Reumatizam最新文献

Rheumatic diseases are among the most common chronic diseases of childhood. Between 30 and 70%of pediatric rheumatology patients reach adulthood with some disease activity, functional limitations, or psychosocialproblems. Transition is the purposeful, planned move of chronic pediatric patients from pediatric to adult care. It is aprocess in which adolescents with chronic conditions prepare for independent care for their health and life in general.Th e establishment of transitional services will ensure better disease control, limit long-term complications, work loss,and unnecessary health care costs, and increase quality of life.

Rheumatoid arthritis (RA) may have an onset at older age. The onset of the disease at the age of 60 andover is called late-onset rheumatoid arthritis (LORA). The aim of this study was to analyze the clinical, laboratory,radiological, and treatment characteristics of patients with LORA compared to those with early-onset RA (EaORA),provided that all the patients had an approximately equal duration of the disease. This is an observational single-centerstudy, which involved 120 patients with an established diagnosis of RA, of which 60 patients had LORA, and 60 patientsEaORA. The disease activity, measured by the Disease Activity Score 28 (DAS28-ESR), was significantly higher in theLORA group compared to the EaORA group (p<0.05). Significantly more patients with LORA had involvement of theshoulders (LORA vs. EaORA, 30% vs. 15%; p <0.05) and knees (LORA vs. EaORA, 46.7% vs. 16.7%; p <0.05). Radiologicalerosive changes were significantly more frequent in the LORA group in comparison with EaORA (p <0.05).There was no difference between the groups regarding rheumatoid factor (RF) positivity (p>0.05), while the numberof patients positive for anti-citrullinated protein antibody (ACPA) was signifi cantly greater in the EaORA group(p<0.05). The values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly higherin the LORA than in the EaORA group. Hemoglobin levels were lower in the LORA group (11.96±1.64 g/dL) than inthe EaORA group (12.18±1.56 g/dL). The most used disease-modifying antirheumatic drugs (DMARDs) were methotrexateand sulfasalazine, while biological drugs were not used.In conclusion, based on the results of our study, LORA has some features that distinguish it from EaORA, such ashigher disease activity, more frequent involvement of large joints, and more pronounced structural damage. Thisshould be taken in account in clinical practice, especially regarding treatment choices.

Primary systemic vasculitides in children are relatively rare diseases. In most cases, they have an unknownetiology and are defined as the presence of inflammation in the blood vessel wall. Establishing the diagnosis ofvasculitis is oft en challenging, since the disorder is multisystem in nature with mostly nonspecific symptoms. The last10 years have seen significant advances in the field of pediatric vasculitis: the development and validation of classificationcriteria as well as tools to assess clinical disease activity and disease outcome, the inclusion of pediatric patients ininternational multicentre randomized controlled trial designs for therapies of vasculitis, clinical trials for very rarepediatric vasculitides, and identification of a special group of monogenic vasculitides. In this paper we want to introducereaders to the giant leap in the field of pediatric vasculitis as a result of the hard work of pediatric rheumatologistsin vasculitis work groups.

In this observational study we examined the impact of disease-modifying antirheumatic drugs (DMARDS) on thedisease activity as well as the values of acute phase reactants and the apolipoprotein A1 (Apo A1) in patients with activerheumatoid arthritis (RA). Eighty patients with active RA and newly discovered RA patients who meet the AmericanRheumatology Association (ARA) 1987 revised criteria were treated with disease modifying anti-rheumatic drugs –DMARDs according to the standard protocol of everyday clinical practice. At 6 and 12 months of treatment the patientsachieved a signifi cant decrease in the disease activity score 28 (DAS28), C-reactive protein (CRP), and erythrocytesedimentation rate (ESR) values. On the other hand, the levels of Apo A-1, which were low at baseline, were signifi -cantly higher. In conclusion, the use of DMARDs in patients with RA reduced disease activity and infl ammation, butalso had a benefi cial eff ect in increasing the levels of atheroprotective Apo A-1 lipoprotein, which can reduce CV risksin these patients.

Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. The aim of thisobservational study was to evaluate pericardial features in patients with different rheumatic diseases. Thirty-fivepatients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, withspecial emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especiallyfocused on the amount of pericardial fluid and pericardial thickness in the posterior wall of the heart.Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed,88.6% had an inflammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptomswere moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardialthickness of 4.68 ± 1.66 mm. Pericardial effusion in a small amount was present in 57.1% of patients, with a meanpericardial fluid amount of 3.3 ± 1.9 mm. The severity of rheumatic disease had a positive and significant correlationwith the presence of pericardial effusion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). The patients had not beenaware of the pericardial involvement and did not have any clinical symptoms.In conclusion, in this short-term small observational study pericardial changes were a frequent finding in therheumatology patients. In general, the pericarditis was subclinical and with small amounts of effusion. The diseaseactivity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients andof longer duration are needed to further explore this issue.

Chronic inflammatory rheumatic diseases are becoming one of the central problems of public health services. Prolongation of expected life span due to better diagnostics and better and more efficacious therapeutic procedures resulted in increasing number of patients with chronic inflammatory diseases in population. Any serious consideration about health problem must include adequate epidemiologic analysis. This text briefly covers the problems of descriptive and analytic epidemiological studies and shortly addresses results of Croatian epidemiological studies of inflammatory rheumatic diseases in the last ten years.

Non-pharmacological treatment of osteoporosis is a mandatory part of all algorithms and recommendations for dealing with this disease. However, the belief that pharmacological therapy is much more superior to treating osteoporosis than non-pharmacological treatment is still common in the medical community. The probable reason is that pharmacological treatment can be measured and statistically analyzed, and that's why the abundance of data from controlled randomized trials, meta-analyses and systematic reviews are available. Non-pharmacological treatment of osteoporosis is not so much represented in evidence based medicine (EBM) because there are a lot of different exercise protocols, different machines with different setups for applying the same models of physical therapy. So the main problem are inclusion criteria in meta-analyses or systematic reviews of patients whose data is collected using different protocols. Non-pharmacological treatment ofosteoporosis: myth or reality? Maybe we did not answer this question in fullness, but by analyzing data from the scientifically relevant data bases we can conclude that non-pharmacological treatment is an important factor in prevention of osteoporosis and part of all treatment protocols available today--almost as equally significant as pharmacological treatment. Cochrane library database and PEDro database provide EBM information that can help to identify the best types of ex- ercises and physical procedures for bone mineral density and prevention of falls. The best result in non-pharmaco- logical treatment of osteoporosis showed a combination of exercise programs that include muscle strengthening exercises, aerobic exercises, exercises with progressive resistance increase, and high-impact exercises. As for individual exercises, a non-weight-bearing high force exercise showed small but statistically significant increase in bone mineral density in femoral neck, in some scientific papers. Exercises for balance and coordination resulted in fewer falls, and therefore fewer fractures caused by osteoporosis in postmenopausal women.

Osteoanabolics are bone forming agents. The first approved osteoanabolic drug for the treatment of osteoporosis is teriparatide (TPTD). In the fracture prevention trial TPTD increased lumbar spine, total hip and femoral neck BMD is significantly greater compared with placebo, and it also prevents new fractures. Differently from the antiresorptive drugs, TPTD showed positive effects on various structural indices and microarchitecture using 2D histomorphometric analyses and 3D direct measurement. The insight into bone physiopathology and the better understanding of the core mechanisms involved in the development of osteoporosis led to the development of new compounds with therapeutic potential. Among them the most promising are Cathepsin K inhibitors and anti-sclerostin drugs.

In addition to the long-established association of HLA-B27 antigen and spondyloarthritis, several studies have shown a similar association with HLA-B7 antigen. But since the whole MHC region carries less than half of the risk for the development of the disease, the main goal of many recently performed researches, which implemented various high-throughput methods, was to discover the influence of genes outside the MHC region on disease development. The results showed that genes closely linked to spondyloarthritis participate in antigen processing and coding of various cytokines. This can lead to the conclusion that diseases from the spondyloarthritis group are polygenic, affected by both autoinflammatory and autoimmune mechanisms.

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, while it is rare in adults. Typical clinical manifestations include palpable purpura without thrombocytopenia and/or coagulopathy, arthritis/arthralgia, abdominal pain, and/or renal involvement. In adulthood the disease tends to be more serious than in children, with renal manifestations developing over a period of several days to one month after initial symptoms. In this article we present a 22-year-old female patient with cutaneous vasculitis and arthralgia, in whom renal disease developed 8 weeks after disease onset with microscopic hematuria and proteinuria in urinalysis. Renal biopsy subsequently performed revealed focal necrotising glomerulonephritis with IgA deposits. The patient was treated with high dose methylprednisolone followed by gradual tapering, which induced complete remission of the disease. In conclusion, patients with HSP should be carefully monitored for systemic involvement, since serious renal disease can develop even as late as two months after disease onset.