Modes of presentation of reactive arthritis based on the affected joints.

INTRODUCTION: Reactive arthritis is an autoimmune condition that occurs as a reaction against an infection site elsewhere in the body. Reactive arthritis affects mostly young ages, mainly group age 20-40 y.o., mostly males with ratio 2:1 against females, sometimes 3:1, and even 14:1. The purpose of the study was to observe the mode of illness presentation based on the number of affected joints. MATERIAL AND METHODS: During the 01.03.2012 - 01.03.2014 in the Clinic for Rheumatology and O.S.I.R. "Vendenisi - AL" in Besiana have been examined, elaborated and hospitalized 100 patients with reactive arthritis, out of them 66 males and 34 females. Patients underwent necessary laboratory, hematological, biochemical, and immunological examinations. Subsequently each affected joint has been examined based on the propedeutics rules (inspection, palpation and assessment of the level of motility), as well as x ray examination. RESULTS: From 100 examined patients 66% were males and 34% females respectively. 11% of them were in the 10-20y.o. group age, 30% belonged to group age 21-30 y.o., 24% of patients to 31-40 y.o. group age, 30% to 41-50 y.o. group age, and 5% of patients to the group age over the 51 year old. Regarding the affected articulations and modes of illness presentation, we've obtained the following results: Knee was affected in 64.7% female and 52,12% male patients respectively, T/C joint in 50% female and 57.57% male patients, MTPH joint in 41.11% female and 48.48% male patients respectively, and R/C joint in 44.11% female and 48.48% male patients respectively. Oligoarticular type is seen in 73% male and 70% female patients. Monoarticular type is seen in 14% male and 13% female patients, and poliarticular type is seen in 10% male and 14% female patients respectively. Results from our study have revealed that: reactive arthritis is more frequent in males than females in ratio 2:1 in the infections of urogenital infection, 3:1 in nasopharyngeal infections, and similar in infections of enteral origin. CONCLUSION: Reactive arthritis mostly attacks young ages 20-40 y.o., while over the age of 50 and below the age of 20 is rarely seen. First reactive arthritis attack in males occurs earlier than in females. Most affected joints are: knee, talocrural joint, metatarsophalangeal (MTPH) joint, radiocarpal (R/C) joint, and proximal interphalanteal (PIPH) joint. Oligoarticular mode of illness presentation is 2.5 more frequent than mono and poliarticular mode of illness presentation.

Treatment of rheumatoid arthritis with biologic DMARDS (Rituximab and Etanercept).

GOAL: To determine efficacy and safety of treatment with Rituximab and Etanercept plus Methotrexate in patients with active Rheumatoid Arthritis (RA), who had an inadequate response to nonbiologic DMARDS therapies and to explore the pharmacogenetics and pharmacodynamics of Rituximab and Etanercept in our populations. Study was done at Rheumatology Clinic of University Clinical Centre in Prishtina during 2009-2011 years. METHODS: We evaluated primary efficacy and safety at 24 weeks in patients enrolled in the study of long-term efficacy of Rituximab and Etanercept. Patients with active Rheumatoid Arthritis and an inadequate response to 1 or more non biologic DMARDS were randomized to receive intravenous Rituximab (1 course consisting of 2 infusions of 1.000 mg each -one group, and Etanercept 25 mg twice weekly -second group, but both groups with background MTX. The primary efficacy end point was a response on the ACR 20%, improvement criteria at 24 weeks, Secondary end points were responses on the ACR 50 and ACR 70, improvement criteria, the DAS 28, and EULAR response criteria at 24 weeks. RESULTS: During our investigations we treated 20 patients, 15 females and 5 males, in the treated group with RTX and 13 patients 8 females and 5 males in the treated group with ETN. Patients of group 1 and group 2 were of ages 37-69 years old and 19-69 years old (average 47-44) Most of the patients belong in 2nd and 3rd functional stage according to Steinbrocker. All ACR response parameters were significantly improved in RTX treated patients who also had clinically meaningful improvement in fatigue, disability and quality of life. Patients showed a trend less progression in radiographic end points. Most adverse events occurred with the first RTX infusion and were mild to moderate severity. CONCLUSION: At 24 weeks, a single course of RTX and ETN provided significant and clinically meaningful improvements in disease activity in patients with active, longstanding RA who had an inadequate response to 1 or more nonbiologic DMARDS.