Rheumatology (Bulgaria)

Association between body composition and bone mineral density assessed by whole body dual-energy X-ray absorptiometry

2022-10-22T15:47:42+03:00

Introduction: Despite the observation that higher body weight has protective effect against the development of osteoporosis, accumulating evidence suggest presence of negative impact of obesity on bone function associated with the low-grade inflammation and production of proinflammatory cytokines from dysfunctional adipose tissue in obese individuals. These data stimulate the interest and suggest need for clarifying studies about the association between the body composition and bone mineral density.

The aim of the study: The aim of the current study was to evaluate the association between body mass index (BMI), body composition (fat mass and lean body mass) and the bone mineral density of the lumbar spine and femoral neck assessed by whole body scan using DXA (dual-energy x-ray absorptiometry).

Materials and methods: A retrospective study was performed with analysis of patient data who have undergone whole body scan in Medical Center “Avis Medica” Pleven, device Lunar prodigy. The values of T-score of the lumbar spine and femoral neck were analyzed and their associations with body composition and BMI.

Results and discussion: 111 women at mean age 59±8 years were included in the study. In the patients with T-score values ≤ /-2.5/ of the lumbar spine and femoral neck BMI was significantly lower. In the group of patients with T-score values of the lumbar spine ≤ /-2.5/ (n=27), significantly lower fat mass was found (2239.90±607.63 grams) in comparison with the cases with T-score > /-2.5/ (n=84) (fat mass 2510.41±570.68 grams; p=0.037). The lean body mass in the patients with T-score ≤ /-2.5/ of the lumbar spine (4025.30±862.58 grams) was also significantly lower vs the group with T-score > /-2.5/ (4760.09±607.63 grams; p=0.000). A significant difference of body lean mass was also found between the groups with different T-score of femoral neck (4110.60±832.01 grams in patients with T-score of femoral neck ≤2.5, n=15; 4802.01±862.87 grams in those with T-score>2.5, n=96, p=0.004). Regarding the fat mass and fat percentage in the groups with different T-score of the femoral neck, they were lower in the patients with osteoporosis with T-score < /-2.5/, but the difference reached statistical significance only for the fat percentage (31 vs 38%, p=006) but not for the fat mass (p=0.081).

Conclusion: The results of the current study confirm the protective effect of the higher lean and fat mass against the development of osteoporosis with possible leading role of the lean mass.

Systemic Lupus in males – clinical-laboratory, immunological and histological characteristics.

2022-10-22T15:47:44+03:00

Systemic lupus erythematosus is a chronic, systemic, non-organ-specific autoimmune disease that affects all organs and systems of the human body and is characterized by the production of autoantibodies against nuclear antigens. Its prevalence in Europe reaches 1:2500. It affects mostly women (female : male ratio=9 : 1) in fertile age group (15-45 years). The clinical course of lupus in males is characterized by more aggressive clinical course and the development of serious complications, such as vasculitis, central nervous system involvement, antiphospholipid syndrome, etc. For the period of 7 years (2012-2019) we observed overall 18 male patients with systemic lupus, 11 with biopsy-proven renal involvement and 7 without clinically significant renal disease (proteinuria < 0.5 g/24 h., no erythrocyturia/cylindruria, normal renal function), mean age at the diagnosis 39.6 +/- 12.3 years. All patients received pathogenetic treatment (corticosteroids + cytotoxic agents). Three had secondary antiphospholipid syndrome, 1 – inflammatory bowel disease, 1 – seronegative spondyloarthropathy. Three had type 2 diabetes. The authors discuss the clinical, immunological and histological characteristics and the therapeutic approach in males with systemic lupus.

Anxiety and depression in patients with primary and secondary fibromyalgia in Bulgaria

2022-10-22T15:47:45+03:00

Fibromyalgia (FM) is characterized by a chronic widespread pain, general fatigue, anxiety, depression, sleep disturbances and functional disorders. FM affects both women and men in 9:1 to 20:1 ratio. Osteoarthritis, systemic lupus erythematosus and other diseases have often been and continue to be associated with fibromyalgia. The incidence rate of secondary FM in SLE and OA patients is around 20%. The purpose of this clinical study is to analyze anxiety and depression in patients with primary and secondary fibromyalgia. In prospective study eighty-three patients with primary FM, 39 patients with FM and osteoarthritis (OA), 23 patients with FM and systemic lupus erythematosus (SLE), 27 patients with SLE and 36 healthy subjects were included. The present study compared chronic pain, anxiety and depression in patients with primary FM, patients with SLE, FM + OA, FM + SLE and healthy subjects. Based on the HADS clinical parameter, anxiety and depression are a statistically significant difference of the control group, as compared to patients with primary FM, FM + OA, FM + SLE (p<0,05) and no difference in patients with SLE (p=0.77). There was no significant difference in HADS depression scores between the three groups of fibromyalgia patients. There was no significant difference in terms of the clinical parameter of depression between the SLE and FM + SLE groups. The comparison between the patient groups is important to evaluate the disease activity and the treatment to be recommended.

Estimation of the concentration of some biomarkers in serum of women with rheumatoid arthritis

2022-10-22T15:47:45+03:00

The current study was conducted on women with rheumatoid arthritis (RA) in Basrah city, Iraq. The study aimed to evaluate the relationship between some biomarkers such as adiponectin hormone, anti-citrullinated protein antibody (ACPA), acute phase C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) in the serum of female patients. In this study, 80 serum samples were collected from women and were distributed as follows: 56 serum samples from women with RA and 24 serum samples from non-infected women who were considered as a healthy group. The patient samples were divided into three categories depending on age, disease severity and duration. The samples were obtained from Basrah General Hospital. The results of the current study showed a significant increase in the concentration of adiponectin, ACPA, CRP and VEGF in RA patients compared to healthy subjects. In addition, there were significant differences in the concentration of these biomarkers between some of the three age groups and between the disease of severity and duration. The study concluded that all the biomarkers under investigation have increased their concentrations in the serum of women suffering from RA.

Multidisciplinary approach in the management of pregnancy and rheumatic diseases – the challenges for obstetricians and gynecologists

2022-10-22T15:47:46+03:00

Rheumatic diseases (RD) primarily affect young women of reproductive age and therefore pregnancy in these patients requires more attention. Pregnancy in women with RD requires a multidisciplinary, carefully coordinated approach before, during and after pregnancy to ensure the best possible prognosis for the mother and the baby. Treatment of patients with RD during pregnancy and in the post-natal period may be a major challenge for both rheumatologists and obstetrics-gynaecologists. Risk stratification and pregnancy planning are key to ensuring normal pregnancy in women with RD and minimal risk of complications. On the other hand, the risks to the fetus are related to the activity of the mother's disease, presence of specific autoantibodies, and mother's therapy. It is of great importance to stabilize the disease, to replace the medication with pregnancy-compatible drugs, tests of the autoantibody status and organ damage assessment. For these reasons, active monitoring of pregnant women with RD should be carried out by rheumatologist and gynecologist.

Axial spondyloarthritis - from inflammation to ankylosis

2022-10-22T15:47:46+03:00

Axial spondyloarthritis is a chronic inflammatory immune-mediated rheumatic disease that mainly affects the sacroiliac joints and the spine and encompasses both sub-units - ankylosing spondylitis and its preceding phase non-radiographic axial spondyloarthritis. The disease is characterized by two main immunopathological processes – chronic inflammation and pathological new bone formation, the causal relationship of which is still not fully understood. Starting as enthesopathic inflammation in the early stages, the disease progresses to ossifying enthesitis as a result of an abnormal immune response to skeletal biomechanical stress associated recurrent tissue microdamage, and a subsequent process of excessive repair and tissue remodeling. Immune-mediated inflammation manifests with a distinct skewing of differentiation towards a Th1/Th17 phenotype and an unbalanced profile of cytokine production, with cytokine dysregulation and predominance of the effects of pro-inflammatory cytokines. Molecular signaling pathways of syndesmophyte formation include bone morphogenetic protein (BMP), wingless-type like (WNT), Dickkopf-1 (Dkk-1), sclerostin, cytokines, and others. The review summarizes the current concepts regarding the pathophysiology of both pathognomonic processes for the disease – inflammation and pronounced osteoproliferation.

Clinical case of a patient with progressive supranuclear palsy – from symptom to diagnosis

2022-10-22T15:47:46+03:00

Progressive supranuclear palsy (PSP) is a neurodegenerative disease classified among the atypical forms of parkinsonism. PSP is characterized by great variability in the involvement of different areas of the central nervous system (CNS). The clinical picture is associated with impaired gait and balance, generalized bradykinesia, visual impairment, dysarthria, dysphagia, pelvic incontinence, dementia and others. We present a clinical case of a 50-year-old woman who, at the end of 2021, was admitted to the Rheumatology department, UMBAL "St. Ivan Rilski" - Sofia, due to weakness in the hands, dropping objects, pain in small joints of the hands, disorder in coordination, difficulty walking and frequent stumbling, slurred speech, tremors involving both hands (more pronounced on the right), memory impairment, pelvic incontinence and hair loss. The clinical case is very indicative of the long journey that a patient with progressive supranuclear palsy takes before being correctly diagnosed.

Antisynthetase syndrome a rare and challenging diagnosis-case report and literature review

2022-10-22T15:47:46+03:00

This case describes a 46-years old woman who initially presented with myopathy and arthropathy (i.e. musculoskeletal manifestations), which delayed the recognition of antisynthetase syndrome (ASS) and contributed for considering the condition as seronegative rheumatoid arthritis for several years. During the next few years, the patient was progressively worsening, with a disability to stand up from a sitting position, gradual onset of exertional dyspnea, difficult-to-control dry cough and thick, hyperkeratotic skin of both hands (mechanic’s hands). This constellation of symptoms was highly suspicious for ASS and additional serological and radiological examinations were done which confirmed the diagnosis of ASS. The need for further detailed investigation when an interstitial lung disease overlaps with a known rheumatoid condition is obligatory, as shown in this case. A multidisciplinary evaluation is highly recommended to evaluate the clinical, serological and radiological findings in each patient suspected for ASS in order to establish early diagnosis and timely management.