Pub Date : 2019-10-19DOI: 10.35465/27.3.2019.pp44-54
Г. Василев, Е. Куртева, Мая Иванова, Е. Иванова-Тодорова, К. Тумангелова-Юзеир, Р. Ганчева, Р. Стоилов, Д. Кюркчиев, G. Vasilev, E. Krasimirova, M. Ivanova, E. Ivanova-Todorova, K. Tumangelova-Yuzeir, R. Gancheva, R. Stoilov, D. Kyurkchiev
In the context of autoimmune inflammatory diseases, the therapeutic benefits of mesenchymal stem cells (MSCs) could be found in their potential to exert immunosuppressive effects and to regulate the immune response. In pursuit of having a more complete look a the regulatory mechanisms performed by AT-MSC, we examined the influence of adipose stem cells (AT-MSC) on blood monocytes from patients with rheumatoid arthritis (RA). Comparison of the effect exerted by the soluble factors produced by AT-MSC vs. cell culture control media, on peripheral blood mononuclear cells (PBMC), showed a significant decrease in the percentage of HLA-DR expressing monocytes, 55.3% (IQR 30-65%) vs. 72% (IQR 62-81%), p = 0.001, as well as a significant decrease in mean fluorescence intensity MFI of HLA-DR was observed, 265 MFI (IQR 102-896 MFI) vs. 473 MFI IQR 160-2201 MFI), p = 0.001. The percentage of CD14 expressing monocytes and CD14 MFI, was increased in PBMC cultured with AT-MSC conditioned media as opposed to control media: 11.7% (IQR 7.6-16.5%) vs. 6.6% (IQR 4.6-11.8%), p = 0.013 and the surface expression density of CD14, 2702 (IQR 1548-3418) vs. 1540 (IQR 1146-2140), p = 0.05. sVEGF-A levels in PBMC cultures from PA patients cultured with conditioned media from AT-MSC were significantly higher than PBMC cultured with control media suppressing secretion of sVEGF-A, 5012 (IQR 2516-5054 pg/ml) vs. 561 pg/ml (IQR 288-699 pg/ml), p = 0.001.
{"title":"Effects exerted by mesenchymal stem cells on monocytes obtained from patients with rheumatoid arthritis and progressive systemic sclerosis","authors":"Г. Василев, Е. Куртева, Мая Иванова, Е. Иванова-Тодорова, К. Тумангелова-Юзеир, Р. Ганчева, Р. Стоилов, Д. Кюркчиев, G. Vasilev, E. Krasimirova, M. Ivanova, E. Ivanova-Todorova, K. Tumangelova-Yuzeir, R. Gancheva, R. Stoilov, D. Kyurkchiev","doi":"10.35465/27.3.2019.pp44-54","DOIUrl":"https://doi.org/10.35465/27.3.2019.pp44-54","url":null,"abstract":"In the context of autoimmune inflammatory diseases, the therapeutic benefits of mesenchymal stem cells (MSCs) could be found in their potential to exert immunosuppressive effects and to regulate the immune response. In pursuit of having a more complete look a the regulatory mechanisms performed by AT-MSC, we examined the influence of adipose stem cells (AT-MSC) on blood monocytes from patients with rheumatoid arthritis (RA). Comparison of the effect exerted by the soluble factors produced by AT-MSC vs. cell culture control media, on peripheral blood mononuclear cells (PBMC), showed a significant decrease in the percentage of HLA-DR expressing monocytes, 55.3% (IQR 30-65%) vs. 72% (IQR 62-81%), p = 0.001, as well as a significant decrease in mean fluorescence intensity MFI of HLA-DR was observed, 265 MFI (IQR 102-896 MFI) vs. 473 MFI IQR 160-2201 MFI), p = 0.001. The percentage of CD14 expressing monocytes and CD14 MFI, was increased in PBMC cultured with AT-MSC conditioned media as opposed to control media: 11.7% (IQR 7.6-16.5%) vs. 6.6% (IQR 4.6-11.8%), p = 0.013 and the surface expression density of CD14, 2702 (IQR 1548-3418) vs. 1540 (IQR 1146-2140), p = 0.05. sVEGF-A levels in PBMC cultures from PA patients cultured with conditioned media from AT-MSC were significantly higher than PBMC cultured with control media suppressing secretion of sVEGF-A, 5012 (IQR 2516-5054 pg/ml) vs. 561 pg/ml (IQR 288-699 pg/ml), p = 0.001.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69837636","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 : 2019-10-18DOI: 10.35465/27.3.2019.pp18-28
Tatyana Simeonova, K. Stefanova, I. Himcheva, P. Yordanova-Laleva, Aneliya A. Dimitrova
This study aims to assess vitamin D levels in women with postmenopausal osteoporosis and healthy women going through menopause. Two groups of menopausal women took part in the study – 41 women with osteoporosis and 22 without osteoporosis. The levels of vitamin D, parathormone, alkaline phosphatase, calcium and phosphorus were examined during the autumn-winter period. Calcium, phosphorus and alkaline phosphatase were established within the reference range in both groups. A negative correlation with increase of parathormone levels among the patients with osteoporosis and vitamin D deficiency was found (r = -0.46, p<0.01). 16 women with osteoporosis (39%) were with normal levels of vitamin D, 14 (34,1%) were with insufficiency and 11 (26,9%) with deficiency. Within the control group, 8 women (36,4%) were with normal levels of vitamin D, 12 (54,5%) were with insufficiency and 2 (9,1%) with deficiency.
{"title":"Vitamin D status, bone mineral density and body mass index in patients with newly diagnosed postmenopausal osteoporosis and healthy menopausal women","authors":"Tatyana Simeonova, K. Stefanova, I. Himcheva, P. Yordanova-Laleva, Aneliya A. Dimitrova","doi":"10.35465/27.3.2019.pp18-28","DOIUrl":"https://doi.org/10.35465/27.3.2019.pp18-28","url":null,"abstract":"This study aims to assess vitamin D levels in women with postmenopausal osteoporosis and healthy women going through menopause. Two groups of menopausal women took part in the study – 41 women with osteoporosis and 22 without osteoporosis. The levels of vitamin D, parathormone, alkaline phosphatase, calcium and phosphorus were examined during the autumn-winter period. Calcium, phosphorus and alkaline phosphatase were established within the reference range in both groups. A negative correlation with increase of parathormone levels among the patients with osteoporosis and vitamin D deficiency was found (r = -0.46, p<0.01). 16 women with osteoporosis (39%) were with normal levels of vitamin D, 14 (34,1%) were with insufficiency and 11 (26,9%) with deficiency. Within the control group, 8 women (36,4%) were with normal levels of vitamin D, 12 (54,5%) were with insufficiency and 2 (9,1%) with deficiency.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49339127","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 : 2019-09-30DOI: 10.35465/27.3.2019.pp66-76
Г. Георгиев, Цветослав Антонов Георгиев, Р. Стоилов, Мая Иванова, G. Georgiev, T. Georgiev, R. Stoilov, M. Ivanova
A significant place in the treatment of osteoarthritis (OA) is taken by physical therapy. Its modalities may be grouped into the following three categories, which could be used alone or in combination: 1) physiotherapeutic (preformed); 2) kinesitherapeutic; 3) resort-climatic (natural) means. The purpose of this review is to outline the place of physical therapy in the treatment of OA. The choice of one or another preformed physical factor depends on the severity of the disease process, the sensitivity of the patient and the physiotherapist's experience. Among the most commonly used physiotherapeutic agents for pain and stiffness and joint function improvement are ultrasound, laser, magnetic therapy, and transcutaneous electrical nerve stimulation. Kinesitherapy aims to soothe pain, strengthen, relax and stretch the muscles, increase the volume of movements, improve gait, aid joints, and more. Balneotherapy has an important place in the complex therapeutic program for diseases of the musculoskeletal system.
{"title":"Opportunities and place of physical therapy in the complex treatment of osteoarthritis","authors":"Г. Георгиев, Цветослав Антонов Георгиев, Р. Стоилов, Мая Иванова, G. Georgiev, T. Georgiev, R. Stoilov, M. Ivanova","doi":"10.35465/27.3.2019.pp66-76","DOIUrl":"https://doi.org/10.35465/27.3.2019.pp66-76","url":null,"abstract":"A significant place in the treatment of osteoarthritis (OA) is taken by physical therapy. Its modalities may be grouped into the following three categories, which could be used alone or in combination: 1) physiotherapeutic (preformed); 2) kinesitherapeutic; 3) resort-climatic (natural) means. The purpose of this review is to outline the place of physical therapy in the treatment of OA. The choice of one or another preformed physical factor depends on the severity of the disease process, the sensitivity of the patient and the physiotherapist's experience. Among the most commonly used physiotherapeutic agents for pain and stiffness and joint function improvement are ultrasound, laser, magnetic therapy, and transcutaneous electrical nerve stimulation. Kinesitherapy aims to soothe pain, strengthen, relax and stretch the muscles, increase the volume of movements, improve gait, aid joints, and more. Balneotherapy has an important place in the complex therapeutic program for diseases of the musculoskeletal system.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49102205","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}
K. Yano, T. Egi, M. Yoneda, Akane Tokui, M. Ikeda, Y. Kaneshiro, K. Kazuki
Aim and object of the study: Extensor tendon rupture in patients with rheumatoid wrists causes dysfunction of the hand and necessitates tendon reconstruction and surgical treatment of the wrist joint. Dynamic outrigger splints using rubber bands have been used for early postoperative mobilization of the fingers. However, these splints are bulky and cause discomfort. We developed a new dynamic splint, which is compact and uses torsion springs instead of the rubber bands used in conventional outrigger splints. The splint extends the metacarpophalangeal joints using a volar finger bar. The objective of this study was to compare the clinical outcomes and subjective assessments between patients treated with the two types of splint. Methodology: Fourteen wrists (14 patients) were included. Clinical outcomes (range of active motion of the metacarpophalangeal joint) and subjective assessments were investigated in patients treated with either an outrigger splint or our new dynamic splint. Results: There were no differences in clinical outcomes between patients treated with the two kinds of splint. The new splint performed better in terms of the subjective assessment of changing clothes and bulkiness. Conclusions: The new splint yielded equivalent clinical outcomes and better subjective assessments compared to conventional outrigger splints due to its reduced size.
{"title":"Newly developed dynamic splint vs. dynamic outrigger splint for postoperative treatment of extensor tendon rupture in patients with rheumatoid wrists - a preliminary study","authors":"K. Yano, T. Egi, M. Yoneda, Akane Tokui, M. Ikeda, Y. Kaneshiro, K. Kazuki","doi":"10.35465/00003","DOIUrl":"https://doi.org/10.35465/00003","url":null,"abstract":"Aim and object of the study: Extensor tendon rupture in patients with rheumatoid wrists causes dysfunction of the hand and necessitates tendon reconstruction and surgical treatment of the wrist joint. Dynamic outrigger splints using rubber bands have been used for early postoperative mobilization of the fingers. However, these splints are bulky and cause discomfort. We developed a new dynamic splint, which is compact and uses torsion springs instead of the rubber bands used in conventional outrigger splints. The splint extends the metacarpophalangeal joints using a volar finger bar. The objective of this study was to compare the clinical outcomes and subjective assessments between patients treated with the two types of splint. Methodology: Fourteen wrists (14 patients) were included. Clinical outcomes (range of active motion of the metacarpophalangeal joint) and subjective assessments were investigated in patients treated with either an outrigger splint or our new dynamic splint. Results: There were no differences in clinical outcomes between patients treated with the two kinds of splint. The new splint performed better in terms of the subjective assessment of changing clothes and bulkiness. Conclusions: The new splint yielded equivalent clinical outcomes and better subjective assessments compared to conventional outrigger splints due to its reduced size.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49256620","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 : 2019-04-11DOI: 10.35465/27.1.2019.PP16-23
T. Shivacheva
The aim of the study is to establish the frequency and sustained remission and low disease activity in patients with RA in the course of long-term treatment with synthetic and biological means (DMARDs) in real conditions. In the conditions of retrospective data analysis of real clinical practice, there were included 209 patients suffering from RA. Activity indexes of RA in all patients were analyzed in the last year of treatment with bDMARDs. The average age of the patients is 59,01 years old. The dominants sex is female (84.6%). The beginning of treatment with biological therapy is delayed with the average of 8.21 year. In all activity indexes of RA, which were monitored in the beginning of the 6th and the 12th months, there was established a significant difference in their variation for the periods surveyed. There is a general trend towards lowering the values of our indicators. In the beginning of the monitored period, the patients going into remission (DAS28 CRP) are approximately 3 times less – 11% (n = 23) in comparison with those in the end of the study – 32.99% (n = 64) (p < 0.001). In 10% of the cases a sustained remission is observed by both combined indexes (DAS28 ESR and DAS28 CRP) (p < 0.001). Today the accurate way is the “treat to target” strategy. The purpose is lowering the activity of the disease to very low levels (or remission) and achieving a long-term remission which is now real and achievable.
{"title":"Evaluation of the activity of RA and sustained remission in patients ongoing biological therapy","authors":"T. Shivacheva","doi":"10.35465/27.1.2019.PP16-23","DOIUrl":"https://doi.org/10.35465/27.1.2019.PP16-23","url":null,"abstract":"The aim of the study is to establish the frequency and sustained remission and low disease activity in patients with RA in the course of long-term treatment with synthetic and biological means (DMARDs) in real conditions. In the conditions of retrospective data analysis of real clinical practice, there were included 209 patients suffering from RA. Activity indexes of RA in all patients were analyzed in the last year of treatment with bDMARDs. The average age of the patients is 59,01 years old. The dominants sex is female (84.6%). The beginning of treatment with biological therapy is delayed with the average of 8.21 year. In all activity indexes of RA, which were monitored in the beginning of the 6th and the 12th months, there was established a significant difference in their variation for the periods surveyed. There is a general trend towards lowering the values of our indicators. In the beginning of the monitored period, the patients going into remission (DAS28 CRP) are approximately 3 times less – 11% (n = 23) in comparison with those in the end of the study – 32.99% (n = 64) (p < 0.001). In 10% of the cases a sustained remission is observed by both combined indexes (DAS28 ESR and DAS28 CRP) (p < 0.001). Today the accurate way is the “treat to target” strategy. The purpose is lowering the activity of the disease to very low levels (or remission) and achieving a long-term remission which is now real and achievable.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49458405","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 : 2019-04-11DOI: 10.35465/27.1.2019.PP44-52
I. Parvova, V. Taneva, E. Ivanova-Todorova, D. Kyurkchiev, Z. Kolarov, E. Hristov
Chronic graft versus host disease is observed within the fi rst 100 days following allogeneic haematopoietic stem cell transplantation and can affect all tissues and organs (in 80% of the cases, it affects the skin). There are some clinical correspondences between chronic graft versus host disease and certain autoimmune diseases, such as systemic scleroderma, Sjogren‘s syndrome, autoimmune hepatitis. We present a case of a 54-year-old man with manifested diffuse, scleroderma-like skin changes, which occurred about a year and a half after allogenic bone marrow transplantation from an unrelated donor due to a blast transformation of chronic myelomonocytic leucosis type 2. The patient was treated in a haematology clinic with corticosteroids, 10 photophoresis sessions, Ciclosporin, Tacrolimus, Mycophenolate mofetil, Imatinib. It has been assumed that this is a case of chronic graft versus host disease resistant to corticosteroids, and Methotrexate 25 mg/weekly every other month was prescribed with no significant clinical improvement. In terms of the differential diagnosis, the question remains whether or not this is a case of paraneoplastic systemic scleroderma – autoimmune phenomena accompanying malignancy and often preceding it for months.
{"title":"A clinical case of a patient with scleroderma-like syndrome in chronic graft-versus host disease","authors":"I. Parvova, V. Taneva, E. Ivanova-Todorova, D. Kyurkchiev, Z. Kolarov, E. Hristov","doi":"10.35465/27.1.2019.PP44-52","DOIUrl":"https://doi.org/10.35465/27.1.2019.PP44-52","url":null,"abstract":"Chronic graft versus host disease is observed within the fi rst 100 days following allogeneic haematopoietic stem cell transplantation and can affect all tissues and organs (in 80% of the cases, it affects the skin). There are some clinical correspondences between chronic graft versus host disease and certain autoimmune diseases, such as systemic scleroderma, Sjogren‘s syndrome, autoimmune hepatitis. We present a case of a 54-year-old man with manifested diffuse, scleroderma-like skin changes, which occurred about a year and a half after allogenic bone marrow transplantation from an unrelated donor due to a blast transformation of chronic myelomonocytic leucosis type 2. The patient was treated in a haematology clinic with corticosteroids, 10 photophoresis sessions, Ciclosporin, Tacrolimus, Mycophenolate mofetil, Imatinib. It has been assumed that this is a case of chronic graft versus host disease resistant to corticosteroids, and Methotrexate 25 mg/weekly every other month was prescribed with no significant clinical improvement. In terms of the differential diagnosis, the question remains whether or not this is a case of paraneoplastic systemic scleroderma – autoimmune phenomena accompanying malignancy and often preceding it for months.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46982875","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 : 2019-04-03DOI: 10.35465/27.1.2019.PP30-43
A. Angelov, A. Kopchev, T. Georgiev, M. Ivanova
Psoriatic arthritis (PsA) is a pleiotropic inflammatory disease from the spectrum of spondyloarthritides which can potentially affect many organ systems. The chronic nature of the inflammatory milieu presented in rheumatic diseases, is similar to that of atherosclerosis, suggesting a common pathogenic basis. Effector cells of innate and adaptive immunity along with pro-inflammatory cytokines and other immune mediators may work together to potentiate endothelial damage and accelerate cardiovascular diseases (CVD). Thus, the risk of CVD and associated complications in PsA might be elevated, especially in patients with severe psoriasis, long-standing disease, and multiple comorbidities. This narrative review focuses on the prevalence of CVD in PsA patients, the overlapping molecular features in the pathogenesis of both conditions, and summarizes the benefits of the current treatments on impairments resolution.
{"title":"Cardiovascular disease in patients with psoriatic arthritis: correlation or causation?","authors":"A. Angelov, A. Kopchev, T. Georgiev, M. Ivanova","doi":"10.35465/27.1.2019.PP30-43","DOIUrl":"https://doi.org/10.35465/27.1.2019.PP30-43","url":null,"abstract":"Psoriatic arthritis (PsA) is a pleiotropic inflammatory disease from the spectrum of spondyloarthritides which can potentially affect many organ systems. The chronic nature of the inflammatory milieu presented in rheumatic diseases, is similar to that of atherosclerosis, suggesting a common pathogenic basis. Effector cells of innate and adaptive immunity along with pro-inflammatory cytokines and other immune mediators may work together to potentiate endothelial damage and accelerate cardiovascular diseases (CVD). Thus, the risk of CVD and associated complications in PsA might be elevated, especially in patients with severe psoriasis, long-standing disease, and multiple comorbidities. This narrative review focuses on the prevalence of CVD in PsA patients, the overlapping molecular features in the pathogenesis of both conditions, and summarizes the benefits of the current treatments on impairments resolution.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46036453","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 : 2019-04-03DOI: 10.35465/27.1.2019.PP3-15
V. Boyadzhieva, N. Stoilov, M. Ivanova, R. Stoilov
The assessment of disease activity is an essential component in the selection of therapeutic approach for the prevention of disability of patients with RA. The current study was conducted to evaluate the disease activity in patients on csDMARDs and bDMARDs after 6 months to 1-year of treatment and to determine whether the benefits of different therapies were sustained over time. For the purpose of the study were selected 220 patients with a mean age 55.05 ± 10.63 SD years, meeting the 1987 ACR classification criteria for RA. Patients were stratified according to treatment regimens into 2 age-matched treatment groups: 96 on csDMARDs and 124 on bDMARD therapy. Patient‘s assessment of disease related pain, global health and physician assessment of global health was made by visual analogue scale (VAS) – 100 mm. Disease activity was the primary outcome domain. Independent joint assessor evaluated 28 joints on baseline, 6th and 12th month of the follow-up period. C-reactive protein (CRP) was used to measure the infl ammation process. DAS28-CRP, CDAI and SDAI were calculated according to the standard formulas. Comparison was performed by analysis variance ANOVA. On baseline, patients on bDMARDs had a significantly higher mean time-averaged 28-joint disease activity score (5.03 ± 0.84 SD vs. 4.35 ± 1.20 SD, p < 0,001), CDAI (25.06 ± 7.32 SD vs. 20.83 ± 10.53 SD, p < 0.001) and SDAI (28.27 ± 8.74 SD vs. 23.19 ± 11.89 SD, p < 0.001) compared to those on csDMARDs. On the 6th month in both groups (bDMARDS and csDMARDs) we found significant decrease in mean DAS28 (p < 0.001, p < 0.001), although no significant difference in disease activity between the groups was measured by this indicator (3.75 ± 2.49 SD vs 3.90 ± 1.10 SD, p = 0.566). Patients on bDMARDs had significantly lower disease activity compared to those on csDMARDs after 6th and 12th month of treatment assessed by CDAI (13.43 ± 4.98 SD vs 16.81 ± 9.94 SD, p = 0.001; 8.65 ± 4.53 SD vs 15.86 ± 10.02 SD, p < 0.001), and SDAI (14.63 ± 5.42 SD vs 18.38 ± 10.49 SD, p < 0.001; 9.39 ± 4.92 SD vs 16.79 ± 10.5 SD, p < 0.001). Unlike results reported by DAS28-CRP which showed no change between the 6th and 12th month in patients receiving csDMARDs (3.90 ± 1.10 SD, 3.82 ± 1.12 SD, p = 0.156), we observed a statistically significant difference in all three time intervals (0, the 6th, 10th month) of the follow up period regarding to CDAI and SDAI. After a year prospective follow-up, therapy with biologic DMARDs results in sustained suppression – minimal disease activity assessed by DAS28-CRP, CDAI and SDAI, compared to patients receiving DMARDs who had moderate disease activity according to these tools. The therapy with bDMARDs was superior to csDMARDs therapy for suppressing disease activity (assessed by DAS28-CRP, CDAI and SDAI) of rheumatoid arthritis (RA) on the 6th and 12th month of the follow-up period.
疾病活动性的评估是选择预防RA患者残疾的治疗方法的重要组成部分。目前的研究旨在评估服用csDMARDs和bDMARDs的患者在治疗6个月至1年后的疾病活动性，并确定不同疗法的益处是否能持续一段时间。本研究选择220例患者，平均年龄55.05±10.63 SD年，符合1987年ACR对RA的分类标准。根据治疗方案将患者分为2个年龄匹配的治疗组:96例接受csdmard治疗，124例接受bDMARD治疗。采用视觉模拟量表(VAS) - 100 mm对患者疾病相关疼痛、整体健康状况和医生整体健康状况进行评估。疾病活动性是主要结果域。独立关节评估者在基线、第6个月和第12个月对28个关节进行了评估。用c反应蛋白(CRP)测定炎症过程。按标准公式计算DAS28-CRP、CDAI、SDAI。比较采用方差分析(ANOVA)。基线时，bDMARDs患者的平均28关节疾病活动度评分(5.03±0.84 SD比4.35±1.20 SD, p < 0.001)、CDAI(25.06±7.32 SD比20.83±10.53 SD, p < 0.001)和SDAI(28.27±8.74 SD比23.19±11.89 SD, p < 0.001)均显著高于csDMARDs患者。在两组(bDMARDS和csDMARDs)的第6个月，我们发现平均DAS28显著降低(p < 0.001, p < 0.001)，尽管该指标在两组之间的疾病活动性没有显著差异(3.75±2.49 SD vs 3.90±1.10 SD, p = 0.566)。在CDAI评估的第6个月和第12个月后，bDMARDs患者的疾病活动性明显低于csDMARDs患者(13.43±4.98 SD vs 16.81±9.94 SD, p = 0.001;8.65±4.53 SD vs 15.86±10.02 SD, p < 0.001)， SDAI(14.63±5.42 SD vs 18.38±10.49 SD, p < 0.001;9.39±4.92 SD vs 16.79±10.5 SD, p < 0.001)。与DAS28-CRP报告的结果不同，接受csDMARDs的患者在第6个月和第12个月之间没有变化(3.90±1.10 SD, 3.82±1.12 SD, p = 0.156)，我们观察到CDAI和SDAI在随访期间的三个时间间隔(0、6、10个月)均有统计学差异。经过一年的前瞻性随访，与接受DMARDs治疗的患者相比，生物DMARDs治疗的结果是持续的抑制——DAS28-CRP、CDAI和SDAI评估的疾病活动性最小，根据这些工具，接受DMARDs治疗的患者疾病活动性中等。在第6个月和第12个月，bDMARDs治疗在抑制类风湿性关节炎(RA)的疾病活动性(通过DAS28-CRP、CDAI和SDAI评估)方面优于csDMARDs治疗。
{"title":"Treatment of rheumatoid arthritis: csDMARDS versus bDMARDS. Prospective study to evaluate disease activity","authors":"V. Boyadzhieva, N. Stoilov, M. Ivanova, R. Stoilov","doi":"10.35465/27.1.2019.PP3-15","DOIUrl":"https://doi.org/10.35465/27.1.2019.PP3-15","url":null,"abstract":"The assessment of disease activity is an essential component in the selection of therapeutic approach for the prevention of disability of patients with RA. The current study was conducted to evaluate the disease activity in patients on csDMARDs and bDMARDs after 6 months to 1-year of treatment and to determine whether the benefits of different therapies were sustained over time. For the purpose of the study were selected 220 patients with a mean age 55.05 ± 10.63 SD years, meeting the 1987 ACR classification criteria for RA. Patients were stratified according to treatment regimens into 2 age-matched treatment groups: 96 on csDMARDs and 124 on bDMARD therapy. Patient‘s assessment of disease related pain, global health and physician assessment of global health was made by visual analogue scale (VAS) – 100 mm. Disease activity was the primary outcome domain. Independent joint assessor evaluated 28 joints on baseline, 6th and 12th month of the follow-up period. C-reactive protein (CRP) was used to measure the infl ammation process. DAS28-CRP, CDAI and SDAI were calculated according to the standard formulas. Comparison was performed by analysis variance ANOVA. On baseline, patients on bDMARDs had a significantly higher mean time-averaged 28-joint disease activity score (5.03 ± 0.84 SD vs. 4.35 ± 1.20 SD, p < 0,001), CDAI (25.06 ± 7.32 SD vs. 20.83 ± 10.53 SD, p < 0.001) and SDAI (28.27 ± 8.74 SD vs. 23.19 ± 11.89 SD, p < 0.001) compared to those on csDMARDs. On the 6th month in both groups (bDMARDS and csDMARDs) we found significant decrease in mean DAS28 (p < 0.001, p < 0.001), although no significant difference in disease activity between the groups was measured by this indicator (3.75 ± 2.49 SD vs 3.90 ± 1.10 SD, p = 0.566). Patients on bDMARDs had significantly lower disease activity compared to those on csDMARDs after 6th and 12th month of treatment assessed by CDAI (13.43 ± 4.98 SD vs 16.81 ± 9.94 SD, p = 0.001; 8.65 ± 4.53 SD vs 15.86 ± 10.02 SD, p < 0.001), and SDAI (14.63 ± 5.42 SD vs 18.38 ± 10.49 SD, p < 0.001; 9.39 ± 4.92 SD vs 16.79 ± 10.5 SD, p < 0.001). Unlike results reported by DAS28-CRP which showed no change between the 6th and 12th month in patients receiving csDMARDs (3.90 ± 1.10 SD, 3.82 ± 1.12 SD, p = 0.156), we observed a statistically significant difference in all three time intervals (0, the 6th, 10th month) of the follow up period regarding to CDAI and SDAI. After a year prospective follow-up, therapy with biologic DMARDs results in sustained suppression – minimal disease activity assessed by DAS28-CRP, CDAI and SDAI, compared to patients receiving DMARDs who had moderate disease activity according to these tools. The therapy with bDMARDs was superior to csDMARDs therapy for suppressing disease activity (assessed by DAS28-CRP, CDAI and SDAI) of rheumatoid arthritis (RA) on the 6th and 12th month of the follow-up period.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41981178","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 : 2019-01-01DOI: 10.35465/27.3.2019.pp3-9
Елена М. Кирилова, Н. Кирилов, Ф. Бишоф, E. Kirilova, N. Kirilov, F. Bischoff
Osteoporosis (OP) is a progressive metabolic bone disease caused by disturbed balance between bone formation and bone resorption. Osteoporotic fractures lead to a deterioration in the quality of patients’ life due to high morbidity and mortality, and the economic burden of osteoporotic fractures is expected to increase. Various tools have been developed to assess the risk of osteoporosis in the clinical practice. The Osteoporosis Self-Assessment Tool (OST) is used to predict osteoporosis and is suitable for self-assessment. The purpose of this study is to assess the ability of the OST score to predict the risk of OP. 180 postmenopausal women with a mean age of 61 ± 13 years (38-86 years) were included in the study. The OST score was evaluated using the formula: (body weight age) × 0.2. Patients were divided into three groups according to the risk of OP: low risk (> -1), moderate risk (-1 to -4) and high risk (<-4). Based on the total lumbar spine T-score, measured by dual-energy X-ray absorptiometry (DEXA), the actual number of the women with OP was established. According to the OST score, 22 women were in the high risk group, 41 women in the moderate risk group, and 117 women in the low risk group. There was a correlation between the risk of OP calculated with OST and the number of patients with OP, established by DEXA measurement - with increased risk of OP, the number of the women with OP also increased (p = 0.000). The percentage of the women with osteoporosis is highest in the high risk group and lowest in the low risk group. In the high risk group, 95.5% of the women had a diagnosis of osteoporosis. These results demonstrate the good ability of OST score to predict the risk of OP in the Bulgarian population.
{"title":"Predictive ability of the osteoporosis self-assessment tool for assessing the risk of osteoporosis","authors":"Елена М. Кирилова, Н. Кирилов, Ф. Бишоф, E. Kirilova, N. Kirilov, F. Bischoff","doi":"10.35465/27.3.2019.pp3-9","DOIUrl":"https://doi.org/10.35465/27.3.2019.pp3-9","url":null,"abstract":"Osteoporosis (OP) is a progressive metabolic bone disease caused by disturbed balance between bone formation and bone resorption. Osteoporotic fractures lead to a deterioration in the quality of patients’ life due to high morbidity and mortality, and the economic burden of osteoporotic fractures is expected to increase. Various tools have been developed to assess the risk of osteoporosis in the clinical practice. The Osteoporosis Self-Assessment Tool (OST) is used to predict osteoporosis and is suitable for self-assessment. The purpose of this study is to assess the ability of the OST score to predict the risk of OP. 180 postmenopausal women with a mean age of 61 ± 13 years (38-86 years) were included in the study. The OST score was evaluated using the formula: (body weight age) × 0.2. Patients were divided into three groups according to the risk of OP: low risk (> -1), moderate risk (-1 to -4) and high risk (<-4). Based on the total lumbar spine T-score, measured by dual-energy X-ray absorptiometry (DEXA), the actual number of the women with OP was established. According to the OST score, 22 women were in the high risk group, 41 women in the moderate risk group, and 117 women in the low risk group. There was a correlation between the risk of OP calculated with OST and the number of patients with OP, established by DEXA measurement - with increased risk of OP, the number of the women with OP also increased (p = 0.000). The percentage of the women with osteoporosis is highest in the high risk group and lowest in the low risk group. In the high risk group, 95.5% of the women had a diagnosis of osteoporosis. These results demonstrate the good ability of OST score to predict the risk of OP in the Bulgarian population.","PeriodicalId":38954,"journal":{"name":"Revmatologiia (Bulgaria)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69837622","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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