Ocular involvement in rheumatic diseases.

Rheumatic diseases are associated with a significant decline in quality of life, which is not only related to the progression of the underlying disease but also to the development of coexisting conditions. One of the possible complications in this group of diseases is ocular involvement. Impaired vision is strongly associated with a significant decline in quality of life and can also exacerbate problems related to physical functioning. Consequently, it can lead to serious complications in the treatment of the underlying disease. Additionally, from a clinical point of view, it is also important to note that ocular diseases may precede the occurrence of inflammatory joint and spinal diseases, as well as organ involvement in systemic connective tissue disorders. Therefore, paying attention to ocular symptoms can help in early diagnosis and thus improve patient prognosis. For the aforementioned reasons, ocular diseases should be carefully considered in routine rheumatologic practice.

Pharmacoeconomic evaluation of treatment effectiveness with selected biologic treatment in rheumatoid arthritis therapy.

OBJECTIVES: Modern treatment of autoimmune diseases is becoming increasingly widely used. We owe it to the continuous and rapid development of biotechnology, molecular biology, immunology, and biochemistry. The proven effectiveness of biological therapy in rheumatoid arthritis (RA) should result in its widespread use. At present, only about 1% of patients with RA have access to biological therapy in Poland. MATERIAL AND METHODS: The study material was retrospectively collected in the Rheumatology and Systemic Tissue Diseases Clinic and Rheumatology Outpatient Clinic in dr Jan Biziel University Hospital No. 2 in Bydgoszcz 2009-2014. Patients were divided into 3 groups: patient receiving infliximab, etanercept and adalimumab. RESULTS: The study involved analyses of cost effectiveness. The time horizon of patient documentation analysis ranged from the time a patient was enrolled to infliximab, etanercept or adalimumab therapy until remission of the disease. The majority of patients achieved remission in the case of adalimumab treatment (85.29%), followed by etanercept (74.07%), then infliximab (37.21%). Taking into account the DAS28 parameter, analysis was performed using medical costs of the analyzed treatment regimens. For this purpose, the incremental cost-effectiveness ratio (ICER) was calculated. According to the analysis, obtaining one DAS28 unit, replacing infliximab with etanercept, would cost PLN 40 964 67. Higher costs would be required in the case of replacement of infliximab with adalimumab - PLN 43 076 08. Obtaining one additional DAS28 unit (in this case, a decrease in DAS28 by one unit) by introducing adalimumab instead of etanercept would amount to PLN 45 409 74. CONCLUSIONS: Undoubtedly, the pharmacoeconomic analysis makes it easier to decide on the appropriate treatment. Therefore, its implementation should be a widely used solution not only for RA, but also for other diseases. Health care and other entities' systems should also be improved in such a way that the data needed for pharmacoeconomic analysis are fully available.

Pharmacoeconomic evaluation of costs of rheumatoid arthritis therapy with selected biological treatment.

OBJECTIVES: Among autoimmune diseases, rheumatoid arthritis (RA) is the most common chronic inflammatory disease of the joints. Its pathogenesis is still not fully understood, but the gained knowledge has contributed to the development of modern treatment. The introduction of biological therapy for RA has been a breakthrough in the standard approach to the treatment of this disease. MATERIAL AND METHODS: The study material was retrospectively collected in the Rheumatology and Systemic Tissue Diseases Clinic and Rheumatology Outpatient Clinic in dr. Jan Biziel University Hospital No. 2 in Bydgoszcz. Patients were divided into 3 groups: patients receiving infliximab - 43 patients, etanercept - 27 patients and adalimumab - 34 patients. In the study, the pharmacoeconomic analysis included direct and indirect medical costs. Direct medical costs analyzed in the study included costs for the purchase of medications, diagnostic and imaging costs, and medical consultations and hospitalization costs. The analysis included all direct medical costs incurred by the hospital and the patient, as well as indirect costs outside the healthcare sector - that is, the Polish Social Insurance Institution benefits (disability benefits, rehabilitation benefits, sickness absences). Direct medical costs are also presented from the perspective of the payer - The Polish National Health Fund - taking into account the cost and percentage share of medical expenses. RESULTS: The analysis concerned resources used since the beginning of treatment with a given biological medication for 24 months or earlier if disease remission occurred.A cost-benefit analysis was carried out in the study using biosimilar medications present on the market in relation to the treatment regimens. Considering the total cost, if only Inflectra were used in therapy, PLN 18 151.98 per patient could be saved, and in the case of Remsima, PLN 16 385.14. In less than 19 months, to use infliximab for 43 patients, PLN 780 475.80 more would have to be spent than in the case of the biosimilar medication Inflectra, and PLN 704 561 in the case of Remsima.The highest total cost is generated by treatment with adalimumab, followed by etanercept, and infliximab. Of the costs analyzed, a significant majority was for biological treatment. CONCLUSIONS: Given the Polish financial conditions, the best solution now is to reduce the prices of biological medications. This is possible through the introduction of biosimilar medications that, when placed on the market, reduce the price of the original medication, as is currently the case with Remicade and Enbrel. The introduction of Inflectra and Remsima, as well as Benepali and Erelzi, has reduced the price base of original medications to similar levels of treatment with biosimilar medications. The wider use of biological treatment would also reduce indirect costs.

Results from Polish Spondyloarthritis Initiative registry (PolSPI) - methodology and data from - the first year of observation.

OBJECTIVES: Report on one-year results from the Polish Spondyloarthritis Initiative registry (PolSPI), containing the cross-sectional analysis of clinical and imaging data as well as database methodology. MATERIAL AND METHODS: The PolSPI registry includes patients with axial (axSpA) and peripheral (perSpA) spondyloarthritis according to ASAS classification criteria, and/or patients with ankylosing spondylitis according to modified New York criteria, psoriatic arthritis according to CASPAR criteria, arthropathy in inflammatory bowel disease, reactive arthritis, juvenile spondyloarthritis or undifferentiated spondyloarthritis. Epidemiologic data and history of signs, symptoms and treatment of spondyloarthritis are collected and assessment of disease activity is performed. Radiographic images of sacroiliac joint, cervical and lumbar spine, and results of bone densitometry are collected. Every 6 months blood samples for inflammatory markers, and for long-term storage are taken. RESULTS: During a one-year period from September 2015 to August 2016, 63 patients were registered on an electronic database; 44 (69.8%) of patients were classified as axial spondyloarthritis (axSpA) and 19 (30.2%) as peripheral spondyloarthritis (perSpA) according to ASAS criteria. Statistically significant differences between axSpA and perSpA were discovered in the percentage of HLA-B27 antigen occurrence (92.6% and 50%, respectively), BASDAI (2.8% and 4.1%, respectively), DAS 28 (2.66% and 4.03%, respectively), percentage of peripheral arthritis (20% and 88.8%, respectively), enthesitis (26.7% and 70.6%, respectively), dactylitis (6.7% and 88.9%, respectively), as well as extra-articular symptoms: acute anterior uveitis (26.7% and 5.6%, respectively) and psoriasis (6.9% and 55.6%, respectively). Patients with axSpA had significantly higher mean grade of sacroiliac involvement according to New York criteria, higher mSASSS score, and lower T-score in femoral neck in bone densitometry. CONCLUSIONS: At the early stage of the disease patients with axSpA compared to those with perSpA, have more advanced structural damage of sacroiliac joints and spine, and lower bone mineral density in the femoral neck. In the upcoming years the PolSPI registry will prospectively follow-up patients with SpA, recording response to treatment and carrying out research on interaction of inflammation and bone remodelling.

Efficacy of radiation synovectomy (radiosynovectomy or radiosynoviorthesis) with yttrium-90 in exudative inflammation of synovial membrane of knee joints in patients with rheumatic diseases - preliminary report.

OBJECTIVES: Hypertrophic and exudative synovitis of the knee is one of the earliest symptoms in rheumatic diseases. In the case of pharmacotherapy failure, other methods which directly remove the inflamed synovial membrane are used - synovectomies. Radiosynovectomy (RSV) is the radiopharmaceutical application of colloidal solution to joint cavities. In this study, the authors assessed the efficacy of knee radiosynovectomy with yttrium-90 (Y-90) in several groups of patients divided into certain rheumatic diseases. MATERIAL AND METHODS: The study group consisted of 70 patients aged from 29 to 65 years with hypertrophic and exudative synovitis of the knee in rheumatic diseases such as rheumatoid arthritis, osteoarthrosis and spondyloarthropathies. Radiopharmaceutical colloid of Y-90, with a radiation dose of 185-222 MBq in a volume of 2-3 ml, was administered to joint. Then the knee joint was immobilized for 72 h. During visits V1, V2, V3 and V4, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured and ultrasound of the knee was performed. Disease activity was evaluated by the WOMAC scale, HAQ and 100-mm visual analog scale (VAS). RESULTS: The most significant difference of synovial hypertrophy, before and after the procedure, was obtained in patients with rheumatoid arthritis. Variability of effusion before and after the procedure in all groups was comparable and statistically significant. The greatest improvement in variability of inflammatory parameters, before and 4 weeks after radiosynovectomy, was observed in patients with rheumatoid arthritis. CONCLUSIONS: In the therapeutic algorithm radiosynovectomy should be located between conservative treatment and operative procedures. Radiosynovectomy does not require hospitalization or prolonged rehabilitation. Radiosynoviorthesis affects the patient's general condition, which is associated with eliminating pain and restoring joint function.

DAS28 score vs. ultrasound examination for assessment of rheumatoid arthritis disease activity: comparison and discussion of pros and cons.

Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease which is characterized by symetrical multiple joints involvement and extra-articular symptoms. Current EULAR diagnostic criteria for RA include disease activity parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are used to calculate disease activity scores, including DAS and DAS28. Recently attempts have been made to assess disease activity using imaging diagnostic modalities, such as magnetic resonance imaging (MRI) and ultrasonography (US). Due to significant progress in therapy effectiveness and early RA diagnosis possibility, imaging modalities become increasingly meaningful and many clinical trials confirm their usefulness. However, there are no consistent criteria for objective assessment of therapy effectiveness based on US. Moreover, it is not US availability that limits its common use, but rather significant variability between operators. This is why US remains only an additional tool to assess therapy efficacy with regard to DAS/DAS28 index.

Coexistence of rheumatoid arthritis and ankylosing spondylitis.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic progressive inflammatory diseases, leading to joint damage and reducing the physical fitness of patients. They are among the most common rheumatic diseases. However, their etiology and symptomatology are different. Formerly, AS was often wrongly diagnosed as RA. Today there are no major diagnostic difficulties in differentiation between these diseases, thanks to modern laboratory tests and imaging. However, a problem may arise when the patient has symptoms typical for both diseases simultaneously. Cases of coexistence of RA with AS - according to our best knowledge - are rare. This study aims to compare our experience in diagnosis and treatment of concomitant RA and AS with the experience of other researchers. Implementation of the proper diagnostic algorithm, allowing for correct diagnosis of both diseases in one patient, may be useful for differential diagnosis of similar cases in the future.

[Assessment of selected factors influencing birthweight in pregnant women with gestational diabetes mellitus]. / Analiza wybranych parametrów wplywajacych na mase ciala noworodka u kobiet z cukrzyca ciezarnych.

OBJECTIVES: Giving birth to a chi;d with an excessive brithweight is one of the most common neonate complications observed in the pregnant women with gestation diabetes (GDM). DESIGN: The aim of the study was an evaluation of selected factors affecting birthweight in the GDM. MATERIALS AND METHODS: Data from 867 pregnant women were analysed. The influence of: age, height, place of living and mother's educational background and BMI before pregnancy and weight gain during pregnancy and also HbA1c, triglycerides (TG) and total cholesterol (TC) values in the 3rd term of pregnancy (T3) were determined. The TC and TG were assessed by the enzymatic method by means of the Bio Merieux firm set--France, HbA1c by means of the immunoturbidimetric method using the Roche firm sets--France. RESULTS: Statistically significant birthweight differences were affirmed according to: mother's height (respectively the groups: < or = 155 vs 156-169 vs > or = 170 cm), BMI before pregnancy (< 25 vs 25-29.9 vs > or = 30 kg/m2), weight gain in pregnancy (< 12 vs > or = 12 kg), TG (< 2.7 vs > 2.7 mmol/l) and HbA1c in T3. No influence of mother's age, her place of living, educational background, HbA1c at admission and TC values in T3 on the neonates birthweight was observed. CONCLUSIONS: The anthropometric and environmental factors (mother's height, weight, weight gain in pregnancy) have a more significant influence on the neonates birthweight of the mothers with GDM, than social-demographic factors (age, educational background, place of living), the way of treatment of GDM and TC in T3. The TG level in T3, beside HbA1c is an independent, prognostic factor of birthweight in GDM.

[Atypical location of Wegener's granulomatosis with breast involvement: case report]. / Nietypowa lokalizacja ziarniniaka Wegenera z zajeciem sutka-- opis przypadku.

INTRODUCTION: Wegener's granulomatosis is a disease of unknown etiology associated with the presence of serum antibodies against proteinase 3 in most cases. It is characterized by formation of inflammatory infiltrates presenting as granulomas with fibrinoid necrosis, as well as by ulceration and inflammation of small and medium-sized vessels with the involvement of upper and lower airways and kidneys. The process may also occur in other less typical locations, such as the gastrointestinal tract, heart, and nervous system. There are some reports on the location of lesions in the breast. CASE REPORT: We report a case of a 57-year-old female with Wegener's granulomatosis. In this patient, lesions in the skin, kidneys, upper airways, and lungs were accompanied by a breast tumor revealing the distinctive pattern of an inflammatory granuloma. The disease began in December 2002. The patient experienced painful and swollen joints, fever, mucous-purulent-bloody nasal discharge, and subcutaneous nodules with a tendency to ulceration. Histologically, the nodules had a texture typical for inflammatory granuloma. Renal symptoms included mild proteinuria, abnormalities in the sediment (fresh and leached erythrocytes), and slightly elevated serum creatinine. HRCT of the lungs revealed bilateral pulmonary nodules. The presence of antineutrophil cytoplasmic antibodies in serum with the cytoplasmic fluorescence pattern (c-ANCA/PR-3) was confirmed. The disease progressed with perforation of the nasal septum and extensive destructive changes within the bony structures of the paranasal sinuses. The patient underwent thoracic surgery in 2008 due to an inflammatory tumor in the upper lobe of the right lung. Two years later a tumor in the right breast was detected. Histopathology of the lung and breast tumors showed high similarity of both processes corresponding to lesions typical for Wegener's granulomatosis. The patient was treated with prednisone, methylprednisolone, methotrexate, cyclophosphamide, and azathioprine. CONCLUSIONS: This case provides evidence that Wegener's granulomatosis is a systemic disease with a wide spectrum of organ involvement which should be taken into account during differential diagnosis of breast tumors.