ABSTRACT
OBJECTIVE: Previous studies have shown that Helicobacter pylori (HP) infection is associated with increased activity and severity of systemic sclerosis (SSc), hence we aimed to evaluate the effect of HP eradication on various symptoms and inflammatory indices. METHODS: The SSc patients without dyspeptic symptoms were prospectively enrolled in this 18-month cross-sectional study. Patients were divided into two groups based on determination of HP infection. The infected group was treated in accordance with the current HP eradication protocol. Assessment of disease activity, severity and organ involvement was performed every 6 months. RESULTS: A total of 42 consecutive SSc patients without dyspepsia and variable disease activity and severity were recruited. Levels of modified Rodnan skin score, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) significantly decreased following HP eradication (pâ¯< 0.001, pâ¯< 0.001 and pâ¯= 0.001, respectively), and in the HP-negative patient group ESR and CRP values increased (pâ¯= 0.03, pâ¯= 0.002). Eradication of HP in the group of infected patients induced progressive and significant improvement of disease activity and severity over time compared to baseline (pâ¯< 0.01, pâ¯< 0.001, respectively), whereas in the HP-negative patient group these scores remained unchanged. In our study, HP eradication was associated with an improvement of clinical symptoms and disease activity. CONCLUSION: These findings suggest that HP detection and subsequent eradication could be beneficial in the management of SSc patients. Although, HP eradication seems to be advantageous in infected SSc patients, larger controlled studies are needed for a potential recommendation.
Subject(s)
Dyspepsia , Helicobacter Infections , Helicobacter pylori , Scleroderma, Systemic , Humans , Helicobacter pylori/metabolism , Cross-Sectional Studies , Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Dyspepsia/complications , Dyspepsia/drug therapy , C-Reactive Protein/analysis , Scleroderma, Systemic/complications , Scleroderma, Systemic/diagnosis , Scleroderma, Systemic/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
OBJECTIVE: To analyze the correlations of saliva production and pH value with disease activity, disease severity, and oral health-related quality of life in patients with diffuse cutaneous systemic sclerosis (dcSSc) without concomitant Sjögren's syndrome (SS) or SS-related antibodies. METHODS: This cross-sectional study included 28 patients with dcSSc and matching healthy controls. Sialometric assessment and caries status were compared between the two groups. Clinical and laboratory parameters were used to evaluate disease severity, in accordance with the Medsger Severity Scale. RESULTS: In patients with dsSSc, reduced saliva production and higher pH value were associated with disease activity and severity; moreover, caries status was correlated with SSc disease characteristics, including disease duration and disease severity. Oral health-related quality of life was negatively correlated with mean salivary flow rate. CONCLUSIONS: These findings contradict the existing notion that reduced saliva production in patients with SSc is linked to SS-related antibodies or caused by underlying SS. In addition, patients with dcSSc exhibit elevated risk of cardiovascular disease and invasive dental treatment has been shown to enhance the rates of stroke and heart attack in the general population; therefore, oral health is particularly important in patients with SSc.
Subject(s)
Scleroderma, Diffuse , Sjogren's Syndrome , Cross-Sectional Studies , Dental Caries Susceptibility , Humans , Quality of Life , Saliva , Scleroderma, Diffuse/diagnosis , Sjogren's Syndrome/diagnosisSubject(s)
Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Adult , Age Distribution , Aged , Aged, 80 and over , Cohort Studies , Croatia/epidemiology , Demography , Female , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Young AdultABSTRACT
Systemic sclerosis (SSC) is an autoimmune disease associated with the risk of malignancies, especially lung cancer, among which adenocarcinoma and squamous cell carcinoma are the most frequent. A 63-year-old female patient with SSC was hospitalized due to blackouts, poor general condition, and changes in her fingers. Because of subsequent epileptic seizures resulting in weakness of the left side of her body, computerized tomography (CT) of the neurocranium was performed which showed metastatic lesions. A CT scan of the thoracic organs displayed pulmonary neoplasia in the right hilum, which were histologically evaluated as grade 2 squamous cell carcinoma. After one month of hospitalization with supportive therapy, the patient's clinical condition improved, and she was discharged into home care with recommendations for further oncological treatment. However, the patient died several days later. In comparison to adenocarcinomas, squamous cell carcinomas of the lungs usually develop through a significantly longer period. We consider that the unusually rapid development of the carcinoma in this patient was stimulated by the immunosuppressive effect of high doses of glucocorticoids that she had been taking for several years on her own initiative.
Subject(s)
Brain Neoplasms/chemically induced , Carcinoma, Squamous Cell/chemically induced , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Lung Neoplasms/chemically induced , Scleroderma, Systemic/drug therapy , Brain Neoplasms/diagnostic imaging , Fatal Outcome , Female , Humans , Lung Neoplasms/diagnostic imaging , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Polymyositis (PM) is an autoimmune disease which affects skeletal muscles. In young age, it usually occurs as an idiopathic disorder associated with specific autoantibodies (anti-Jo), while in older age it is often associated with neoplasms. It can present with symptoms of other autoimmune diseases, such as systemic sclerosis (SSc), a rare progressive disease characterized by collagen deposits in various tissues and organs. A 65-year-old patient, long-time smoker, came to the ER because of painful edema in the distal parts of his limbs and proximal muscle weakness of his arms and legs. Although his muscle enzymes were not increased, PM was confirmed by the characteristic pathohistological finding. The patient had sclerodermal skin lesions on his back, but he did not have other typical SSc symptoms, and the specific autoantibodies were negative. He received glucocorticoid therapy (GC) after we had finished screening for malignant tumors. He felt better, his muscle strength returned, and the limb edema disappeared. Four weeks later, he developed symptoms which are more typical of SSc, such as dysphagia, Raynaud's phenomenon, and skin thickening of the limbs that had been swollen. PM is often associated with SSc. It is not clear if the exacerbation of latent SSc was stimulated by GC, or if it was just a simple overlap of the two diseases with different onsets. There are no therapy guidelines for the treatment of this combination of diseases. Careful use of GC is necessary even if SSc symptoms are discreet, because of the well-known effects of GC in SSc.
Subject(s)
Glucocorticoids/therapeutic use , Polymyositis/complications , Polymyositis/drug therapy , Scleroderma, Systemic/complications , Scleroderma, Systemic/drug therapy , Aged , Humans , MaleABSTRACT
Fibromylagia (FM) is a complex chronic condition usually presenting with symptoms of widespread pain and fatigue, as well as sleep and cognitive disorders. The diagnosis is made by exclusion of other diseases and according to the EULAR criteria. The treatment of the disease is multidisciplinary and associated with a better understanding of the disease pathophysiology. The most commonly used drugs are tricylic antidepressants (TCA), serotonin and noradrenalin uptake inhibitors (SNRI), anticonvulsants, and opioids. For the purpose of reducing the patient's overall symptom burden, adjunctive therapy with medicines targeted at specific symptoms, including sleep disorders, symptoms of irritable bowel syndrome, or autoimmune diseases, should be considered. Current therapeutic models neither completely treat FM symptoms nor benefit all patients; therefore, further research on new therapeutic approaches is needed.
Subject(s)
Fibromyalgia/classification , Fibromyalgia/therapy , Rheumatic Diseases/diagnosis , Fibromyalgia/diagnosis , Humans , Rheumatic Diseases/therapyABSTRACT
Golimumab is a human monoclonal antibody which inhibits tumor necrosis factor-alpha (TNF-α) and is approved for the treatment of inflammatory arthritides (rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis) when the conventional non-pharmacological and pharmacological therapies fail to cause remission or low disease activity. In this retrospective study there were included patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis who were treated in Croatia with golimumab, from June 2011 to June 2013. included and these retrospective data are compared with similar data from clinical trials and other available databases. Standard variables of disease activity and functional ability were observed. Results demonstrated significant efficacy of golimumab regarding lowring the disease activity and imrpving functional ability in pateints with these inflammatory rherumatic disease. In conclusion, in this retrospective study during two years treatment golimumab showed efficacy in decreasing disease activity and imrpove functional ability in patiemts with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Psoriatic/drug therapy , Arthritis, Rheumatoid/drug therapy , Spondylitis, Ankylosing/drug therapy , Arthritis, Psoriatic/physiopathology , Arthritis, Rheumatoid/physiopathology , Croatia , Humans , Retrospective Studies , Spondylitis, Ankylosing/physiopathologyABSTRACT
It is a well-documented fact that sex hormones are implicated in the immune response and that androgens and estrogens modulate susceptibility and progression of autoimmune rheumatic diseases. Estrogens are considered to stimulate cell proliferation and humoral immune responses while androgens exert suppressive effects on both humoral and cellular immune responses. Autoimmune diseases are common in females, especially during the generative period, the most representative of estrogen-related autoimmune diseases being systemic lupus erythematosus. Estrogens and androgens are involved in the pathogenesis of the disease; both exogenous and endogenous estrogens are strong stimulators of cytokine production and disease activity. Some physiological conditions, as well as some drugs and chronic stress, can modulate hormone levels. Low levels of gonadal androgens have been detected in body fluids of both male and female rheumatoid arthritis patients, supporting the possibility of the pathogenic role for decreased androgen levels. Views on hormone replacement therapy or hormonal contraception in rheumatic diseases have been modified and in most rheumatic diseases, including rheumatoid arthritis, hormones are not prohibited. There are still controversies regarding systemic lupus; the new standpoint being that hormonal contraception is not contraindicated in women with inactive or stable active SLE, except for those with positive antiphospholipid antibodies.
Subject(s)
Androgens , Estrogens , Rheumatic Diseases , Female , Humans , Lupus Erythematosus, Systemic , MaleABSTRACT
Rheumatoid arthritis (RA) is chronic inflammatory rheumatic disease which leads to joint damage, functional im- pairment and reduced quality of life. The disease should be recognized early when there is a "window of oppor- tunity" to apply adequate treatment which may prevent structural damage. As clinical presentation of RA is not always typical, great knowledge and clinical experience, including collaboration of rheumatologist, general practi- tioner and patient, are required. The treatment should be started immediately upon the diagnosis, while the choice of modality of treatment depends on the rheumatologist in accordance with the patient. The RA patients with the higher risk of aggressive disease need to be recognized because they require more aggressive treatment from the start. The goal of the treatment is remission or at least low disease activity. Current treatment of RA includes disease modifying antirheumatic drugs (DMARDs) synthetics and biologics, nonsteroidal antirheumatic drugs (NSAIDs), glucocorticoids, analgesics, and rarely cytostatics. The course of disease is usually fluctuating with the exchange of relapses and remissions. Recognition of the relapsing patient on time enables treatment intensification or modifications in treatment scheme. Special issue in RA represents glucocorticoid-induced osteoporosis (GIO) which should be prevented by usage of calcium and vitamin D supplements and treated by antiresorptive or osteoanabolic agents. Besides the treatment of the primary disease, the care of RA patients should consider comorbidities, side effects of treatment, complications of disease, and psychosocial aspects of chronic disease.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthritis, Rheumatoid/diagnosis , Biological Products/therapeutic use , Humans , Recurrence , Remission InductionABSTRACT
Vasculitis is clinicopathologic process characterized by inflammation and damage of blood vessels, often resulting in complete or partial occlusion of the involved vessels and ischemic damage to the supplied organ or tissue. The vasculitides are a large group of heterogeneous diseases for which it has been assumed that pathogenesis is largely autoimmune. It may be a primary or secondary manifestation of a disease process and may affect single or multiple organs. Inflammation affects vessel's walls partly or completely resulting with the loss of vascular integrity. Vasculitides has been classified by whether inflammation predominantly damage small, medium, or large vessels.
Subject(s)
Vasculitis/physiopathology , HumansABSTRACT
The objective was to analyse epidemiological tendencies of rheumatoid arthritis (RA) in Dalmatia County in order to identify possible spatial clusters of RA. Patient-interviewers were trained to administer telephone surveys. 197 RA patients controlled at Rheumatology and immunology department of Clinical hospital of Split were mapped to place of residence by telephone survey. Statistical evidence of clustering was determined by calculating Poisson probabilities in putative areas. Four clusters were identified; the largest one was in the region of Sinj. The female/male ratio was 5.79:1. Majority of RA patients were among age 50 to 59 (30.45 %). The results show inter-regional variations with the marked clusters in the north of Dalmatia suggesting that clusters with higher incidence of RA have specific genetic and environmental background. Prevalence of RA in female was higher than in current literature, while the age of onset 50-59 years is similar with data from recent studies.
Subject(s)
Arthritis, Rheumatoid/epidemiology , Croatia/epidemiology , Female , Health Surveys , Humans , Male , Middle Aged , Prevalence , Sex DistributionABSTRACT
Hypertrophic osteoarthropathy is a syndrome presenting with dclubbing, limbs enlargement, pain and swelling of foot and long bones osteitis. Hypertrophic osteoarthropathy is a rare paraneoplastic syndrome in the patients with primary or metastatic lung cancer. We report 39-year old female patient who presented with arthritis and paraneoplastic hypertrophic osteoarthropathy revealing lung adenocarcinoma.
Subject(s)
Adenocarcinoma/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Osteoarthropathy, Secondary Hypertrophic/etiology , Paraneoplastic Syndromes/etiology , Adenocarcinoma/complications , Adult , Female , Humans , Lung Neoplasms/complications , RadiographySubject(s)
Acute Coronary Syndrome/chemically induced , Contrast Media/adverse effects , Drug Hypersensitivity/etiology , Meglumine/adverse effects , Organometallic Compounds/adverse effects , Contrast Media/administration & dosage , Female , Humans , Magnetic Resonance Imaging/adverse effects , Magnetic Resonance Imaging/methods , Meglumine/administration & dosage , Middle Aged , Myocardial Ischemia/chemically induced , Organometallic Compounds/administration & dosage , SyndromeABSTRACT
Helicobacter pylori (H. pylori) is suspected to be one of the factors triggering systemic sclerosis (SSc). Data on the possible role of H. pylori are lacking. The aim of this study was to assess the effect of H. pylori infection in SSc patients. Forty-two SSc patients without dyspeptic symptoms were recruited--26 were H. pylori-positive and 16 were H. pylori-negative on the basis of invasive test. We evaluated the disease severity using clinical and laboratory parameters according to the Medsger Severity Scale. The level of SSc activity was evaluated according to Valentini activity score. The prevalence of H. pylori infection in population of SSc patients is 62%. Severity of skin, gastrointestinal, and joint/tendon involvement was different between H. pylori-positive and -negative SSc patients (p < 0.001 for skin involvement, p = 0.002 and p = 0.03 for gastrointestinal and joint/tendon involvement, respectively) as well as erythrocyte sedimentation rate (p = 0.002). Severity score according to Medsger was higher in the H. pylori-positive than in the H. pylori-negative SSc patients (p < 0.001). Our data suggest that H. pylori infection correlates with severity of skin, gastrointestinal, and joint/tendon involvement in SSc patients. H. pylori-positive SSc patients showed higher severity score compared to H. pylori-negative. Therefore, H. pylori infection may play a role in the pathogenesis of SSc and also can provide some prognostic information.
Subject(s)
Helicobacter Infections/complications , Helicobacter pylori/isolation & purification , Scleroderma, Systemic/complications , Adult , Aged , Female , Humans , Male , Middle Aged , Prognosis , Risk Factors , Scleroderma, Systemic/diagnosis , Severity of Illness IndexABSTRACT
The antineutrophil cytoplasmic antibody (ANCA) are associated with distinct forms of primary small vessel vasculitides, collectively reffered to as ANCA-associated vasculitis (AAV). ANCA were originally identified by IIF. Importantly, however, only ANCA directed to PR3 (PR3-ANCA) or MPO (MPO-ANCA) are relevant for the diagnosis AAV, there is international consensus that ANCA should be detected by a combination of IIF and antigen-specific assays, i.e. detection of PR3 and MPO-ANCA. Several novel technologies have become available for antigen-specific ANCA detection.
Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Antibodies, Antineutrophil Cytoplasmic/analysis , Biomarkers/blood , Clinical Laboratory Techniques , HumansABSTRACT
The anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides are a group of uncommon diseases characterised by inflammatory cell infiltration and necrosis of blood vessel walls. ANCA there has been considerable progress towards understanding their pathogenesis. This results in endothelial activation with increased transmigration and adherence of neutrophils to vessel walls. Specific for granulomatosis with polyangiitis are nasal or oral inflammation and development of oral ulcers and purulent or bloody nasal discharge. The chest radiograph usually showed the presence of nodules or fixed infiltrates. Microscopic polyangiitis affects the smallest blood vessels and may also affect medium-sized vessels, demonstrates the tropism for the kidneys--glomerulonephritis and lungs--pulmonary capillaritis. The characteristic features of eosinophilic granulomatosis with polyangiitis are asthma, eosinophilia in peripheral blood, sinusitis and pulmonary infiltrates which may be transient, than mononeuritis multiplex. It is important to differentiate ANCA vasculitis and syndromes that may mimic them, particularly infection, malignancy and connective tissue disease.
Subject(s)
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Antibodies, Antineutrophil Cytoplasmic/analysis , Churg-Strauss Syndrome/diagnosis , Diagnosis, Differential , Granulomatosis with Polyangiitis/diagnosis , Humans , Microscopic Polyangiitis/diagnosisABSTRACT
Polymyositis and Dermatomyositis are often connected with autoimmune diseases and are closely linked with specific autoantibodies. Clinical manifestations are mild in correlation with clinical picture ofmyositis related to malignancy. Pulmonary complications are main cause of mortality in overlap syndromes with autoimmune diseases. Infection, cardiovascular complications and underlying malignancy provide greater mortality risk.
Subject(s)
Autoimmune Diseases/diagnosis , Connective Tissue Diseases/diagnosis , Dermatomyositis/diagnosis , Neoplasms/diagnosis , Polymyositis/diagnosis , Autoimmune Diseases/complications , Connective Tissue Diseases/immunology , Dermatomyositis/immunology , Humans , Neoplasms/immunology , Polymyositis/immunology , SyndromeABSTRACT
Vaccine preventable infections occur more often in patients with autoimmune and chronic rheumatic diseases when compared to the general population. Most vaccines are immunogenic, efficacious and safe in those patients, even with immunosuppressive treatment, excluding rituximab. Live attenuated vaccines should be avoided in patients receiving long-term immunosuppressive therapy. The occurrence of adverse events and autoimmune phenomena is almost the same in vaccinated patients with rheumatic diseases and in vaccinated healthy individuals. A deeper research is needed regarding safety of vaccination and the influence of new immunomodulating drugs on efficacy of vaccination since the studies that were undertaken so far are retrospective or performed on small cohorts of patients. Evidence-based recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases developed by European League Against Rheumatism (EULAR) will help rheumatologists in making a decision about vaccinating their patients.