Rheumatology (Bulgaria)

Evaluation of Headache Treatment in Patients with Fibromyalgia

2025-09-28T17:57:37+03:00

Fibromyalgia (FM) is characterized by chronic widespread pain lasting for a minimum of three months and pain at mechanical pressure in at least 11 of the 18 tender points. Four treatment groups with FM patients and a healthy control group were followed within 3 months in the Clinic of rheumatology, Sofia. The accompanying clinical symptoms were evaluated by a 5-point grading system. These results are useful for the everyday clinical practice and treatment of fibromyalgia.

VITAMIN K2 AND VITAMIN D: INFLUENCE ON BONE TURNOVER IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS

2025-09-28T17:52:01+03:00

Introduction: Vitamins K2 and D play a central role in calcium metabolism and interact synergistically in maintaining bone and cardiovascular health. Vitamin D stimulates the synthesis of proteins that are activated by vitamin K2-dependent carboxylation. The effects of vitamin K2 on calcium metabolism, bone turnover, and its potential role in the prevention and treatment of osteoporosis are not fully understood.

Aim: To investigate the levels of vitamins K2 and D in patients with osteoporosis and menopausal women and to study their influence on bone turnover.

Materials and methods: 48 menopausal women were studied, divided into two groups after measuring the BMD of the lumbar spine with DXA: a working group, 26 women with osteoporosis aged 65.62±9.2 years, and a control group of 22 women without osteoporosis aged 63.55±8.7 years. Plasma concentrations of calcium, phosphates, ALP, vitamin D, PTH, OC, ucOC were measured. Vitamin K2 status was indirectly assessed by the ucOC/OC ratio.

Results: The measured indicators did not show significant differences in the two groups. In both groups ucOC/OC ratio is high and indicates a vitamin K2 deficiency. Vitamin D levels indicate insufficiency. In the OP group, OC showed a positive correlation with vitamin D (p = 0.015) and with ALP (p = 0.025). UcOC showed a positive correlation with vitamin D (p = 0.033). UcOC/OC ratio showed a high negative correlation with OC (p < 0.001) and a negative correlation with ALP, (p = 0.043).

Conclusion: Our data indicate poor vitamin K2 and D status. In the postmenopausal OP group, both vitamins affect bone turnover through the interrelated levels of PTH, ALP and OC, which suppresses osteoblast function and disrupts the balance between bone formation and resorption in favor of resorption.

Navigating the diagnostic complexity of SLE with overlapping allergic reactions and tick-bites: case-based review

2025-10-02T09:17:07+03:00

Systemic Lupus Erythematosus (SLE) is a multifaceted autoimmune disease characterized by various clinical manifestations, complicating its diagnosis and management. This case report discusses the diagnostic challenges of SLE, mainly when initial presentations include symptoms suggestive of allergic reactions or are linked to environmental exposures, such as a tick bite. A 45-year-old male presented with symptoms including progressive lower limb edema, photosensitivity, and generalized weakness, initially attributed to a toxic-allergic reaction following a tick bite. Overlapping symptoms with Lyme disease and other autoimmune conditions further complicated the diagnostic process. Despite initial treatments for presumed allergic and infectious causes, the patient's condition deteriorated, ultimately leading to a diagnosis of SLE. This case underscores the importance of maintaining a broad differential diagnosis and employing a comprehensive, multidisciplinary approach when evaluating patients with complex and overlapping clinical histories. Early recognition and targeted diagnostic strategies are essential to prevent delays in diagnosis and ensure timely, appropriate management, thereby reducing the risk of severe complications.

NEW INSIGHTS INTO THE PATHOGENESIS OF OSTEOARTHRITIS

2025-09-28T17:52:02+03:00

The multifactorial pathogenesis of osteoarthritis (OA) and the diversity of its phenotypic manifestations have been subjects of discussion in recent years. This report summarizes the latest data from clinical studies regarding the pathogenesis (PG) of OA. Aspects of PG are examined, such as: the consequences of trauma, the involvement of heat shock proteins, mitochondrial dysfunction, disturbances in the JAK/STAT signaling pathway, low-grade focal inflammation, the role of different macrophage populations, telomere shortening in the aging process, and more. Special attention is given to the involvement of genetic and epigenetic factors in the multifactorial pathogenesis of osteoarthritis. These factors, through mechanisms of gene expression modulation—such as DNA methylation and demethylation, histone modifications, acetylation and deacetylation, and activation of microRNAs—contribute to either silencing or enhanced expression of genes associated with OA. In this way, fine post-transcriptional tuning is maintained, which increases resistance to chronic diseases, including OA. Knowledge of epigenetic control could provide a more in-depth, holistic understanding of the etiology and pathogenesis of OA and offer future directions for its management.

MALT–LYMPHOMAS IN PRIMARY SJÖGREN'S SYNDROME

2025-09-28T17:52:02+03:00

Sjögren's syndrome is a systemic autoimmune disease involving the exocrine glands. In the course of the disease, in parallel with the systemic manifestations, lymphoproliferative disorders frequently. The risk of developing lymphomas in patients with Sjögren's syndrome is increased up to 44 times compared to the rest of the population. Among them, MALT-lymphomas, which have an indolent course, occupy a special place. Genetic factors, immune processes and chronic inflammation play a role in the basis of the malignant transformation of the disease, especially the site of infection with Helicobacter pylori.

NEW THERAPEUTIC OPPORTUNITIES SHARED BY INFLAMMATORY ARTHRITIS, OBESITY AND TYPE 2 DIABETES TO IMPROVE THE INFLAMMATORY RESPONSE

2025-09-28T17:52:02+03:00

Obesity is a pro-inflammatory condition associatedwith increased severity of various types of inflammatory arthritis. Weight loss is associated withimproved activity of the disease in certain forms of inflammatory arthritis such as rheumatoid arthritisand psoriatric arthritis. In addition, fundamentalscientific experiments demonstrate the weight-independent anti-inflammatory andimmunomodulatory effects of GLP-1 receptoragonists associated with inhibition of the NF-KB pathway, improving mitochondrial dysfunction-induced by TNF- α, preventing the expression of NOX-4 and oxidative stress, reduction of the expression of proinflammatory mediators such as IL-6 and IL-1β, reduction of the expression of matrix metalloproteinases. Taking into account the chronic inflammatory background, shared by inflammatory arthritis, obesity and type 2 diabetes, it is obvious that the inadequate behavior of any of these conditions can make the others worse.

Keywords: obesity, inflammatory arthritis, rheumatoid arthritis, psoriatric arthritis, type 2 diabetes, GLP-1 receptor agonists, TNF- α, oxidative stress, proinflammatory mediators, oxidative stress, matrix metalloproteinases

Capillaroscopy in patients with exposure to risk factors in the work environment and rheumatic diseases

2025-09-28T17:52:02+03:00

Capillaroscopy is a non-invasive method for assessing microcirculation that provides important information about the condition of capillaries and the pericapillary space. The method is valuable for the diagnosis and monitoring of various diseases with manifestations of Raynaud's phenomenon (RP), such as systemic connective tissue diseases, diabetes, hypertension, occupational diseases and other conditions that lead to microcirculation disorders. It plays an extremely important role in the early diagnosis and prognosis of these diseases, helping to detect both functional and structural changes in the capillary network, even in cases in the absence of many characteristic clinical symptoms.

Raynaud's phenomenon is a disease characterized by reversible attacks of vasospasm leading to impaired peripheral circulation. It can be primary (idiopathic) or secondary (associated with other diseases). Capillaroscopy is the gold standard in rheumatology practice for differentiating primary from secondary Raynaud's phenomenon and has been included in the EULAR/ACR classification criteria for systemic sclerosis (SSc) since 2013. In primary RP, functional disorders of the capillaries are observed, without structural changes, while in secondary RP, which is associated with systemic, general or occupational diseases, it leads to various structural changes with characteristic signs of microangiopathy. The method has not only diagnostic, but also prognostic value in systemic sclerosis, lupus erythematosus, dermatomyositis, etc. Specific capillaroscopic patterns are observed - "scleroderma" and "scleroderma-like", and non-specific changes can also be detected in the early stages of the disease.

In recent years, there has been an increase in publications reporting data on various capillaroscopic findings in patients with vibration disease (VD). It is a specific occupational disease caused by prolonged exposure to vibrations, which leads to microcirculatory and peripheral nerve damage, including Raynaud's phenomenon. Studies have shown that capillaroscopy provides important information about the state of microcirculation in patients with occupationally induced microangiopathy, and more specifically in cases of exposure to local and general vibrations. The method can be used for diagnosis and monitoring of these diseases, helping to detect abnormal capillaroscopic findings, including elongated capillaries, hemorrhages, and avascular zones. Capillaroscopy, as a non-invasive method, is effective for diagnosing and monitoring the progression of diseases and can be used in combination with other functional studies to better assess the patient's condition.

Opportunities for therapy of musculoskeletal diseases through balneotherapy and SPA tourism.

2025-09-28T17:52:02+03:00

This article aims to review the possibilities and existing recommendations for the application of balneotherapy and SPA therapy in musculoskeletal diseases (MSDs), as well as the possibilities for their integration into the health and tourism sector.

The recommendations of the international medical community place balneotherapy alongside physiotherapy as an important element in the treatment of patients with inflammatory and degenerative joint diseases. The article showed clear data that a number of studies prove a significant reduction in pain, improvement in functional capacity and quality of life in osteoarthritis, fibromyalgia and other conditions. Favorable biological effects on cortisol levels and inflammatory markers are also observed. European comparative analyses emphasize the social importance of balneotherapy, related to access, financing and health policy. In Bulgaria, there is a wide network of specialized medical and sanatorium facilities, supported by the Ministry of Health and the National Social Insurance Institute.