Rheumatology (Bulgaria)

National consensus for capillaroscopy in rheumatology

2022-01-19T13:36:17+02:00

Not applicable.

Pharmacoeconomic models in rheumatology

2021-12-06T16:22:42+02:00

Pharmacoeconomic models of chronic diseases explore the development of the disease, patients’ pathways through it and calculate the cost-effectiveness of the therapy with different medicines.

The goal of the current study is to identify the pharmacoeconomic models used in rheumatology, their historical development and utilization.

Systematic search in PubMed was performed with key words „pharmacoeconomic, models, rheumatology, and cost-effectiveness “.

On total 58 manuscripts were identified, describing mainly the rheumatoid arthritis development. The first one in line is the ACCES model of rheumatoid arthritis which have been validated in Sweden, Norway, etc. This is one of the first Markov model in rheumatology. Biological medicines are in the primary area of interest for modelling their therapeutic results. During the latest year scientists are working for the development of the web based platform to forecast the biological therapy (model PREDIRA).

In alliance with other therapeutic areas with the development of artificial intelligence the pharmacoeconomic models is expected to increase, especially those build with data from real world clinical practice.

ASSESSMENT OF THE FRACTURE RISK THROUGH FRACTURE RISK ASSESSMENT TOOL (FRAX) IN POSTMENOPAUSAL WOMEN

2021-12-06T16:22:42+02:00

Current National Osteoporosis Foundation (NOF) guidelines recommend treating patients with a 10-year fracture risk (FRAX) of ≥3% for hip fractures or ≥20% for major osteoporotic fractures to reduce the future fracture risk. The present study investigated the distribution of the women in the groups with a FRAX score for major osteoporotic fractures below 20% and for hip fractures below 3%, as well as a FRAX score for major osteoporotic fractures ≥20% and for hip fractures ≥3%. We found that women with a fracture risk corresponding to a FRAX score for major osteoporotic fractures ≥20% and with a FRAX score for hip fractures ≥3% were significantly older (p = 0.000) and had significantly lower weight and height (p = 0.000) compared to women with FRAX score for major osteoporotic fractures below 20% and with a FRAX score for hip fractures below 3%. Regarding the risk factors studied, women with a history of rheumatoid arthritis who currently use corticosteroids have the highest risk of fractures with a FRAX score for major osteoporotic fractures ≥20% and a FRAX score for hip fractures ≥3%.

Clinical value of soluble urokinase-type plasminogen activator receptor (SuPAR) as a biomarker of disease activity in Behcet’s disease

2021-12-06T16:22:42+02:00

Background: Behçet's disease (BD) is a chronic multisystemic vasculitic disease of unknown pathogenesis. Diagnosis and disease activity measurement has always been a challenge. Soluble urokinase plasminogen activator receptor (suPAR) is showing an increased utility as a promising diagnostic and prognostic inflammatory biomarker in different systemic inflammatory disorders.

Objectives: To study the clinical value of plasma Soluble urokinase plasminogen activator receptor (suPAR) in patients with Behçet's disease, and if it can be used as a measure to disease activity. Methods: According to the International Criteria for Behcet's Disease (ICBD), fifty adult Behçet's disease patients were enrolled in the study, and forty healthy adult subjects were included in a case-control study. An enzyme-linked immunosorbent assay was used to obtain quantitative data. Results: The suPAR level was not statistically different between the patients with BD patients and the controls. No correlation was found between suPAR levels and disease activity (BDFAC). Conclusion: Very few studies analyzed the clinical value of suPAR level in patients with BD and its correlation with disease activity. Our results show that suPAR does not seem to play a role in the disease mechanism of BD.

Keywords: Behçet's disease, suPAR, disease activity, inflammation.

Intraarticular therapy with hyaluronic acid and platelet-rich plasma in hip OA – modern aspects

2021-12-06T16:22:43+02:00

Intraarticular therapy in ОА, particularly in НОА, is very important, as it is directly targeting the problematic joint, affording stable therapeutic concentrations in situ to be maintained with minimal systemic and adverse effects of the administrated drugs. The presented review consists of 2 parts: descriptive and systematic analysis. In the first part mechanisms of action, indications, contraindications, methods of administration and adverse effects of the intraarticular therapy with hyaluronic acid (IA-HA) and with platelet-rich plasma (IAPRP) are presented, as well as the official statements of the major rheumatologic organizations (EULAR; ACR; OARSI), concerning this issue. In the systemic reviews 34 original studies on IA-НА in НОА and 7 original studies on IA-PRP in НОА are analysed. The data of rapidity, expression and sustainability of the effects of IA-HA/IA-PRP are assessed by meta analyses, the obtained results are compared to those from the open 8 descriptive and 8 systemic 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.

COVID-19 IN AUTOIMMUNE RHEUMATIC DISEASES - FREQUENCY, COURSE, EFFECTIVENESS AND COMPLICATIONS IN VACCINATION

2021-12-06T16:22:43+02:00

The onset of the pandemic caused by the new coronavirus has raised many questions in the global rheumatology society regarding the clinical course of the disease, effectiveness and complications of SARS-SoV-2 vaccination.

The aim of this review is to analyze the information available up to date on the course of COVID-19 in patients with autoimmune rheumatic diseases (ARD), the frequency of complications in these patients, the effectiveness and side effects of vaccination against COVID-19. Various studies in Europe and the United States have found that the risk of severe COVID-19 in patients with ARD is similar to that in the general population. Negative prognostic factors are thought to be old age, comorbidity, moderate / high ARD activity, and corticosteroid (CS) intake at doses> 10 mg / day. Patients with systemic ARD are considered to be at higher risk of thromboembolic events due to chronic inflammation and / or the presence of antiphospholipid syndrome, as well as the nature of COVID-19 - an endothelial lesion causing thrombosis and microangiopathy. It is observed a higher risk of severe pneumonia in patients treated with Rituximab, as well as an increase in hospitalizations and deaths amongst them. The opposite trend is observed in patients treated with anti-TNF. With the development of vaccines against COVID-19, questions arise about their effectiveness in patients with ARD, as well as the frequency of complications associated with them. In these studies, slightly lower levels of neutralizing antibodies were observed in patients with ARD compared to the general population, most commonly associated with Methotrexate or targeted synthetic DMARDs. The most common side effects seen in these patients after vaccination are pain at the injection site, fatigue and headache. Complaints of the musculoskeletal system are more common in patients with ARD than in the general population. Exacerbations of the underlying disease following vaccination, requiring hospitalization, are rare.

Overlap of granulomatosis with polyangiitis and ankylosing spondylitis, large joints arthritis and elevated rheumatoid factors

2021-12-06T16:22:43+02:00

We present the case of a patient with long-standing history of ankylosing spondylitis without an established diagnosis; highly elevated rheumatoid factors; osteoarthritis of both ankles; newly diagnosed granulomatosis with polyangiitis (GPA) with pulmonary changes; severe progressive acute polyneuropathy of the upper and lower extremities. The patient received treatment with intravenous methylprednisolone 1 mg/kg daily for 15 days with gradual dose reduction to 8 mg daily, pulse therapy with intravenous methylprednisolone 1 g and intravenous cyclophosphamide 1 g monthly for 5 months, after that rituximab 600 mg intravenous in day 1,8, 16, 23, symptomatic treatment with B vitamins. Patient responded well to treatment and gradual restoration of mobility of the lower extremities, reduction of numbness in hands and feet, and complete resolution of ankle osteoarthritis was observed. Some polymorphisms appear to confer risk to multiple autoimmune diseases. Studies of familial associations between GPA and other autoimmune diseases have concluded that first-degree relatives of persons with GPA have a modest increase in risk of common autoimmune diseases in general (relative risk 1.32) and of rheumatoid arthritis, multiple sclerosis, psoriatic arthritis in particular.