The Influence of Rheumatoid Arthritis and Osteoarthritis on the Occurrence of Arterial Hypertension: An 8-Year Prospective Clinical Observational Cohort Study.

Rheumatoid arthritis (RA) increases the risk of cardiovascular mortality and morbidity, including a 50-60% increased risk of cardiovascular disease (CVD). Arterial hypertension (HT) is considered the major contributing risk factor for CVD development in RA patients. In this investigation, we compared the incidence and prevalence of HT between RA and osteoarthritis (OA) and the influence of HT on CVD development in CVD-naive patients in both groups. This was a prospective clinical cohort investigation with an 8-year follow-up period. A total of 201 participants, 124 with RA (investigation group) and 77 with OA (control group), without diagnosed CVD or symptomatic heart failure were included. After selection according to inclusion and exclusion criteria, both groups underwent initial and final visits, and the investigation group underwent annual visits to assess disease activity. Case report forms were completed for each visit. The obtained data were analyzed by a statistician. No difference in the incidence or prevalence of HT was found between the investigation and control groups. No difference in the prevalence of HT was reported between the study groups and age-standardized data from the general population. The investigation group had a higher incidence of CVD than the control group. RA participants with long-term remission had a marginally lower HT prevalence. Although previous studies reported a higher HT prevalence in RA than in OA and the general population, our findings did not support this. The RA group had a higher incidence of CVD, but it is possible that optimal disease control with long-term remission could reduce HT incidence and prevalence while also having beneficial effects on other cardiovascular risk factors (CV) and, consequently, CVD occurrence.

Role of Inflammatory Cytokines in Rheumatoid Arthritis and Development of Atherosclerosis: A Review.

Uncontrolled chronic inflammation results in cardiovascular disease and early death. In this review, we studied the impact of rheumatoid arthritis on the cardiovascular system, including the early and accelerated development of atherosclerosis and its clinical manifestations, focusing on the inflammatory mechanisms leading to arterial wall damage, rapid atherosclerotic plaque formation, and thrombosis. Furthermore, the effect of medications used to treat rheumatoid arthritis on the cardiovascular system was studied. The effect of chronic inflammation and medication on traditional cardiovascular risk factors is not the main subject of this review. We observed that uncontrolled chronic inflammation and some medications directly impact all the stages of atherosclerosis. In conclusion, reducing inflammation and maintaining long-term remission in rheumatoid arthritis may prevent early atherosclerosis. We believe that this review will encourage a better interdisciplinary approach to the management of these patients and further research in this field.

Role of galectin-3 in diagnosis and severity assessment of epicardial artery lesions in patients with suspected coronary artery disease.

BACKGROUND: This study aimed to investigate the possible role of serum galectin-3 (Gal-3) levels in the diagnosis and assessment of significant epicardial artery lesions in patients with suspected coronary artery disease (CAD). METHODS: This was a single-center cross sectional cohort study including 168 subjects with suspected CAD and indications for coronary angiography divided into three groups: percutaneous coronary intervention (PCI) group (N 64), coronary artery bypass graft surgery (CABG) group (N 57), and group with no coronary stenosis (N 47). Gal-3 levels were measured and the syntax score (Ss) was calculated. RESULTS: The mean value of Gal-3 in the PCI and CABG group was 19.98 ng/ml, while in the control group, it was 9.51 ng/ml (p < 0.001). The highest value of Gal-3 was found in the group of subjects with three-vessel disease (p < 0.001). When subgroups were analyzed by Gal-3 levels (< 17.8 ng/ml low, 18.8-25.9 ng/ml intermediate, > 25 ng/ml high risk) there was a significant difference between at least two Gal-3 groups for the arithmetic mean of Syntax score (p < 0.001). The syntax I's arithmetic mean at low and intermediate-risk Gal-3 levels was significantly lower than at high-risk Gal-3 levels (p < 0.001). CONCLUSION: Gal-3 could be used as an additional tool for diagnosis and severity assessment of atherosclerotic disease in patients with suspected CAD. Furthermore, it could help identify high-risk subjects in patients with stable CAD.

Differences in the prevalence and characteristics of metabolic syndrome in rheumatoid arthritis and osteoarthritis: a multicentric study.

The purpose of the study was to examine whether rheumatoid arthritis (RA) patients have higher prevalence of metabolic syndrome (MetS) than osteoarthritis (OA) patients in association with a higher level of chronic systemic inflammation in rheumatoid arthritis. A total of 583 RA and 344 OA outpatients were analyzed in this multicentric study. Metabolic syndrome was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. A 1.6-fold higher prevalence of MetS was found in patients with OA compared with the RA patients. Among the parameters of MetS, patients with OA had significantly higher levels of waist circumference, systolic blood pressure, fasting blood glucose and triglycerides, whereas HDL cholesterol and diastolic blood pressure values were similar in both groups of patients. Higher values of inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)] in MetS than in non-MetS patients and higher prevalence of MetS in patients with CRP level ≥5 mg/L in both RA and OA patients were found. In multivariate logistic regression analysis, significant predictors of MetS were type of arthritis (OA vs. RA; OR 2.5 [95 % CI 1.82-3.43]), age (OR 1.04 [95 % CI 1.03-1.06]) and ESR (OR 1.01; [95 % CI 1.00-1.01]). The significant association between OA and MetS was maintained in the regression model that controlled for body mass index (OR 1.87 [95 % CI 1.34-2.61]). The present analysis suggests that OA is associated with an increased risk of MetS, which may be due to a common underlying pathogenic mechanism.

[Antisynthetase syndrome - a case report]. / Antisintetaza sindrom - prikaz bolesnice.

Twenty-eight year-old woman with predominant signs of polymyositis, pulmonary interstitium involvement and with positive anti-Jo1 antibodies was suspected for antisynthetase syndrome. Over the next three months sores and ulcerations have appeared at the fingertips. In the later course of the disease clinical picture of mixed connective tissue disease associated with interstitial lung disease, with a dominant picture of systemic sclerosis have emerged. She was treated with glucocorticoides and immunosuppressive therapy. Patient condition was mostly stable, without significant progression of lung lesions. Early diagnosis and treatment antisynthetase syndrome significantly contributes to more favorable course and outcome of disease. A prerequisite for that are well-defined diagnostic criteria and an appropriate choice of treatment.

Is the prevalence of arterial hypertension in rheumatoid arthritis and osteoarthritis associated with disease?

In this study, we compare the prevalence of arterial hypertension (HT) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients, exposed to high- and low-grade chronic inflammation, respectively, to assess the possible association between chronic inflammation and HT. A total of consecutive 627 RA and 352 OA patients were enrolled in this multicentric study. HT was defined as a systolic blood pressure (BP) ≥ 140 and/or diastolic BP ≥ 90 mmHg or current use of any antihypertensive drug. Overweight/obesity was defined as body mass index (BMI) ≥ 25, and patients ≥65 years were considered elderly. The prevalence of HT was higher in the OA group than in the RA group [73.3 % (95 % CI, 68.4, 77.7) and 59.5 % (95 % CI, 55.6, 68.4) P < 0.001, respectively]. When the results were adjusted for age and BMI, the HT prevalence was similar in both groups [RA 59 % (95 % CI, 55.1, 63.8) OA 60 % (95 % CI, 58.4, 65.0)]. In both groups, the prevalence of HT was higher in the elderly and those who were overweight than in the younger patients and those with a BMI < 25. Overweight (BMI ≥ 25) and age ≥65 were independent predictors of HT in multivariate logistic regression model, which showed no association between HT and the disease (RA or OA). The results indicate a robust association of age and BMI with HT prevalence in both RA and OA. The difference in HT prevalence between RA and OA is due rather to age and BMI than to the features of the disease, putting into question specific association of HT with RA.

[Laboratory diagnostics of polymyositis/dermatomyositis]. / Laboratorijska dijagnostika polimiozitisa/dermatomiozitisa.

Polymyositis/dermatomyositis is chronic systemic inflammatory disease that usually affects the skin and muscle tissue. The diagnosis of polymyositis/dermatomyositis isn't simple, and represents challenge for clinicians, it is based on the integration of results: medical history and clinical presentation, laboratory findings enzymes more or less specific to muscle tissue, myositis-specific autoantibodies and autoantibodies associated with myositis which can be found at other inflammatory connective tissue diseases without myositis, electromyography findings, and biopsy of muscle and skin. Laboratory tests contribute and assist in the diagnosis of polymyositis/dermatomyositis but they should always be evaluated in context with clinical picture and other tests and decisions about diagnosis and/or treatment are based on the integration of the results.

Fulminant meningococcal sepsis in a young child--a case report.

We are presenting a case of isolated fulminant meningococcal sepsis with two and a half year old child. Initial symptoms were obscure and common to many medical conditions, but also previously described as symptoms of meningococcal sepsis. Unrecognizing the seriousness of the condition child died at home, within few hours after examination and discharge from the hospital. Autopsy and microbiological findings unquestionably proved that the child died from septic shock caused by fulminant meningococcal sepsis.

[Arthritis in paraneoplastic syndrome--a way to early cancer diagnosis? A case report]. / Artritis u sklopu paraneoplasticnog sindroma- -put do rane dijagnoze neoplazme? Prikaz bolesnika.

Paraneoplastic syndrome is defined by clinical, radiological, and biological features associated with malignant disease without direct tumor invasion. The aim of our study was to present clinical and laboratory features of six cases ofparaneoplastic arthritis, witch can help to establish early cancer diagnosis, and help to distinguish paraneoplastic arthritis from other rheumatic diseases. According to our case analysis, pareneoplastic arthritis has occurred in both sex equally, all patients were older than 45 years, in most of cases it occurred within 14 months before cancer diagnosis, usually in early stage of cancer. Clinical features of paraneoplastic arthritis were: symmetric poliarthritis, usually were affected small hand joints and knees, predominant acute onset, and rheumatic nodes weren't present. Laboratory tests showed: high inflammatory markers (C-reactive protein, and erythrocyte sedimentation level), negative rheumatoid factor, and negative anti-citrullinated protein antibody. X-ray scan did not show signs of joint destruction. Long term remission ofparaneoplastic arthritis was achieved by treatment of cancer.

Vascular thrombosis associated with antiphospholipide syndrome.

The aim of this study was to present our diagnostic and therapeutic experience with antiphospholipide syndrome (APS) and vascular thrombosis. Ninety-nine patients with positive antiphospholipide antibodies (aPL) and vascular thrombosis were included in the study: forty patients, according to clinical classification criteria, had primary antiphospholipide syndrome (PAPS), and fifty-nine patients had secondary antiphospholipide syndrome (SAPS). In PAPS group, 82.5% of the patients were LA-positive, 37.5% of the patients were IgG aCL-positive, 27.5% of the patients were IgM aCL-positive, and 15% of the patients were IgG antibeta2GPI-positive. In SAPS group, 61% of the patients were LA-positive, 50.8% of the patients were IgG aCL-positive, and 47.5% of the patients were IgM aCL-positive. Administered therapy was low molecular weight heparin (LMWH) throughout 7 days, followed by warfarin with prothrombin time maintained between 2.0 and 3.0 INR.

Giant cell arteritis: how to diagnose?--a case report.

We present a case of 77 years old male with suspected giant cell arteritis. With anamnesis, physical examination, immunological tests, Colour Doppler ultrasonography of superficial temporal artery and finally with patohistological analysis of temporal artery biopsy, we came to right diagnosis.