Reumatizam最新文献

{"title":"[Pregnant patient with rheumatoid arthritis treated with methotrexate and infliximab].","authors":"Marija Bakula,&nbsp;Mislav Cerovec,&nbsp;Krešimir Rukavina,&nbsp;Nada Čikeš,&nbsp;Branimir Anić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Tumor necrosis factor-alpha inhibitors have become an established therapeutic regimen for patients\u0000with rheumatoid arthritis. Regarding their harmful potential they are classified as category B medications. Animal\u0000reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled\u0000studies in pregnant women. Disease-modifying antirheumatic drugs (DMARDs) are often used in combination with\u0000biological therapy and treatment with methotrexate has shown good results. This antimetabolite is classified as a\u0000category X drug and its teratogenic effect is well known. The incidence of inflammatory rheumatic diseases is significantly higher in women. There are many reports on pregnant patients treated with biological therapy, oft en in combination\u0000with DMARDs. The effects of such a therapy on reproductive health is a theme of debate, with controversial\u0000views on the matter. We present a patient with rheumatoid arthritis whose pregnancy was discovered at 31 weeks of\u0000gestation. During that period she had been treated with methotrexate and infliximab, with no adverse effects.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 1","pages":"6-9"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35976053","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":"[CLASSIFICATION AND DIAGNOSIS OF AXIAL SPONDYLOARTHRITIDES – HISTORY, PRESENT STATE, AND PERSPECTIVES].","authors":"Simeon Grazio","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Spondyloarthritis (SpA) is a group of inflammatory rheumatic diseases that share some common genetic,\u0000clinical, serological, radiological, and prognostic features. Since the early 1960s, several classification criteria for\u0000SpA have been proposed, and some of them were also used for diagnostic purposes. The ASAS international group of\u0000experts established a set of classification criteria for SpA, dividing them into axial or peripheral, according to predominant\u0000involvement. The paradigmatic entity of axial SpA is ankylosing spondylitis, which is diagnosed in clinical\u0000practice with significant delay. Therefore the ASAS classification introduced the term “non-radiographic axial SpA”,\u0000which refers to changes in the sacroiliac joints seen on MRI, but not on radiograph. Although the ASAS classification\u0000has been widely accepted in the professional community, recently initiatives were raised suggesting changes and aiming\u0000at improvements. In this paper these objections are discussed, as well as the responses of experts who consider that\u0000these changes are not necessary.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"1-17"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35981767","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 ULTRASOUND OF MUSCULOSKELETAL SYSTEM IN RHEUMATOLOGY IN CROATIA – CURRENT STATUS AND NEW PERSPECTIVES].","authors":"Porin Perić,&nbsp;Nadica Laktašić-Žerjavić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In recent years, diagnostic ultrasound of the musculoskeletal system (MSUS) has become almost inevitable\u0000in everyday clinical practice in rheumatology. Due to the efforts of the European League Against Rheumatism\u0000(EULAR), the use of MSUS has significantly increased in Europe. Unfortunately, there are still certain open issues related\u0000to MSUS, primarily regarding different ways of interpretation of US findings, the standardization of MSUS findings,\u0000and the lack of clear criteria for assessing the competency of sonographers and their certification.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"99-104"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982820","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":"[JUVENILE IDIOPATHIC ARTHRITIS].","authors":"Lana Tambić Bukovac,&nbsp;Marija Perica","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Juvenile idiopathic arthritis (JIA) is the most common rheumatic disorder in children and one of the\u0000most common causes of part-time or long-term disability. The term juvenile idiopathic arthritis defines the main characteristics\u0000of the disease: joint inflammation of unknown origin manifested before the 16th birthday and lasting for more\u0000than six weeks. JIA is very rare in infancy, with highest frequency in preschool age. It is not a single disease, but a group\u0000of disorders with some common features of different immunopathogenesis and with different clinical manifestations. According\u0000to the revised International League of Associations for Rheumatology (ILAR) criteria, JIA is classified into 8\u0000subtypes, but this classification is still a “work in progress“ because with new knowledge gained in genetics and immunology,\u0000the classification will obviously have to be changed and refined. New research of the disease pathogenesis is the basis\u0000for the development of new and better treatments for JIA. The goal of such treatments is not just to relieve pain, but also\u0000to control inflammation and stop irreversible joint damage and long-term disability. Biological agents have significantly\u0000improved the disease prognosis.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"53-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982886","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":"[JUVENILE SPONDYLOARTHRITIS].","authors":"Lovro Lamot,&nbsp;Miroslav Harjaček","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Juvenile spondyloartrhritis is a group of multifactorial diseases in which a disturbed interplay occurs\u0000between the immune system and environmental factors on a predisposing genetic background, which leads to inflammation\u0000and structural damage of the target tissue. First symptoms of jSpA rarely involve the spine, while asymmetrical\u0000oligoarthritis of lower extremities, dactylitis, and peripheral enthesitis are much more common. There are many classification\u0000criteria for jSpA, but the majority of pediatric rheumatologists currently use the International League Against\u0000Rheumatism (ILAR) criteria according to which most patients with jSpA are classified into the enthesitis-related arthritis\u0000group of juvenile idiopathic arthritis. To meet these criteria, a patient should have arthritis and/or enthesitis,\u0000with two or more symptoms such as sacroiliac joint tenderness and/or inflammatory back pain, HLAB27 genotype,\u0000HLA B27 genotype-associated disease in a first- or second-degree relative, uveitis, and male sex with eight or more\u0000years of age. Therefore, diagnosis is most oft en made only based on clinical examination and medical history. Anti-\u0000nuclear antibodies (ANA), rheumatoid factor (RF), and HLA testing with B27, B7, and DR4 alleles are preferred. Since\u0000subclinical gut inflammation is present in many patients, it is recommended to check fecal calprotectin levels. In patients\u0000with signs of peripheral enthesitis it is warranted to perform power Doppler musculoskeletal ultrasound (PDUS),\u0000and in patients with signs of axial involvement radiographic and contrast-enhanced magnetic resonance imaging.\u0000Most patients are treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy, while in refractory\u0000cases with peripheral disease synthetic disease- modifying antirheumatic drugs (DMARDs), such as sulfasalazine,\u0000are used. In patients with axial involvement, biological DMARDs such as adalimumab, infliximab, and etanercept are\u0000obligatory. Although a number of studies gave us a good insight into the disease pathogenesis, the response to treatment\u0000and prognosis are still difficult to predict.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982888","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":"[RHEUMATOLOGY IN PEDIATRIC CARDIOLOGY FROM FETAL STAGE TO ADULTHOOD. THE ROLE OF FETAL ECHOCARDIOGRAPHY].","authors":"Ivan Malčić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Even though in the last ten years pediatric cardiology and rheumatology have formally separated in\u0000Croatia as well, strong links still remain between them. They are no longer manifested through rheumatic fever, but\u0000through other rheumatic entities: systemic lupus erythematosus, antiphospholipid syndrome, systemic scleroderma,\u0000Kawasaki disease, polyarteritis nodosa, and some forms of granulomatous vasculitis. We take special note of the occurrence\u0000of complete congenital atrioventricular block (CCAVB) in pregnant women who, due to systemic connective\u0000tissue diseases, develop distinctive ANA antibodies (anti-SSA/Ro and/or anti SSB/La), but who are also likely to have\u0000the same inflammation within the heart, leading to the development of restricted cardiomyopathy associated with\u0000CCAVC. Although rheumatology has thus been involved with early fetal age for some time now, there are also some\u0000issues relating to the embryonal stage (the association between methotrexate/folic acid and heart development in embryos),\u0000as well as to the late fetal stage (antiprostaglandin anti-infl ammatory agent impact on premature ductus arteriosus\u0000closure). We gave special attention to the neonatal lupus syndrome, the most serious complication in the fetal\u0000period. Thus the multiple association between cardiology and rheumatology in all age groups, from the embryonal and\u0000fetal stage to adulthood, is being realized. The aim of this paper is to present some important links and thus further\u0000emphasize the new cooperation between pediatric cardiology and rheumatology from fetal stage to adulthood.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"86-92"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982893","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":"[EVALUATION OF PAIN AND LOCAL PHARMACOLOGICAL PAIN TREATMENT IN RHEUMATOLOGY].","authors":"Tea Schnurrer-Luke-Vrbanić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The objective of this review is to present outcome measurement tools for chronic musculoskeletal\u0000pain in rheumatology patients and to provide an overview of local pharmacological pain treatment.\u0000Reliable and valid assessment of pain is fundamental for both clinical trials and effective pain management. The\u0000complex nature of pain makes objective measurement impossible. Evaluation of chronic musculoskeletal pain and its\u0000impact on physical, emotional, and social functions requires multidimensional qualitative tools and health-related\u0000quality of life instruments. The main recommendation concerning outcome measurements of pain is that they should\u0000include an evaluation of pain, fatigue, disturbed sleep, physical functioning, emotional functioning, and patient global\u0000ratings of satisfaction and quality of life. Despite the growing field of new instruments and publications related to measuring\u0000the various aspects of chronic pain, there is still little agreement on the topic among researchers and clinical\u0000experts and no unified approach has been adopted. There is still considerable need for the development of a core set of\u0000measurement tools and response criteria regarding chronic pain management.\u0000It is well known that pain in articular joints and soft tissues of the musculoskeletal system represents the most\u0000common symptom presenting to rheumatologists. Therefore, local pharmacological pain tretment has an important\u0000role in rheumatology treatment algorithms. Topical administration, as well as injection administration in joints and\u0000soft tissue trigger points, can be done under the control of musculoskeletal ultrasound. The most frequently prescribed\u0000drugs include NSARs and corticosteroids, with their effectiveness being well-proven in evidence-based practice.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"31-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35984503","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":"[JUVENILE SPONDYLOARTHRITIS].","authors":"Lovro Lamot, Miroslav Harjaček","doi":"10.5772/39149","DOIUrl":"https://doi.org/10.5772/39149","url":null,"abstract":"Juvenile spondyloartrhritis is a group of multifactorial diseases in which a disturbed interplay occurs between the immune system and environmental factors on a predisposing genetic background, which leads to inflammation and structural damage of the target tissue. First symptoms of jSpA rarely involve the spine, while asymmetrical oligoarthritis of lower extremities, dactylitis, and peripheral enthesitis are much more common. There are many classification criteria for jSpA, but the majority of pediatric rheumatologists currently use the International League Against Rheumatism (ILAR) criteria according to which most patients with jSpA are classified into the enthesitis-related arthritis group of juvenile idiopathic arthritis. To meet these criteria, a patient should have arthritis and/or enthesitis, with two or more symptoms such as sacroiliac joint tenderness and/or inflammatory back pain, HLAB27 genotype, HLA B27 genotype-associated disease in a first- or second-degree relative, uveitis, and male sex with eight or more years of age. Therefore, diagnosis is most oft en made only based on clinical examination and medical history. Anti- nuclear antibodies (ANA), rheumatoid factor (RF), and HLA testing with B27, B7, and DR4 alleles are preferred. Since subclinical gut inflammation is present in many patients, it is recommended to check fecal calprotectin levels. In patients with signs of peripheral enthesitis it is warranted to perform power Doppler musculoskeletal ultrasound (PDUS), and in patients with signs of axial involvement radiographic and contrast-enhanced magnetic resonance imaging. Most patients are treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy, while in refractory cases with peripheral disease synthetic disease- modifying antirheumatic drugs (DMARDs), such as sulfasalazine, are used. In patients with axial involvement, biological DMARDs such as adalimumab, infliximab, and etanercept are obligatory. Although a number of studies gave us a good insight into the disease pathogenesis, the response to treatment and prognosis are still difficult to predict.","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 1","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5772/39149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70923579","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":"[VAGAL NERVE STIMULATION IN THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS – RESULTS THROUGH DAY 84 OBTAINED AT THE CROATIAN CENTER OF AN INTERNATIONAL PILOT STUDY].","authors":"Ines Doko,&nbsp;Simeon Grazio,&nbsp;Frane Grubišić,&nbsp;Ralph Zitnik","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Electrical stimulation of the vagus has proven effective in various inflammatory conditions in animal\u0000models. The aim of this study is to show the effect of vagal nerve neurostimulation on clinical and laboratory parameters in two patients with active rheumatoid arthritis (RA) and an inadequate response to methotrexate.</p><p><strong>Patients and methods: </strong>The research was conducted as part of an international pilot study. Patients were implanted with the Cyberonics system for electrical stimulation of the vagus. After an initial in-clinic stimulation, the patients\u0000performed the stimulations at home for 42 days, when the device was inactivated. On day 56 the stimulations were reinitiated. The following parameters were evaluated: tender and swollen joint count, physician’s (PGA) and patient’s (PtGA) global score, intensity of pain, disease activity (DAS28), functional ability (HAQ), serum CRP level, and EULAR response.</p><p><strong>Results: </strong>In the period from the screening visit to the day 42 visit, both patients experienced an improvement of\u0000DAS28 (7.00 and 6.22 vs. 4.03 and 2.13), PGA (70 and 53 vs. 27 and 16), PtGA (48 and 43 vs. 15 and 14), tender joint count (26 and 28 vs. 4 and 0), swollen joint count (24 and 14 vs. 8 and 2), intensity of pain (72 and 87 vs 21 and 7), HAQ score (2.25 and 2.25 vs. 1.5 and 1.375), and CRP levels (23.8 and 5.58 vs. 13 and 4.61). After the device deactivation, DAS28 and VAS pain worsened in both patients.</p><p><strong>Conclusion: </strong>Vagal neural stimulation in the treatment of patients with active RA and an inadequate response to\u0000methotrexate is effective in reducing clinical symptoms and parameters of inflammation. Our results are in accordance with the results obtained in other centers. Research on a larger number of subjects is necessary for a better evaluation of the effect of this new approach to the treatment of patients with rheumatoid arthritis.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 2","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982381","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":"[AUTOIMMUNITY AND IMMUNODEFICIENCIES].","authors":"Alenka Gagro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Autoimmune diseases and primary immunodeficiencies share a common pathogenesis characterized\u0000by dysregulation of immunity. Although most autoimmune diseases show a polygenic inheritance pattern, it has been\u0000shown that monogenic defects of various immune system components could lead to autoimmunity as well. These findings\u0000have opened a new pathway for understanding the development of autoimmune diseases and the overlap between\u0000immunodeficiency and autoimmunity. Th e mechanism of how a single gene defect leads to autoimmunity is not completely\u0000known. The purpose of this clinically-oriented review is to describe the incidence, clinical presentation, and\u0000possible mechanisms of autoimmunity in patients with primary immunodeficiencies relevant to rheumatologists.</p>","PeriodicalId":76426,"journal":{"name":"Reumatizam","volume":"63 Suppl 1 ","pages":"66-72"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982887","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}