Ankylosing spondyloarthritis (AS) is a chronic inflammatory rheumatic disease, strongly related to human leukocyte antigen (HLA)-B27. Cardiac involvement in AS manifests in 2 to 10% of patients as aortic insufficiency, aortitis, mitral valve fibrosis, or disturbance in the conduction of the heart. In this article, we present a case of a 49-year-old male patient with AS, who was referred to our medical institution for elective aortic valve surgery because of severe aortic regurgitation. The histological findings revealed fibrosing endocarditis of aortic valve and nonspecific aortitis of aortic root. Late postoperatively, we observed exacerbation of AS and narrowing of the main left coronary artery (LAD). Our case highlights the importance of proper treatment of AS before and after cardiac surgery. Furthermore, in this case, we suspect association between cardiopulmonary bypass, activity of AS, and coronary artery disease.
Tyrimo tikslas. Išanalizuoti spondilodiscitu sirgusiųjų demografines charakteristikas, ligos klinikines, laboratorines išraiškas, gulėjimo stacionare trukmę, pasirinktą gydymo taktiką bei baigtis. Tyrimo metodai. Retrospektyviai išanalizuotos spondilodiscitu sirgusių pacientų, 15 metų laikotarpyje (nuo 2004 m. sausio iki 2018 m. gruodžio) gydytų Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose ligos istorijos. Vertinti šie kriterijai: demografiniai rodikliai, klinikiniai požymiai, gretutinė patologija, mikrobiologiniai ir laboratoriniai tyrimai, radiologiniai pokyčiai, pažeidimo lokalizacija, gydymo stacionare trukmė, gydymo būdas, antibiotikų skyrimas, ligos išeitys. Rezultatai. 73,2 proc. spondilodiscito atvejų gydyta konservatyviai, kombinuotas gydymas (chirurginis gydymas ir antibiotikoterapija) taikytas 26,7 proc. sirgusiųjų (n = 82). 78,1 proc. sirgusiųjų pasveiko, 23 pacientams nustatytas ligos atkrytis, mirtingumas – 2,9 proc. (n = 9). Išvados. Spondilodiscitas nustatytas vidutinio bei vyresnio amžiaus žmonėms, dalis jų serga lėtinėmis reumatinėmis, onkologinėmis ligomis, cukriniu diabetu. Dažniausias ligos simptomas – nugaros skausmas. Pagrindinis ligos sukėlėjas – S. aureus. Ypač pažeidžiama stuburo sritis – juosmeniniai slanksteliai. MRT – jautriausias ir specifiškiausias vaizdinis tyrimas diagnozuojant spondilodiscitą.
BackgroundInfectious spondylodiscitis is infection involving the intervertebral disc and contiguous vertebrae. Nowadays, cases of infectious spondylodiscitis are increasing [1]. Therefore it is important to include infectious spondylodiscitis in the differential diagnosis of low back pain.ObjectivesTo analyse the characteristics of infectious spondylodiscitis in patients treated in rheumatology department focusing upon clinical, bacteriological, therapeutical aspects and treatment outcomes.MethodsA retrospective monocentric study involving 82 cases of infectious spondylodiscitis admitted between January 2010 and December 2014 at the rheumatology department in Hospital of Lithuanian University of Health Sciences. Demographic characteristics, risk factors, underlying diseases, microorganism agents, different treatment, duration of treatment and outcome were recorded.ResultsEighty two patients are included in this study. There were 42 males (51.22%) and 40 females (48.78%). The mean age was 64.22 years, ranged from 30 to 86 years. No microorganism agent was found in 65.85% of patients (n=54). Microorganism agent was identified in 34.15% of patients (n=28) according to positive blood culture. Staphylococcus aureus was found in 50% of cases (n=14), Escherichia coli in 14.29% (n=4), MRSA in 7.14% (n=2). 58.54% of patients had sources of infection and 43.75% of them had septicaemia. In 65.85% of cases (n=54) patients felt a fever. 37,81% (n=31) of patients immune system was suppressed: 38.71% of them had diabetes mellitus type 2 (n=12), 41.94% oncology disease (n=13), 19.35% used glucocorticoids (n=6). In all cases 100% (n=82) patients felt affected area pain (neck, back pain). The most common affected place is lumbal vertebrae 82.9%. All patients were treated with intravenous antibiotics, in two cases also was applied surgical treatment. 48.78% of patients were treated with first generation cephalosporins, 39.0% of patients were treated with second generation cephalosporins, 32.93% of patients were treated with penicillin antibiotics, 12.20% of patients were treated with penicillin and beta-lactamase inhibitor combinations. Also 40.24% of patients additionally had metronidazole, 26.83% vancomycin and 15.85% clindamycin. The mean duration of intravenous treatment with antibiotics was 29 days. 12.20% patients had relapsed, 2 died. The period from onset of symptoms to diagnosis confirmation is between 1 and 24 weeks. Underlying rheumatic diseases were found in 46.3% of patients (n=38). 29.2% of patients had osteochondrosis, 11.0% gout and 6.1% rheumatoid arthritis.ConclusionsThe diagnosis of infectious spondylodiscitis are often delayed. Usually in less than half of cases it is possible to identify causative agent therefore broad-spectrum antibiotics are prescribed.ReferencesKehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. Journal of infection 2014 Apr;68(4):313-320.Disclosure of InterestNone declared
Background Inflammatory back pain (IBP) is one of the main presenting symptoms in spondyloarthropathies (SpA). The prevalence of inflammatory back pain in young people population is unknown. The identification of chronic IBP, starting before age 45 can help diagnose SpA early. Objectives To determine the prevalence of chronic low back pain and inflammatory back pain in a cohort of young people. Methods Students were asked to fill out the questionnaire containing questions about low back pain, symptoms duration, all relevant inflammatory back pain parameters (according Calin and ASAS IBP criteria). Overall 3480 questionnaires were completed. Results The average age of respondents was 24±4,75 years; 76,35% of respondents were females. 1744 (50,1%) students reported having at least one episode of low back pain. 10,3% of all respondents (358), had chronic back pain. From 2657 interviewed 10,6% females had chronic low back pain, from 823 males 9,2%. 72 students (2, 1%) fulfilled ASAS IBP criteria, 48 (1.8%) females, 24 (2.9% males) respectively.101 (2,9%) respondents were defined as suffering inflammatory back pain according Calin criteria, 73 (2,7%) females and 28 (3.4%) males. The difference between prevalence of IBP among genders was not statistically significant. Conclusions In our study prevalence of inflammatory back pain among young people cohort was 2,1-2,9%, prevalence of chronic back pain – 10,3%. The data suggest that prevalence of inflammatory back pain did not differ significantly between young men and women. Acknowledgements Sieper, J. et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann. Rheum. Dis. 68, 784–788 (2009). Calin, A. et al. Clinical history as a screening test for ankylosing spondylitis. JAMA 237, 2613–2614 (1977). Disclosure of Interest None Declared
Background: During the COVID-19 pandemic, telemedicine has become an important means to control the disease with the help of a doctor for patients with chronic diseases. To make treatment of chronic rheumatic diseases effective, it is important that patients have a positive attitude towards the remote consulting and maintained health related individual behavior, which depends on the patient’s health locus of control. Methods: The sample of the survey consists of 207 Lithuanian patients with chronic rheumatic diseases. Most of them have been diagnosed with spondyloarthritis (n=83), connective tissue diseases (n=53) and rheumatoid arthritis (n=49). To reveal the attitude towards remote consultations of a rheumatologist, an original questionnaire has been developed, which includes reasons for prioritizing remote consultations of a rheumatologist, and positive and negative attitude towards the consultations. Health locus of control was assessed by Multidimensional Health Locus of Control (MHLC) scale, which contains Internality, Chance and Powerful Others subscales. Results: The survey revealed the main reasons why patients with chronic rheumatic diseases choose remote consultations. When comparing the average of statements revealing positive attitude M=2.78 with the negative one of M=1.51 it becomes obvious that the attitude of subjects towards remote consultations is favorable. A correlation analysis was performed to assess the correlation of patient positive or negative attitudes towards remote consultations with the health locus of control. The results did not establish a correlation between patients’ positive attitude towards the named consultations and internality locus of control. However, it has been obtained that a negative attitude towards remote consultations has albeit not strong, but a statistically significant correlation with two indicators of health locus of control – Chance (r=0.203, p≤0.0001) and Powerful Others (r=0.94, p=0.01). Conclusion: The survey revealed a favorable attitude of patients with chronic rheumatic diseases towards remote consultations. Furthermore, it showed that personal conviction of a patient that health depends on circumstances and influence of other people worsens the attitude towards remote consultations. Keywords: telerheumatology, remote consultations, health locus of control.
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