Rheumatology (Bulgaria)

A Systematic Review of Point-of-Care Ultrasound (POCUS) of Multiorgan Assessment of Systemic Lupus Erythematosus

2025-05-02T12:34:57+03:00

Background: Systemic lupus erythematosus (SLE) can affect multiple organs, presenting a diverse array of clinical symptoms. In recent years, Point-of-Care Ultrasound (POCUS) has become increasingly accessible, supported by robust evidence. POCUS can be particularly beneficial for evaluating SLE patients improving diagnostic accuracy and reducing time-to-decision. Purpose: Systematically identify the assessment of SLE patients through the use of POCUS. Methods: The data sources MEDLINE, EMBASE, LILACS, Google Scholar and ProQuest One Academic were used, English and Spanish language were included, no limits regarding publication date or age, and review articles were excluded. Articles screening and data extraction was performed by two authors independently. Disagreements were resolved through a third author. Organ or system evaluation using POCUS were collected. Results: A total of 52 articles met the inclusion criteria. Assessment using POCUS detected various acute and chronic complications arising from SLE, particularly articular and cardiac compromise. Synovitis and pericardial effusion were the most frequently reported complications. Most of the reports (92%) did not specify whether they evaluated other organs with POCUS. Limitation: Most of the studies were case reports. Conclusion: Multiorgan POCUS assessment in patients with SLE, especially those suspected of disease activity, holds the potential to offer improved evaluation of SLE complications and activity. Studies are needed to develop a standardized multiorgan assessment protocol for SLE using POCUS to improve diagnosis and treatment.

PROSPERO registry number: CRD42024529087. The search was done in April 2024

Efficacy of connected devices in promoting physical activity and rehabilitation among patients with Rheumatoid arthritis and Spondyloarthritis: A systematic review

2025-05-02T12:34:58+03:00

Objective: To evaluate the efficacy of connected devices in promoting physical activity and rehabilitation among patients with IRD.

Data sources: Keywords related to connected devices, physical activity, rehabilitation, and IRD (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis) were used to search for intervention trials published as articles and abstracts in the databases MEDLINE, Web of Science, Scopus, American College of Rheumatology (ACR) abstract archive and European Alliance of Associations for Rheumatology (EULAR) abstract archive. No restrictions were applied in terms of publication date.

Study selection: Interventions consisting of connected used for promoting physical activity and rehabilitation were included. Studies reporting the following primary or secondary outcomes: physical activity measurements, function of a limb region, and performance-based physical function tests were included. Studies reporting only disease activity outcomes or only evaluating feasibility of connected programs were excluded.

Data Extraction: Data from each report were extracted by two researchers independently. The obtained data were narratively summarized.

Data Synthesis: The search identified584 studiesand15met the inclusion criteria. The studies’ design was: randomized controlled trials (n=9), non-randomized intervention trials (n=3), cross-sectional study (n=1), prospective observational study (n=1), and a case-control study (n=1). Promoting physical activity using a wearable device, was improved significantly in one study. Among 9 studies assessing rehabilitation, a significant improvement was found in four studies for hand strength, in 2 studies for cardiorespiratory fitness, and in 2 studies for muscle endurance. Two of the 3 studies focusing mobility showed a significant increase for intervention groups.

Conclusion: The present study indicates that connected devices are simple and safe tools to improve mainly performance-based physical function in patients with IRD. However, further studies with larger population sizes and a longer follow-up period are needed to make reliable conclusions.

Evaluating Quality of Life in Systemic Lupus Erythematosus: Modern Approaches and Perspectives

2025-05-02T12:34:58+03:00

Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations. Timely diagnosis and accurate assessment of disease activity are essential for determining optimal therapeutic strategies for each patient. Over recent decades, the prognosis for SLE patients has significantly improved. However, even with proper treatment and remission, quality of life (QoL) remains substantially impaired. This underscores the importance of evaluating health-related quality of life (HRQoL) as part of a comprehensive approach to managing SLE patients. A holistic understanding of a patient`s overall condition involves not only physical health but also psychological and social well-being. In recent years, numerous QoL questionnaires have been increasingly utilized in rheumatological practice. Generic questionnaires, such as the Short Form-36 (SF-36), facilitate comparisons across different diseases but may lack sensitivity to the specific clinical symptoms of SLE. Conversely, lupus-specific questionnaires, including LupusQoL, SLEQOL, LupusPRO, and L-QoL, offer more precise insights by capturing multiple aspects of the disease from the patient`s perspective. Current guidelines emphasize the need to integrate HRQoL assessments into routine clinical practice and research. The literature review highlights the growing role of lupus-specific questionnaires in clinical trials and raises the critical question of their effectiveness and applicability in daily practice to improve medical care.

GLOBAL TRENDS AND PROBLEMS OF INFECTIOUS DISEASES – COVID-19, HIV/AIDS, TUBERCULOSIS

2025-05-02T12:34:58+03:00

Summary: Globalization and the interconnectedness of countries in the modern world pose new challenges to public health. Over the centuries, infectious diseases have proven to be one of the major threats to global health. Historically, several pandemics and epidemics have changed and claimed the lives of millions of people around the world. Many infectious agents continue to pose a serious problem despite advances in medicine, public health awareness campaigns and vaccination. The aim of this review is to review global epidemiological trends and challenges related to three key infectious diseases: COVID-19, HIV/AIDS, and tuberculosis. The COVID-19 pandemic, along with the long-standing threats of HIV/AIDS and tuberculosis, is posing a serious challenge to health systems and socio-economic structures in many countries. COVID-19, caused by SARS-CoV-2, has spread rapidly around the world, resulting in significant numbers of cases, deaths, and long-term health problems. The consequences of infection “long” COVID-19 and post-COVID-19 unlocked syndromes have become one of the main causes of reduced work capacity and impaired quality of life in recent years. At the same time, HIV/AIDS remains a global health problem, especially in certain regions, and tuberculosis continues to pose a serious threat, especially in conditions of limited access to health services. Each of these health problems poses specific requirements for treatment and prevention, while leading to serious health, social and economic consequences, despite global initiatives and strategies to address them.

Treat to target - case series of patients with rheumatoid arthritis and no radiographic progression at long-term follow up

2025-05-02T12:34:58+03:00

Rheumatoid arthritis is a chronic autoimmune inflammatory joint disease characterized by pain, morning stiffness and symmetrical polyarthritis, leading to destruction of the affected joints in long term. The goal of the treat-to-target strategy in treating the disease is to achieve remission or low disease activity. Today, there are various conventional, biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs), which are widely used in rheumatological practice in order to personalize the therapeutic strategy for each patient. One of the main goals of treatment is to suppress and slow the radiographic progression of the disease, which leads to disability, impaired quality of life and reduced work capacity of patients. There are different scales for assessing joint destruction, based on radiographic examination of small and large joints of the hands and feet, due to which we can assess structural changes in dynamics. We present three clinical cases of patients with long-standing seropositive rheumatoid arthritis, treated with conventional and/or biologic DMARDs, who achieved long-term remission and minimal radiographic progression of the disease.

Severe bone deformities in primary hyperparathyroidism

2025-05-05T16:58:02+03:00

The classic description of primary hyperparathyroidism (PHPT) is as a disease of kidney stones and bones. However, the clinical manifestation of osteitis fibrosa cystica with severe bone changes is rare in modern medicine. We present a clinical case of a 30-year-old man with severe bone deformities of the long bones, scoliosis, brown tumors and severe osteoporosis. At the time of the diagnosis, he has the classic biochemical and hormonal picture of primary hyperparathyroidism: severe hypercalcemia, hypophosphatemia, and significantly elevated parathyroid hormone values. The changes are temporarily affected after surgical treatment of the parathyroid adenoma. After a four-year loss to follow-up, the patient presented with worsening symptoms and hypercalcemia, possibly due to incomplete tumor removal. The bone changes are debilitating and imply incomplete reverse development, considering their severity and duration. Comparison is made with other similar cases in the literature.

FIRST BULGARIAN EULAR-ENDORSED COURSE ON CAPILLAROSCOPY AND MICROCIRCULATION IN RHEUMATIC DISEASES

2025-05-02T12:34:58+03:00

The first Bulgarian EULAR-endorsed Course on Capillaroscopy and Microcirculation in rheumatic diseases (2024) was a logic consequence of the increasing need of international education in capillaroscopy in Bulgaria and reflects also the intensive collaboration between European experts in the field of capillaroscopy.

The aim of the course was to present the proper technique of capillaroscopy, analysis of capillaroscopic images, interpretation of the results, differentiation between normal and pathological findings in rheumatic diseases. The full immersion 3-day-course provided a summary of the most recent advances in the field of microvascular pathology in rheumatic diseases from leading experts in the field. The course covered both basic theoretical and practical principles in performing and interpretation of capillaroscopic examination, as well as innovative aspects regarding microvasculopathy in rheumatic diseases based on the contemporary knowledge and the considerable practical experience of the experts.

Members of the scientific committee and lecturers were three international guests - Prof. Dr. Maurizio Cutolo, Prof. Dr Vanessa Smith and Prof. Dr Ulf Müller-Ladner. Bulgarian organizers and lecturers were Prof Dr Rumen Stoilov (President of the Bulgarian Rheumatology Society), Prof Dr Sevdalina Lambova, Dr Vladimira Boyadzhieva, Prof. Dr. Hristo Dobrev and Dr Nikolay Stoilov.