IgA vasculitis after COVID-19: a case-based review.

IgA-associated vasculitis (IgAV) known as Henoch - Schönlein purpura (HSP) disease is an inflammatory disorder of small blood vessels. It's the most common type of systemic vasculitis in children which can be associated with the inflammatory process following infections. IgA vasculitis is a rare and poorly understood systemic vasculitis in adults. Coronavirus disease 2019 (COVID-19) has been associated with HSP in both adults and children. A 58-year-old woman was diagnosed with HSP, fulfilling the clinical criteria: palpable purpura, arthritis, hematuria. The disclosure of the HSP disease was preceded by a infection of the respiratory tract. COVID-19 infection was confirmed via the presence of IgM and IgG antibodies. This case indicates the possible role of SARS-CoV-2 in the development of HSP. The clinical course of IgAV in adults appears to be different from pediatric IgAV, especially due to higher risk of renal complications. Symptoms of the disease quickly resolved with low-dose of steroids.

Differential approach to peripheral blood cell ratios in patients with systemic lupus erythematosus and various manifestations.

New markers of systemic lupus erythematosus (SLE) activity are under investigation. In recent years, the researchers have been focusing increased attention on the role of haematological indicators in assessing the disease activity. Specifically, neutrophil-, basophil-, eosinophil-, monocyte- and platelet-to-lymphocyte ratios (NLR, BLR, ELR, MLR and PLR) have been considered. The specific objective of this study was to determine the suitability of the haematological markers for the assessment of SLE activity and SLE-related organ damage. This study is a retrospective analysis of 136 patients with SLE (124 women and 12 men) who received chloroquine/hydroxychloroquine (HQ/HCQ) monotherapy or HQ/HCQ therapy combined with low/medium doses of glucocorticoid. All patients were assessed for disease activity using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scale. In addition, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) inflammatory parameters were determined in each patient. NLR, BLR, ELR, MLR and PLR were evaluated and correlated with the SLE activity parameters and inflammatory markers. The mean values of the haematological indicators were compared in particular manifestations of SLE-induced organ damage. For numerical variables, descriptive statistics were calculated: median, standard deviation, minimum and maximum values. The Mann-Whitney U test was used for the comparison of continuous variables in the two groups. The Spearman rank correlation test was used to search for any relationships between variables. A p value < 0.05 was considered to be statistically significant. We have found a positive correlation between ELR, MLR and the SLEDAI scale (r = 0.22 and r = 0.27, respectively). NLR, MLR and PLR ratios were significantly correlated with ESR and CRP. Considerably higher NLR values were found in patients with cutaneous and/or mucosal symptoms and with kidney involvement compared to patients without such involvement (4.26 ± 4.2 vs 3.27 ± 2.7; p = 0.05 and 5.45 ± 5.6 vs 3.05 ± 2.0; p < 0.001 respectively). BLR and MLR were significantly higher in patients manifesting symptoms of vasculitis (0.09 ± 0.1 vs 0.02 ± 0.01; p < 0.001 and 3.1 ± 4.2 vs 0.3 ± 0.1; p < 0.001 respectively), arthritis and/or myositis (0.04 ± 0.09 vs 0.02 ± 0.01; p = 0.01 and 1.02 ± 2.6 vs 0.35 ± 0.4; p = 0.01 respectively), whereas elevated ELR ratios were observed in patients with vasculitis (0.4 ± 0.5 vs 0.08 ± 0.06; p < 0.001) compared to patients without such organ involvement. The PLR marker was substantially higher in patients exhibiting haematological disorders in the course of SLE (276.6 ± 226.4 vs 192.6 ± 133.5; p = 0.01). The results indicate that ELR and MLR are effective markers of SLE activity. The haematological indicators may predict SLE-dependent organ damage, particularly cutaneous, mucosal, arthritic, myositic, haematological and kidney involvement.

Nephrotic syndrome in the course of type 1 diabetes mellitus and systemic lupus erythematosus with secondary antiphospholipid syndrome - diagnostic and therapeutic problems.

Nephrotic syndrome (NS) can be a symptom of many autoimmune, metabolic, or infectious diseases. Kidney involvement is often observed in the course of diabetes mellitus (DM) and systemic lupus erythematosus (SLE). The development of NS with coexisting SLE and DM generates serious diagnostic problems. In this paper, the authors present diagnostic and therapeutic dilemmas in a patient with long-lasting DM, SLE, and secondary antiphospholipid syndrome, in whom NS symptoms appeared. Histopathological examination of the kidney confirmed the diagnosis of lupus nephritis. Immunosuppressive and anticoagulant drugs were used. The authors demonstrated that the character of morphologic lesions in the kidney biopsy can help in diagnosis, nephropathy classification, and further therapeutic decisions, which are distinct in both diseases.

Reasons for diagnostic delays of axial spondyloarthritis.

OBJECTIVE: Introduction: The probability of development of axial spondyloarthritis (axSpA) is estimated to be above 90% among patients with chronic back pain, presence of HLA B27 antigen and positive family history of ankylosing spondylitis (AS), psoriasis, reactive arthritis, inflammatory bowel disease or uveitis. The nonradiographic axSpA and ankylosing spondylitis diseases' activity has a comparable impact on the patients' quality of life and from the practical point of view the approach to treatment of each of them is the same. The aim: The attempt to identify the reasons of diagnostic delays of AS among patients hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin and to suggest the ways of improving the accuracy of diagnostic track among other healthcare providers than rheumatologists. PATIENTS AND METHODS: Material and methods: We performed a retrospective analysis of the records of 82 patients' with the established diagnosis of AS, hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin in 2000-2019, and of 45 years of age and older. RESULTS: Results: From among 82 patients (28 women and 54 men) the diagnosis of AS after 45 years of age was established in 25 patients (10 women and 15 men) - group t, and in the other 57 patients (group n) the diagnosis was established before 45 years of age. On average the age at the time of diagnosis in the whole group (t+n) was 40,7±10,2 (18-76) years, the age at the beginning of inflammatory back pain (age of axial symptoms) was 30,9±8,5 (13-51) years and the diagnostic delay (period between first axial symptoms and diagnosis establishment) was 9,75±9,5 (0-46) years. We did not find any statistically significant associations between sex and age at the moment of diagnosis, age of the beginning of axial symptoms and the time of diagnostic delay. There was no significant difference of incidence of enthesitis, uveitis, arthritis, prevalence of family history of spondyloarthritis and CRP level between group t and n. Antigen HLA B27 was more frequently present in group t. CONCLUSION: Conclusions: Instead of the recognition progress and worldwide popularization of knowledge about axSpA, the diagnostic delays in this field are still estimated to last many years, the patients are looking for other specialists' help, and they can be not knowledgeable of the inflammatory back pain criteria. Currently, HLA B27 antigen and C-reactive protein are the two most commonly used biomarkers for diagnostic and disease activity monitoring purposes of axSpA and magnetic resonance is the only "imaging biomarker". The presence of extra-axial symptoms does not improve the diagnostic sensitivity.

[Uwarunkowania opóznienia rozpoznan osiowych spondyloartropatii zapalnych].

OBJECTIVE: Wstep: Prawdopodobienstwo rozwoju osiowej postaci spondyloartropatii zapalnej (axSpA) wynosi ponad 90% u chorych z przewleklym bólem kregoslupa, obecnym antygenem HLA B27 i dodatnim wywiadem rodzinnym w kierunku zesztywniajacego zapalenia stawów kregoslupa (ZZSK), luszczycy, reaktywnego zapalenia stawów, chorób zapalnych jelit lub zapalenia blony naczyniowej oka. Aktywnosc choroby w postaci nieradiologicznej axSpA i ZZSK podobnie wplywa na jakosc zycia a z praktycznego punktu widzenia podejscie do leczenia jest jednakowe. Cel pracy: Próba identyfikacji przyczyn spóznionych rozpoznan ZZSK wsród chorych hospitalizowanych w Klinice Reumatologii i Ukladowych Chorób Tkanki Lacznej w Lublinie oraz sugestie dotyczace poprawy sciezki diagnostycznej, zwlaszcza wsród lekarzy innych specjalnosci niz reumatolodzy. PATIENTS AND METHODS: Material i metody: Retrospektywnej analizie poddano historie chorób 82 pacjentów z ustalonym rozpoznaniem ZZSK hospitalizowanych w Klinice Reumatologii i Ukladowych Chorób Tkanki Lacznej w Lublinie w latach 2000-2019, którzy ukonczyli 45. rok zycia. RESULTS: Wyniki: Sposród 82 chorych (28 kobiet i 54 mezczyzn) rozpoznanie ZZSK po 45. roku zycia postawiono u 25 chorych (10 kobiet i 15 mezczyzn) - grupa t (30,4%), u pozostalych 57 chorych (grupa n) rozpoznanie ustalono przed 45. rokiem zycia. Sredni wiek w chwili rozpoznania w calej grupie (t+n) wynosil 40,7±10,2 (18-76) roku, wiek, w którym pojawil sie zapalny ból kregoslupa (wiek objawów osiowych) wynosil 30,9±8,5 (13-51) roku a opóznienie rozpoznania (okres od pojawienia sie objawów osiowych do ustalenia rozpoznania) 9,7±9,5 (0-46) roku. Nie stwierdzono istotnych statystycznie zaleznosci miedzy plcia a wiekiem w chwili rozpoznania, wiekiem pojawienia sie objawów osiowych i opóznieniem rozpoznania. Nie zaobserwowano istotnych zaleznosci miedzy czestoscia wystepowania zapalenia przyczepów sciegnistych, blony naczyniowej oka, stawów obwodowych, chorób z kregu spondyloartropatii zapalnych w rodzinie oraz stezenia CRP miedzy grupa t i n. Antygen HLA B27 czesciej obecny byl w grupie t. CONCLUSION: Wnioski: Mimo postepu w diagnostyce i wiekszego upowszechniania wiedzy na temat spondyloartropatii zapalnych, opóznienia w rozpoznaniu tych chorób sa wieloletnie, poniewaz pacjenci bardzo czesto poszukuja pomocy u innych specjalistów, którzy moga byc niezaznajomieni z kryteriami bólu zapalnego kregoslupa. W chwili obecnej jedynymi biomarkerami wykorzystywanymi w diagnostyce i monitorowaniu aktywnosci spondyloartropatii zapalnych jest odpowiednio obecnosc antygenu HLA B27 i stezenie CRP a jedynym "biomarkerem obrazowym" jest rezonans magnetyczny. Wystepowanie objawów pozaosiowych nie poprawia czulosci diagnostycznej.

Monitoring the activity of anca-associated vasculitis: some questionnaires and laboratory parameters

Systemic vasculitis is a group of diseases manifested by symptoms from many organs. ANCA-associated vasculitis (AAV) require chronic and often aggressive immunosuppressive treatment. This treatment should be adapted to the disease activity. Assessment of AAV is based on various disease activity questionnaires which contain clinical symptoms of the disease and lab results. The most useful questionnaire is BVAS version 3 (Birmingham Vasculitis Activity Score). In every patients, distinction between activity of AAV and irreversible damage is needed. ANCA antibodies are a predictor of poor prognosis in some patients. Using of these antibodies in monitoring of AAV activity has got minor importance.

[Cryoglobulins and cryoglobulinemic vasculitis].

Cryoglobulinemia is defined as the presence of cryoglobulins in the blood. Cryoglobulinemia is often observed in the course of many diseases (infection, hematological disorders, autoimmune disorders) or has an idiopathic character. The classification of cryoglobulinemia is based on the immunological analysis of cryoglobulins and the activity of the rheumatoid factor (RF). The presence of cryoglobulins may induce cryoglobulinemic vasculitis (CV) which manifests with skin changes, arthritis and the dysfunction of internal organs. Diagnosis of cryoglobulinemia refers to the detection of cryoprecipitate in the blood serum sample. In the treatment of cryoglobulinemia various groups of medications may be used: corticosteroids, cyclophosphamide, azathioprine and rituximab. The purpose of the treatment is to reduce the production of cryoglobulins and the inflammation caused by their presence. Additionally, the treatment of organs complication is also crucial. If the viral infection is the causative agent of vasculitis, combination therapy will be recommended: antiviral and immunosuppressive therapy.

[Musculoskeletal symptoms in a group of granulomatosis with polyangiitis patients].

OBJECTIVE: Introduction: Musculoskeletal symptoms are not characteristic for granulomatosis with polyangiitis (GPA) patients. However, they could be present in two-thirds of patients at the onset of the disease and may provoke diagnostic difficulties. The aim: To assess retrospectively musculoskeletal manifestations in a group of GPA patients. PATIENTS AND METHODS: Material and methods: The analyzed group consisted of 44 patients with GPA (27M, 17F) aged 46.7 years (16-75) and treated at the Department of Rheumatology and Connective Tissue Diseases in Lublin between 2010-2016. All patients were c-ANCA positive, and p-ANCA were present only in one patient (2.3%). The delay in GPA diagnosis averaged 15.9 months (0-166). RESULTS: Results: Joint manifestations were present in 43.2 % of patients (non-destructive arthritis in 22.7%, arthralgia in 20.5%), in 73.7% of cases anticipating GPA diagnosis by on average of 20.1 months (4-98). In 57.5% of patients joint manifestations were present from the beginning of the disease, most commonly as polyarthritis (68.4%). Myalgia was reported by 11.4% of patients. Among patients with arthritis 5 were RF-positive, none ACPA-positive, and 1 had ANA present. CONCLUSION: Conclusions: Musculoskeletal manifestations appear in a high proportion of GPA patients, in most cases preceding the diagnosis. Such a situation may cause diagnostic difficulties and the diagnosis delay.

[Serum free light chains for monitoring systemic lupus erythematosus activity].

OBJECTIVE: Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease leading to chronic inflammation of numerous tissues and organs. The search for clinically useful markers of its activity is ongoing. At present, it is suggested that serum free light chains (FLC) may be useful in assessing SLE activity. The aim of study: To investigate the relationship between serum levels of free light chains (FLC) and the activity of SLE. PATIENTS AND METHODS: Material and methods: Eighty-four SLE patients (75 female; 9 men) aged 34.9±11.8 years, with the disease duration of 6.2±5.2 years, were included. The disease activity was assessed by: circulating C3 and C4 complement components levels, anti-double-stranded DNA (anti-DNA), SLEDAI-2K scale and levels of FLC. We also assessed the relationship between levels of FLC and clinical manifestations of SLE. RESULTS: Results: Median serum levels of FLC κ and FLC λ were 25.9 ± 15.6mg/L and 21.2 ± 9.4 mg/L in SLE pts, respectively. Serum levels of FLC κ were positive in 60 SLE pts (71.4%) and FLC λ in 20 SLE pts (23.8%). The significant correlations were found between levels of FLC κ, FLC λ and of anti-dsDNA (p=0.01; r=0.27); (p=0.001; r=0.35), C3 complement (p<0.02; r= -0.25); (p<0.004; r= -0.31), C4 complement (p<0.04; r= -0.22); (p<0.006; r= -0.3) and SLEDAI -2K (p<0.009; r=0.28); (p<0.001; r=0.35). The SLE pts with arthritis / myositis and hematologic symptoms had significantly higher FLC levels than those without. CONCLUSION: Conclusion: Measurement of serum levels of FLC can help in the periodical assessment of the disease activity in SLE pts.

Coexistence of diabetes mellitus type 1 with diffuse systemic sclerosis - case report and literature review.

Diabetic sclerodactyly is a frequently recognized skin finding that may occur in patients with diabetes mellitus but coexistence of diabetes and systemic sclerosis is rare. We describe a case of coexistence of type 1 diabetes mellitus and systemic sclerosis in 42-year-old man with the history of Raynaud's phenomenon, progressive diffuse hardening of the skin and sclerodactyly, slowly worsening with time. The medical history included type 1 diabetes since childhood with microvascular complications. The patient presented a typical capillaroscopic scleroderma-like pattern, antinuclear antibodies and sclerotic lesions in gastrointestinal system. Summing up, our case represents the rare coexistence of autoimmune diseases like diabetes mellitus type 1 and systemic sclerosis.

Autoantibodies against gliadin in rheumatoid arthritis and primary Sjögren's syndrome patients.

INTRODUCTION: Patients with rheumatoid arthritis (RA) and those with primary Sjögren's syndrome (pSS), beside non-specific antibodies, present with organ-specific autoantibodies, including those typical of celiac disease (CD). In the pathogenesis of CD, a role is played by anti-tissue transglutaminase, anti-endomysium, and anti-gliadin (AGA) antibodies. CD can be comorbid with RA and pSS. The aim of the study was to evaluate the prevalence of AGA in RA and pSS patients and discussion of their clinical significance. MATERIAL AND METHODS: The study included 121 patients with RA and 30 patients with pSS. IgG AGA were determined by ELISA method. Additionally, the presence of IgG antimitochondrial antibodies (AMA) was determined in all patients. A further observation included patients with AGA. RESULTS: In the RA group, AGA were detected in five patients (4.1%), and in the pSS group - in two patients (6.7%). All patients in the pSS AGA (+) had AMA and autoimmune thyroid disease (AITD). These differences were statistically significant compared to the pSS AGA (-) and AMA (+) group (p=0.002) and the AGA (-) and AITD (+) group (p=0.003). At the time of the study, none of the patients had been diagnosed with CD. CONCLUSIONS: AGA, typical of CD, are significantly more frequently detected in patients with RA and pSS than in the general population. The presence of autoantibodies may have an impact on the clinical picture of the disease and further medical procedures. CD testing is warranted in selected patients.

[Biological treatment in severe Still's disease--a case report]. / Leczenie biologiczne w ciqikiej postaci choroby Stilla--opis przypadku.

Still's disease and systemic juvenile idiopathic arthritis (JIA) are multisystem inflammatory diseases of unknown etiology, different disease course and prognosis. Still's disease is characterized by hectic fever, arthritis, skin rash, organomegaly, elevated serum ferritin and inflammatory factors. Early diagnosis and intensive treatment can prevent disease progression and reduce complications such as amyloidosis, physical disability. The first choice of treatment are high doses of corticosteroids and synthetic disease-modifying drugs (DMARDs), including methotrexate (MTX), cyclosporine (CsA). Biologic agents are second line therapy when DMARDs aren't effective, e.g. monoclonal antibodies blocking the action of TNF-alpha (anti-TNF-α), interleukin-1 (ANK--anakinra) and interleukin-6 (TCZ--tocilizumab). We describe in details treatment strategies applied in a young woman with severe Still's disease treated with combination therapy of DMARDs and anti-TNF-α, including etanercept (ETA) or certolizumab (CER). TCZ was applied for the treatment of Still's disease following treatment failure with anti-TNF-α. We've achieved a complete remission of the Still's disease during treatment TCZ.

Comparison of clinical and serological parameters in female and male patients with systemic sclerosis.

OBJECTIVES: The course of systemic sclerosis (SSc) can differ in female and male patients. According to the literature the incidence rates of diffuse cutaneous SSc, scleroderma renal crisis and digital ulceration are higher in male patients. The aim of the study was to compare selected clinical and serological parameters in male and female patients with SSc. MATERIAL AND METHODS: The study encompassed 101 European Caucasian patients with SSc, including 23 men, hospitalized in the Department of Rheumatology. Patients fulfilled the American Rheumatism Association (ARA) classification criteria for SSc. The study groups of men and women were assessed according to the SSc subtype, incidence of internal organ involvement and presence of antinuclear antibodies considered SSc markers. RESULTS: Diffuse cutaneous (dc) SSc was observed more commonly in men than in women (13/23 vs. 25/78; p = 0.03). The time from the development of Raynaud's phenomenon to the diagnosis was significantly shorter in male compared to female patients (3.2 ±4.7 vs. 7.5 ±7.1; p = 0.01). The incidence of scleroderma renal crisis (SRC) was significantly higher (3/23 vs. 2/78; p = 0.04) and of other calcifications significantly lower in the male group compared to the female group (1/23 vs. 20/78; p = 0.02). CONCLUSIONS: We concluded that the incidence of dcSSc is higher in men compared to women. The time from the development of Raynaud's phenomenon to the diagnosis is shorter in the male compare to female group. The incidence of SRC is higher, whereas that of calcifications is lower in SSc men. The serological profiles of female and male patients with SSc are comparable.

Disappearance of white matter lesions on MRI and clinical recovery after initiating antiretroviral therapy in a case of HIV infection presenting as spastic paraparesis.

We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection. Antiretroviral treatment was initiated leading, together with rehabilitation, to a progressive improvement of symptoms. Pathological lesions on brain MRI completely disappeared. In conclusion, HIV test should be done in every patient with neurological signs of unknown cause.

Giant haematoma of the posterior compartment of thigh in a patient with coronavirus disease 19 pneumonia and pulmonary embolism - Case Report.

Introduction. During the Coronavirus-19 (Covid-19) pandemic, a significant increase in the frequency of complications in the form of venous thrombosis was observed. However, there is also the other side of the coin - an increase in the tendency to bleeding in the course of COVID19. Case Report. We present the case of a patient hospitalised in the COVID-19 Isolation Ward due to severe pneumonia in the course of SARS-CoV2 infection. She developed respiratory failure requiring a non-invasive mechanical ventilation. In addition, pulmonary embolism was diagnosed, the treatment with low molecule heparin was initiated. Soon, the patient developed a huge haematoma of the posterior compartment of the thigh causing deformation and dysfunction of the limb and resulting with acute haemorrhagic anaemia. Conclusion. Our article is a contribution to the discussion on the need to pay attention to the possibility of haemorrhagic complications in the course of anticoagulant treatment due to venous thrombosis in COVID-19 patients.

[Biological therapies in systemic lupus erythematosus]. / Terapie biologiczne w toczniu rumieniowatym ukladowym.

The prevention of chronic organic damage and complete inhibition of inflammatory activity of the disease are the main goals in the treatment of systemic lupus erythematosus (SLE). Current therapies of SLE are not effective enough and they may cause various serious side effects. Biological therapies, affecting important pathogenetic disturbances in the immunological system of SLE patients, give hope for the development of a new treatment for SLE. Currently the most advanced clinical trials are being conducted with anti-lymphocyte B drugs, such as rituximab, belimumab and epratuzumab. Belimumab as the first biological agent was registered for treatment of the active, seropositive form of SLE. The advances in immunology and rheumatology nowadays raise the hope of finding effective and safe treatment for SLE. In our article we present an overview of data concerning perspectives of biological treatment in SLE.

ß2-microglobulin as a marker of systemic lupus erythematosus activity.

BACKGROUND: Systemic lupus erythematosus (SLE) is characterized by alternating periods of activity and remission. A portion of the patients suffers from the chronically active form of the disease. The search for clinically useful markers of its activity is ongoing. At present, it is suggested that ß2-microglobulin (ß2M) may be useful in assessing SLE activity. OBJECTIVES: The objective of the paper was to investigate the relationship between serum ß2M concentration and SLE activity. MATERIAL AND METHODS: The study group consisted of 69 SLE patients (62 women and 7 men), aged 34.5 ±11 years (19-69). Patients with kidney failure and infection were excluded from the study group. The concentration of ß2M was measured using an ELISA test. SLE activity was assessed with Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and by measuring the levels of C3 and C4 complement components, anti-double stranded DNA antibodies (anti-dsDNA antibodies) and ß2M. The relationship between ß2M and the clinical manifestation of SLE was also covered in the study. RESULTS: The study revealed a statistically significant correlation between ß2M concentration and SLEDAI-2K disease activity index (p < 0.05; r = 0.6), anti-dsDNA titer (p < 0.05; r = 0.3), and C4 component serum level (p < 0.05; r = -0.3). ß2M concentration was significantly higher in patients with arthritis and/or myositis (p = 0.005), vasculitis (p = 0.005), and hematological manifestations of SLE (p = 0.02). CONCLUSIONS: Periodical determination of ß2M concentration in SLE patients may prove helpful in assessing the disease activity.

[Overlap syndrome autoimmune hepatitis and primary biliary cirrhosis associated with antiphospholipid syndrome]. / Zespól nakladania autoimmunologicznego zapalenia i pierwotnej marskosci zólciowej watroby skojarzony z zespolem antyfosfolipidowym.

The paper presents diagnostic problems and therapeutic management in a case of 34 year old woman with antiphospholipid syndrome (APS) connected with overlap syndrome: autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). Life threatening cardiac arrhythmia was the first clinical manifestation of the disease. Pulmonary embolism occurred a few months later, with the presence of antiphospholipid antibodies. The diagnosis of AlH and PBC was made as a result of further research of complex immunological disturbances observed in the patient and after liver biopsy.

Clinical picture of late-onset systemic lupus erythematosus in a group of Polish patients.

INTRODUCTION: The prevalence of late-onset systemic lupus erythematosus (SLE) diagnosed in patients over the age of 50 years is estimated at 10% to 20%. SLE in elderly patients has specific features with misleading signs and symptoms, but its clinical course seems milder compared with that in younger patients. OBJECTIVES: The aim of the study was to assess clinical manifestations of late-onset SLE in a group of patients treated in Poland. PATIENTS AND METHODS: From a group of 230 consecutive patients with SLE, individuals with late-onset disease were selected. We retrospectively analyzed the incidence of clinical features of SLE, concomitant diseases, and treatment. The incidence of clinical features in late-onset patients was compared with that in a group of 108 patients with early-onset SLE. RESULTS: Late-onset SLE was confirmed in 20 patients (8.7%) including 16 women (80%) and 4 men (20%). A delay in diagnosis was 31.7 months (0-144). The most common SLE features were arthritis (50%), rash (40%), nephropathy (40%), photosensitivity (30%), mouth ulcerations (30%), interstitial lung disease (30%), fever (25%), leukopenia (65%), and thrombocytopenia (35%). Kidney involvement was present in all men and in 25% of women. Thrombotic complications were noted in 38.8% of the patients. Concomitant diseases were common in our study group. CONCLUSIONS: The clinical picture of late-onset SLE differs from that of early-onset SLE. Arthritis, leukopenia, and thrombotic complications are frequent, while skin manifestations, photosensitivity, nephropathy, vasculitis, and central nervous system involvement are less common in late-onset SLE. The diagnosis of late-onset SLE is often delayed, and treatment is determined by the presence of concomitant diseases.

Relationship between rheumatoid arthritis activity and antithyroid antibodies.

INTRODUCTION: Rheumatoid arthritis (RA) is known to be associated with a higher prevalence of antithyroid antibodies and autoimmune thyroid disease, but there have been few studies regarding the correlations between the presence of these antibodies and RA activity. OBJECTIVES: The aim of this study was to analyze the relationship between antithyroid antibody titers and selected parameters of RA activity. PATIENTS AND METHODS: A total of 75 consecutive hospitalized patients with RA were enrolled into the study. Levels of antithyroid peroxidase antibodies (aTPO), antithyroglobulin antibodies (aTG), and antithyrotropin receptor antibodies (aTSH-R) were measured. The analysis of disease activity was based on the disease activity score with 28-joint count (DAS28), duration of morning stiffness, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) and hemoglobin levels. RESULTS: Antithyroid antibodies were present in 13.3% of the patients (n = 10), aTPO in 9.3% (n = 7), aTG in 8% (n = 6), and aTPO and aTG in 4% (n = 3); aTSH-R was not detected in any of the patients. Significant positive correlations (P <0.05) were observed between aTPO and DAS28 (r = 0.35, P = 0.002), aTG and ESR (r = 0.25, P = 0.02), and aTG and CRP (r = 0.23, P = 0.04). There were significant differences in the mean DAS28 between the aTPO­positive and aTPO­negative groups (5.35; 95% confidence interval [CI], 4.39-6.3 vs. 4.12, respectively; 95% Cl, 3.81-4.43; P = 0.017) and between the aTG-positive and aTG-negative groups (5.65; 95% Cl: 4.64-6.67 vs. 4.11; 95% Cl: 3.81-4.41; P = 0.005; respectively). CONCLUSIONS: Our results suggest that RA activity may be associated with the presence of antithyroid antibodies. This finding could be useful in the clinical evaluation of RA patients.