Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune and inflammatory disease. Conventional synthetic and biologic disease-modifying antirheumatic drugs (DMARDs), Janus kinase ...inhibitors, and rituximab are used to treat the disease. There are no recommendations or guidelines for the treatment of patients with both inflammatory arthritis and end-stage renal disease (ESRD), despite the safety and efficacy of the mentioned drugs. The anti-interleukin-6 receptor antibody tocilizumab (TCZ) has not been used as a long-term therapy for hemodialysis (HD) patients with RA, except in a few case reports. Case Description: We present the case of a 41-year-old patient with RA and ESRD on maintenance HD due to type 1 diabetes-related complications. Due to high RA disease activity, the patient was not a suitable candidate for a kidney transplant. Because TCZ is used to treat both RA and kidney transplant rejection, therapy with a full dose of TCZ was administered. The patient has achieved sustained clinical remission (for the past four years) with no adverse events reported. Conclusions: Herein, we present the safe and effective use of TCZ in an RA patient on HD who is also a candidate for kidney transplant. Consequently, TCZ could be the treatment of choice for RA patients with ESRD who have not achieved disease control (low activity or remission) with conventional synthetic DMARDs. Clinical studies are required to evaluate the efficacy and safety of biologic DMARDs and Janus kinase inhibitors in patients with both inflammatory arthritis and ESRD.
The aim of this study was to develop a Croatian Delphi-based expert consensus for screening interstitial lung disease (ILD) associated with connective tissue disease (CTD). A systematic literature ...review was conducted on risk factors for the development of ILD, prevalence and incidence of ILD, diagnostic and screening methods for ILD, and prognosis of ILD in idiopathic inflammatory myopathy (IIM), mixed connective tissue disease (MCTD), primary Sjögren's syndrome (pSS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) were performed. Based on the evidence found, experts developed questionnaires for screening and monitoring ILD in each CTD, which were provided via an online survey. Following the electronic survey, two screening algorithms were developed based on the consensus opinions. The detection strategy for ILD included high-resolution computed tomography (HRCT) in addition to pulmonary function testing for IIM, MCTD, and SSc. and pulmonary function testing for newly diagnosed pSS, RA and SLE. However, in patients with identified risk factors for ILD HRCT, these tests should also be performed. A screening strategy for early identification of patients with various CTD-ILD was first developed by a multidisciplinary team of rheumatologists, pulmonologists, and radiologists to identify early CTD patients at risk of ILD, a severe extra-articular manifestation of CTD.
The Central European Congress of Rheumatology (CECR) has been organized by seven Central European countries: Austria, Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. These countries ...have lots of similarities, but also differences, with respect to rheumatology research. In this paper, based on questionnaires, we wish to demonstrate achievements and difficulties in rheumatology research performed in our region.
Brži od reume Mayer, Miroslav
Medicus (Zagreb, Croatia : 1992),
10/2019, Volume:
28, Issue:
2 Tjelesna aktivnost
Journal Article
Peer reviewed
Open access
Upalne su reumatske bolesti prevalentne i znatan su teret oboljelima, ali i društvu u cjelini. Uz izravnu štetu kronične su bolesti opterećene posljedicama autoimunosne upale, a tu su i znatni i ...učestali komorbiditeti, komplikacije bolesti, diferentne terapije, zatim troškovi apsentizma, prezentizma, prerane smrtnosti i invaliditeta te visoke cijene lijekova, nemedikamentne terapije i pomagala. Gubitak godina i kvalitete života znatan je. Promoviranje fizičke aktivnosti i bavljenja sportom te borba protiv sedentarnog načina života mogu bitno pridonijeti primarnoj prevenciji. Redovito vježbanje dokazano pozitivno utječe na dugoročnu aktivnost upalnih reumatskih bolesti, održavanje stanja remisije, poboljšanje kvalitete života, teške komorbiditete te, posljedično, na konačne ishode. Poznavanje utjecaja vježbanja i fizičke aktivnosti na mehanizme, tijek i ishod upalnih reumatskih bolesti bitno je jer je i dalje nedostatna svijest pacijenata, ali i medicinskog osoblja o velikoj važnosti redovitog vježbanja i fizičke aktivnosti.
Bicipitoradial bursitis (BRB) is the inflammation of the bicipitoradial bursa, a bursa located in the cubital fossa between the biceps tendon and radial tuberosity. It is a relatively uncommon ...condition mostly attributed to repetitive use; however, it can be associated with other conditions, including rheumatoid arthritis (RA). We present a 52-year-old woman who presented with novel joint pain with swelling lasting 2 months with elevated rheumatoid factor (RF) 246.2 IU/mL and anti-cyclic citrullinated peptide (CCP) antibodies >1200 IU/mL, highly suggestive of RA. It should be noted the patient works as a butcher, with earlier conditions, including carpal tunnel syndrome (CTS) which was operated on. The patient also had numbness of the right hand with electromyoneurography (EMNG) suggestive of CTS relapse and noticed swelling of the cubital fossae. As a part of the workup, a right elbow ultrasound was done showing a mass, which was confirmed by magnetic resonance imaging as BRB. Given the clinical picture, elevated RF and anti-CCP antibodies, and BRB, it was concluded that the patient likely has early RA, and BRB as a result of both repetitive use in combination with the early RA onset which possibly exacerbated an earlier, stable condition. BRB can be large enough to compress local neural structures causing symptoms, which may be an explanation for the EMNG result of CTS relapse, possibly caused by BRB instead as CTS relapse is relatively uncommon. Although a rare condition usually attributed to repetitive use, BRB can also be associated with other conditions including RA as in our case.
Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease that is manifested by the sensation of dry eyes and dry mouth. The higher incidence of non-Hodgkin lymphoma (NHL) among pSS has ...already been extensively researched. However, there are uncertanties whether the mortality risk in pSS patients and in pSS patients with NHL is increased. The purpose of this study was to describe the prevalence of NHL among pSS patients and to calculate their mortality risk. We retrospectively analysed data on 1367 patients treated in our rheumatology department under the ICD-10 code M35.0. The study finally recruited 155 patients who met the 2016 ACR/EULAR criteria for the diagnosis of pSS. Descriptive statistics was used in data analysis. We applied the indirect standardization by age to compare the incidence rate of NHL in our cohort to general population. Additionally, we compared the mortality in our study to the general population by calculating the standardized mortality ratio (SMR). The overall incidence rate of NHL was 440 per 100,000 patient-years. The SIR compared to the general population was 30.13 (95% CI 12.87–54.63). The overall mortality rate of pSS patients in our cohort was nearly identical to that of the general population (SMR = 0.98 95% CI (0.47–1.69)). This study confirms that there are significant differences in lymphoma prevalence, histology, and prognosis across the studied populations. Furthermore, this study found that patients with pSS have similar mortality risk as the general population, and no patient in our cohort died from NHL.
We redescribe the holotype and only known specimen of the early eureptile Coelostegus prothales from the Upper Carboniferous of the Czech Republic using photogrammetric scanning and a virtual 3D ...rendition of its skull. New information is available on several skull and lower jaw bones, including the postorbital, supratemporal, tabular, postparietal, angular, and prearticular. The new data also permit the correct identification of previously undetected or mis-identified elements (e.g., supratemporal; quadratojugal; angular). We provide an amended diagnosis of Coelostegus and a new reconstruction of the skull in dorsal and lateral views. To evaluate the affinities of Coelostegus, we code this taxon in two recently published taxon-character matrices. Parsimony and Bayesian analyses do not permit firm conclusions on the phylogenetic position of Coelostegus or, indeed, the status and extrinsic relationships of protorothyridid amniotes. Coelostegus emerges either as the sister taxon to the recently redefined Diapsida (Araeoscelidia; Varanopidae; Parareptilia; Neodiapsida), as one of the most basal protorothyridids, or as a derived stem-group amniote in various parsimony-based analyses, or as the basalmost protorothyridid in one Bayesian analysis, with protorothyridids forming a paraphyletic array relative to Diapsida. We review the cranial similarities and differences between Coelostegus and other protorothyridid genera and discuss the implications that various phylogenetic results have for our understanding of early amniote relationships.
The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon ...involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0-24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0-2; range 1-10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).
Primary spinal melanomas are extremely rare lesions. In 1906, Hirschberg reported the first primary spinal melanoma, and since then only 40 new cases have been reported. A 47-year-old man was ...admitted suffering from low back pain, fatigue and loss of body weight persisting for three months. He had a 17-year-old history of an operated primary spinal melanoma from T7-T9, which had remained stable for these 17 years. Routine laboratory findings and clinical symptoms aroused suspicion of a metastatic disease. Multislice computed tomography and magnetic resonance imaging revealed stage-IV melanoma with thoracic, abdominal and skeletal metastases without the recurrence of the primary process. Transiliac crest core bone biopsy confirmed the diagnosis of metastatic melanoma. It is important to know that in all cases of back ore skeletal pain and unexplained weight loss, malignancy must always be considered in the differential diagnosis, especially in the subjects with a positive medical history. Patients who have back, skeletal, or joint pain that is unresponsive to a few weeks of conservative treatment or have known risk factors with or without serious etiology, are candidates for imaging studies. The present case demonstrates that complete surgical resection alone may result in a favourable outcome, but regular medical follow-up for an extended period, with the purpose of an early detection of a metastatic disease, is highly recommended.
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