Revista Romana de Reumatologie最新文献

{"title":"Etiopathogenic mechanisms of tobacco constituents in rheumatoid arthritis","authors":"L. Macovei, I. Pharmacy, A. Cardoneanu, A. Burlui, E. Rezus","doi":"10.37897/rjr.2019.1.1","DOIUrl":"https://doi.org/10.37897/rjr.2019.1.1","url":null,"abstract":"Active smoking is considered a risk factor for rheumatoid arthritis. Smokers show respiratory extra-articular manifestations and complications, such as interstitial lung disease and chronic obstructive pulmonary disease. Smokers may receive a more intensive drug therapy than non-smokers, but they have a poor prognosis. Smoker’s resistance to therapy may be caused by the pharmacokinetic interactions between drugs and tobacco constituents. The present account of some of those thousands of components of the gas and tar phase of cigarette smoke (polynuclear aromatic hydrocarbons, quinones, cyanide, heavy metals, bacterial endotoxins, nicotine and carbon monoxide) may help explain the inconclusive incrimination of tobacco use in the development of rheumatoid arthritis and convince more clinicians to recommend smoking cessation.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44850047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlations between nailfold capillaroscopy findings and distinct clinical forms of juvenile dermatomyositis","authors":"Sigrid Covaci, Bucharest Romania Pharmacy ”Carol Davila”, O. Farkas, A. Cochino","doi":"10.37897/rjr.2019.1.3","DOIUrl":"https://doi.org/10.37897/rjr.2019.1.3","url":null,"abstract":"Juvenile dermatomyositis is the most common idiopathic inflammatory myopathy in childhood. Nailfold capillaroscopy plays an important role in its assessment, being useful for diagnosis and follow-up. It is well documented that the morphological changes of nailfold capillaries reflect microvascular alterations presented in connective tissue diseases, including juvenile dermatomyositis. Several studies reported that the extent of microangiopathy detected by nailfold capillaroscopy examination offers a good correlation with disease activity and severity in juvenile dermatomyositis. The aim of this study was to assess the associations between distinct nailfold capillaries abnormalities and juvenile dermatomyositis clinical forms.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44349700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic dilemmas in a case of early-onset large vessel vasculitis","authors":"A. Ciotoracu, D. Ramba, L. Pana, R. Ionescu, B. Pharmacy","doi":"10.37897/rjr.2019.1.7","DOIUrl":"https://doi.org/10.37897/rjr.2019.1.7","url":null,"abstract":"Vasculitides are inflammatory disorders which affect the blood vessels. There are three major categories of vasculitides depending on the size of the injured vessels. Although each category can affect any size artery, usually large vessel vasculitis affects large arteries. Takayasu arteritis and Giant Cell arteritis are known to be the two main types of large vessel arteritis. We present the case of a patient with a delayed diagnosis of Takayasu disease who sequentially develops a series of complications. The atypical evolution of the disease confirms once again the complexity of the vasculitic disorders and raises questions about the understanding of their pathophysiologic mechanisms.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42077514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a place for anti-nucleosome antibody assessment in scleroderma?","authors":"A. Burlui, I. Pharmacy, A. Cardoneanu, L. Macovei, L. Arhire, M. Graur, E. Rezus","doi":"10.37897/rjr.2018.4.4","DOIUrl":"https://doi.org/10.37897/rjr.2018.4.4","url":null,"abstract":"Introduction. The hallmarks of systemic sclerosis (SSc) include microangiopathy, autonomic dysfunction, as well as immune disturbance and the widespread fibrosis of the skin and visceral organs. While the significance of SSc-specific autoantibodies such as anti-centromere and anti-topoisomerase I has long been demonstrated, the clinical relevance of non-specific autoantibodies remains a matter of debate. Our primary objective was to assess the relationships between non-SSc-specific antibody titers and the clinical characteristics of scleroderma patients. Secondary objectives included a comparison between SSc, SLE and healthy controls (HC) with respect to autoantibody values, as well as the analysis of the immune disturbance in elderly individuals in the 3 groups. Material and method. We conducted a cross-sectional study in which we recruited 67 adult patients with SSc, 67 age and gender-matched individuals with SLE and healthy controls (HC). Biological samples (venous blood) were collected in order to determine the levels of anti-SSA/Ro, anti-SSB/La, anti-U1RNP and anti-nucleosome antibodies (ELISA). We recorded the presence of digital ulcers (DUs), ILD (thoracic X-rays), and PAH (Doppler echocardiography) in the scleroderma cohort. Results. The frequency of anti-nucleosome antibody positivity in the scleroderma group exceeded our expectations, resembling that of lupus patients. Moreover, our findings indicate an association between serum anti-nucleosome antibody titers and SSc-related cardiopulmonary involvement. Anti-U1RNP antibodies were linked to PAH. We did not identify a notable relationship between the 4 autoantibodies studied and DUs. However, the latter were significantly more frequent in male patients. Although elderly individuals with scleroderma did not demonstrate a significantly decreased autoantibody production, lupus patients over 60 years of age exhibited a decline in anti-nucleosome antibody titers. Discussions. Earlier research reported an association between anti-nucleosome and anti-U1RNP antibodies with SSc-related cardiopulmonary impairment. Moreover, male gender is currently regarded as an important risk factor for the development of scleroderma DUs. Conclusions. Recent research provides new insights on the pathogenic processes of autoimmune rheumatic diseases, in an attempt to identify potential risk factors for organ involvement. Our study confirms the link between anti-nucleosome antibodies and cardiopulmonary involvement in the SSc population. Moreover, the impact of immunosenescence on the dynamics of autoantibody production in connective tissue diseases remains in need of further investigation.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44737268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune checkpoint inhibitors and rheumatic adverse events","authors":"Ioana Crețu, B. Pharmacy, M. Bojincă, M. Milicescu, B. Crețu, R. Ionescu","doi":"10.37897/rjr.2018.4.1","DOIUrl":"https://doi.org/10.37897/rjr.2018.4.1","url":null,"abstract":"Immune checkpoint inhibitors are used with increasing regularity in metastatic disease. Anti-CTLA4 (ipilimumab) anti-PD1 (pembrolizumab, nivolumab) or anti-PD-L1(avelumab, atezolizumab) are approved for use in metastatic melanoma, non-small cell lung cancer, renal cell carcinoma and other malignancies. Despite their advantages, their immune adverse reactions are important. This paper is a review current literature regarding rheumatologic adverse reactions that follow ICI treatment. Their frequency is not high but it is important to correctly diagnose and treat them. Most of the adverse reactions are mild and moderate. The treatment for immune related adverse events (IRAEs) is currently not supported by a sufficient amount of studies. The best treatment option is therefore based on the rheumatologist experience.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43798835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing antinuclear antibodies in relatives of patients with systemic lupus erithematosus","authors":"M. Dună, D. Predețeanu, F. Berghea, D. Opriș-Belinski, R. Ionescu, B. Pharmacy","doi":"10.37897/rjr.2018.4.3","DOIUrl":"https://doi.org/10.37897/rjr.2018.4.3","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which deposit within tissues and fix complement leading to systemic inflammation (1). Is a heterogeneous disease with a continuum of disease activity. Some patients can have predominant skin and joint involvement, whereas others can present with organ-threatening diseases such as nephritis, cardiac involvement or even neurologic manifestations. Relatives of patients with SLE appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable (2,3). The purpose of ANA (antinuclear antibody) determination is generally to screen patients suspected from generalised autoimmune diseases, that is, systemic lupus erythematosus (SLE), rheumatoid arthritis, Sjögren’ s syndrome, scleroderma, polymyositis, or mixed connective tissue disease. Clinical and paraclinical studies are needed to reach a definitive diagnosis.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43763901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the diagnosis of systemic lupus erythematosus still a challenge? A case report","authors":"Alma-Mirona Nicu, S. Daia-Iliescu, C. Panea, R. Ionescu","doi":"10.37897/rjr.2018.4.6","DOIUrl":"https://doi.org/10.37897/rjr.2018.4.6","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease that remains frequently underdiagnosed due to the heterogeneity of its symptoms. Lack of specific features at the initial presentation often results in delayed diagnosis. We present the case of a 58 years old SLE patient with renal, neurological, hematological and articular involvement and associated antiphospholipid syndrome, whose first manifestation of the disease occurred 20 years before the diagnosis could be made. SLE is a disease with a wide array of symptoms. As such, unless a strong index of suspicion is maintained, the disease diagnosis and specific treatment may be easily delayed.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47138060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articular involvement in inflammatory bowel disease – the most frequent extraintestinal manifestation","authors":"A. Cardoneanu, I. Pharmacy, A. Burlui, C. Mihai, C. C. Prelipcean, L. Macovei, E. Rezus","doi":"10.37897/rjr.2018.4.5","DOIUrl":"https://doi.org/10.37897/rjr.2018.4.5","url":null,"abstract":"Objectives. Inflammatory bowel disease (IBD) are part of a pathology that has an ascending incidence both in Romania and around the world. It is well known that intestinal inflammation in IBD is not limited to the intestinal epithelium. Sometimes, extraintestinal manifestations (EIM) may have a more severe clinical expression than the intestinal disorder or may even encourage an increased morbidity. The research motivation focused on the development of specific clinical and epidemiological data for patients diagnosed with IBD who associate EIM. Material and methods. We performed a retrospective study including 517 patients with intestinal inflammation (Crohn disease CD, ulcerative colitis UC or undifferentiated colitis NC) diagnosed during 1975-2016 in the N-E region of Romania. All the cases were extracted from the national database (IBD Prospect). Results. In our study the prevalence of UC versus CD cases prevailed. There were 368 cases (71.2%) of UC, 135 cases (26.1%) of CD and 10 cases of NC (1.9%). The prevalence of EIM in IBD patients in N-E Romania was 9,9% which was quite low. In the study group, EIMs occurred with a higher frequency in patients diagnosed with CD compared to UC. Thus, of the 51 cases of IBD and EIM, 27 (52.9%) belonged to the CD’s phenotype and 24 cases (47.1%) of the UC’s phenotype. Discussions. Both patients with CD and UC experienced a greater risk than the rest of patients for developing EIM. The most frequent EIMs were highlighted at the level of musculoskeletal system. Among EIM, there were 38 cases (74,5%) with articular manifestations (of which 26 had peripheral manifestations arthritis, 12 cases developed axial manifestations – sacroiliitis/ankylosing spondylitis SI/AS). Also, cases with multiple EIM had at least one articular manifestation. Conclusions. Our results sustain, once again, the fact that inflammation in IBD is not limited at the level of gastrointestinal tract. The presence of EIM, especially joint involvement, is a certainty validated by the results of many clinical trials.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49289779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epstein-Barr virus is the cause of rheumatoid arthritis","authors":"Ilija Barukčić","doi":"10.37897/rjr.2018.4.2","DOIUrl":"https://doi.org/10.37897/rjr.2018.4.2","url":null,"abstract":"Aim. Many studies presented some evidence that EBV might play a role in the pathogenesis of rheumatoid arthritis. Still, there are conflicting reports concerning the existence of EBV in the synovial tissue of patients suffering from rheumatoid arthritis. This systematic review assesses the causal relationship between Epstein-Barr virus (EBV) and rheumatoid arthritis (RA) for gaining a better understanding of the pathogenesis of RA. Methods. This systematic review and meta-analysis aim to answer among other questions the following: Is there a cause effect relationship between Epstein-Barr virus and rheumatoid arthritis? The method of the conditio sine qua non relationship was used to proof the hypothesis without Epstein-Barr virus no rheumatoid arthritis. In other words, if rheumatoid arthritis is present, then Epstein-Barr virus has to be present too. The mathematical formula of the causal relationship k was used to proof the hypothesis, whether there is a cause effect relationship between Epstein-Barr virus and rheumatoid arthritis. Significance was indicated by a p-value of less than 0.05. Results. The studies analysed were able to provide convincing evidence that Epstein-Barr virus is a necessary condition (a conditio sine qua non) of rheumatoid arthritis. Furthermore, the studies analysed provide impressive evidence of a cause-effect relationship between Epstein-Barr virus and rheumatoid arthritis. Conclusion. EBV infection of human synovial tissues is a conditio sine qua non, a conditio per quam of rheumatoid arthritis. In other words, Epstein-Barr virus is the cause of rheumatoid arthritis.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42418187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoporosis is associated with a lower prevalence of body mass index-defined obesity in rheumatoid arthritis","authors":"C. Nuta, Bucharest Geriatrics, C. Popescu, D. Predețeanu, R. Ionescu, B. Pharmacy","doi":"10.37897/rjr.2018.3.3","DOIUrl":"https://doi.org/10.37897/rjr.2018.3.3","url":null,"abstract":"Objective. The objective of this initial phase of the study is to retrospectively screen rheumatoid arthritis (RA) phenotype characteristics associated with osteoporosis. Methods. The study included all RA patients who randomly came to the university rheumatology department between January and July 2018. Demographic data, anthropometric data, RA-specific variables, osteoporosis data and comorbidities were collected retrospectively and cross-sectionally from the first (and most frequently the only) observation sheet of each patient within the study timeframe. Correlations and comparison were analyzed using appropriate non-parametric tests, all of the reported being significant (p<0.05). Results. The sample included 149 RA patients (60.8 years mean age; 81.2% women), 40 (26.8%) of which had osteoporosis and 31 (20.8%) were obese. Compared to RA patients without osteoporosis, RA patients with oste- oporosis were significantly older (56.0 respectively 71.0 years) and had: lower body mass index (BMI; 23.8 kg/m 2 respectively 29.6 kg/m 2 ), longer disease duration (11.0 respectively 17.0 years), higher prevalence of rural dwell- ing (prevalence ratio – PR=2.46), smoking (PR=3.71), inflammation (PR=1.35), anti-citrullinated protein antibody positivity (PR=1.51), glucocorticoids (PR=1.85) and carotid artery disease (PR=3.01), but a lower prevalence of obesity (PR=3.43). Lumbar bone mineral density was significantly correlated with BMI (rho=0.294) and with rheumatoid factor titers (rho=0.311), controlling for age, gender and disease duration. Conclusions. BMI-defined obesity seems to be associated with a lower prevalence of osteoporosis among RA patients, while disease severity (treatment with glucocorticoids, inflammation and ACPA positivity) is associated with a higher prevalence of osteoporosis. Gain of adipose tissue and loss of bone tissue seem to be antagonistic and parallel body composition alterations in RA.","PeriodicalId":33518,"journal":{"name":"Revista Romana de Reumatologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45161570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}