Rheumatology (Bulgaria)最新文献

{"title":"Endocan as an Early Predictor of Endothelial Dysfunction and Atherosclerosis in Egyptian Patients with Rheumatoid Arthritis.","authors":"S. E. Gadow, H. El-Banna, Shaimaa A. Abd Elwahab, Rasha A AGaber, E. Shaban, Alaa M El-Salawy","doi":"10.35465/31.1.2023.pp17-22","DOIUrl":"https://doi.org/10.35465/31.1.2023.pp17-22","url":null,"abstract":"Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Inflammation leads to endothelial cells activation. Activated endothelial cells with increased leukocytes adhesion molecules expression, which can induce endothelial dysfunction (ED) and atherosclerosis. \u0000Aim: to measure the serum level of Human endothelial cell-specific molecule-1 (endocan) in patients with rheumatoid arthritis and to evaluate its relation to endothelial dysfunction and atherosclerosis. \u0000Materials and methods: the study included 30 consecutive RA patients, and 30 healthy control subjects. RA disease activity was measured by the DAS-28 score. Serum endocan was measured by enzyme-linked immunosorbent assay (ELISA). The collected data were statistically analyzed using SPSS program version 16. \u0000Results: There was a significant elevation in Endocan level in RA patients (1.81 ± 0.66 ng/ml) compared to control group (1.41 ± 0.59ng/ml) (P= 0.012). Serum endocan levels showed significant positive correlation with disease activity score-28(DAS-28), ESR, CRP, LDL and carotid intima media thickness (cIMT) (P = 0.015, 0.004, <0.001, 0.008, 0.005 respectively). Linear regression analysis revealed that the serum endocan level, age and disease activity were independent predictors for cIMT, and atherosclerosis development in RA patients.  \u0000Conclusion: Endocan is a useful marker to predict endothelial dysfunction and atherosclerosis in patients with rheumatoid arthritis.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122985433","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":"Therapeutic potential of mesenchymal stem cell-derived secretome in autoimmune patients","authors":"A. Yordanova, E. Ivanova-Todorova","doi":"10.35465/31.1.2023.pp37-53","DOIUrl":"https://doi.org/10.35465/31.1.2023.pp37-53","url":null,"abstract":"A thorough investigation of the underlying immunopathogenetic pathways is required in order to create effective therapeutic methods for the complex clinical cases of patients with an autoreactive immune system that can harm the organism. Currently, the most commonly used therapeutic alternatives have severe side effects and reduced effectiveness after long-term treatment of patients with autoimmune diseases. The secretome of mesenchymal stem cells (MSCs-secretome) does, however, contain compounds with potential therapeutic applications, a promising new clinical strategy for treating the aforementioned patients. The data presented in this review summarizes information from experimental research and a small amount of clinical practice knowledge. It also raises fundamental questions regarding the role of modern, innovative therapies in helping autoimmune patients. \u0000  \u0000 ","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131942301","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":"Effectiveness and safety of upadacitinib – data from real clinical practice in Bulgaria","authors":"R. Moraliyska, Simona Bogdanova, S. Dimitrov, G. Gerganov, S. Hristova, Tsvetoslav Georgiev, T. Shivacheva","doi":"10.35465/31.1.2023.pp3-16","DOIUrl":"https://doi.org/10.35465/31.1.2023.pp3-16","url":null,"abstract":"Objectives: Aim of the study was to assess the therapeutic efficacy and safety of upadacitinib in Rheumatoid arthritis patients with moderate to high disease activity in real-world clinical practice and to identify predictors of therapeutic success. \u0000Materials and methods: A retrospective single-center study was performed in RA patients treated with upadacitinib 15 mg daily. Demographic and clinical indicators were analyzed. The effectiveness and safety of the medication were evaluated over a six-month period. Disease activity was assessed with index-based scores. The primary endpoint was defined as low disease activity over a six-month treatment period with upadacitinib 15 mg/day (DAS28CRP ≤ 3.2, CDAI ≤ 10 and SDAI ≤ 11). \u0000Results: 41 patients were included, mean age 56.56 years (± 13.4), with long-standing RA (8 years ± 5.8), mostly female (80.5%). 19.5% of them were obese (BMI ≥ 30 kg/m2), 80.5% had osteoarthritis and 58.5% - hypertensive disease. Erosive arthritis was observed in 41.5% of patients  and 61% had functional class III motor deficit. \"Bio-naïve\" were 58.5%, the rest had previous experience with biologic therapy. Upadacitinib was used as monotherapy in 90% of patients and in combination with Methotrexate in 10%. There was a significant reduction in the painful and swollen joint counts, VAS and CRP six months after starting treatment with upadacitinib. Low disease activity was achieved by a significant proportion of patients (DAS28CRP-70.7%, CDAI-60.5% and SDAI 63.2%).  Therapeutic outcome was not determined by demographics, clinical factors, comorbidities, or prior biologic treatment. Increase in liver enzymes (n=3), decrease in hemoglobin levels (n=2), and urinary tract infection (n=2) were the adverse events recorded over the six-month treatment period. One patient died from COVID-19. \u0000Conclusion: A significant proportion of RA patients on treatment with upadacitinib 15 mg was able to achieve the therapeutic target in real clinical settings. No predictors of therapeutic efficacy were found. The registered side effects do not differ from the safety profile of the medication.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132903877","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":"Elevated serum levels of TNF-α and IL-17 in psoriatic and rheumatoid arthritis","authors":"A. Angelov, G. Vasilev, A. Yordanova, E. Ivanova-Todorova, D. Kyurkchiev, M. Ivanova","doi":"10.35465/31.1.2023.pp23-36","DOIUrl":"https://doi.org/10.35465/31.1.2023.pp23-36","url":null,"abstract":"Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are chronic inflammatory immune-mediated rheumatic diseases, in which cytokine dysregulation is key for pathogenesis. In terms of the specific processes involved in predominantly enthesopathic inflammation and predominantly synovial inflammation, PsA and RA are distinct disease entities. The aim of the present study was to investigate the serum cytokine expression profiles of TNF-α and IL-17 in the two inflammatory arthropathies, discussing their role in the context of disease activity assessed by means of DAS28-CRP, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The study included 32 patients with PsA, 30 with RA and 20 healthy subjects. In patients with RA and PsA, higher serum levels of both cytokines were measured compared to healthy controls, with the difference being significant, except for TNF-α for patients with PsA, whose concentration was numerically but not significantly higher compared to healthy individuals. We also recorded a significant increase in circulating TNF-α in RA versus PsA, with no difference for IL-17 in the two inflammatory joint diseases. The two studied cytokines did not show a significant difference in serum concentrations according to the state of the disease activity (DAS28- CRP < 3.2 vs. DAS28- CRP ≥ 3.2) in both PsA and RA, as well as association with clinical and laboratory parameters of activity from correlation analyses, supporting the claim that they are not useful markers for its assessment. In conclusion, both cytokines are clearly abundant in the circulation in conditions of both inflammatory arthropathies. The TNF-α and IL-17 pathways are important links and an active participant in these types of rheumatic inflammation.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128801481","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":"A clinical case of primary aggressive B-cellular lymphoma in thyroid gland","authors":"S. Pashkunova, S. Stratieva, T. Valova","doi":"10.35465/31.1.2023.pp102-107","DOIUrl":"https://doi.org/10.35465/31.1.2023.pp102-107","url":null,"abstract":"We describe a clinical case of primary aggressive B-cellular thyroid lymphoma. Thyroid lymphoma occurred exclusively in the thyroid gland of patients with Hashimoto‘s thyroiditis as a rapidly growing mass in the thyroid gland. Therefore, progressively enlarging goiter and compression symptoms are the most common clinical manifestations.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121991963","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":"Tenascin-C and Interleukin-17 Up-regulation in Axial Spondyloarthritis Patients","authors":"Mohammed S. Al-Hindawi, A. Al-Gebori, Mohamme H ALosami","doi":"10.35465/30.4.2022.pp3-11","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp3-11","url":null,"abstract":"Background: Axial spondyloarthritis (axSpA) is an inflammatory, systemic rheumatic condition that mostly affects the axial skeleton. Tenascin-C (TN-C) is a hexameric glycoprotein of considerable size, upregulated in many inflammatory conditions, while Interleukin-17 (IL-17) a cytokine that plays an important role in SpA symptoms. Objective: to investigate the upregulation between the serum levels of TN-C and IL-17 in Iraqi axSpA patients and the disease characteristics. Patients and Methods: Seventy-four axSpA patients and 28 matched controls were studied. Fifty-four patients received a tumor necrosis factor inhibitor (TNFi) and 20 did not. Serum TN-C and IL-17 concentrations were determined using the ELISA technique. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was assessed. For statistical tests, Chi Square, Mann Whitney, Independent Samples T, and Pearson's correlation tests are used. Results: Patients mean age was 35.6±0.9 years, 65 males and 9 females, and disease duration was 5.18±0.6 years. 47.4% were smokers, 47% had inflammatory low back pain, and HLA-B27 was present in 91%. BASDAI mean was 6.1±0.4 in non-TNFi and 2.6±0.3 in those on TNFi. The serum TN-C concentration was significantly increased in patients, especially those on non-TNFi (79±9.6 pg/mL) compared to those on TNFi (69.1±3.2 pg/mL) and control (53±3.9 pg/mL) (p=0.003). Serum IL-17 was significantly elevated in those receiving TNFi (877.9±257 pg/mL) compared to non-TNFi (487.2±234 pg/mL) and control (182.4±36.6 pg/mL) (p=0.033). The TN-C significantly correlated with erythrocyte sedimentation rate (r=0.27, p=0.02) and with hemoglobin (Hb) concentration (r=0.26, p=0.02). TN-C and IL-17 were non-significantly related (r=0.14, p=0.2). Conclusions: axSpA Patients demonstrated high levels of serum TN-C, particularly in those not receiving TNFi, and high IL-17 levels in those receiving TNFi, suggesting that there is an association with tissue injury from the disease and stimulation of immunological and resident tissue cells. Patients who had not received TNFi showed significantly higher disease activity than others.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"93 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120889701","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":"Patient with Systemic Lupus Erythematodes, high pANCA antibodies and end-stage renal failure","authors":"R. Gancheva, Tsvetana Petranova, M. Ivanova, I. Sheitanov, A. Kundurdjiev, M. Nikolova, Neli Koleva, R. Stoilov, R. Rashkov","doi":"10.35465/30.4.2022.pp57-64","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp57-64","url":null,"abstract":"A 47-year-old female patient with active Systemic lupus erythematosus (SLE) - skin, joint, hematological, and renal involvement was admitted for rapidly progressive renal failure at the background of very high anti-dsDNA and pANCA antibodies. Active pathogenetic treatment was started pulse therapy with methylprednisolone, intravenous immunoglobulins (IVIG) and cyclophosphamide, blood transfusions were performed, symptomatic treatment with infusions ad diuretic was initiated. Due to progression of renal failure with volume overload and increase in urea and creatinine levels renal-replacement therapy was initiated. The patient developed E. faecalis and E. durans sepsis with disseminated intravascular coagulation and ground-glass-type lung changes and the condition further deteriorated to fatal multiorgan failure. The authors discuss the role of pANCA antibodies in SLE with renal and lung involvement.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115842328","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":"Pain in COVID-19 and features of pathogenetic molecular mechanisms","authors":"Simona Bogdanova, T. Shivacheva, Tsvetoslav Georgiev, Petar D. Petrov","doi":"10.35465/30.4.2022.pp28-33","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp28-33","url":null,"abstract":"Although it has been almost three years since the World Health Organization (WHO) declared a pandemic, COVID-19 is still an unsolved problem, thereby attracting great scientific interest. The disease has a heterogeneous clinical picture with multiple manifestations from different organs and systems. Currently, COVID-19 is perceived as a polysyndromic inflammatory disease involving not only the respiratory system, but also the musculoskeletal system, the cardiovascular system, the skin, the excretory and the nervous system, and is accompanied by a number of hematological, gastrohepatoenterological and endocrine disorders. Various pain phenomena also appear in the clinical presentation of the disease, often as a single manifestation or in combination with symptoms from different organs and systems. The pathogenesis of pain is complex and there is still no consensus on the exact driving mechanisms. Several different signaling pathways play an important role in the generation of pain impulses and perception. They are different for different types of pain. At this stage, the role of angiotensin-converting enzyme 2 (ACE), the renin-angiotensin system (RAC), angiotensin 2 receptors (AT2R), direct neuronal invasion of the virus, the involvement of pro-inflammatory cytokines, hypoxia, the involvement of macrophages, is discussed. as well as the role of overactivity of the immune system, causing the so-called \"cytokine storm\". Pain is the result of complex biochemical processes influenced to varying degrees by biological, physiological and social factors. Our knowledge at this stage remains scarce and is the subject of many studies on the key pathogenic mechanisms. Therefore, the purpose of this review is to describe the known mechanisms for the occurrence and persistence of pain in patients with COVID-19, as well as to classify the pain phenomena and present its most common localizations. The diagnosis and treatment of COVID-19 and associated pain should be carried out by a multidisciplinary team of specialists, given the heterogeneous clinical presentation of the disease.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134329151","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":"Ревматологични аспекти на IgG4-свързаната болест","authors":"Detelin Dimov","doi":"10.35465/30.4.2022.pp41-56","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp41-56","url":null,"abstract":"Резюме. Имуноглобулин  G4-свързаната болест (IgG4-СБ) е имуноопосредствано заболяване, характеризиращо се с тъканна инфилтрация от IgG4(+)плазмоцити, водеща до фиброза и деструкция на засегнатия орган. В обсега на IgG4-СБ влизат всички органи и системи, но в обзора са представени актуални диагностични и терапевтични данни само за локализациите й в слъзните и слюнчените жлези, бъбреците, ретроперитонеума, белите дробове, аортата и артериите, които са терен и на ревматологична патология (васкулити, синдром на Sjogren, СЛЕ, системна склероза и др.).","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133596781","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":"Early diagnosis of Takayasu arteritis","authors":"Soner Emin, V. Boyadzhieva, Zhaklin Dimov, R. Stoilov, N. Stoilov","doi":"10.35465/30.4.2022.pp74-85","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp74-85","url":null,"abstract":"Systemic vasculitis is a group of heterogeneous diseases characterized by inflammation of the vascular wall. They can be primary or arise in the context of another disease. Blood vessels of different sizes are affected, being mainly divided into small, medium and large vessels. Takayasu's arteritis is a vasculitis of the large blood vessels, most often affecting the aorta and its branches, subclavian arteries, iliac, femoral arteries and others. The presented clinical case concerns a woman with non-specific symptoms - low fever, sweating, weight loss, easy fatigue. After excluding an infectious genesis of the complaints, a diagnosis of Takayasu's Arteritis was made in the early phase of the disease as a result of Positron emission tomography. Corticosteroid and immunosuppressive therapy was started. When conducting a control PET, 20 months after the start of the therapy, a significant regression to  absence of the findings from the imaging study was observed. \u0000 ","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125010257","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}