Polyarteritis nodosa and Sjögren's syndrome: overlap syndrome.

Polyarteritis nodosa (PAN) belongs to a group of necrotic angiitis. During the illness, necrotic changes are found in small and middle dimensions arteries. Primary Sjögren's syndrome is a chronic, autoimmunological systematic illness of connective tissue with characteristic infiltration of lymphocytes and plasmatic cells in endocrine glands. Despite the fact that both disease entities are well known and primary Sjögren's syndrome is the second most commonly appearing autoimmunological sickness, the coexistence of both simultaneously is described very rarely. So far only three such cases have been presented. The case of 53-year-old woman is presented, who since 2003 has been hospitalized due to her ailments several times, at surgery, internal medicine, and rheumatology wards. In 2006, she was admitted to rheumatology clinic of Pomeranian Medical University (PAM) to be diagnosed both subjectively and objectively. Additional examinations proved that she had been suffering from overlapping PAN and primary Sjögren's syndrome (PSS). She fulfilled 5 out of 10 criteria for PAN and all criteria for PSS. For treatment the boluses of methyloprednisolon and cyclophosphamid every 4 weeks were used what resulted in curing the patient.

[Adverse effects of cyclosporin a observed in rheumatoid arthritis and psoriatic arthritis]. / Dzialania niepozadane w czasie leczenia cyklosporyna a u chorych na reumatoidalne i Luszczycowe zapalenie stawów-obserwacje wlasne.

INTRODUCTION: Rheumatoid arthritis (RA) and psoriatic arthritis (PA) represent diseases which often demand aggressive therapy in order to control the process and inhibit lesion formation in joints and organs. This kind of therapy can be achieved with cyclosporin A (CsA), particularly when combined with methotrexate (MTX). This combination is far more effective than single-drug therapy and is capable of significantly reducing the number of articular lesions. Considering the fact that monotherapy is associated with many adverse effects, it is feared that both drugs in combination may produce cumulative toxicity. The aim of this work was to determine the frequency of adverse effects caused by CsA in patients treated for RA and PA at the Outpatient Rheumatology Clinic of the First Public Hospital in Szczecin. MATERIAL AND METHODS: Our study group consisted of 61 patients, including 47 with RA--35 females, mean age 51 yrs (range: 21-69 yrs), mean disease duration 9.9 yrs (range: 2-23 yrs); 12 males, mean age 51.8 yrs (range: 33-74 yrs), mean disease duration 8 yrs (range: 3-14 yrs) and 14 with PA--6 females, mean age 41.1 yrs (range: 33-55 yrs), mean disease duration 7.8 yrs (range: 2-16 yrs); 8 males, mean age 42.9 yrs (range: 35-50 yrs), mean disease duration 7.0 yrs (range: 0.5-21 yrs). All patients were on MTX. During 11 years of follow-up, CsA was withdrawn due to adverse effects in 20 patients (32.8%). The following adverse effects were observed: arterial hypertension (n=19), hand tremor (n=11), hirsutism (n=7), elevated creatinine (n=17), gingival hypertrophy (n=9), abnormal appetite (n=2), peripheral neuropathy (n=1), lymphocytosis (n=1), skin lesions (n=1), diarrhea (n=2), recurrent infections (n=1), candidiasis (n=1), zoster (n=1), and neoplasm (n=2). Adverse effects responsible for withdrawal of CsA in 14 patients (23%) appeared more frequently during the first 12 months of therapy. Our observations indicate that CsA is well tolerated. The majority of adverse effects subsided after dose reduction or temporary withdrawal of the drug.

[Addison's disease imitating fibromyalgia]. / Choroba addisona imitujaca fibromialgie.

We present the case of a 33-year-old female with generalized pain in the musculoskeletal system, fatigue, and many other symptoms. She was initially diagnosed with fibromyalgia but other tests finally confirmed Addison's disease. Supplementation with adrenal hormones resulted in total remission of pain and of other symptoms. This case serves to illustrate diagnostic pitfalls in patients with a generalized pain syndrome.

[The quality of life of patients who suffer from rheumatoid arthritis in reference to their physical fitness and mental state]. / Jakosc zycia chorych na reumatoidalne zapalenie stawów w odniesieniu do sprawnosci fizycznej i stanu psychicznego.

INTRODUCTION: A chronic inflammation leads to joints deformations, which in consequence results in disability and decrease in quality of life. In the 1960s, the evaluation of the treatment of patients with chronic disease started to include quality of life. THE AIM OF THE STUDY: to evaluate quality of life in patients with rheumatoid arthritis (RA) on the basis of chosen questionnaires; to determine the usefulness of chosen questionnaires in assessing quality of life of patients suffering from rheumatoid arthritis; to investigate whether quality of life of patients with rheumatoid arthritis depends on radiological and functional stage of disease, its duration, their age, sex and activity of the disease. MATERIAL AND METHODS: The study involved RA patients treated in the Department ofRheumatology and Rheumatologic Outpatient Clinic SPSK-1 in Szczecin. Patients' quality of life was evaluated with following questionnaires: Medical Outcomes Study 36-Item Short Form (SF-36), the Health Assessment Questionnaire (HAQ) and Arthritis Impact Measurement Scale (AIMS). The quality and understanding of all scales were tested with Cronbach test for reliability. The results were statistically analyzed using Spearman test, the chi2 test or the chi2 test with Yates' correction, Kruskal-Wallis test and analysis of variance and covariance. The study group consisted of 155 RA patients (117 females and 38 males). No significant differences were found between males and females in age and in degree of radiological changes. RESULTS: The value of alpha-Cronbach's reliability factor accounted 0.99, 0.93, 0.81 in AIMS, HAQ and SF-36 questionnaires respectively. There were significant correlations between questionnaires and their scales, particularly in regard to physical fitness. The correlation between HAQ score and AIMS Physical Functioning scales in total and SF Physical Functioning accounted 0.78 and 0.67 (p < 0.001) respectively. No differences in evaluation of quality of life between men and women were found. No correlation was found between both the duration of RA and the age of patients and the activity of the disease as measured with DAS 28 indicator; correlation coefficient accounted 0.07 (p = 0.39) and 0.11 (p = 0.16) respectively. However, older subjects with longer duration of a disease and more active inflammatory process assessed their quality of life as poorer (correlation coefficient between DAS 28 and HAQ, AIMS Physical Functioning scales in total, SF-36 Physical Functioning accounted = 0.44, 0.43, -0.41 respectively; p = 0.0000. In addition, the radiological and functional stage of disease influenced essentially the assessment of the quality of life in examined group. CONCLUSIONS: 1. The questionnaires used in the study: HAQ, AIMS and SF-36 were highly useful and they mutually correlated significantly in assessing quality of life of patients suffering from rheumatoid arthritis. 2. High mutual correlation of the questionnaires assessing Quality of Life of RA patients, that was found in the study, indicates, that each of them could be interchangeably used in everyday medical practice. 3. Quality of life of rheumatoid arthritis patients depends on: radiological and functional stage of the disease, its duration and activity.

[Quality of life and activity of disease in patients with rheumatoid arthritis]. / Jakosc izycia i aktywnosc choroby u chorych na reumatoidalne zapalenie stawów.

PURPOSE: The aim of this study was to evaluate the quality of life in patients with rheumatoid arthritis (RA) considering their age, activity of the disease, its duration and radiological stage. MATERIAL AND METHODS: The study group consisted of 151 women (mean age 55.0 years, mean duration of RA 9.4 years) and 45 men (mean age 55.0 years, mean duration of RA 9.4 years). All subjects were treated at the Department of Rheumatology and at the SPSK-1 rheumatology outpatient clinic in Szczecin. Diagnosis of RA was established according to ARA criteria of 1987. The radiological stage of the disease was established according to Steinbrocker's criteria. The patient's quality of life was evaluated with the Health Assessment Questionnaire. The activity of RA was determined with the Disease Activity Score DAS 28. RESULTS: Significant correlation between HAQ score and DAS 28 was found (correlation coefficient--R = 0.38; p < 0.001). Age (R = 0.31, p < 0.001) and radiological stage of RA (R = 0.26, p < 0.001) were also found to affect the quality of life. CONCLUSIONS: The quality of life of patients with rheumatoid arthritis is significantly influenced by their age, activity of the disease, and radiological stage of RA.

[Adult-onset Still's disease]. / Choroba Stilla u doroslych.

INTRODUCTION: The authors present the course and manifestations of adult-onset Still's disease on the basis of five cases diagnosed at the Department of Rheumatology, Pomeranian Medical University in Szczecin. MATERIAL AND METHODS: The usefulness of two most popular sets of diagnostic criteria of adult-onset Still's disease (Yamaguchi and Cush) was analyzed. At onset of the disease, two out of five patients met both sets of the diagnostic criteria, two others met criteria of Yamaguchi and one of Cush. During follow-up, criteria of Yamaguchi were met in all cases. RESULTS: The authors suggest to use the Cushs criteria of adult-onset Still's disease when the patient does not meet the criteria of Yamaguchi and other causes of fever are excluded.