death with a negative impact on patients. The COVID-19 pandemic has arisen serious concerns in the rheumatology community regarding the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It has been stated that severe forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. Nevertheless, it remains unclear whether the use of biological agents subjects the patient to a higher risk, or rather protects them against severe forms of the disease. According to the American College of Rheumatology, rheumatic diseases were not identified as a risk factor that predicted poor outcome in patients with COVID-19. However, various studies have certified that corticosteroid treatment in patients with chronic rheumatic diseases at a dose >10 mg/day is associated with an increased risk of infection as well as the possibility of developing more severe COVID-19 symptoms.
{"title":"COVID-19 in patients with chronic inflammatory rheumatic diseases: Do these patients have a higher risk of COVID-19 due to their underlying medication?","authors":"Claudia Dragomir, A. Burlui, Geanina-Florica Popescu, Ioan-Teodor Dragoi, A. Cardoneanu, L. Macovei, E. Rezus","doi":"10.37897/rjr.2021.2.1","DOIUrl":"https://doi.org/10.37897/rjr.2021.2.1","url":null,"abstract":"Since the first case was reported to the World Health Organization (in late December 2019 in Wuhan, Hubei Province, China), by mid-June 2021, there have been 175,541,600 confirmed cases of COVID-19 globally, including 3,798,361 reported deaths. Many of those infected with SARS-CoV-2 have an asymptomatic form of the disease or mild flu-like symptoms. In another category of patients, the disease may be more aggressive, with a severe form that can lead to acute respiratory distress syndrome (ARDS), respiratory failure, and even death with a negative impact on patients. The COVID-19 pandemic has arisen serious concerns in the rheumatology community regarding the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It has been stated that severe forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. Nevertheless, it remains unclear whether the use of biological agents subjects the patient to a higher risk, or rather protects them against severe forms of the disease. According to the American College of Rheumatology, rheumatic diseases were not identified as a risk factor that predicted poor outcome in patients with COVID-19. However, various studies have certified that corticosteroid treatment in patients with chronic rheumatic diseases at a dose >10 mg/day is associated with an increased risk of infection as well as the possibility of developing more severe COVID-19 symptoms.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46481989","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) occur frequently in women of fertile age. In the pathogenesis of SLE, estrogen plays an important role, hormonal changes such as pregnancy and the postpartum increase the risk of disease flares. Also, pregnancy in SLE patients carries a higher fetal risk compared with healthy women. Pregnancy outcome may be optimized by careful planning of the pregnancy and close follow-up of the mother and of the fetus. SLE is associated with high maternal and fetal risk especially when non-diagnosed before planning a pregnancy. Herein we present two cases of SLE manifested by preeclampsia and acute renal insufficiency during labor and postpartum period, with a difficult diagnosis after a few months of a worsening clinical situation.
{"title":"Pregnancy, systemic lupus erythematosus and a short communication on labor complications as new onset of the disease","authors":"A. Simionescu, S. Daia-Iliescu","doi":"10.37897/rjr.2021.2.3","DOIUrl":"https://doi.org/10.37897/rjr.2021.2.3","url":null,"abstract":"Systemic lupus erythematosus (SLE) occur frequently in women of fertile age. In the pathogenesis of SLE, estrogen plays an important role, hormonal changes such as pregnancy and the postpartum increase the risk of disease flares. Also, pregnancy in SLE patients carries a higher fetal risk compared with healthy women. Pregnancy outcome may be optimized by careful planning of the pregnancy and close follow-up of the mother and of the fetus. SLE is associated with high maternal and fetal risk especially when non-diagnosed before planning a pregnancy. Herein we present two cases of SLE manifested by preeclampsia and acute renal insufficiency during labor and postpartum period, with a difficult diagnosis after a few months of a worsening clinical situation.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41848509","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. Andronache, C. Suța, Sabina Ciocodei, I. Bulbuc, C. Mihailov, O. Arghir, M. Șuța, Constanta Romania Medimar Imagistic Services
Background. Rheumatoid arthritis (RA) is a systemic inflammatory disease, associated with a number of extra-articular organ manifestations. Pulmonary involvement is a frequent and severe extraarticular manifestations of rheumatoid arthritis. RA can affect lung parenchyma, airways and pleura. Objectives. To identify RA-related lung disease on chest computed tomography (CT). Material and methods. We performed high-resolution computed tomography (HRCT) on a total of 92 patients with longstanding RA. Results. The subjects were predominantely female (79.3%), the age at entry was 63.77 ±11.56 years, and 42.9% had a history of smoking. Disease duration was 15.00±11.55 years. Pulmonary CT abnormalities were found in 71 of the 92 patients (77.2%). The most common HRCT anomalies were: linear attenuation (reticulation) (52.11%), bronchiectasis andbronchial wall thickening (45%), nodular attenuation (39.43%) and pleural involvement (pleural effusion or thickening) (39.43%). Conclusions. We conclude that RA-related lung disease was commonly detected on chest CT imaging in longstanding RA patients.
{"title":"Pulmonary abnormalities on high-resolution computed tomography in patients with long standing rheumatoid arthritis","authors":"I. Andronache, C. Suța, Sabina Ciocodei, I. Bulbuc, C. Mihailov, O. Arghir, M. Șuța, Constanta Romania Medimar Imagistic Services","doi":"10.37897/rjr.2021.1.3","DOIUrl":"https://doi.org/10.37897/rjr.2021.1.3","url":null,"abstract":"Background. Rheumatoid arthritis (RA) is a systemic inflammatory disease, associated with a number of extra-articular organ manifestations. Pulmonary involvement is a frequent and severe extraarticular manifestations of rheumatoid arthritis. RA can affect lung parenchyma, airways and pleura. Objectives. To identify RA-related lung disease on chest computed tomography (CT). Material and methods. We performed high-resolution computed tomography (HRCT) on a total of 92 patients with longstanding RA. Results. The subjects were predominantely female (79.3%), the age at entry was 63.77 ±11.56 years, and 42.9% had a history of smoking. Disease duration was 15.00±11.55 years. Pulmonary CT abnormalities were found in 71 of the 92 patients (77.2%). The most common HRCT anomalies were: linear attenuation (reticulation) (52.11%), bronchiectasis andbronchial wall thickening (45%), nodular attenuation (39.43%) and pleural involvement (pleural effusion or thickening) (39.43%). Conclusions. We conclude that RA-related lung disease was commonly detected on chest CT imaging in longstanding RA patients.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43717772","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}
Antiphospholipid antibodies syndrome (APS) is an acquired prothrombotic status, that is due to the occurrence of a certain type of autoantibodies directed against negatively charged phospholipid structures – hence the name. Neoplasia is also characterized by a systemic procoagulant status, through various mechanisms. Obviously, both conditions may occur in the same patient, raising the question of a possible causal relation. Regardless of the potential liaison between the two events, clinicians caring for neoplastic patients as well as for APS patients, should be aware of the presence of both conditions in the same patient, as this has important therapeutic consequences.
{"title":"Antiphospholipid syndrome and cancer","authors":"R. Ionescu, B. Pharmacy","doi":"10.37897/rjr.2021.1.2","DOIUrl":"https://doi.org/10.37897/rjr.2021.1.2","url":null,"abstract":"Antiphospholipid antibodies syndrome (APS) is an acquired prothrombotic status, that is due to the occurrence of a certain type of autoantibodies directed against negatively charged phospholipid structures – hence the name. Neoplasia is also characterized by a systemic procoagulant status, through various mechanisms. Obviously, both conditions may occur in the same patient, raising the question of a possible causal relation. Regardless of the potential liaison between the two events, clinicians caring for neoplastic patients as well as for APS patients, should be aware of the presence of both conditions in the same patient, as this has important therapeutic consequences.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47973582","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}
Eosinophilic fasciitis is a rare disorder of unknown etiology and poorly understood pathogenesis. It may be triggered by excessive exercise, physical factors such as radiation therapy, exposure to certain medications, infections, the initiation of hemodialysis and some other medical conditions. Skin modifications appear with collagenous thickening of the subcutaneous fascia with typical aspect of “peau d’orange” and the “groove sign”. Arthritis, myalgia, myositis, neuropathies may occur. The majority of patients have peripheral blood eosinophilia. The diagnosis is confirmed with a full thickness incisional biopsy of skin and subcutaneous tissue down to the muscle surface and fascia. Systemic glucocorticoids are the mainstay of treatment, but some patients require additional immunosuppressive therapy. The long-term prognosis of this disease is unknown and in some cases the disease may releapse. We describe two patients with eosinophilic fasciitis, their evolution and complications, associating other pathologies: morphea and antiphospholipid syndrome, making the diagnosis and the treatment more challenging.
{"title":"Two case reports and a literature review on eosinophilic fasciitis","authors":"D. Mazilu, I. Saulescu, R. Ionescu","doi":"10.37897/rjr.2021.1.6","DOIUrl":"https://doi.org/10.37897/rjr.2021.1.6","url":null,"abstract":"Eosinophilic fasciitis is a rare disorder of unknown etiology and poorly understood pathogenesis. It may be triggered by excessive exercise, physical factors such as radiation therapy, exposure to certain medications, infections, the initiation of hemodialysis and some other medical conditions. Skin modifications appear with collagenous thickening of the subcutaneous fascia with typical aspect of “peau d’orange” and the “groove sign”. Arthritis, myalgia, myositis, neuropathies may occur. The majority of patients have peripheral blood eosinophilia. The diagnosis is confirmed with a full thickness incisional biopsy of skin and subcutaneous tissue down to the muscle surface and fascia. Systemic glucocorticoids are the mainstay of treatment, but some patients require additional immunosuppressive therapy. The long-term prognosis of this disease is unknown and in some cases the disease may releapse. We describe two patients with eosinophilic fasciitis, their evolution and complications, associating other pathologies: morphea and antiphospholipid syndrome, making the diagnosis and the treatment more challenging.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70159280","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}
Spondylatrhritis is a multifaceted disease, primary involving the axial skeleton. But sometimes, the patient present either with articular involvement plus other organ invelovement, or with only extraarticular involvement. As the most frequent, uveitis is the main extraarticular manifestation (EAM) of spondylarthritis. This EAM is very important because it can be the first manifestation of SpA, so it may bring the patient to the doctor, be it an ophthalmologist or a rheumatologist. Diagnosing uveitis in the context of SpA, is of paramount importance also because anterior uveitis is an emergency, because it can lead to blindness. So, knowing the clinical appearance and the treatment of uveitis in the context of SpA is crucial for providing the best care for SpA patients.
{"title":"Uveitis as an extraarticular manifestation in spondyloarthritis","authors":"R. Ionescu, B. Pharmacy","doi":"10.37897/RJR.2020.4.1","DOIUrl":"https://doi.org/10.37897/RJR.2020.4.1","url":null,"abstract":"Spondylatrhritis is a multifaceted disease, primary involving the axial skeleton. But sometimes, the patient present either with articular involvement plus other organ invelovement, or with only extraarticular involvement. As the most frequent, uveitis is the main extraarticular manifestation (EAM) of spondylarthritis. This EAM is very important because it can be the first manifestation of SpA, so it may bring the patient to the doctor, be it an ophthalmologist or a rheumatologist. Diagnosing uveitis in the context of SpA, is of paramount importance also because anterior uveitis is an emergency, because it can lead to blindness. So, knowing the clinical appearance and the treatment of uveitis in the context of SpA is crucial for providing the best care for SpA patients.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44783737","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：