A. Ciotoracu, C. Busuioc, A. Nicola, Paul Miron-Basalic, M. Rusei, M. Dună, N. Copcă, D. Predețeanu, B. Pharmacy
Peripheral arthritis can be triggered by a variety of causes, two of them being calcium pyrophosphate (CPP) disease and peripheral spondyloarthritis (pSpA). After the identification of pSpA, further paraclinical investigations guided by the clinical context of the patient can help differentiate between different subsets of this pathology such as reactive arthritis (ReA), psoriatic arthritis and spondyloarthritis (SpA) related to inflammatory bowel disease. As in many other rheumatologic conditions, diagnostic criteria for pSpA are currently lacking. Classification criteria were implemented for research purpose and were not designed to be used in the case of an individual patient. Nevertheless, used with caution, classification criteria can serve as a valuable tool in guiding the diagnostic approach. We describe the case of a 52 year-old man for which the final diagnosis of ankylosing spondylitis (AS) with overlapped ReA and concurrent CPP disease was made based on a complex decision-making process, along with a comprehensive differential diagnosis. The association between SpA and crystalinduced arthritis is extremely rare, with only a few cases being reported until now. In this particular case, ASAS classification criteria for pSpA were able to strengthen the diagnosis.
{"title":"Diagnostic challenges in a case of reactive arthritis with concurrent calcium pyrophosphate disease","authors":"A. Ciotoracu, C. Busuioc, A. Nicola, Paul Miron-Basalic, M. Rusei, M. Dună, N. Copcă, D. Predețeanu, B. Pharmacy","doi":"10.37897/RJR.2020.4.6","DOIUrl":"https://doi.org/10.37897/RJR.2020.4.6","url":null,"abstract":"Peripheral arthritis can be triggered by a variety of causes, two of them being calcium pyrophosphate (CPP) disease and peripheral spondyloarthritis (pSpA). After the identification of pSpA, further paraclinical investigations guided by the clinical context of the patient can help differentiate between different subsets of this pathology such as reactive arthritis (ReA), psoriatic arthritis and spondyloarthritis (SpA) related to inflammatory bowel disease. As in many other rheumatologic conditions, diagnostic criteria for pSpA are currently lacking. Classification criteria were implemented for research purpose and were not designed to be used in the case of an individual patient. Nevertheless, used with caution, classification criteria can serve as a valuable tool in guiding the diagnostic approach. We describe the case of a 52 year-old man for which the final diagnosis of ankylosing spondylitis (AS) with overlapped ReA and concurrent CPP disease was made based on a complex decision-making process, along with a comprehensive differential diagnosis. The association between SpA and crystalinduced arthritis is extremely rare, with only a few cases being reported until now. In this particular case, ASAS classification criteria for pSpA were able to strengthen the diagnosis.","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":"46267565","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. Codreanu, R. Ionescu, D. Predețeanu, E. Rezus, M. Pârvu, C. Mogoșan, C. Popescu, S. Rednic, B. Pharmacy, I. Pharmacy, C. Pharmacy
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the current pandemic, causing so far over 100.000 cases and more than 4500 deaths in Romania. Clinical manifestations are variable, ranging from mild forms (fever, dry cough, dyspnea, tachypnea, asthenia, myalgia) to severe bilateral pneumonia (COV- ID-19). Generally, patients with inflammatory/autoimmune rheumatic diseases have an increased risk of infections compared to the general population, especially if under treatment with immunosuppressive therapies. In the absence of infection or exposure to SARS-CoV-2, the use of specific drugs (non-steroidal anti-inflammatory drugs – NSAIDs; glucocorticoids - GC; conventional synthetic - csDMARDs, targeted synthetic – tsDMARDs and bio- logic disease-modifying anti-rheumatic drugs - bDMARDs, denosumab) should be unaffected. In patients with exposure to SARS-Co V-2, but without symptoms of COVID-19, NSAIDs, hydroxychloroquine, sulfasalazine and, in specific cases, IL-6 inhibitors may be continued, methotrexate, leflunomide, non-anti-IL-6 bDMARDs, tsDMARDs and immunosuppressants should be temporarily discontinued until a negative result for SARS-CoV-2 or for up to 2 weeks asymptomatic state for specific post-epidemiological COVID-19 symptoms. In patients with confirmed or suspected COVID-19 infection, non-anti-IL-6 bDMARDs, tsDMARDs, methotrexate, leflunomide, sulfasalazine and immunosuppressants must be temporarily discontinued. In such particular cases, IL-6 inhibitors and hydroxychloroquine may be continued, depending on the clinical context. In forms with severe respiratory manifestations, NSAIDs must be stopped. In all cases, non-essential medical consultations and maneuvers should be reduced where appropriate, with optimal use of telemedicine. Social distancing, facial masks and constant hand hygiene is advised for all patients, according to national and international recommendations.
{"title":"Recommendations of the Romanian Society of Rheumatology regarding the management of patients with rheumatic diseases in the context of the SARS-CoV-2 pandemic","authors":"C. Codreanu, R. Ionescu, D. Predețeanu, E. Rezus, M. Pârvu, C. Mogoșan, C. Popescu, S. Rednic, B. Pharmacy, I. Pharmacy, C. Pharmacy","doi":"10.37897/rjr.2020.3.1","DOIUrl":"https://doi.org/10.37897/rjr.2020.3.1","url":null,"abstract":"SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is responsible for the current pandemic, causing so far over 100.000 cases and more than 4500 deaths in Romania. Clinical manifestations are variable, ranging from mild forms (fever, dry cough, dyspnea, tachypnea, asthenia, myalgia) to severe bilateral pneumonia (COV- ID-19). Generally, patients with inflammatory/autoimmune rheumatic diseases have an increased risk of infections compared to the general population, especially if under treatment with immunosuppressive therapies. In the absence of infection or exposure to SARS-CoV-2, the use of specific drugs (non-steroidal anti-inflammatory drugs – NSAIDs; glucocorticoids - GC; conventional synthetic - csDMARDs, targeted synthetic – tsDMARDs and bio- logic disease-modifying anti-rheumatic drugs - bDMARDs, denosumab) should be unaffected. In patients with exposure to SARS-Co V-2, but without symptoms of COVID-19, NSAIDs, hydroxychloroquine, sulfasalazine and, in specific cases, IL-6 inhibitors may be continued, methotrexate, leflunomide, non-anti-IL-6 bDMARDs, tsDMARDs and immunosuppressants should be temporarily discontinued until a negative result for SARS-CoV-2 or for up to 2 weeks asymptomatic state for specific post-epidemiological COVID-19 symptoms. In patients with confirmed or suspected COVID-19 infection, non-anti-IL-6 bDMARDs, tsDMARDs, methotrexate, leflunomide, sulfasalazine and immunosuppressants must be temporarily discontinued. In such particular cases, IL-6 inhibitors and hydroxychloroquine may be continued, depending on the clinical context. In forms with severe respiratory manifestations, NSAIDs must be stopped. In all cases, non-essential medical consultations and maneuvers should be reduced where appropriate, with optimal use of telemedicine. Social distancing, facial masks and constant hand hygiene is advised for all patients, according to national and international recommendations.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42303016","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}
S. Firulescu, C. Pharmacy, P. Ciurea, C. D. Pârvănescu, B. Chisălău, A. Bărbulescu, Simona Bănicioiu Covei, Ș. Dinescu, F. Vreju
Overlap syndrome (OS) is a clinical condition that fulfils the criteria of at least two conjunctive tissue diseases (CTD) occurring in the same patient at the same time or at different moments and its complex clinical picture often makes the diagnosis difficult. Aim. The aim of the study was to evaluate the frequency of renal involvement in a group of patients with overlap syndrome, compared to single CTD. Methods. The observational retrospective study included 122 patients diagnosed with CTD and OS, admitted into Rheumatology Clinic of the Emergency County Clinical Hospital Craiova, between 2011 and 2018, with similar mean age for the two groups (51.41 + 10.88 yo for OS group and 50.78 + 12.65 yo for the other). Results. The proteinuria was significantly lower in the OS group 8% in comparison to the ones without OS (20%) (p = 0.044). The presence of SLE disease and its immunologic changes seems to impact negatively the kidneys, no matter the disease that is associated. Thus, we noticed the presence of renal disease in a percentage of 50% for the patients that associated SLE to SSc, 25% for the ones with SLE and MTCD and 27% for SLE-RA. Conclusions. Although the frequency of renal disease is lower in case of OS, it is important to be recognized, appropriately monitored and integrated in therapeutic decision, especially that some associations are more prone to develop kidney involvement.
{"title":"Renal involvement in overlap syndrome","authors":"S. Firulescu, C. Pharmacy, P. Ciurea, C. D. Pârvănescu, B. Chisălău, A. Bărbulescu, Simona Bănicioiu Covei, Ș. Dinescu, F. Vreju","doi":"10.37897/rjr.2020.2.3","DOIUrl":"https://doi.org/10.37897/rjr.2020.2.3","url":null,"abstract":"Overlap syndrome (OS) is a clinical condition that fulfils the criteria of at least two conjunctive tissue diseases (CTD) occurring in the same patient at the same time or at different moments and its complex clinical picture often makes the diagnosis difficult. Aim. The aim of the study was to evaluate the frequency of renal involvement in a group of patients with overlap syndrome, compared to single CTD. Methods. The observational retrospective study included 122 patients diagnosed with CTD and OS, admitted into Rheumatology Clinic of the Emergency County Clinical Hospital Craiova, between 2011 and 2018, with similar mean age for the two groups (51.41 + 10.88 yo for OS group and 50.78 + 12.65 yo for the other). Results. The proteinuria was significantly lower in the OS group 8% in comparison to the ones without OS (20%) (p = 0.044). The presence of SLE disease and its immunologic changes seems to impact negatively the kidneys, no matter the disease that is associated. Thus, we noticed the presence of renal disease in a percentage of 50% for the patients that associated SLE to SSc, 25% for the ones with SLE and MTCD and 27% for SLE-RA. Conclusions. Although the frequency of renal disease is lower in case of OS, it is important to be recognized, appropriately monitored and integrated in therapeutic decision, especially that some associations are more prone to develop kidney involvement.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47769993","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}
Anterior acute uveitis is the most frequent extraarticular involvement in patients with rheumatologic diseases such as spondyloarthritis and it can often be the first clinical feature. In many cases, a prompt recognition and an early referral by the ophthalmologist to the rheumatologist can be crucial for the accurate diagnosis of these disorders. On the other hand, recognition of the signs and symptoms of ocular inflammation by the rheumatologist can facilitate prompt referral to an ophthalmologist and improve patient outcomes. Comprehensive care through collaboration between ophthalmologists and rheumatologists can help with optimal diagnostic and therapeutic decisions tailored to the individual patient.
{"title":"Interdisciplinary collaboration in managing patients with anterior uveitis and spondyloarthritis","authors":"Cristina Stan, A. Rednik, S. Rednic","doi":"10.37897/rjr.2020.2.1","DOIUrl":"https://doi.org/10.37897/rjr.2020.2.1","url":null,"abstract":"Anterior acute uveitis is the most frequent extraarticular involvement in patients with rheumatologic diseases such as spondyloarthritis and it can often be the first clinical feature. In many cases, a prompt recognition and an early referral by the ophthalmologist to the rheumatologist can be crucial for the accurate diagnosis of these disorders. On the other hand, recognition of the signs and symptoms of ocular inflammation by the rheumatologist can facilitate prompt referral to an ophthalmologist and improve patient outcomes. Comprehensive care through collaboration between ophthalmologists and rheumatologists can help with optimal diagnostic and therapeutic decisions tailored to the individual patient.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48359845","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. Stanciu, S. Daia-Iliescu, M. Diculescu, R. Ionescu
Glycogen storage diseases are genetic metabolic disorders of glycogen metabolism. There are more than 12 types and they are grouped based on the enzyme deficiency and the affected tissue. We present the case of a 43-year-old female with glycogen storage disease type III with liver, skeletal and cardiac muscle involvement whose disease was misdiagnosed with idiopathic inflammatory myopathy and treated with glucocorticoids. Glucocorticoids are an inadequate therapy for this metabolic myopathy and they interfere with the carbohydrate metabolism causing more glycogen storage in the liver.
{"title":"Metabolic vs inflammatory myopathy: Diagnostic difficulties and errors in myopathies – case report","authors":"A. Stanciu, S. Daia-Iliescu, M. Diculescu, R. Ionescu","doi":"10.37897/rjr.2019.3.6","DOIUrl":"https://doi.org/10.37897/rjr.2019.3.6","url":null,"abstract":"Glycogen storage diseases are genetic metabolic disorders of glycogen metabolism. There are more than 12 types and they are grouped based on the enzyme deficiency and the affected tissue. We present the case of a 43-year-old female with glycogen storage disease type III with liver, skeletal and cardiac muscle involvement whose disease was misdiagnosed with idiopathic inflammatory myopathy and treated with glucocorticoids. Glucocorticoids are an inadequate therapy for this metabolic myopathy and they interfere with the carbohydrate metabolism causing more glycogen storage in the liver.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46995549","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}
Cristina Elena Gofiţă, Anca Emanuela Msetescu, F. Vreju, C. Vere, M. Boldeanu, O. Rogoveanu, P. Ciurea
Objectives. The biological markers that can indicate specifically and sensitively the absence or presence of a certain condition or its state can be used for diagnostic support and disease monitoring. Thus, this research set out to study the changes in neuropeptides (substance P and calcitonin gene-related peptide) pro-inflammatory (TNFα, IL-1β and IL-6) and anti-inflammatory (IL-10) cytokine levels in the blood of patients with CRPS. Material and methods. Sixty patients were enlisted from the local Rheumatology Clinic of the Emergency County Hospital of Craiova and split into two groups (acute and chronic). CRPS related symptoms were estimated by means of the Neuropathic Pain Questionnaire. The quantification of cytokines and neuropeptides in blood was achieved using the high sensitivity colorimetric ELISA method. Outcomes. Cytokine analysis led to statistically insignificant results, while for the neuropeptides we obtained significantly increased values in the patient groups. ROC curves were used to assess the diagnostic accuracy of the neuropeptides both returning good AUC values. Conclusions. Our results indicate that the neuropeptide (substance P and calcitonin gene-related peptide) profile has a good diagnostic sensitivity. A limitation of the study is the low number of patients in the acute group, including more patients in this phase might offer more insights on the cytokines’ role, as they could be increased in comparison to chronic patients, due to their short half-life and low acting concentrations.
{"title":"CRPS diagnosis based on inflammation marker analysis","authors":"Cristina Elena Gofiţă, Anca Emanuela Msetescu, F. Vreju, C. Vere, M. Boldeanu, O. Rogoveanu, P. Ciurea","doi":"10.37897/rjr.2019.3.2","DOIUrl":"https://doi.org/10.37897/rjr.2019.3.2","url":null,"abstract":"Objectives. The biological markers that can indicate specifically and sensitively the absence or presence of a certain condition or its state can be used for diagnostic support and disease monitoring. Thus, this research set out to study the changes in neuropeptides (substance P and calcitonin gene-related peptide) pro-inflammatory (TNFα, IL-1β and IL-6) and anti-inflammatory (IL-10) cytokine levels in the blood of patients with CRPS. Material and methods. Sixty patients were enlisted from the local Rheumatology Clinic of the Emergency County Hospital of Craiova and split into two groups (acute and chronic). CRPS related symptoms were estimated by means of the Neuropathic Pain Questionnaire. The quantification of cytokines and neuropeptides in blood was achieved using the high sensitivity colorimetric ELISA method. Outcomes. Cytokine analysis led to statistically insignificant results, while for the neuropeptides we obtained significantly increased values in the patient groups. ROC curves were used to assess the diagnostic accuracy of the neuropeptides both returning good AUC values. Conclusions. Our results indicate that the neuropeptide (substance P and calcitonin gene-related peptide) profile has a good diagnostic sensitivity. A limitation of the study is the low number of patients in the acute group, including more patients in this phase might offer more insights on the cytokines’ role, as they could be increased in comparison to chronic patients, due to their short half-life and low acting concentrations.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43747268","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. Nicola, M. Greere, Adelina Birceanu, D. Balanescu, M. Dună, D. Predețeanu
Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects the axial skeleton and sometimes the peripheral joints, leading to the development of bone bridges and ankyloses with impaired joint mobility and quality of life. The HLA B27 antigen, which occurs in approximately 97% of patients, is an important risk factor and also a diagnostic element to consider. The typical onset of the disease is in the 3rd-4th decade of life; juvenile onset of AS under 16 years is associated with the predominant involvement of peripheral joints and multiple complications (coxitis, acute anterior uveitis) which influence the evolution of the disease under treatment being related with a negative prognosis. Noonan syndrome is a genetic disease with dominant autosomal transmission characterized by a small stature and other phenotypic features associated with congenital heart defects, especially pulmonary stenosis and atrial septal defect. Multiple genes within the RAS subfamily involved in various cellular signaling pathways such as signal transmission via mitogen-activated protein kinases are responsible for the occurrence of the disorder. Different hematological diseases such as myeloproliferative syndrome and neoplastic disease, particularly affecting the lung, may be correlated with Noonan syndrome. We present the case of a young patient with juvenile onset AS and Crohn’s disease who has Noonan syndrome with operated pulmonary stenosis and septal atrial defect, the association of these diseases bringing together cumulative complications that required multiple therapies and surgical interventions with strict monitoring.
{"title":"A rare association: Ankylosing spondylitis and a genetic disease","authors":"A. Nicola, M. Greere, Adelina Birceanu, D. Balanescu, M. Dună, D. Predețeanu","doi":"10.37897/rjr.2019.3.4","DOIUrl":"https://doi.org/10.37897/rjr.2019.3.4","url":null,"abstract":"Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects the axial skeleton and sometimes the peripheral joints, leading to the development of bone bridges and ankyloses with impaired joint mobility and quality of life. The HLA B27 antigen, which occurs in approximately 97% of patients, is an important risk factor and also a diagnostic element to consider. The typical onset of the disease is in the 3rd-4th decade of life; juvenile onset of AS under 16 years is associated with the predominant involvement of peripheral joints and multiple complications (coxitis, acute anterior uveitis) which influence the evolution of the disease under treatment being related with a negative prognosis. Noonan syndrome is a genetic disease with dominant autosomal transmission characterized by a small stature and other phenotypic features associated with congenital heart defects, especially pulmonary stenosis and atrial septal defect. Multiple genes within the RAS subfamily involved in various cellular signaling pathways such as signal transmission via mitogen-activated protein kinases are responsible for the occurrence of the disorder. Different hematological diseases such as myeloproliferative syndrome and neoplastic disease, particularly affecting the lung, may be correlated with Noonan syndrome. We present the case of a young patient with juvenile onset AS and Crohn’s disease who has Noonan syndrome with operated pulmonary stenosis and septal atrial defect, the association of these diseases bringing together cumulative complications that required multiple therapies and surgical interventions with strict monitoring.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46754020","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}
The study of intestinal microbiota is an important and current subject. It is well known that the gut microbiota plays a decisive role in the development of intestinal function, contributes to the defense against different infections, gives tolerance to ingested foods, regulating and maintaining the function of the intestinal barrier. The gut microbiota is different from individual to individual, determining, through the molecular profile, an “individual profile”. Intestinal dysbiosis is associated with multiple diseases such as IBD, irritable bowel syndrome, nosocomial infections or rheumatic inflammatory disorders. By characterizing intestinal dysbiosis in patients, a link could be made between these bacteria and the pathogenic mechanisms of the diseases, assigning these structures key roles in the onset of systemic disorders. This allows a better understanding of the pathophysiological mechanisms of the diseases and allow having a targeted treatment aimed at improving dysbiosis and restoring the normal microbial gut profile.
{"title":"The signature of intestinal dysbiosis in inflammatory rheumatic diseases","authors":"A. Cardoneanu, R. P. Iași, A. Burlui, E. Rezus","doi":"10.37897/rjr.2019.3.1","DOIUrl":"https://doi.org/10.37897/rjr.2019.3.1","url":null,"abstract":"The study of intestinal microbiota is an important and current subject. It is well known that the gut microbiota plays a decisive role in the development of intestinal function, contributes to the defense against different infections, gives tolerance to ingested foods, regulating and maintaining the function of the intestinal barrier. The gut microbiota is different from individual to individual, determining, through the molecular profile, an “individual profile”. Intestinal dysbiosis is associated with multiple diseases such as IBD, irritable bowel syndrome, nosocomial infections or rheumatic inflammatory disorders. By characterizing intestinal dysbiosis in patients, a link could be made between these bacteria and the pathogenic mechanisms of the diseases, assigning these structures key roles in the onset of systemic disorders. This allows a better understanding of the pathophysiological mechanisms of the diseases and allow having a targeted treatment aimed at improving dysbiosis and restoring the normal microbial gut profile.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46884669","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. Enache, C. Popescu, C. Codreanu, M. Șuța, B. Pharmacy
Objective. The study aimed to observe the frequency of ultrasound-defined tenosynovitis in ankle tendon and to evaluate the relationship of ankle tenosynovitis with clinical examination and rheumatoid arthritis (RA) activity measures. Methods. RA patients were recruited in 2018 in the random order of presentation from the out-patient clinic. On the same day of inclusion, all patients underwent clinical examination, laboratory tests (inflammatory markers), ankle ultrasound and patient-reported outcomes. Results. the study included 183 patients with established RA, mostly women (86.3%), with mean age of 57.3 years. The most frequent tenosynovitis was observed in the tibialis posterior tendon (TP; 40.4%), followed by the peroneus longus (23.0%) and peroneus brevis (18.0%) tendons. Compared to patients without TP tenosynovitis, patients with TP tenosynovitis had significantly higher titres of rheumatoid factors (RF; median of 123 IU/mL compared to 64 IU/mL; p = 0.023). Clinically tender (55.2%) and swollen (30.6%) ankles were 4.2 and respectively 11.6 times more likely to reveal tenosynovitis on ultrasound. The presence of ankle tenosynovitis was associated with higher disease activity measures. DAS28 increased proportionally and significantly with the number of ankles with tenosynovitis, the grade of ankle tenosynovitis and power Doppler activity. The absence of ankle tenosynovitis independently and significantly decreased DAS28 with 1.2 points (p < 0.001). Conclusions. the most frequent ankle tenosynovitis observed in RA patients involves the TP tendon, which is associated with higher titres of RF. Swollen ankles are more specific and better predictors of ultrasound-defined ankle tenosynovitis, which has a directly proportional relationship with disease activity in RA. Disease activity scores should include clinical evaluation of ankles and ultrasound information.
{"title":"Ankle ultrasound tenosynovitis is a significant predictor of DAS28 – defined rheumatoid arthritis activity","authors":"L. Enache, C. Popescu, C. Codreanu, M. Șuța, B. Pharmacy","doi":"10.37897/rjr.2019.3.3","DOIUrl":"https://doi.org/10.37897/rjr.2019.3.3","url":null,"abstract":"Objective. The study aimed to observe the frequency of ultrasound-defined tenosynovitis in ankle tendon and to evaluate the relationship of ankle tenosynovitis with clinical examination and rheumatoid arthritis (RA) activity measures. Methods. RA patients were recruited in 2018 in the random order of presentation from the out-patient clinic. On the same day of inclusion, all patients underwent clinical examination, laboratory tests (inflammatory markers), ankle ultrasound and patient-reported outcomes. Results. the study included 183 patients with established RA, mostly women (86.3%), with mean age of 57.3 years. The most frequent tenosynovitis was observed in the tibialis posterior tendon (TP; 40.4%), followed by the peroneus longus (23.0%) and peroneus brevis (18.0%) tendons. Compared to patients without TP tenosynovitis, patients with TP tenosynovitis had significantly higher titres of rheumatoid factors (RF; median of 123 IU/mL compared to 64 IU/mL; p = 0.023). Clinically tender (55.2%) and swollen (30.6%) ankles were 4.2 and respectively 11.6 times more likely to reveal tenosynovitis on ultrasound. The presence of ankle tenosynovitis was associated with higher disease activity measures. DAS28 increased proportionally and significantly with the number of ankles with tenosynovitis, the grade of ankle tenosynovitis and power Doppler activity. The absence of ankle tenosynovitis independently and significantly decreased DAS28 with 1.2 points (p < 0.001). Conclusions. the most frequent ankle tenosynovitis observed in RA patients involves the TP tendon, which is associated with higher titres of RF. Swollen ankles are more specific and better predictors of ultrasound-defined ankle tenosynovitis, which has a directly proportional relationship with disease activity in RA. Disease activity scores should include clinical evaluation of ankles and ultrasound information.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41665732","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. Dună, D. Balanescu, C. Iosif, N. Copcă, D. Predețeanu, R. Ionescu
Belimumab is a human immunoglobulin G1-lambda-1 (IgG1-λ) monoclonal antibody that targets the soluble BLyS human protein, also known as B-cell activating factor (BAFF) approved for the treatment of systemic lupus erythematosus (SLE). Serious and sometimes fatal infections have been reported in patients receiving novel immunosuppressive agents, including belimumab. Thus, physicians should exercise caution when considering belimumab in patients with SLE. A 50-year-old woman with SLE presented with a severe, diffuse rash two months after initiating treatment with belimumab. A skin biopsy revealed epidermal necrolysis with keratinocyte detachment and apoptosis in the basal layer of the epidermis, suggestive for toxic epidermal necrolysis (TEN). Belimumab was discontinued and 500 mg of pulse IV methylprednisolone therapy every day for 3 days were administered, with resolution of the skin lesions in the following days. To the best of our knowledge, this is the first case of belimumab-associated TEN.
{"title":"One case of toxic epidermal necrolysis after treatment with belimumab in a patient with systemic lupus erythematosus","authors":"M. Dună, D. Balanescu, C. Iosif, N. Copcă, D. Predețeanu, R. Ionescu","doi":"10.37897/rjr.2019.3.5","DOIUrl":"https://doi.org/10.37897/rjr.2019.3.5","url":null,"abstract":"Belimumab is a human immunoglobulin G1-lambda-1 (IgG1-λ) monoclonal antibody that targets the soluble BLyS human protein, also known as B-cell activating factor (BAFF) approved for the treatment of systemic lupus erythematosus (SLE). Serious and sometimes fatal infections have been reported in patients receiving novel immunosuppressive agents, including belimumab. Thus, physicians should exercise caution when considering belimumab in patients with SLE. A 50-year-old woman with SLE presented with a severe, diffuse rash two months after initiating treatment with belimumab. A skin biopsy revealed epidermal necrolysis with keratinocyte detachment and apoptosis in the basal layer of the epidermis, suggestive for toxic epidermal necrolysis (TEN). Belimumab was discontinued and 500 mg of pulse IV methylprednisolone therapy every day for 3 days were administered, with resolution of the skin lesions in the following days. To the best of our knowledge, this is the first case of belimumab-associated TEN.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45976311","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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