Polymyositis (PM) is an autoimmune disease which affects skeletal muscles. In young age, it usually
occurs as an idiopathic disorder associated with specific autoantibodies (anti-Jo), while in older ...age it is often associated
with neoplasms. It can present with symptoms of other autoimmune diseases, such as systemic sclerosis (SSc), a
rare progressive disease characterized by collagen deposits in various tissues and organs.
A 65-year-old patient, long-time smoker, came to the ER because of painful edema in the distal parts of his limbs
and proximal muscle weakness of his arms and legs. Although his muscle enzymes were not increased, PM was confirmed
by the characteristic pathohistological finding. The patient had sclerodermal skin lesions on his back, but he did
not have other typical SSc symptoms, and the specific autoantibodies were negative. He received glucocorticoid therapy
(GC) after we had finished screening for malignant tumors. He felt better, his muscle strength returned, and the
limb edema disappeared. Four weeks later, he developed symptoms which are more typical of SSc, such as dysphagia,
Raynaud’s phenomenon, and skin thickening of the limbs that had been swollen.
PM is often associated with SSc. It is not clear if the exacerbation of latent SSc was stimulated by GC, or if it was
just a simple overlap of the two diseases with different onsets. There are no therapy guidelines for the treatment of this
combination of diseases. Careful use of GC is necessary even if SSc symptoms are discreet, because of the well-known
effects of GC in SSc.
Vaskulitis je rijetko upalno zbivanje stijenke krvne žile koje dovodi do potpune ili djelomične okluzije krvne žile te ishemije tkiva ili organa koje ta krvna žile opskrbljuje. Vaskulitisi su složena ...grupa bolesti uglavnom autoimunosnog podrijetla. Vaskulitični proces može biti primaran ili sekundaran i može zahvatiti jedan ili više organa. Upala zahvaća dio ili cijelu stijenku krvne žile s posljedičnim gubitkom vaskularnog integriteta. Vaskulitisi se klasificiraju na temelju upalnog oštećenja malih, srednjih ili velikih krvnih žila.
Nausea and vomiting are well-known gastrointestinal complications in chronic renal failure and are frequent indications for the commencement of dialysis. Although the administration of antiemetic ...drugs (metoclopramide and, recently, ondansetron) is usually mentioned, there are scanty data on their effects.
A double-blind crossover study was done in 10 uremic patients. All the patients were uremic and suffered from nausea and vomiting. The drugs were randomly administered intravenously (either metoclopramide 10 mg or ondansetron 8 mg) 2 h after blood drawing for laboratory tests either on the 1st or on the 3rd study day at the same time. The outcomes were scored after 24 h of follow-up by (1) one of us (D.P.; 1-3 points: 1 = no effect; 2 = moderate effect - decreased frequency of vomiting, and 3 = good effect - no vomiting), and (2) by the patients (1-5 points).
The results obtained showed that ondansetron was more effective in controlling nausea and vomiting than metoclopramide, either objectively (2.80 +/- 0.422 vs. 1.40 +/- 0.699, p < 0.005) or subjectively (4.10 +/- 0.738 vs. 2.10 +/- 0.994, p < 0.005).
We conclude that at the dosage level studied ondansetron is about twice as effective as metoclopramide in the symptomatic relief of uremia-induced nausea and vomiting.
Cilj istraživanja: Cilj istraživanja bio je utvrditi klinička obilježja malignih bolesti u bolesnika sa sistemskim eritemskim lupusom (SLE) liječenih u Kliničkome bolničkom centru (KBC) Split.
...Materijal i metode: U istraživanje su uključeni bolesnici sa SLE-om koji su liječeni u KBC-u Split u razdoblju od
1. siječnja 2007. do 31. prosinca 2016. godine. Podatci su prikupljani restrospektivno, pretraživanjem medicinske
dokumentacije.
Rezultati: Od 271 bolesnika maligni su tumor imala 24 (8,85%) bolesnika od kojih su 3 bila muškog spola (12,50%), a 21 ženskog spola (87,50%). Ukupno je zabilježeno 27 malignih tumora jer su neki bolesnici imali više od jednog tumora. Tri bolesnika (12,50%) sa SLE-om i malignomom bila su muškarci, a 21 su bile žene (87,50%). Bolesnici sa SLE-om i malignomom bili su znatno stariji od bolesnika koji boluju samo od SLE-a (t = 3,43; p < 0,001). Većina bolesnika (79,17%) oboljela je od malignog tumora nakon postavljanja dijagnoze SLE-a. Najčešće sijelo maligne bolesti bilo je grlo maternice (25%), zatim štitnjača (12,50%), pluća (8,33%), debelo crijevo (8,33%) i dojka (8,33%). Prema patohistološkom nalazu, najveći broj bolesnika imao je karcinom (83,33%; p < 0,001). Većina bolesnika s malignom bolesti bila je pozitivna na ANA antinuclear antibody (79,17%) i ENA extractable nuclear antibody (79,17%). Bolesnici s malignomom najčešće su bili na terapiji glukokortikoidima (54,16%) te kombinaciji glukokortikoida i imunosupresiva (29,16%).
Zaključak: Maligne bolesti javljaju se u starijih bolesnika sa SLE-om. Prema rezultatima našeg istraživanja, najčešća lokalizacija maligne bolesti jest grlo maternice iako se u literaturi najčešće spominje ne Hodgkinov limfom. Većina bolesnika s malignomom i SLE-om bila je pozitivna na ANA i ENA.
Sustavna skleroza (SSc) rijetka je bolest vezivnog tkiva, klinički obilježena poremećajima u vaskularnim, imunosnim i fibroznim putovima. Nutritivni status danas se rabi kao biljeg za aktivnost i ...težinu bolesti koji ujedno predviđa i smrtnost u pacijenata sa SSc-om. Cilj ovog istraživanja bio je odrediti nutritivni status (stupanj malnutricije) bolesnika sa SSc-om te odrediti moguću povezanost nutritivnog statusa sa stanjem usne šupljine, samoprocijenjenim doživljajem zdravlja, funkcionalnom onesposobljenošću i stupnjem uznapredovalosti bolesti te s težinom kliničke slike i aktivnošću osnovne bolesti. U istraživanju smo određivali nutritivni status (stupanj malnutricije) u 17 bolesnika sa SSc-om uz pomoć alata probira Malnutrition Universal Screening Tool (MUST). Iz dobivenih podataka o nutritivnom statusu tražili smo njegovu povezanost sa stanjem usne šupljine mjerenim upitnikom OHIP-49, sa samoprocijenjenim doživljajem zdravlja mjerenim upitnikom SF-36 te s funkcionalnom onesposobljenošću i stupnjem uznapredovalosti bolesti mjerenim upitnikom SHAQ. Od ukupno 17 bolesnika visoki rizik od razvoja malnutricije procijenjen je u 11 bolesnika (65%), dok je srednji rizik od razvoja malnutricije imalo 6 bolesnika (35%). Jedine znatne razlike (P < 0,05) bile su u vrijednostima upitnika SHAQ. Ispitanici s visokim rizikom od malnutricije imali su znatno više vrijednosti dobivene tim upitnikom. Kod skupine s visokim rizikom od malnutricije prema MUST-u uočene su znatno češće pozitivne vrijednosti SCL70, negativne vrijednosti ACA-e, veća aktivnost bolesti te veća učestalost općih, kožnih i zglobnih simptoma. Rezultati ovog istraživanja upućuju na povezanost nutritivnog statusa (stupnja malnutricije) s težinom kliničke slike i aktivnošću osnovne bolesti. S obzirom na malen broj bolesnika uključenih u ovo istraživanje, za potpunu potvrdu naših zaključaka potrebna su dodatna istraživanja na većem broju bolesnika.
Rheumatoid arthritis (RA) is chronic inflammatory rheumatic disease which leads to joint damage, functional im- pairment and reduced quality of life. The disease should be recognized early when there ...is a "window of oppor- tunity" to apply adequate treatment which may prevent structural damage. As clinical presentation of RA is not always typical, great knowledge and clinical experience, including collaboration of rheumatologist, general practi- tioner and patient, are required. The treatment should be started immediately upon the diagnosis, while the choice of modality of treatment depends on the rheumatologist in accordance with the patient. The RA patients with the higher risk of aggressive disease need to be recognized because they require more aggressive treatment from the start. The goal of the treatment is remission or at least low disease activity. Current treatment of RA includes disease modifying antirheumatic drugs (DMARDs) synthetics and biologics, nonsteroidal antirheumatic drugs (NSAIDs), glucocorticoids, analgesics, and rarely cytostatics. The course of disease is usually fluctuating with the exchange of relapses and remissions. Recognition of the relapsing patient on time enables treatment intensification or modifications in treatment scheme. Special issue in RA represents glucocorticoid-induced osteoporosis (GIO) which should be prevented by usage of calcium and vitamin D supplements and treated by antiresorptive or osteoanabolic agents. Besides the treatment of the primary disease, the care of RA patients should consider comorbidities, side effects of treatment, complications of disease, and psychosocial aspects of chronic disease.
Rheumatoid arthritis (RA) is chronic inflammatory rheumatic disease which leads to joint damage, functional im- pairment and reduced quality of life. The disease should be recognized early when there ...is a "window of oppor- tunity" to apply adequate treatment which may prevent structural damage. As clinical presentation of RA is not always typical, great knowledge and clinical experience, including collaboration of rheumatologist, general practi- tioner and patient, are required. The treatment should be started immediately upon the diagnosis, while the choice of modality of treatment depends on the rheumatologist in accordance with the patient. The RA patients with the higher risk of aggressive disease need to be recognized because they require more aggressive treatment from the start. The goal of the treatment is remission or at least low disease activity. Current treatment of RA includes disease modifying antirheumatic drugs (DMARDs) synthetics and biologics, nonsteroidal antirheumatic drugs (NSAIDs), glucocorticoids, analgesics, and rarely cytostatics. The course of disease is usually fluctuating with the exchange of relapses and remissions. Recognition of the relapsing patient on time enables treatment intensification or modifications in treatment scheme. Special issue in RA represents glucocorticoid-induced osteoporosis (GIO) which should be prevented by usage of calcium and vitamin D supplements and treated by antiresorptive or osteoanabolic agents. Besides the treatment of the primary disease, the care of RA patients should consider comorbidities, side effects of treatment, complications of disease, and psychosocial aspects of chronic disease.
It is a well-documented fact that sex hormones are implicated in the immune response and that androgens and estrogens modulate susceptibility and progression of autoimmune rheumatic diseases. ...Estrogens are considered to stimulate cell proliferation and humoral immune responses while androgens exert suppressive effects on both humoral and cellular immune responses. Autoimmune diseases are common in females, especially during the generative period, the most representative of estrogen-related autoimmune diseases being systemic lupus erythematosus. Estrogens and androgens are involved in the pathogenesis of the disease; both exogenous and endogenous estrogens are strong stimulators of cytokine production and disease activity. Some physiological conditions, as well as some drugs and chronic stress, can modulate hormone levels. Low levels of gonadal androgens have been detected in body fluids of both male and female rheumatoid arthritis patients, supporting the possibility of the pathogenic role for decreased androgen levels. Views on hormone replacement therapy or hormonal contraception in rheumatic diseases have been modified and in most rheumatic diseases, including rheumatoid arthritis, hormones are not prohibited. There are still controversies regarding systemic lupus; the new standpoint being that hormonal contraception is not contraindicated in women with inactive or stable active SLE, except for those with positive antiphospholipid antibodies.
