Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease which is characterized by symetrical multiple joints involvement and extra-articular symptoms. Current EULAR diagnostic criteria for RA include disease activity parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are used to calculate disease activity scores, including DAS and DAS28. Recently attempts have been made to assess disease activity using imaging diagnostic modalities, such as magnetic resonance imaging (MRI) and ultrasonography (US). Due to significant progress in therapy effectiveness and early RA diagnosis possibility, imaging modalities become increasingly meaningful and many clinical trials confirm their usefulness. However, there are no consistent criteria for objective assessment of therapy effectiveness based on US. Moreover, it is not US availability that limits its common use, but rather significant variability between operators. This is why US remains only an additional tool to assess therapy efficacy with regard to DAS/DAS28 index.
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic progressive inflammatory diseases, leading to joint damage and reducing the physical fitness of patients. They are among the most common rheumatic diseases. However, their etiology and symptomatology are different. Formerly, AS was often wrongly diagnosed as RA. Today there are no major diagnostic difficulties in differentiation between these diseases, thanks to modern laboratory tests and imaging. However, a problem may arise when the patient has symptoms typical for both diseases simultaneously. Cases of coexistence of RA with AS – according to our best knowledge – are rare. This study aims to compare our experience in diagnosis and treatment of concomitant RA and AS with the experience of other researchers. Implementation of the proper diagnostic algorithm, allowing for correct diagnosis of both diseases in one patient, may be useful for differential diagnosis of similar cases in the future.
ObjectivesHypertrophic and exudative synovitis of the knee is one of the earliest symptoms in rheumatic diseases. In the case of pharmacotherapy failure, other methods which directly remove the inflamed synovial membrane are used – synovectomies. Radiosynovectomy (RSV) is the radiopharmaceutical application of colloidal solution to joint cavities. In this study, the authors assessed the efficacy of knee radiosynovectomy with yttrium-90 (Y-90) in several groups of patients divided into certain rheumatic diseases.Material and methodsThe study group consisted of 70 patients aged from 29 to 65 years with hypertrophic and exudative synovitis of the knee in rheumatic diseases such as rheumatoid arthritis, osteoarthrosis and spondyloarthropathies. Radiopharmaceutical colloid of Y-90, with a radiation dose of 185-222 MBq in a volume of 2-3 ml, was administered to joint. Then the knee joint was immobilized for 72 h. During visits V1, V2, V3 and V4, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured and ultrasound of the knee was performed. Disease activity was evaluated by the WOMAC scale, HAQ and 100-mm visual analog scale (VAS).ResultsThe most significant difference of synovial hypertrophy, before and after the procedure, was obtained in patients with rheumatoid arthritis. Variability of effusion before and after the procedure in all groups was comparable and statistically significant. The greatest improvement in variability of inflammatory parameters, before and 4 weeks after radiosynovectomy, was observed in patients with rheumatoid arthritis.ConclusionsIn the therapeutic algorithm radiosynovectomy should be located between conservative treatment and operative procedures. Radiosynovectomy does not require hospitalization or prolonged rehabilitation. Radiosynoviorthesis affects the patient's general condition, which is associated with eliminating pain and restoring joint function.
ObjectivesAmong autoimmune diseases, rheumatoid arthritis (RA) is the most common chronic inflammatory disease of the joints. Its pathogenesis is still not fully understood, but the gained knowledge has contributed to the development of modern treatment. The introduction of biological therapy for RA has been a breakthrough in the standard approach to the treatment of this disease.Material and methodsThe study material was retrospectively collected in the Rheumatology and Systemic Tissue Diseases Clinic and Rheumatology Outpatient Clinic in dr. Jan Biziel University Hospital No. 2 in Bydgoszcz. Patients were divided into 3 groups: patients receiving infliximab – 43 patients, etanercept – 27 patients and adalimumab – 34 patients. In the study, the pharmacoeconomic analysis included direct and indirect medical costs. Direct medical costs analyzed in the study included costs for the purchase of medications, diagnostic and imaging costs, and medical consultations and hospitalization costs. The analysis included all direct medical costs incurred by the hospital and the patient, as well as indirect costs outside the healthcare sector – that is, the Polish Social Insurance Institution benefits (disability benefits, rehabilitation benefits, sickness absences). Direct medical costs are also presented from the perspective of the payer – The Polish National Health Fund – taking into account the cost and percentage share of medical expenses.ResultsThe analysis concerned resources used since the beginning of treatment with a given biological medication for 24 months or earlier if disease remission occurred.A cost-benefit analysis was carried out in the study using biosimilar medications present on the market in relation to the treatment regimens. Considering the total cost, if only Inflectra were used in therapy, PLN 18 151.98 per patient could be saved, and in the case of Remsima, PLN 16 385.14. In less than 19 months, to use infliximab for 43 patients, PLN 780 475.80 more would have to be spent than in the case of the biosimilar medication Inflectra, and PLN 704 561 in the case of Remsima.The highest total cost is generated by treatment with adalimumab, followed by etanercept, and infliximab. Of the costs analyzed, a significant majority was for biological treatment.ConclusionsGiven the Polish financial conditions, the best solution now is to reduce the prices of biological medications. This is possible through the introduction of biosimilar medications that, when placed on the market, reduce the price of the original medication, as is currently the case with Remicade and Enbrel. The introduction of Inflectra and Remsima, as well as Benepali and Erelzi, has reduced the price base of original medications to similar levels of treatment with biosimilar medications. The wider use of biological treatment would also reduce indirect costs.
Zaburzenia ze strony przewodu pokarmowego w przebiegu tocznia rumieniowatego układowegoGastrointestinal manifestations associated with systemic lupus erythematosus J Jo oa an nn na a Z Za al le ew ws sk ka a, , T Ta ac cj ja an na a B Ba ar rc cz zy yń ńs sk ka a, , M Ma ał łg go or rz za at ta a W Wę ęg gi ie er rs sk ka a, , S Sł ła aw wo om mi ir r J Je ek ka a Klinika Reumatologii i Układowych Chorób Tkanki Łącznej, Szpital Uniwersytecki Nr 2 im. dr. Jana Biziela w Bydgoszczy, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, UMK w Toruniu S Sł ło ow wa a k kl lu uc cz zo ow we e: : toczeń rumieniowaty układowy, przewód pokarmowy, objawy gastroenterologiczne.K Ke ey y w wo or rd ds s: : systemic lupus erythematosus, alimentary tract, gastrointestinal manifestations. S t r e s z c z e n i eToczeń rumieniowaty układowy (TRU) jest chorobą autoimmunologiczną, w przebiegu której dochodzi do uszkodzenia wielu narządów i układów. Choroba charakteryzuje się różnorodnością objawów. Występowanie objawów gastroenterologicznych stanowi niekiedy problem diagnostyczny, gdyż mogą się one ujawniać w przebiegu choroby podstawowej, być wynikiem działań niepożądanych leków, ich przyczyną może być także współistniejąca choroba przewodu pokarmowego. S u m m a r ySystemic lupus erythematosus (SLE) is autoimmune connective tissue disease which leads to multi-system organ failure. The disease is characterized by a variety of symptoms. The presence of gastrointestinal symptoms is often a diagnostic problem, as they may result from the disease, medication side effects, and concomitant diseases of the digestive tract. WstępZwiązek między występowaniem objawów ze strony przewodu pokarmowego u chorych z toczniem rumieniowatym układowym (TRU) pierwszy zauważył William Osler. W 1895 r. wykazał on, że objawy żołądkowo-jelitowe mogą maskować przebieg choroby [1]. Jadłowstręt, nudności i wymioty występują u ok. 50% pacjentów z TRU. Stanowią one element procesu chorobowego w TRU, ale występują również w przebiegu odrębnych chorób współtowarzyszących lub są wynikiem stosowanej farmakoterapii [2]. Sultan i wsp.[3] podkreślają, iż na przestrzeni lat zmieniło się podejście do tego zagadnienia. Zauważyli oni, że badacze lat 60. i 70. XX wieku opisywali niezwykle małą częstość występowania objawów gastroenterologicznych w przebiegu choroby -od 1,3% wg Couris i wsp. do 27,5% wg Matolo i Albo [4,5]. Jama ustnaZmiany w jamie ustnej zostały opisane po raz pierwszy przez Bazina w 1861 r. Należą one do kryteriów TRU ustanowionych przez American College of Rheumatology [6]. Owrzodzenia jamy ustnej występują u 7-52% pacjentów z TRU [7]. Różnorodna częstość występowania owrzodzeń jamy ustnej wynika z demograficznych różnic między badanymi populacjami. Najczęściej, bo u 46% pacjentów chorujących na TRU, zmiany występowały u mieszkańców Wielkiej Brytanii, natomiast w Brazylii dotyczyły 15% pacjentów, a w Szwecji 11% chorych [3]. Najczęściej zajętymi okolicami są błona śluzowa policzków, podniebienie twarde oraz granica języczka. Wyróżnia się zmiany o char...
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