Rheumatology (Bulgaria)最新文献

{"title":"Клиничен случай на пациент с Thoracic outlet syndrome","authors":"Zhaklin Rumenova Dimova, Vladimira Boyadzhieva, Soner Emin, Nikolay Stoilov","doi":"10.35465/30.4.2022.pp65-73","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp65-73","url":null,"abstract":"Thoracic outlet syndrome (TOS) представлява група от изменения, които водят до компресия на брахиалния плексус, причиняваща симптоми на болка, мускулна слабост и изтръпване в областта на рамената и горните крайници. Класификацията на TOS се базира на патофизиологични симптоми и се дели основно на неврогенен (nTOS), венозен (vTOS) и артериален (aTOS). В зависимост от етиологията, ТОС може да се класифицира като вроден, травматичен или фукционално придобит.  \u0000Представяме клиничен случай на 34-годишен мъж, който постъпи в Клиника по ревматология, УМБАЛ “Св.Иван Рилски” през месец юли 2022 година. Болният съобщава за оплаквания от изтръпване в пръстите на ръцете, слабост на горните крайници при отвеждане на ръцете нагоре и периунгвално посиняване. При пациентът е проведена флебография през 2021 година, със заключение закомпресия на v.subclavia dextra et sinistra при абдукция и ипсилатерална ротация на главата. От проведената КТ-ангиография, се установява компресия от дясна обща илиачна артерия върху лява обща илиачна вена, която е дилатирана, кореспондираща в най-висока степен с Мей-Търнър синдром. В клиниката по ревматология се извърши капиляроскопия, от която се визуализира периферен съдов спазъм и неспецифични промени. От лабораторните и имунологични изследвания не се установяват отклонения. ","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"113 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":"115588660","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":"Biomarkers in Systemic Lupus Erythematodes","authors":"V. Reshkova, S. Monov","doi":"10.35465/30.4.2022.pp12-27","DOIUrl":"https://doi.org/10.35465/30.4.2022.pp12-27","url":null,"abstract":"A biomarker is defined as a genetic, biological, biochemical or molecular event, whose alterations correlate with the pathogenesis and/or manifestations of a disease and can be evaluated qualitatively and/or quantitatively in laboratories. Biomarkers are used for diagnosis, assessment of activity and better understanding of the pathogenesis of SLE (systemic lupus erythematodes). Biomarkers in SLE are conditionally subdivided into markers of genetic susceptibility, markers of diagnosis and markers of disease activity. Recent genetic studies of SLE have focused on correlating SLE (susceptibility, disease spectrum and severity) with polymorphisms of hypothetical candidate genes. These include genes coding for mannose-binding lectin (MBL), cytokines (IL-6, IL-10, IL-21, TNF-α and osteopontin), chemokines (MCP-1), cytokine receptors/antagonists (type II TNF-α receptor and IL-1 receptor antagonist), Fcγ receptors (FcγRIIa, FcγRIIb, FcγRIIIa, and FcγRIIIb), IFNα, programmed death protein-1 (PD-1; also known as PDCD-1) and other cell surface receptors (cytotoxic T lymphocyte antigen-4 (CTLA-4) involved in the pathogenesis of SLE. Biomarkers for diagnostic are anti-dsDNA, erythrocyte-bound C4d/Erythrocyte-CR1 and platelet-bound C4d. Markers of disease activity are complement components, cytokines, soluble cytokine receptors IL-2R, TNFR, IL-1Ra, soluble molecules expressed on the cell surface − BLyS (BAFF), CD27, CD154, endothelial dysfunction markers − sICAM, sVCAM, thrombomodulin, circulating endothelial cells, acute-phase proteins − CRP, ferritin. Genetic testing for biomarkers in SLE patients is currently being introduced in the Rheumatology Clinic to “Sv. Ivan Rilski” Multiprofile University Hospital for Active Treatment, Sofia, Bulgaria. Its performance is expected to help solve multiple unmet needs in SLE patients – precise diagnosis, identification and prediction of the timing of disease flares, clinical assessment and adequate treatment approach.   \u0000 ","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"18 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":"115142087","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":"Association between body composition and bone mineral density assessed by whole body dual-energy X-ray absorptiometry","authors":"Martin N Nikolov, S. Lambova, N. Nikolov","doi":"10.35465/30.3.2022.pp3-14","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp3-14","url":null,"abstract":"Introduction: Despite the observation that higher body weight has protective effect against the development of osteoporosis, accumulating evidence suggest presence of negative impact of obesity on bone function associated with the low-grade inflammation and production of proinflammatory cytokines from dysfunctional adipose tissue in obese individuals. These data stimulate the interest and suggest need for clarifying studies about the association between the body composition and bone mineral density. \u0000The aim of the study: The aim of the current study was to evaluate the association between body mass index (BMI), body composition (fat mass and lean body mass) and the bone mineral density of the lumbar spine and femoral neck assessed by whole body scan using DXA (dual-energy x-ray absorptiometry). \u0000Materials and methods: A retrospective study was performed with analysis of patient data who have undergone whole body scan in Medical Center “Avis Medica” Pleven, device Lunar prodigy. The values of T-score of the lumbar spine and femoral neck were analyzed and their associations with body composition and BMI. \u0000Results and discussion: 111 women at mean age 59±8 years were included in the study. In the patients with T-score values ​​≤ /-2.5/ of the lumbar spine and femoral neck BMI was significantly lower. In the group of patients with T-score values of the lumbar spine ≤ /-2.5/ (n=27), significantly lower fat mass was found (2239.90±607.63 grams) in comparison with the cases with T-score > /-2.5/ (n=84) (fat mass 2510.41±570.68 grams; p=0.037). The lean body mass in the patients with T-score ≤ /-2.5/ of the lumbar spine (4025.30±862.58 grams) was also significantly lower vs the group with T-score > /-2.5/ (4760.09±607.63 grams; p=0.000). A significant difference of body lean mass was also found between the groups with different T-score of femoral neck (4110.60±832.01 grams in patients with T-score of femoral neck ≤2.5, n=15; 4802.01±862.87 grams in those with T-score>2.5, n=96, p=0.004). Regarding the fat mass and fat percentage in the groups with different T-score of the femoral neck, they were lower in the patients with osteoporosis with T-score < /-2.5/, but the difference reached statistical significance only for the fat percentage (31 vs 38%, p=006) but not for the fat mass (p=0.081). \u0000Conclusion: The results of the current study confirm the protective effect of the higher lean and fat mass against the development of osteoporosis with possible leading role of the lean mass.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"1962 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129664623","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":"Systemic Lupus in males – clinical-laboratory, immunological and histological characteristics.","authors":"A. Kundurdjiev, M. Nikolova, A. Kostadinova, D. Genov, M. Hristova, Neli Koleva, R. Gancheva, Z. Kolarov, D. Kiurkchiev, E. Todorova, D. Monov, K. Chupetlovska, T. Todorov, V. Minkova, J. Ananiev","doi":"10.35465/30.3.2022.pp15-20","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp15-20","url":null,"abstract":"Systemic lupus erythematosus is a chronic, systemic, non-organ-specific autoimmune disease that affects all organs and systems of the human body and is characterized by the production of autoantibodies against nuclear antigens. Its prevalence in Europe reaches 1:2500. It affects mostly women (female : male ratio=9 : 1) in fertile age group (15-45 years). The clinical course of lupus in males is characterized by more aggressive clinical course and the development of serious complications, such as vasculitis, central nervous system involvement, antiphospholipid syndrome, etc. For the period of 7 years (2012-2019) we observed overall 18 male patients with systemic lupus, 11 with biopsy-proven renal involvement and 7 without clinically significant renal disease (proteinuria < 0.5 g/24 h., no erythrocyturia/cylindruria, normal renal function), mean age at the diagnosis 39.6 +/- 12.3 years. All patients received pathogenetic treatment (corticosteroids + cytotoxic agents). Three had secondary antiphospholipid syndrome, 1 – inflammatory bowel disease, 1 – seronegative spondyloarthropathy. Three had type 2 diabetes. The authors discuss the clinical, immunological and histological characteristics and the therapeutic approach in males with systemic lupus.  ","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"216 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122379959","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":"Clinical case of a patient with progressive supranuclear palsy – from symptom to diagnosis","authors":"Z. Dimova, Soner Emin, V. Boyadzhieva, N. Stoilov","doi":"10.35465/30.3.2022.pp67-72","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp67-72","url":null,"abstract":"Progressive supranuclear palsy (PSP) is a neurodegenerative disease classified among the atypical forms of parkinsonism. PSP is characterized by great variability in the involvement of different areas of the central nervous system (CNS). The clinical picture is associated with impaired gait and balance, generalized bradykinesia, visual impairment, dysarthria, dysphagia, pelvic incontinence, dementia and others. We present a clinical case of a 50-year-old woman who, at the end of 2021, was admitted to the Rheumatology department, UMBAL \"St. Ivan Rilski\" - Sofia, due to weakness in the hands, dropping objects, pain in small joints of the hands, disorder in coordination, difficulty walking and frequent stumbling, slurred speech, tremors involving both hands (more pronounced on the right), memory impairment, pelvic incontinence and hair loss. The clinical case is very indicative of the long journey that a patient with progressive supranuclear palsy takes before being correctly diagnosed.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121518030","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":"Estimation of the concentration of some biomarkers in serum of women with rheumatoid arthritis","authors":"Muneera M. Adlan, F. Kata, Saad W. Alsulaitti","doi":"10.35465/30.3.2022.pp59-66","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp59-66","url":null,"abstract":"The current study was conducted on women with rheumatoid arthritis (RA) in Basrah city, Iraq. The study aimed to evaluate the relationship between some biomarkers such as adiponectin hormone, anti-citrullinated protein antibody (ACPA), acute phase C-reactive protein (CRP) and vascular endothelial growth factor (VEGF) in the serum of female patients. In this study, 80 serum samples were collected from women and were distributed as follows: 56 serum samples from women with RA and 24 serum samples from non-infected women who were considered as a healthy group. The patient samples were divided into three categories depending on age, disease severity and duration. The samples were obtained from Basrah General Hospital. The results of the current study showed a significant increase in the concentration of adiponectin, ACPA, CRP and VEGF in RA patients compared to healthy subjects. In addition, there were significant differences in the concentration of these biomarkers between some of the three age groups and between the disease of severity and duration. The study concluded that all the biomarkers under investigation have increased their concentrations in the serum of women suffering from RA.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125255007","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":"Axial spondyloarthritis - from inflammation to ankylosis","authors":"M. Ivanova, A. Angelov, G. Vasilev, P. Goycheva","doi":"10.35465/30.3.2022.pp44-58","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp44-58","url":null,"abstract":"Axial spondyloarthritis is a chronic inflammatory immune-mediated rheumatic disease that mainly affects the sacroiliac joints and the spine and encompasses both sub-units - ankylosing spondylitis and its preceding phase non-radiographic axial spondyloarthritis. The disease is characterized by two main immunopathological processes – chronic inflammation and pathological new bone formation, the causal relationship of which is still not fully understood. Starting as enthesopathic inflammation in the early stages, the disease progresses to ossifying enthesitis as a result of an abnormal immune response to skeletal biomechanical stress associated recurrent tissue microdamage, and a subsequent process of excessive repair and tissue remodeling. Immune-mediated inflammation manifests with a distinct skewing of differentiation towards a Th1/Th17 phenotype and an unbalanced profile of cytokine production, with cytokine dysregulation and predominance of the effects of pro-inflammatory cytokines. Molecular signaling pathways of syndesmophyte formation include bone morphogenetic protein (BMP), wingless-type like (WNT), Dickkopf-1 (Dkk-1), sclerostin, cytokines, and others. The review summarizes the current concepts regarding the pathophysiology of both pathognomonic processes for the disease – inflammation and pronounced osteoproliferation.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131678528","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":"Anxiety and depression in patients with primary and secondary fibromyalgia in Bulgaria","authors":"Валентина Симеонова Решкова, Рашо Рашков","doi":"10.35465/30.3.2022.pp21-32","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp21-32","url":null,"abstract":"Fibromyalgia (FM) is characterized by a chronic widespread pain, general fatigue, anxiety, depression, sleep disturbances and functional disorders. FM affects both women and men in 9:1 to 20:1 ratio. Osteoarthritis, systemic lupus erythematosus and other diseases have often been and continue to be associated with fibromyalgia. The incidence rate of secondary FM in SLE and OA patients is around 20%. The purpose of this clinical study is to analyze anxiety and depression in patients with primary and secondary fibromyalgia. In prospective study eighty-three patients with primary FM, 39 patients with FM and osteoarthritis (OA), 23 patients with FM and systemic lupus erythematosus (SLE), 27 patients with SLE and 36 healthy subjects were included. The present study compared chronic pain, anxiety  and depression in patients with primary FM, patients with SLE, FM + OA, FM + SLE and healthy subjects. Based on the HADS clinical parameter, anxiety and depression are a statistically significant difference of the control group, as compared to patients with primary FM, FM + OA, FM + SLE (p<0,05) and no difference in patients with SLE (p=0.77). There was no significant difference in HADS depression scores between the three groups of fibromyalgia patients. There was no significant difference in terms of the clinical parameter of depression between the SLE and FM + SLE groups. The comparison between the patient groups is important to evaluate the disease activity and the treatment to be recommended.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129806818","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":"Multidisciplinary approach in the management of pregnancy and rheumatic diseases – the challenges for obstetricians and gynecologists","authors":"Никола Поповски, Аспарух Николов, Тихомир Тотев","doi":"10.35465/30.3.2022.pp33-43","DOIUrl":"https://doi.org/10.35465/30.3.2022.pp33-43","url":null,"abstract":"Rheumatic diseases (RD) primarily affect young women of reproductive age and therefore pregnancy in these patients requires more attention. Pregnancy in women with RD requires a multidisciplinary, carefully coordinated approach before, during and after pregnancy to ensure the best possible prognosis for the mother and the baby. Treatment of patients with RD during pregnancy and in the post-natal period may be a major challenge for both rheumatologists and obstetrics-gynaecologists. Risk stratification and pregnancy planning are key to ensuring normal pregnancy in women with RD and minimal risk of complications. On the other hand, the risks to the fetus are related to the activity of the mother's disease, presence of specific autoantibodies, and mother's therapy. It is of great importance to stabilize the disease, to replace the medication with pregnancy-compatible drugs, tests of the autoantibody status and organ damage assessment. For these reasons, active monitoring of pregnant women with RD should be carried out by rheumatologist and gynecologist.","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125993393","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":"New therapeutic options for the treatment of ankylosing spondylitis.","authors":"V. Boyadzhieva, N. Stoilov, M. Geneva-Popova, M. Ivanova, R. Stoilov","doi":"10.35465/30.2.2022.pp85-101","DOIUrl":"https://doi.org/10.35465/30.2.2022.pp85-101","url":null,"abstract":"The pathogenesis of spondyloarthritis (SpA) is multifactorial and involves multiple immune cells and cytokines that are signaled by Janus kinase (JAK). Inhibition of JAK signaling pathways has emerged as a new therapeutic option for patients with inflammatory joint diseases. Despite the proven effect of treatment with anti-IL-17, as well as TNFα inhibitors, some patients with ankylosing spondylitis cannot reach minimal disease activity or remission. This necessitated the development of a new class of molecules, and in recent years more and more clinical studies have proven their role in the treatment of both rheumatoid arthritis and ankylosing spondylitis. JAK inhibition is a promising therapeutic strategy for the treatment of SpA and its application has potential in patients with axial, polyarticular, or extraarticular manifestations of the disease in psoriatic arthritis and ankylosing spondylitis. \u0000The present literature review aims to highlight the new therapeutic options offered by this class of target synthetic disease-modifying antirheumatic drugs and to summarize the clinical trial data for tofacitinib, upadacitinib and filgotinib reported to date. ","PeriodicalId":380764,"journal":{"name":"Rheumatology (Bulgaria)","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127585470","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}