Rheumatology (Bulgaria)

Multivariate analysis of risk factors for major osteoporotic fracture risk assessed with radiofrequency echographic multi spectrometry (REMS)

2022-04-09T20:20:45+03:00

Aim. The 10-year probability of a FRAX for a major osteoporotic fracture (MOF) above 20% is considered a high fracture risk based on health and economic estimates. The aim of the current study was to identify the multivariate significant risk factors for FRAX MOF ≥20%, calculated by BMD of the femoral neck based on a assessment with the innovative radiofrequency echographic multispectrometry (REMS) ultrasound technique for axial skeletal scans.

Object of the study. For 304 women aged 40-90 years examined by REMS, age, height, weight, body mass index (BMI), menopause and the following risk factors for calculating FRAX were assessed - previous fractures, family history of hip fractures, smoking , alcohol consumption ≥3 units daily, use of corticosteroids (CS), diagnosed rheumatoid arthritis (RA) and secondary osteoporosis.

Methodology. According to the value of FRAX MOF women were divided into two groups - with FRAX MOF <20% and with FRAX MOF ≥20%. A binary logistic regression analysis was performed to assess the multivariate significant risk factors for FRAX MOF ≥20%.

Results and conclusions. Significant risk factors in the multivariate analysis for FRAX MOF ≥20% were previous fracture, use of CS, diagnosis of RA and BMD_US of the left femoral neck. The previous fracture increased the risk of FRAX MOF ≥20% by a factor of 38.77. Women who use CS showed about a 13.5-fold higher risk of FRAX MOF ≥20% than those who do not use CS. The diagnosis of rheumatoid arthritis increases the risk of FRAX MOF ≥20% by 6.92. Any 1% increase in left femoral BMD reduced the risk of FRAX MOF ≥20% by 0.29%. This specific model, designed to predict FRAX MOF ≥20% with REMS, may be useful for deciding on therapy in women with high risk factors for FRAX MOF ≥ 20%.

Relationship between juvenile idiopathic arthritis and periodontal diseases

2022-04-09T20:20:45+03:00

Background: Juvenile idiopathic arthritis (JIA) is an arthritis of unknown etiology that begins before the 16^th birthday and persists for at least six weeks with other known conditions excluded. In JIA, there is a destructive inflammatory process in the border between bone and connective tissue of the joint similar to the inflammatory process of the supporting tissue around the tooth in periodontitis.

Objective: To emphasize the role of a pedo-dentist in the multidisciplinary management of JIA (to treat this detrimental disease before it becomes irreversible).

Patients and Methods: A case-control study was conducted among JIA patients at Baghdad Teaching Hospital, Rheumatology Unit and private rheumatology clinic during the period September 2020 to May 2021. Twenty Iraqi patients diagnosed with JIA by rheumatologist (after fulfilling International League of Associations for Rheumatology (ILAR) criteria), compared with 20 healthy control individuals matched age. All patients were sent to specialized pediatric dental clinic in Baghdad where dental examination was applied. The examinations were conducted by two certified specialist pedo-dentist to indices Dental ﬁndings (dmf-s/DMF-S), Gingival inﬂammation (GI), Plaque index (PI). The surfaces of Ramfjord teeth were examined with diagnostic instruments (mirror and periodontal probe) and scored for all indices.

Results: According to joint numbers involved, the polyarticular manner was the most common in 40% of patients, followed by oligoarticular in 35% of patients, and systematic manner in 20% of patients. In addition, one case presented with enthesitis related arthritis. The mean of gingival index (GI) in patients’ group (0.88±0.623) was higher than that of control group (0.61±0.53), without any significant difference (p=0.0545). However, the plaque index (PI) results showed high statistically significant difference (p=0.0162), similarly, the dmfs demonstrated a high significant difference (p=0.026) between patient and control groups. The DMFs was statistically significant (p=0.015), CRP level in relation to the indices, all indices have a significant high level association level (≥5mg/L) over normal level of CRP (<5 mg/L), effect of Prednisolone was statistically significant for GI (p=0.0245), and dmfs (p=0.0015). However, it was not significantly different in the value of PI (p=0.098), and DMFs (p=0.0627). In our study DMARDs (MTX) had a direct effect on GI and PI with a statistically significant difference (p=0.0164), and (p=0.017), respectively. Finally, the role of MTX on dmfs and DMFs was not significant.

Conclusions: The indices used in this study to evaluate oral health in JIA children were GI has no significant difference compared to healthy children; PI was significantly higher compared to healthy children; the dmfs/DMFS both showed significantly higher compared to healthy children. The high CRP level has a significant association with GI, PI and dmfs, but no significant association with DMFs. Regarding the JIA treatment, Prednisolone has significantly modified all indices (in particular GI and DMFs), NSAIDs has significantly modified PI only, DMARDs (MTX) had direct effect on GI and PI, but no role on dmfs and no significant effect on DMFs.

INTRAARTICULAR THERAPY IN HIP OSTEOARTHRITIS. REASONS FOR THE VARIABILITY OF THE RESULTS OF INTRAARTICULAR THERAPIES

2022-04-09T20:20:45+03:00

The presented review consists of 2 parts: descriptive and systemic analysis. In the first part mechanisms of action, indications, contraindications, methods of administration and adverse effects of intraarticular corticosteroids (IACS) are described, as well as the most common used in the studies on intraarticular therapy comparators, such as natural saline(NS) and local anesthetics (LA). Also the official statements and recommendations of the rheumatologic organizations (EULAR; ACR; OARSI) are quoted. In the systemic review 20 original studies on IACS in НОА are analysed. The data of rapidity, expression and sustainability of the effects of IACS are assessed by meta-analyses, the obtained results are compared to those of the open 4 descriptive and 4 systematic reviews of foreign authors. In the discussion the different interpretations of the results from the original studies and preceding meta-analyses are pointed out according to the authors’ opinion.

Mitochondrial dysfunction and biological therapy: a new look at rheumatoid arthritis

2022-04-09T20:20:45+03:00

A marked increase in interest towards the mitochondria and their implication into the pathogenesis of various immune-mediated diseases is observed. A multitude of studies are establishing the mitochondrial dysfunction and it's pathophysiological sequelae as key events, contributing to the progression of rheumatoid arthritis. The oxidative stress and release of mitochondrial molecules into the intra- and extracelular compartments are a result of the loss of function and integrity of the mitochondria. Some biomarkers, which accurately reflect the state of oxidative stress in rheumatoid arthritis patients, have been successfuly identified. The change in the levels of those markers as a result of treatment with biologic DMARDs (bDMARDs) has been analyzed. However, there is still insufficient data regarding the effect of the target-synthetic DMARDs (tsDMARDs) on the oxidative stress.

MANAGEMENT OF COMPLICATIONS FROM DERMAL FILERS AND INTRAARTICULAR MANIPULATIONS: RARE OR NOT SO RARE?

2022-04-09T20:20:46+03:00

With the development of Dermatology, the popularity of dermal fillers and the interest in them inevitably increases. More and more, patients are seeking their own dermatologist for cosmetic correction. The increase in the number of procedures performed leads to an increase in the frequency of their complications, which is one of the main reasons why these patients seek consultation with a rheumatologist.

Intra- and periarticular administration of corticosteroids is an important part of rheumatological practice in the treatment of various inflammatory joint diseases. This in turn carries risks of side effects that may be related to the systemic or local action of the corticosteroid.

We present two cases from the clinical practice related to complications after injecting hyaluronic acid and corticosteroid. The first case is of a woman in whom an aesthetic correction was made to rejuvenate the hands by placing hyaluronic acid in the dorsal part of the hands. The patient complained of redness, warmth, shine, swelling and burning pain in the area of manipulation. The second case is of a patient with Juvenile Idiopathic Arthritis with bilateral carpitis who has been injected with intra-articular corticosteroids repeatedly (more than 20 for a period of 18 years). After the last intra-articular administration of corticosteroid in the radiocarpal joint, it was observed hypopigmentation and skin atrophy in the area of the procedure.

CONNECTIVE TISSUE DISEASE-ASSOCIATED INTERSTITIAL LUNG DISEASE: CASE REPORTS

2022-04-09T20:20:46+03:00

Interstitial lung diseases (ILD) or diffuse parenchymal lung diseases (DPLD) account for approximtely 15% of all pulmonary pathology in clinical practice. These include over 200 diseases, many of which are rare and of unknown etiology. Systemic connective tissue diseases (SCTDs) are a heterogeneous group of rheumatic diseases. They are characterized by various organs systems involvement with autoimmune phenomena and positive autoantibodies. Pulmonary manifestations represent one of the multiple organ involvements. ILD in SCTDs is characterized by inflammation and subsequent development of interstitial pulmonary fibrosis, progressing to impaired gas exchange.

We present here a patient with long-term systemic sclerosis, a patient with antisynthetase syndrome and a patient with systemic lupus erythematosus with rheumatoid arthritis and concomitant ILD. Clinical manifestations are described in details, high-resolution CT scans of the lungs are presented. Two-years methylprednisolone and cyclophosphamide pulse therapies were administered in systemic sclerosis patient, and systemic lupus and antisynthetase syndrome patients underwent methylprednisolone pulse therapy for two years. This treatment was followed by chronic administration of corticosteroids, Imuran and chloroquine. Patients with SCTDs and ILD require a multidisciplinary approach, including clinical, radiographic and histological testing.

Chylothorax as a rare manifestation of systemic lupus erythematosus flare up - case study

2022-05-18T19:22:06+03:00

We present a case of systemic lupus erythematosus (SLE), which was diagnosed before 7 years, and antirheumatic therapy was prescribed. However, following relief of the initial symptoms, the patient stopped taking medications and presented again, after being symptom-free for three years, with chylothorax and symptoms, which were entirely different from the first visit. The patient was treated with a combination of hydroxychloroquine, prednisolone and azathioprine following ruling out of malignancy and infections and responded well to the therapy.

Reactive arthritis (ReA) following the first dose of Covid-19 vaccine; A case report

2022-04-17T12:05:58+03:00

Introduction: The development of vaccination against COVID-19 infection was a promising step during the battle against this pandemic; however, some vaccines were associated with some complications starting with just flu-like symptoms up to anaphylaxis; of the reported complications is joints pain. Here, we report a case who developed reactive arthritis (ReA) after receiving the first dose of the Pfizer-BioNTech Covid-19 vaccine.

Case presentation: A healthy 54 years old male with no previous history of any medical condition was presented with bilateral hand and bilateral knee pain after one week of receiving his first dose of Pfizer-BioNTech Covid-19 vaccine. Clinical examination revealed swelling, tenderness, and erythema over the right index metacarpophalangeal joint and the medial aspect of the right knee. Radiographs of the hand and knee were normal. Laboratory investigations were within normal values except for an elevated ESR (15 mm/hr.) and a positive CRP titer of 48 mg/l. The symptoms entirely resolved after two weeks of non-steroidal anti-inflammatory medications.

Conclusions: Although rare, however, ReA could be presented as a complication of Covid-19 vaccination, and physicians should be aware of the possibility of its occurrence.