Pub Date : 2020-12-28DOI: 10.35465/28.4.2020.PP59-71
R. Dacheva, S. Monov
Абстракт: Прогресивната системна склероза (Systemic sclerosis, SSc) представлява системно заболяване на съединителната тъкан, характеризиращо се с фиброзни промени, засягащи кожата и вътрешните органи, васкулопатия и имунна дисрегулация. Интерстициалните пневмонии представляват група дифузни паренхимни белодробни болести (diffuse parenchymal lung disease – ДПББ), или още наричани интерстициални белодробни болести, ИББ (interstitial lung diseases – ILD). ИББ е водещо усложнение на SSc и е водеща причина за смъртност при пациенти със SSc. Патогенезата на белодробното увреждане включва три основни процеса - персистираща увреда на еднотелните клетки, активация на имунната система и активация на фибробласти, водещо до акумулация на екстрацелуларен матрикс и тъканна увреда. Необходим е комплексен подход за правилно диганостициране и избор на терапия.
{"title":"Systemic sclerosis-associated interstitial lung disease: review of the literature","authors":"R. Dacheva, S. Monov","doi":"10.35465/28.4.2020.PP59-71","DOIUrl":"https://doi.org/10.35465/28.4.2020.PP59-71","url":null,"abstract":"Абстракт: Прогресивната системна склероза (Systemic sclerosis, SSc) представлява системно заболяване на съединителната тъкан, характеризиращо се с фиброзни промени, засягащи кожата и вътрешните органи, васкулопатия и имунна дисрегулация. Интерстициалните пневмонии представляват група дифузни паренхимни белодробни болести (diffuse parenchymal lung disease – ДПББ), или още наричани интерстициални белодробни болести, ИББ (interstitial lung diseases – ILD). ИББ е водещо усложнение на SSc и е водеща причина за смъртност при пациенти със SSc. Патогенезата на белодробното увреждане включва три основни процеса - персистираща увреда на еднотелните клетки, активация на имунната система и активация на фибробласти, водещо до акумулация на екстрацелуларен матрикс и тъканна увреда. Необходим е комплексен подход за правилно диганостициране и избор на терапия.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44221380","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}
Pub Date : 2020-12-28DOI: 10.35465/28.4.2020.PP3-18
L. Stefanov, T. Bolyarova-Konova, Z. Kolarov, P. Pavlova, M. Ivanova
Antibodies against cyclic citrullinated peptides (ACPA) have significant prognostic value for the onset or progression of rheumatoid arthritis (RA). Extraarticular citrullination and the production of ACPA as an immune response have been well documented in a number of tissues, including inflamed gingiva associated with periodontal disease. The aim of this study was to analyze the relative value of serum ACPA, determined by anti-CCP test, in the periodontitis (P) associated with RA severity`s assessment. The study included 60 patients with a mean age of 58 ± 10 (34 to 74 years), of whom 44 were women and 16 were men with concomitant P and RA. All patients underwent clinical and laboratory tests for the diagnosis of RA and clinical periodontal examination for the diagnosis of P, after signed informed consent. In the studied cohort we found that the average number of lost teeth was 8 ± 5 (0-18), and the average depth of periodontal pockets in mm was 4.4 ± 1.1. In 50% of patients there was a loss of attachment> 5 mm, and in 43% we found furcation lesions. Fifty-eight patients (96.7%) had a 100% prevalence of probing bleeding (BoP), and 47 patients (78.3%) had PISA ≥ 934.71mm². The mean value of PISA in the studied patients was 1727.04 ± 873.64 (214.37 - 4324.00). We did not find a statistically significant difference in serum ACPA levels depending on the severity of periodontal parameters PD (p = 0.357), CAL (p = 0.589) and PISA (p = 0.788). We found that the ROC-based cutoff values for ACPA were high (123.85 IU / ml) and had low sensitivity and specificity in distinguishing between severe and moderate / mild forms of periodontal disease.
{"title":"Serum anti-CCP antibodies in periodontitis associated with rheumatoid arthritis - relative value for the severity of periodontitis","authors":"L. Stefanov, T. Bolyarova-Konova, Z. Kolarov, P. Pavlova, M. Ivanova","doi":"10.35465/28.4.2020.PP3-18","DOIUrl":"https://doi.org/10.35465/28.4.2020.PP3-18","url":null,"abstract":"Antibodies against cyclic citrullinated peptides (ACPA) have significant prognostic value for the onset or progression of rheumatoid arthritis (RA). Extraarticular citrullination and the production of ACPA as an immune response have been well documented in a number of tissues, including inflamed gingiva associated with periodontal disease. The aim of this study was to analyze the relative value of serum ACPA, determined by anti-CCP test, in the periodontitis (P) associated with RA severity`s assessment. The study included 60 patients with a mean age of 58 ± 10 (34 to 74 years), of whom 44 were women and 16 were men with concomitant P and RA. All patients underwent clinical and laboratory tests for the diagnosis of RA and clinical periodontal examination for the diagnosis of P, after signed informed consent. In the studied cohort we found that the average number of lost teeth was 8 ± 5 (0-18), and the average depth of periodontal pockets in mm was 4.4 ± 1.1. In 50% of patients there was a loss of attachment> 5 mm, and in 43% we found furcation lesions. Fifty-eight patients (96.7%) had a 100% prevalence of probing bleeding (BoP), and 47 patients (78.3%) had PISA ≥ 934.71mm². The mean value of PISA in the studied patients was 1727.04 ± 873.64 (214.37 - 4324.00). We did not find a statistically significant difference in serum ACPA levels depending on the severity of periodontal parameters PD (p = 0.357), CAL (p = 0.589) and PISA (p = 0.788). We found that the ROC-based cutoff values for ACPA were high (123.85 IU / ml) and had low sensitivity and specificity in distinguishing between severe and moderate / mild forms of periodontal disease.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46488321","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp42-48
Ташева, Игорь Петров, С. Павлова, Л. Гроздински, З. Станков, I. Tasheva, I. Petrov, S. Pavlova, L. Grozdinski, Z. Stankov
Takayasu arteritis is a chronic, rare arteritis that causes arterial stenosis / occlusion and dilation, affects the aorta and its branches. The most commonly affected branches are the subclavian artery and the common carotid artery. It is mainly diagnosed in women under 40 years of age. It is most commonly observed in Japan, Southeast Asia, India and Mexico. We represent a clinical case of a patient with Takayasu arteritis, with diagnosed significant stenosis of the common carotid arteries and subclavian artery. Doppler sonography was used for screening. Endovascular treatment of lesions with different localization has been applied in stages. They have been successfully and effectively treated by implanting different types of stent on the Takayasu-affected artery lesions. No intra-procedural major events were observed, as well as death or severe complications during the follow-up.
{"title":"Endovascular treatment of a patient with Takayasu arteritis","authors":"Ташева, Игорь Петров, С. Павлова, Л. Гроздински, З. Станков, I. Tasheva, I. Petrov, S. Pavlova, L. Grozdinski, Z. Stankov","doi":"10.35465/27.4.2019.pp42-48","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp42-48","url":null,"abstract":"Takayasu arteritis is a chronic, rare arteritis that causes arterial stenosis / occlusion and dilation, affects the aorta and its branches. The most commonly affected branches are the subclavian artery and the common carotid artery. It is mainly diagnosed in women under 40 years of age. It is most commonly observed in Japan, Southeast Asia, India and Mexico. We represent a clinical case of a patient with Takayasu arteritis, with diagnosed significant stenosis of the common carotid arteries and subclavian artery. Doppler sonography was used for screening. Endovascular treatment of lesions with different localization has been applied in stages. They have been successfully and effectively treated by implanting different types of stent on the Takayasu-affected artery lesions. No intra-procedural major events were observed, as well as death or severe complications during the follow-up.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42096468","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp3-17
Първова, Е. Христов, А. Рангелов, I. Parvova, E. Hristov, A. Rangelov
To analyze reports of adverse drug reactions (ADRs) occurring during and after treatment of rheumatologic diseases with biological medicinal products (BMPs), published in the scientific literature; to determine the type, frequency, grade of severity and evaluate the causality with the ongoing treatment. The literature search was conducted in MEDLINE and PubMed databases for the period from November 2002 to November 2016. We found 710 publications, and 225 papers were selected for data extraction. We carried out descriptive and variational analyses as basic statistical analyses. We defined mean values, standard deviation, minimum, maximum, 95% confidence intervals. We assessed the results using PICOS instrument – population, intervention, comparison, outcomes and study design. The analyzed population included 137,564 patients with rheumatic diseases. Original articles and reviews account for the largest share of publications - 183 (81.33%). The most frequently used medicinal products were monoclonal antibodies. We found data of 284 types of ADRs. The most commonly reported ADRs were: common infections, development (activation) of tuberculosis infection, malignancies. ADRs were found in 12,979 patients, i.е. in 9,43% of the population, there was at least one ADR. Our systematic review has shown increased interest in the pharmacovigilance of biological medicinal products. The larger share of scientific publications, however, use non-standardized terminology to describe ADRs, which is not in line with the current pharmacovigilance concept. Ignorance of the notions, inaccurate and incorrect handling of scientific-regulatory terminology, and errors in ADRs reporting and publication in scientific literature do not allow for systematic reviews in this field.
{"title":"Analysis of adverse drug reactions in the treatment of rheumatological diseases with biological medicinal products – a systematic review of scientific publications","authors":"Първова, Е. Христов, А. Рангелов, I. Parvova, E. Hristov, A. Rangelov","doi":"10.35465/27.4.2019.pp3-17","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp3-17","url":null,"abstract":"To analyze reports of adverse drug reactions (ADRs) occurring during and after treatment of rheumatologic diseases with biological medicinal products (BMPs), published in the scientific literature; to determine the type, frequency, grade of severity and evaluate the causality with the ongoing treatment. The literature search was conducted in MEDLINE and PubMed databases for the period from November 2002 to November 2016. We found 710 publications, and 225 papers were selected for data extraction. We carried out descriptive and variational analyses as basic statistical analyses. We defined mean values, standard deviation, minimum, maximum, 95% confidence intervals. We assessed the results using PICOS instrument – population, intervention, comparison, outcomes and study design. The analyzed population included 137,564 patients with rheumatic diseases. Original articles and reviews account for the largest share of publications - 183 (81.33%). The most frequently used medicinal products were monoclonal antibodies. We found data of 284 types of ADRs. The most commonly reported ADRs were: common infections, development (activation) of tuberculosis infection, malignancies. ADRs were found in 12,979 patients, i.е. in 9,43% of the population, there was at least one ADR. Our systematic review has shown increased interest in the pharmacovigilance of biological medicinal products. The larger share of scientific publications, however, use non-standardized terminology to describe ADRs, which is not in line with the current pharmacovigilance concept. Ignorance of the notions, inaccurate and incorrect handling of scientific-regulatory terminology, and errors in ADRs reporting and publication in scientific literature do not allow for systematic reviews in this field.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48664487","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp18-26
Background: In the literature there are reports that the key interleukins, IL-1β and IL-18, for the initiation and maintenance of gouty inflammation are associated with renal and cardiovascular disorders. They have a major regulatory function in the innate immune response and in vascular pathology. Objective: We aimed to determine serum levels of IL-1β and IL-18 in controls with inactivated osteoarthritis, patients with asymptomatic hyperuricemia, gouty arthritis without tophi subjects and gouty tophi individuals out of flare, and to establish whether their serum concentrations are connected to ultrasound alterations of the kidneys and heart. Materials and methods: The study is cross-sectional in design. A total of 83 consecutive patients were included: 18 with inactivated osteoarthritis, 29 with asymptomatic hyperuricemia, 22 gouty arthritis without tophi and 18 gouty tophi individuals out of flare. Serum interleukin concentrations were determined by enzyme-linked immunosorbent assay (ELISA) with Human IL-1β and IL-18 ELISA kits (Platinum, eBioscience, Vienna, Austria). By applying ultrasound were measured: renal resistive index (RRI) with 3.5 MHz transducer working with pulse Doppler frequency of 2.5 MHz and left ventricular mass index (LVMi), determined with 2.5 MHz transducer Phased Array. Data were analyzed by One-Sample Kolmogorov-Smirnov, ANOVA, Tukey HSD, Kruskal Wallis, Mann-Whitney and Fisher’s exact test. Correlational analyzes were performed by using the Spearman correlation coefficient. Results: In gouty tophi subjects serum IL-1β level was undetectable compared to the other three groups, (p<0.001). The serum concentration of IL-18 was comparable across the groups, (p=0.154). Given that the level of IL-1β was undetectable in gouty tophi patients, a correlation analysis in this group with serum uric acid concentration, RRI and LVMi was not performed. In the remaining three groups, which had values of IL-1β above zero, we did not detect an association with the above mentioned parameters. No correlation was found between IL-18 concentration and serum uric acid, RRI and LVMi in the groups. Conclusion: We suggest that serum IL-1β and IL-18 levels do not reflect the severity of the disease and cardiovascular risk in the examined gout patients.
{"title":"Serum concentrations of IL-1β and IL-18 in gout patients out of flare are not connected to cardiovascular alterations","authors":"","doi":"10.35465/27.4.2019.pp18-26","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp18-26","url":null,"abstract":"Background: In the literature there are reports that the key interleukins, IL-1β and IL-18, for the initiation and maintenance of gouty inflammation are associated with renal and cardiovascular disorders. They have a major regulatory function in the innate immune response and in vascular pathology. Objective: We aimed to determine serum levels of IL-1β and IL-18 in controls with inactivated osteoarthritis, patients with asymptomatic hyperuricemia, gouty arthritis without tophi subjects and gouty tophi individuals out of flare, and to establish whether their serum concentrations are connected to ultrasound alterations of the kidneys and heart. Materials and methods: The study is cross-sectional in design. A total of 83 consecutive patients were included: 18 with inactivated osteoarthritis, 29 with asymptomatic hyperuricemia, 22 gouty arthritis without tophi and 18 gouty tophi individuals out of flare. Serum interleukin concentrations were determined by enzyme-linked immunosorbent assay (ELISA) with Human IL-1β and IL-18 ELISA kits (Platinum, eBioscience, Vienna, Austria). By applying ultrasound were measured: renal resistive index (RRI) with 3.5 MHz transducer working with pulse Doppler frequency of 2.5 MHz and left ventricular mass index (LVMi), determined with 2.5 MHz transducer Phased Array. Data were analyzed by One-Sample Kolmogorov-Smirnov, ANOVA, Tukey HSD, Kruskal Wallis, Mann-Whitney and Fisher’s exact test. Correlational analyzes were performed by using the Spearman correlation coefficient. Results: In gouty tophi subjects serum IL-1β level was undetectable compared to the other three groups, (p<0.001). The serum concentration of IL-18 was comparable across the groups, (p=0.154). Given that the level of IL-1β was undetectable in gouty tophi patients, a correlation analysis in this group with serum uric acid concentration, RRI and LVMi was not performed. In the remaining three groups, which had values of IL-1β above zero, we did not detect an association with the above mentioned parameters. No correlation was found between IL-18 concentration and serum uric acid, RRI and LVMi in the groups. Conclusion: We suggest that serum IL-1β and IL-18 levels do not reflect the severity of the disease and cardiovascular risk in the examined gout patients.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42040098","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp63-66
T. Kalenchic, N. Didenko, S. Kabak
The current report presents a case of late-onset systemic lupus erythematosus (SLE). A 75-year-old Caucasian woman was admitted to the clinical hospital because of dyspnea, dry cough, low-grade fever, wrist pain. There were no oral and skin lesions or lymphadenopathy observed. Laboratory tests revealed hypochromic microcytic anemia with hemoglobin 111 g/l, lymphopenia 0,54 x 10/l, the erythrocyte sedimentation rate (ESR) elevation up to 47 mm/h and the C-reactive protein level up to 10,7 mg/l. Tumor markers (CA-125, CA-19.9, СА-15,3, α-fetoprotein) concentration, hepatic and renal function were within the reference ranges. Of note, urinalysis didn’t reveal proteinuria or microscopic hematuria and was considered normal. Computed tomography revealed bilateral pulmonary consolidation in S10, sacculated pleuritis, solitary lymphadenopathy, and pericardial effusions. Diagnosis of SLE was confirmed based on three clinical signs (synovitis of proximal interphalangeal joints, serositis including pleuritis, hematological disorders: anemia, lymphocytopenia) and positive findings of three immunological tests (anti-double-stranded DNA antibodies [Anti-dsDNA], antinuclear antibodies [ANA], and anti-nucleosome antibodies [ANuA]). This case demonstrates that late-onset SLE may be one of the reasons for the accumulation of pleural fluid in elderly patients.
本文报告一例迟发性系统性红斑狼疮(SLE)。一名75岁白人妇女因呼吸困难、干咳、低烧、手腕疼痛入院。未见口腔及皮肤病变及淋巴结病变。实验室检查显示低色性小细胞贫血，血红蛋白111 g/l，淋巴细胞减少0.54 x 10/l，红细胞沉降率(ESR)升高高达47 mm/h, c反应蛋白水平高达10.7 mg/l。肿瘤标志物(CA-125、CA-19.9、СА-15、3、α-胎蛋白)浓度及肝肾功能均在参考范围内。值得注意的是，尿分析没有发现蛋白尿或显微镜下血尿，认为是正常的。计算机断层扫描显示S10双侧肺实变、囊状胸膜炎、孤立性淋巴结病和心包积液。根据三个临床症状(近端指间关节滑膜炎、包括胸膜炎的浆液炎、血液学疾病:贫血、淋巴细胞减少症)和三种免疫检查(抗双链DNA抗体[Anti-dsDNA]、抗核抗体[ANA]、抗核小体抗体[ANuA])阳性结果，确认SLE的诊断。本病例提示迟发性SLE可能是老年患者胸腔积液的原因之一。
{"title":"Pulmonary manifestations of late-onset systemic lupus erythematosus: a case report","authors":"T. Kalenchic, N. Didenko, S. Kabak","doi":"10.35465/27.4.2019.pp63-66","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp63-66","url":null,"abstract":"The current report presents a case of late-onset systemic lupus erythematosus (SLE). A 75-year-old Caucasian woman was admitted to the clinical hospital because of dyspnea, dry cough, low-grade fever, wrist pain. There were no oral and skin lesions or lymphadenopathy observed. Laboratory tests revealed hypochromic microcytic anemia with hemoglobin 111 g/l, lymphopenia 0,54 x 10/l, the erythrocyte sedimentation rate (ESR) elevation up to 47 mm/h and the C-reactive protein level up to 10,7 mg/l. Tumor markers (CA-125, CA-19.9, СА-15,3, α-fetoprotein) concentration, hepatic and renal function were within the reference ranges. Of note, urinalysis didn’t reveal proteinuria or microscopic hematuria and was considered normal. Computed tomography revealed bilateral pulmonary consolidation in S10, sacculated pleuritis, solitary lymphadenopathy, and pericardial effusions. Diagnosis of SLE was confirmed based on three clinical signs (synovitis of proximal interphalangeal joints, serositis including pleuritis, hematological disorders: anemia, lymphocytopenia) and positive findings of three immunological tests (anti-double-stranded DNA antibodies [Anti-dsDNA], antinuclear antibodies [ANA], and anti-nucleosome antibodies [ANuA]). This case demonstrates that late-onset SLE may be one of the reasons for the accumulation of pleural fluid in elderly patients.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43567250","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp27-41
Т. Тодоров, Л. Мекенян, С. Попова, Алексей Григорьевич Баталов, P. Todorov, L. Mekenjan, S. Popova, A. Batalov
Low back pain (LBP) is an extremely common symptom in populations of all ages with significant economic and social burden worldwide. As such it should be among the priorities for trying to find more efficient methods for prevention and treatment. Currently the exact cause for the complaints can be found in most of the cases following thorough clinical examination, adequate diagnostic tests and modern image diagnosis. Most often the complaints are cause by degenerative processes affecting certain structures in the lumbosacral area – the intervertebral discs, the tendons/entheses along the iliac crest, the sacroiliac and lumbar facet joints. Platelet rich plasma (PRP) is a widely used therapeutic method aimed at recovering (both anatomical and functional) degenerative or traumatic damaged collagen tissues by injecting/applying autologous blood concentrate, rich in growth factors and other biologically active molecules. PRP demonstrates huge potential in stimulating cell proliferation and metabolic activity in vitro. Trials with animals show/prove the full recovery of the structural changes and the matrix integrity of the damaged tissue. In recent years some prospective clinical studies and published case series report that PRP could be a safe and efficient therapy for patients with chronic low back pain that do not yield to traditional/standard treatment options. Data though limited/scarce for the time being includes/covers the most common cause for this complaint, namely pathology of the intervertebral discs, facet and sacroiliac joints, as well as paraspinal soft tissues. The possibility for precise intralesional application of this regeneration autologous product in the damaged tissue gives it a huge advantage over the common algorithms currently used in the clinical practice to treat patients with such complaints. Future bigger studies including image methods to evaluate the structural recovery of the degenerative changed tissue responsible/blamed for the pain and functional deficit would bring light to the place PRP therapy should take in the treatment of low back pain.
{"title":"Platelet rich plasma application in chronic low back pain – clinical and anatomical rationale and review of the literature","authors":"Т. Тодоров, Л. Мекенян, С. Попова, Алексей Григорьевич Баталов, P. Todorov, L. Mekenjan, S. Popova, A. Batalov","doi":"10.35465/27.4.2019.pp27-41","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp27-41","url":null,"abstract":"Low back pain (LBP) is an extremely common symptom in populations of all ages with significant economic and social burden worldwide. As such it should be among the priorities for trying to find more efficient methods for prevention and treatment. Currently the exact cause for the complaints can be found in most of the cases following thorough clinical examination, adequate diagnostic tests and modern image diagnosis. Most often the complaints are cause by degenerative processes affecting certain structures in the lumbosacral area – the intervertebral discs, the tendons/entheses along the iliac crest, the sacroiliac and lumbar facet joints. Platelet rich plasma (PRP) is a widely used therapeutic method aimed at recovering (both anatomical and functional) degenerative or traumatic damaged collagen tissues by injecting/applying autologous blood concentrate, rich in growth factors and other biologically active molecules. PRP demonstrates huge potential in stimulating cell proliferation and metabolic activity in vitro. Trials with animals show/prove the full recovery of the structural changes and the matrix integrity of the damaged tissue. In recent years some prospective clinical studies and published case series report that PRP could be a safe and efficient therapy for patients with chronic low back pain that do not yield to traditional/standard treatment options. Data though limited/scarce for the time being includes/covers the most common cause for this complaint, namely pathology of the intervertebral discs, facet and sacroiliac joints, as well as paraspinal soft tissues. The possibility for precise intralesional application of this regeneration autologous product in the damaged tissue gives it a huge advantage over the common algorithms currently used in the clinical practice to treat patients with such complaints. Future bigger studies including image methods to evaluate the structural recovery of the degenerative changed tissue responsible/blamed for the pain and functional deficit would bring light to the place PRP therapy should take in the treatment of low back pain.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42252017","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp55-62
N. Stoilov, V. Boyadzhieva
Antiphospholipid syndrome is a systemic autoimmune disease with unclear etiology and complex pathogenesis. It can be a single nosological unit or in the context of another systemic disease of the connective tissue – most commonly systemic lupus erythematosus (SLE). The presence of antiphospholipid antibodies in pregnant women is associated with an increased rate of complications during pregnancy. The most common symptoms are preeclampsia and eclampsia, early spontaneous abortions and late fetal loss, in the absence or presence of a proven genetic defect for congenital thrombophilia and/or chromosomal diseases. A multidisciplinary approach and regular patient consultations are key factors in the follow-up and positive outcomes of pregnancy in women with SLE and antiphospholipid syndrome (APS). Timely treatment with corticosteroids, anticoagulants, antiаggregant agents, and intravenous immunoglobulins repeatedly increases the chance of successful completion of pregnancy with live birth.
{"title":"A case report of a patient with a live born child from the 14th pregnancy after 13 spontaneous abortion, diagnosed with systemic lupus erythematosus and antiphospholipid syndrome","authors":"N. Stoilov, V. Boyadzhieva","doi":"10.35465/27.4.2019.pp55-62","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp55-62","url":null,"abstract":"Antiphospholipid syndrome is a systemic autoimmune disease with unclear etiology and complex pathogenesis. It can be a single nosological unit or in the context of another systemic disease of the connective tissue – most commonly systemic lupus erythematosus (SLE). The presence of antiphospholipid antibodies in pregnant women is associated with an increased rate of complications during pregnancy. The most common symptoms are preeclampsia and eclampsia, early spontaneous abortions and late fetal loss, in the absence or presence of a proven genetic defect for congenital thrombophilia and/or chromosomal diseases. A multidisciplinary approach and regular patient consultations are key factors in the follow-up and positive outcomes of pregnancy in women with SLE and antiphospholipid syndrome (APS). Timely treatment with corticosteroids, anticoagulants, antiаggregant agents, and intravenous immunoglobulins repeatedly increases the chance of successful completion of pregnancy with live birth.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41503445","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}
Pub Date : 2019-12-01DOI: 10.35465/27.4.2019.pp49-54
Вл. Бояджиева, Н. Стоилов, Е. Куртева, Р. Стоилов, V. Boyadzhieva, N. Stoilov, E. Kurteva, R. Stoilov
Chikungunya virus (CHIKV) is an arthritogenic arbovirus infection transmitted through the mosquitoes Aedes aegypti and Aedes albopictus. The clinical picture is diverse - from mildly flowing, almost asymptomatic forms to characteristic episodes of fever, polymyalgia, polyarthralgia, and arthritis. Globalization of the world is increasing the chances of infection spreading outside known endemic areas. This necessitates a broad differential diagnosis, especially in cases that mimic inflammatory joint diseases such as rheumatoid arthritis. The presented clinical case is of a patient who has returned from a trip to the Maldives and is the first in the Republic of Bulgaria as far as we know, and is established after a detailed literature reference has been made. Rheumatologists, even in non-CHIKV-endemic regions, should consider CHIKV in their evaluation of symmetric polyarthritis lasting above six weeks, especially in case of anamnesis for a trip to the endemic regions to CHIKV that are likely to expand in the near future. However, demonstrating positive antibodies to the Chikungunya virus is the rheumatologist‘s primary help in distinguishing the two diseases.
{"title":"Chikungunya viral arthritis mimicking seronegative rheumatoid arthritis","authors":"Вл. Бояджиева, Н. Стоилов, Е. Куртева, Р. Стоилов, V. Boyadzhieva, N. Stoilov, E. Kurteva, R. Stoilov","doi":"10.35465/27.4.2019.pp49-54","DOIUrl":"https://doi.org/10.35465/27.4.2019.pp49-54","url":null,"abstract":"Chikungunya virus (CHIKV) is an arthritogenic arbovirus infection transmitted through the mosquitoes Aedes aegypti and Aedes albopictus. The clinical picture is diverse - from mildly flowing, almost asymptomatic forms to characteristic episodes of fever, polymyalgia, polyarthralgia, and arthritis. Globalization of the world is increasing the chances of infection spreading outside known endemic areas. This necessitates a broad differential diagnosis, especially in cases that mimic inflammatory joint diseases such as rheumatoid arthritis. The presented clinical case is of a patient who has returned from a trip to the Maldives and is the first in the Republic of Bulgaria as far as we know, and is established after a detailed literature reference has been made. Rheumatologists, even in non-CHIKV-endemic regions, should consider CHIKV in their evaluation of symmetric polyarthritis lasting above six weeks, especially in case of anamnesis for a trip to the endemic regions to CHIKV that are likely to expand in the near future. However, demonstrating positive antibodies to the Chikungunya virus is the rheumatologist‘s primary help in distinguishing the two diseases.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44511704","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}
Pub Date : 2019-10-19DOI: 10.35465/27.3.2019.pp10-17
Т. Shivacheva
The purpose of this study is to analyze real-life data in order to characterize patients with RA and cardiovascular diseases that are treated with biological agents. Material and Methods: In a retrospective study, data from real clinical practice were analyzed in 195 patients with seropositive RA, which are being treated with biological agents. Results: In patients with existing CVD, significantly higher mean ESR values (23.95 vs. 19.31, p = 0.031) and CRP (6.41 vs. 3.36, p = 0.004) were detected over the period of the study period of treatment. In contrast to the laboratory parameters, mean values of clinical parameters of RA - TJC, SJC and VAS clinical sings did not show a significant difference in patients with and without CVD. The time average value of DAS28 (ESR) during the study period was significantly higher in patients with CVD (3.7 vs. 3.39, p = 0.002) compared to those without CVD. DAS28 (CRP) shows the same trend. In patients with CVD, the time average value of the follow-up indicator was 3.21, and in patients without CVD, 2.88 (p <0.001). Conclusion: The results of this study, in PA patients conducting treatment with biological agents in the real life, outside of the clinical study conditions, demonstrate that independently of treatment, patients with CVD continue to maintain higher background inflammation. An optimization of therapeutic behavior in real life is necessary to improve the long-term prognosis of these patients.
本研究的目的是分析现实生活中的数据，以确定接受生物制剂治疗的RA和心血管疾病患者的特征。材料和方法:在一项回顾性研究中，分析了195例血清阳性RA患者的真实临床实践数据，这些患者正在接受生物药物治疗。结果:在已有心血管疾病的患者中，在研究期间检测到的ESR平均值(23.95比19.31,p = 0.031)和CRP(6.41比3.36,p = 0.004)显著高于治疗期间。与实验室参数相比，有无心血管疾病患者RA - TJC、SJC和VAS临床sing的临床参数平均值均无显著差异。研究期间，CVD患者DAS28 (ESR)的时间平均值显著高于无CVD患者(3.7 vs. 3.39, p = 0.002)。DAS28 (CRP)表现出同样的趋势。CVD患者随访时间平均值为3.21，无CVD患者随访时间平均值为2.88 (p <0.001)。结论:本研究结果表明，在临床研究条件之外，在现实生活中接受生物制剂治疗的PA患者中，CVD患者继续保持较高的背景炎症。为了改善这些患者的长期预后，有必要在现实生活中优化治疗行为。
{"title":"Real-life data – a characteristic of RA in patients with cardiovascular diseases on the background of treatment with biological agents","authors":"Т. Shivacheva","doi":"10.35465/27.3.2019.pp10-17","DOIUrl":"https://doi.org/10.35465/27.3.2019.pp10-17","url":null,"abstract":"The purpose of this study is to analyze real-life data in order to characterize patients with RA and cardiovascular diseases that are treated with biological agents. Material and Methods: In a retrospective study, data from real clinical practice were analyzed in 195 patients with seropositive RA, which are being treated with biological agents. Results: In patients with existing CVD, significantly higher mean ESR values (23.95 vs. 19.31, p = 0.031) and CRP (6.41 vs. 3.36, p = 0.004) were detected over the period of the study period of treatment. In contrast to the laboratory parameters, mean values of clinical parameters of RA - TJC, SJC and VAS clinical sings did not show a significant difference in patients with and without CVD. The time average value of DAS28 (ESR) during the study period was significantly higher in patients with CVD (3.7 vs. 3.39, p = 0.002) compared to those without CVD. DAS28 (CRP) shows the same trend. In patients with CVD, the time average value of the follow-up indicator was 3.21, and in patients without CVD, 2.88 (p <0.001). Conclusion: The results of this study, in PA patients conducting treatment with biological agents in the real life, outside of the clinical study conditions, demonstrate that independently of treatment, patients with CVD continue to maintain higher background inflammation. An optimization of therapeutic behavior in real life is necessary to improve the long-term prognosis of these patients.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45241475","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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