Rheumatology (Bulgaria)

Assessment of chronic fatigue in patients with fibromyalgia

2026-03-01T20:15:36+00:00

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. Fatigue in FM was assessed using the Chronic Fatigue Scale (FSS) and the Modified Fatigue Scale (MFIS). The results obtained have practical significance and provide the conviction to investigate the accompanying symptoms in FM, to consider the relationship between them and to observe their complex response to the treatment.

Artificial intelligence (AI) and capillaroscopy: new horizons

2026-03-01T15:53:52+00:00

Nailfold capillaroscopy (NFC) is a well-established, highly specialized, non-invasive method for assessing microcirculation and represents the “gold standard” in rheumatology for distinguishing primary from secondary Raynaud’s phenomenon (RP). Through analysis of capillary structures in the nailfold region, clinicians can identify diff erent patterns (scleroderma, scleroderma-like, and non-specifi c). Despite its clinical signifi cance, image interpretation remains challenging due to subjectivity and the requirement for substantial examiner expertise. In recent years, artifi cial intelligence (AI) has off ered novel solutions through the automated recognition and analysis of capillary structures. Machine learning and deep learning approaches have demonstrated high eff ectiveness in detecting abnormalities, classifying capillary patterns, and predicting the risk of systemic sclerosis. Projects such as CAPI-Detect, along with various other machine learning, deep learning, and neural network models (DenseNet-121, Effi cientNet-B0, ResNet-34, NFC-Net), have shown that AI can identify novel quantitative parameters not accessible through traditional visual assessment and can increase the objectivity and reproducibility of results up to 90%. Most studies in this fi eld focus on capillaroscopic patterns in systemic sclerosis (SSc); however, pilot studies in juvenile dermatomyositis, diabetes mellitus, and hypertension further highlight the applicability of these technologies. Some AI models are even capable of distinguishing onychomycosis, nail psoriasis, and subungual melanoma. Machine learning and deep learning models based on image analysis (Vision Transformer, ViT) appear to represent an additional valid system for the early and rapid interpretation of NFC images and morphological biomarkers in systemic sclerosis (SSc), integrating EULAR-validated algorithms for distinguishing scleroderma from non-scleroderma patterns with artifi cial intelligence (AI). Beyond its diagnostic applications, AI also holds potential in disease monitoring, assessment of therapeutic response, and the development of personalized treatment strategies. The processing of digital images through validated machine learning algorithms, neural networks, and related approaches is aligned with the priorities of the National Health Strategy 2030 for digitalization and the development of eHealth (Policy 2.5). The establishment of a National Digital Platform for Medical Diagnostics is envisaged, aimed at supporting all medical specialties. This platform will be integrated with the National Health Information System and the electronic patient record, with the primary objective of improving the quality of healthcare services. The integration of AI into medical practice opens new opportunities to support early diagnosis and improved management of patients with microangiopathy, facilitating timely detection and the prevention of complications, with the ultimate aim of ensuring better quality of life and preserved functional capacity.

Interstitial lung disease in rheumatoid arthritis – current events

2026-03-01T20:15:36+00:00

Rheumatoid arthritis (RA) is an autoimmune inflammatory joint disease with a chronic-progressive course. It occurs with progressive, symmetrical, erosive arthritis and extraarticular manifestations. The incidence of RA is 1 - 2% of the population. It affects women and men in a ratio of 9:1. Extra-articular manifestations are found in about 50% of patients with RA: consumptive and astheno-adynamic syndrome, splenomegaly, pericarditis, vasculitis, subcutaneous nodules, pulmonary involvement. Pulmonary involvement is found in 4 to 68% of patients with RA. The earliest pulmonary complications are respiratory manifestations – interstitial lung disease (ILD), bronchiolitis and cylindrical bronchiectasis. ILD in the course of rheumatoid arthritis occurs twice as often in men between 50 and 60 years of age. Several studies confirm that the most common radiographic presentation of ILD in patients with RA is usual interstitial pneumonia (UIP), with peripheral reticular opacities and honeycombing seen on high-resolution computed tomography (HRCT). Important for the occurrence, clinical course, and prevention of pulmonary fibrosis manifestations is to assess the presence of biomarkers in the serum of these patients with rheumatoid arthritis. 98 articles were found investigating biomarkers in interstitial lung disease associated with rheumatoid arthritis (ILD-RA), with 83 studies being of high quality, 15 being of moderate quality. The biomarkers studied were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated antibody (anti-CCP), rheumatoid factor (RF), Krebs von den Lungen 6 (KL-6), surfactant protein D (SP-D), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9. (CA19-9), matrix metalloproteinase 7 (MMP-7), chemokine ligand 10 (CXCL-10), neutrophil to lymphocyte ratio (NLR) in patients with rheumatoid arthritis only and in patients with ILD-RA. Treatment of the disease includes corticosteroids, immunosuppressants, biological therapy, kinase inhibitors. These medications are used to treat not only rheumatoid arthritis, but also systemic manifestations.

Updated recommendations for physical activity and non-pharmacological treatment in patients with osteoarthritis

2026-03-01T15:58:03+00:00

Clinical case of a patient with mitochondrial myopathy – diagnostic and therapeutic challenges

2026-03-01T20:15:07+00:00

Mitochondrial myopathies are a heterogeneous group of hereditary neuromuscular disorders in which pathogenic alterations in mitochondrial or nuclear DNA impair oxidative phosphorylation. The clinical spectrum is broad and frequently includes multisystem involvement, such as muscle weakness, sensorineural hearing loss, cardiac manifestations, and neurological symptoms. Due to the overlap of these features with autoimmune myositis, establishing the correct diagnosis presents a signifi cant challenge in rheumatologic practice. We report the case of a 54-year-old woman with progressive proximal muscle weakness, myalgia, and sudden bilateral sensorineural hearing loss, initially suggestive of autoimmune myositis. Paraclinical investigations demonstrated elevated muscle enzymes, a myopathic pattern on electromyography, and a chronic infl ammatory infi ltrate on muscle biopsy. Molecular-genetic testing revealed a heteroplasmic MT-TK m.8344A>G mutation, confi rming the diagnosis of mitochondrial myopathy. This case highlights the role of genetic evaluation in patients with multisystem symptoms and its importance in avoiding unnecessary immunosuppressive therapy.

COVID-19 vaccination and rheumatological manifestations: RS3PE syndrome?

2026-03-01T20:15:36+00:00

Rheumatological manifestations of SARS-CoV-2 infection and COVID-19 vaccination are being repeatedly reported. Herein, we describe a case of a 75-year-old woman who presented with pitting edema of hands and feet and arthritis of small joints following the administration of BNT162b2 (BioNTech-Pfizer) mRNA vaccine. We also discuss potential mechanisms that might explain the occurrence of RS3PE as a rheumatological manifestation of COVID-19 vaccination.