Better Safe than Sorry: Rheumatoid Arthritis, Interstitial Lung Disease, and Medication-A Narrative Review.

It is well known that rheumatoid arthritis (RA) patients are at an increased risk of developing non-infectious pulmonary complications, especially interstitial lung disease (ILD); however, the clinician must keep in mind that lung disease could not only be a manifestation of the underlying condition, but also a consequence of using disease-modifying therapies. New-onset ILD or ILD worsening has also been reported as a possible consequence of both conventional disease-modifying antirheumatic drugs (DMARDs) and biologic agents. This study is a narrative review of the current literature regarding the potential risk of developing interstitial lung disease along with the administration of specific drugs used in controlling rheumatoid arthritis. Its purpose is to fill knowledge gaps related to this challenging patient cohort by addressing various aspects of the disease, including prevalence, disease features, treatment strategies, and patient outcomes.

Ankle involvement in rheumatoid arthritis - a comparison of inflammatory signs on musculoskeletal ultrasound and magnetic resonance imaging.

AIM: To evaluate the frequency of tibiotalar and subtalar joints together with extensor, flexor and peroneal tendons inflammatory lesions in rheumatoid arthritis (RA) patients by using ultrasound (US) and magnetic resonance imaging (MRI). MATERIAL AND METHODS: Fifty RA patients and 25 healthy subjects were prospectively included. All patients and controlsunderwent clinical examination (to screen for swollen and/or tender ankles) and ankle US and MRI (to screen for synovialhypertrophy - SH, tenosynovitis and power Doppler - PD signals). The imaging tests were compared using overall agreement, positive agreement, Cohen's κ, sensitivity, specificity and positive likelihood ratio. RESULTS: The subtalar joint had the highest frequency of US-detected SH (30%), as well as positive PD signals (10%). Regarding US joint effusion, the tibiotalar joint recorded the highest frequency (44%). The most frequent US tenosynovitis was detected in the tibialis posterior tendon (40%). Compared to MRI, US evaluation of tibiotalar joints had very good agreement and large effect on detection probability for both SH and effusion (kappa 0.84, positive likelihood ratio 21.1). Compared to MRI, the sensitivity and specificity for US joint involvement ranged between 72.0-88.5% and 82.4-95.8%, and for tenosynovitis were 33.3-78.6% and 85.2-100%,  respectively. Compared to asymptomatic RA patients (n=25), those with at least one symptomatic ankle (n=25) had significantly higher frequencies of both SH and effusion in all the evaluated structures. CONCLUSION: US has high sensitivity and specificity in detecting RA inflammatory lesions in the ankle and rearfoot, in very good agreement with MRI. The high frequency of ankle inflammatory lesions in RA should result in increased interest in the imaging evaluation of these structures.

Smoking, snoring and obstructive sleep apnea.

Obstructive sleep apnea (OSA), with an apnea/hypopnea index (AHI) > or =5 events per hour, is recognized as an important cause of medical morbidity and mortality, being associated with a wide range of significant medical consequences, including arterial hypertension, cardiovascular diseases, metabolic diseases, neurological diseases and psychological effects. Tobacco smoking is considered a predisposing factor for pulmonary and cardiovasculary diseases and a risk factor for developing OSA. Since snoring is frequent in smokers and a common symptom, even a preclinical form of OSA, it is reasonable to speculate that smoking is an independent risk factor for snoring and may be associated with OSA. Current studies have observed there is a synergistic effect between smoking and OSA, both increasing the risk of cardiovascular disease through oxidative stress, endothelial dysfunction and abnormal inflammatory response. OSA, itself could be responsible for nicotine addiction.

The role of simvastatin in the therapeutic approach of rheumatoid arthritis.

The pleiotropic effects of statins, especially the anti-inflammatory and immunomodulatory ones, indicate that their therapeutic potential might extend beyond cholesterol lowering and cardiovascular disease to other inflammatory disorders such as rheumatoid arthritis. Therefore, we undertook a prospective cohort study to evaluate the efficacy and safety of simvastatin used for inflammation control in patients with rheumatoid arthritis. One hundred patients with active rheumatoid arthritis divided into two equal groups (the study one who received 20 mg/day of simvastatin in addition to prior DMARDs and the control one) were followed up over six months during three study visits. The results of the study support the fact that simvastatin at a dose of 20 mg/day has a low anti-inflammatory effect in patients with rheumatoid arthritis with a good safety profile.