ObjectiveThe objective of this study was to determine the length of delay in diagnosis of inflammatory rheumatic diseases, and to indicate the main factors responsible for such delays.Material and methodsA retrospective multi-centre questionnaire survey carried out among 197 patients with diagnosed inflammatory rheumatic diseases or undergoing the diagnostic process.ResultsThe most common early symptoms of inflammatory rheumatic disease included joint pain (94%), joint swelling (78%), morning joint stiffness (77%), fatigue (76%), and sleep disturbed by joint pain (74%). When asked about the reasons for seeking medical help, most patients indicated intensification of the symptoms (89%) and the fact that the symptoms made them unable to perform daily activities or work (86%). Limited access to specialists (70%) and the conviction that the symptoms will resolve spontaneously (57%) had the biggest impact on delaying a visit to a doctor. Before visiting a rheumatologist, the patients consulted their symptoms with their general practitioners (GPs, 95%), orthopaedicians (43%), and neurologists (29%). Almost half of the patients (48%) consulted their symptoms with at least 2 non-rheumatologists, whereas as many as 21% of patients visited 4 or more specialists. After the onset of symptoms of rheumatic disease, 28% of patients delayed seeing any doctor for 4 months or longer. 36% of patients waited 4 months or longer for a referral to a rheumatologist. The great majority of the patients (85%) made an appointment with a rheumatologist within a month of receiving a referral. 25% of patients waited 4 months or longer to see a rheumatologist.ConclusionsDiagnostic delays result from both the level of patients’ awareness (ignoring early symptoms) and improper functioning of the health care system. In the case of the health care system, the source of delays is not only “queues to rheumatologists”, but also referring patients to non-rheumatologists.
Labial salivary gland biopsy (LSGB) is a minimally invasive and safe surgical procedure performed in the diagnosis and monitoring of selected diseases such as Sjögren's syndrome (SS), sarcoidosis, and amyloidosis. The aim of this study is to present the main possibilities and indications for the usefulness of LSGB in these diseases, their histopathological criteria, and the main advantages and limitations. Histopathological confirmation of SS is based on the presence of lymphocytic infiltrates, known as focal lymphocytic sialadenitis (FLS). FLS refers to the histopathological pattern of the presence of one or more foci in the biopsies, while the tissue surrounding the foci is composed mainly of unaffected parenchyma. A focus is defined as an aggregate of ≥ 50 lymphocytes, and the focus score (FS) is the total number of foci per 4 mm 2 of salivary gland tissue. FLS should be distinguished from other types of sialadenitis such as nonspecific chronic sialadenitis, sclerosing chronic sialadenitis, granulomatous inflammation, and lymphomas. Streszczenie Biopsja wargowych gruczołów ślinowych (LSGB) jest minimalnie inwazyjnym i bezpiecznym zabiegiem chirurgicznym wykorzystywanym w diagnostyce i monitorowaniu wybranych chorób, takich jak zespół Sjögrena (SS), sarkoidoza, amyloidoza. Celem pracy było przedstawienie głównych możliwości i wskazań do zastosowania LSGB, kryteriów histopatologicznych, głównych zalet i ograniczeń. Histopatologiczne potwierdzenie SS opiera się na stwierdzeniu obecności nacieków limfocytarnych znanych jako ogniskowe limfocytarne zapalenie gruczołów ślinowych (FLS). Nazwa FLS odnosi się histopatologicznie do obecności jednego lub więcej ognisk w biopsji, podczas gdy ognisko jest otoczone głównie przez niezmienioną tkankę miąższową. Ognisko jest definiowane jako skupisko 50 lub więcej limfocytów, a wynik jest liczbą ognisk przypadającą na 4 mm 2 tkanki gruczołowej. Ogniskowe limfocytarne zapalenie gruczołów ślinowych powinno być różnicowane z innymi typami zapalenia, takimi jak niespecyficzne zapalenie gruczołów ślinowych, twardniejące przewlekłe zapalenie gruczołów ślinowych, zapalenie ziarniniakowe i chłoniaki.
IgG4-related disease (IgG4-RD) is an immune-mediated disease condition that can affect almost any organ, including the head and neck. It is a chronic, systemic inflammation of unknown etiology. Tumor formation is the most common clinical symptom. Any tumor in the head and neck area is always a concern for an otorhinolaryngologist, head and neck surgeon, that we are dealing with malignant neoplastic growth. Ultrasound imaging, computer tomography, magnetic resonance imaging and even fine needle aspiration biopsy usually do not exclude neoplastic hyperplasia. Only open biopsy or excision biopsy followed by histopathological examination suggest the diagnosis of IgG4-RD, which requires further diagnosis, mainly serological. The authors present the most common IgG4-RD in the head and neck area, diagnostic criteria and their differentiation from apparently similar diseases.
Seronegative spondyloarthropathies are a group of diseases characterized by several clinical features such as inflammatory back pain, sacroiliac joint inflammation, and the presence of the HLA B27 antigen, which occurs more frequently than the general population. Non-specific bowel inflammation, skin lesions, particularly psoriasis or uveitis, are also typical in patients or their family members [1]. In many situations, clinical progression of spondyloarthropathies can be assessed by imaging of the sacroiliac joints [2, 3]. SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis), is a rare disease, classified as seronegative spondyloarthropathy due to many typical clinical features for this group of diseases. A large variety of symptoms and atypical clinical picture of SAPHO syndrome causes significant diagnostic difficulties [3, 4]. Presented here is a case report of a 41-year-old male patient with a twenty-year history of the disease. Initially, his disease took the form of chronic, recurrent multifocal osteomyelitis (CRMO), which finally turned into a spondyloarthropathy that met the classification criteria for ankylosing spondylitis.
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