Frequent Rheumatic Diseases Research Articles

Sexual Dysfunctions and Gynecomastia in Male Rheumatological Patients Treated with Methotrexate: A Systematic Review.

Objectives: The aim of the current review was to elucidate the clinical context and presentation of sexual dysfunction (SD) and gynecomastia in rheumatological patients undergoing methotrexate treatment. Moreover, we aimed also to make physicians aware of the occurrence of these side effects, to adequately inform the patient before starting treatment. Methods: Systematic review (PROSPERO id: CRD42022358275) was performed according to preferred reporting items for systematic reviews and meta-analyses. Studies (1 January 1995 to 31 May 2022) were identified by highly sensitive searches of electronic databases (Medline, Embase, Cochrane Library databases). Key terms included: (("sexual dysfunction" OR "erectile dysfunction" OR "impotence") AND ("methotrexate" OR "MTX")) and (("gynecomastia" OR "male breast") AND ("methotrexate" OR "MTX")). Results: A total of seven papers (seven case reports), involving a total of eleven patients (min one, max three), were included in the final analysis. The age of the patients ranged from 19 to 68 years (median: 50.9 years). Rheumatoid arthritis (RA) was the most frequent rheumatic disease reported (n = 8, 72.7%). No patients reported erectile dysfunction (ED) and/or gynecomastia before using MTX. Time to onset of SD and gynecomastia after MTX ranged from 2 to 104 weeks (median: 22.7 weeks). ED (n = 5, 45.4%) and gynecomastia (n = 3, 27.2%) were the most common forms of presentation. Conclusions: Future prospective controlled studies with a large sample size and long follow-up as well as randomized controlled trials are needed to confirm this association, investigate its pathophysiological basis, assess the safest dosages, evaluate the most appropriate management, and provide clear recommendations.

Безопасность долгосрочного применения ритуксимаба у пациентов с ювенильным идиопатическим артритом: результаты когортного ретроспективного исследования

Juvenile idiopathic arthritis (JIA) is the most frequent rheumatic disease of childhood. The goal of juvenile arthritis therapy is to achieve durable clinical and laboratory remission and a good quality of life. Various groups of drugs are used in the treatment of JIA, one of which is the anti-CD20 drug rituximab. Rituximab causes B-cell depletion, which may lead to decreased immunoglobulin levels, decreased antigen-presenting function of B-lymphocytes and impaired T-cell response. The main side effects of rituximab administration are infusion reactions, hypogammaglobulinaemia, neutropenia and infectious complications. Safety studies of rituximab use have been conducted mainly in adult patients with rheumatoid arthritis, in paediatric patients with oncological diseases and diffuse connective tissue diseases. There have been no long-term safety studies of rituximab in children with JIA. Objective. To evaluate the safety of long-term use of rituximab in patients with juvenile idiopathic arthritis. Patients and methods. A cohort retrospective study of patients with JIA aged from 2 to 17 years with evaluation of adverse events on the background of rituximab therapy was carried out; the maximum duration of follow-up was 165 months. Rituximab was administered by intravenous drip at a dose of 375 mg/m2 body surface area by 4 weekly injections (61% of all courses given) or 2 injections of 1000 mg 2 weeks apart (29%). 4% had 1 administration per course; 6% had 3 consecutive weekly administrations. The indication for repeat rituximab administration and the number of administrations were determined on an individual basis. Safety was assessed by registration of adverse events (AEs) according to medical records; AEs registered during the patient's hospitalisation and anamnestic data on AEs during the interhospital period were taken into account; infectious, infusion and other AEs were considered separately. Results. Rituximab demonstrated a sufficiently high safety profile: 88/102 (86%) patients did not report any serious AEs (grade ≥3); life-threatening AEs (grade 4-5) were reported in 7/102 (7%) patients, included 4 episodes of severe pneumonia, 3 episodes of sepsis; their incidence was 2.5 cases per 100 PY. The incidence of infectious AEs was 57.4/100 patient-years; 85% of them corresponded to mild severity; most often infectious AEs were registered in the first year of rituximab therapy; pneumonia (16/100 PY) and ENT infections (11.3/100 PY) prevailed in the structure. Infusion reactions developed with an incidence of 34.8/100 PY, most frequently registered at the first rituximab administration and manifested as influenza-like syndrome (18.4/100 PY) and rash (10.3/100 PY). The incidence of neutropenia was 17/100 PY, erythropenia 0.7/100 patient-years; decreased blood immunoglobulin levels (IgA – 5.3 episodes, IgM – 6.7, IgG – 3.4/100 patient-years), increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity – 3.9/100 PY, 1 episode of increased serum urea levels. Conclusion. The use of rituximab in patients with JIA may be accompanied by the development of AEs, which include infusion reactions, infectious complications, cytopenias, decreased level of immunoglobulins in blood, increased activity of ALT and AST. Implementation of the algorithm for the management of patients with JIA under rituximab treatment into clinical practice will allow to ensure monitoring of AEs, their detection at early stages, timely initiation of adequate therapy to prevent the development of severe complications. Key words: juvenile idiopathic arthritis, safety of therapy, rituximab, adverse events, infusion reactions, infectious complications

Coronavirus Disease 2019 in Rheumatic Patients with Inflammatory Disorders: A Descriptive Study from a High Infection Incidence Region of Northern Spain.

Since the first confirmed case of severe acute respiratory syndrome coronavirus 2 in Spain in January 2020, the susceptibility of patients with rheumatic disease has remained unclear. In this report, we will describe the main features of coronavirus disease 2019 (COVID-19) that occurred in rheumatic patients with inflammatory disorders and try to identify features associated with severe disease. We included all rheumatic patients with immune-mediated diseases followed at 6 centers belonging to the public healthcare system in the Basque Country (Spain) and diagnosed with COVID-19 from March 1, 2020, to May 31, 2020. In total, 131 patients were included in this study. The most frequent rheumatic disease was rheumatoid arthritis (46.6%), and the main comorbidities were arterial hypertension (45%). Fortyseven percent were taking glucocorticoids (GC) (62 patients), 61.8% were under treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and 25 patients (19.1%) were receiving targeted therapies (TT). Thirty-eight percent of patients required hospital admission, 2.3% required transfer to intensive care uni, and the rate of mortality was 9.2%. Associated factors in univariate analysis for a bad outcome were older age, use of GC, obesity, previous cardiovascular disease, and lymphopenia. Use of GC and lymphopenia remained within the multivariate model. The frequency of COVID-19 seems to be similar in rheumatic patients as in the general population. Advanced age, obesity, heart disease, glucocorticoids, and low levels of lymphocytes were more common among the patients with a bad outcome. Neither exposure to csDMARD nor TT was associated with severe cases.

BASIC PRINCIPLES OF PHYSICAL MEDICINE IN OSTEOARTHRITIS

Osteoarthritis (OA) is a frequent rheumatic disease of adults and older age. A sedentary lifestyle is the primary cause of knee, hip, and spine OA. However, it also affects the hands and causes disability in everyday life. Physical therapy improves muscle strength and quality of life, maintains a range of motion and flexibility, and reduces pain. Although more studies on OA are needed, from the patient’s perspective, physical therapy is effective. Sarcopenia and decreased muscle strength of the joints affects the evolution of OA. Inactivity and reduced function developing with age and OA favor obesity and sarcopenia. Exercise and the addition of various physical agents significantly reduce the burden related to OA.

21 Disease activity and body mass index in juvenile idiopathic arthritis: is the truth revealed?

BackgroundActive disease in chronic rheumatic diseases in adults seems to be associated with overweight and obesity [1]. Juvenile Idiopathic Arthritis (JIA) is the most frequent rheumatic disease in children. The relationship between body mass index (BMI) and disease activity in JIA patients is less studied.ObjectiveTo determine the link between BMI and disease activity in JIA patients.MethodsWe conducted a cross-sectional study including 35 JIA patients meeting the International League of Associations for Rheumatology (ILAR) 2001 criteria.For each patient, we collected the following data: age, age at the onset of JIA, disease duration, patient global assessment (PGA), visual analogic scale (VAS), tender joint count (TJC), swollen joint count (SJC), disease activity using the Juvenile Arthritis Disease Activity score (JADAS), and therapeutic management.The weight and height were measured for each patient. The BMI was calculated and interpreted according to the World Health Organization classification.We also measured C-reactive protein (CRP) and Erythrocyte sedimentation rate (ERS) level.ResultsWe included 15 boys and 20 girls. The mean age was 12.2 ± 3.61 years. The mean age at the onset of the disease was 8.65 ± 3.83 years. The mean disease duration was 4.1 ± 3.29 years.The mean PGA and the mean VAS were 3.4 ± 3.02 and 3.37 ± 2.92, respectively.The mean TJC and the mean SJC were 1.48 ± 1.69 and 0.61 ± 0.77, respectively.The mean CRP and ESR were 7.51 ± 11.85 mg/l and 18.88 ± 15.53 mm, respectively.The mean JADAS was 7.58 ± 6.3. Twenty-four patients were under non-steroidal anti-inflammatory drugs (69%), 10 patients were under methotrexate (34%), and 5 patients were under TNFα inhibitor (14%).The mean BMI was 19.94 ± 5.46 kg/m². Fourteen patients were underweight (40%), 15 patients had a BMI in the normal range (43%), 4 patients were overweight (11%), and 2 patients were obese (6%).Underweight patients had higher PGA, higher CRP level, higher tender joint count (TJC), and higher JADAS compared with overweight and obese patients, but without significant difference (PGA: 2.97 ± 2.6 vs 2 ± 1.89, p = 0.4; CRP: 7.54 ± 15.09 vs 4.25 ± 4.19 mg/l, p = 0.6; TJC: 1.7 ± 1.56 vs 1 ± 0.8, p = 0.3, and JADAS: 6.3 ± 6.18 vs 2.98 ± 2.24, p = 0.1).No correlations were found between BMI and the following parameters: TJC, SJC, EGP, CRP, ESR, and JADAS.ConclusionData about associations between underweight, obesity, and disease activity in JIA are conflicting. Some authors suggested that active disease is associated with adiposity [2]. Others showed that underweight patients had higher disease activity [3]. Although there was no significant difference, our study is consistent with Neto et al. study. Indeed, active disease seems to affect the child’s appetite and weight gain leading to cachexia [3]. Other studies are needed to confirm these results.

77 Case series of juvenile scleroderma from Nigeria

BackgroundThe word scleroderma means ‘hard skin’ that develops due to excessive accumulation of collagen. It is the third most frequent rheumatic disease in paediatric rheumatology after juvenile idiopathic arthritis and systemic lupus erythematosus. When it occurs in individual <16 years, it is called juvenile scleroderma. It is a rare disease that occurs in one per million children, documented to be more common in African adults with poorer survival states compared with Caucasians.Objectives To describe the clinical and laboratory characteristics of children with juvenile scleroderma seen in our clinic, thus, increasing its awareness.MethodsRetrospective review of records of three children diagnosed with juvenile scleroderma at the paediatric Rheumatology Clinic of Lagos State University Teaching Hospital(LASUTH) between May 2018 to April 2022.Results Case 1 A 12-year-old girl presented with skin tightness of the left hand and thigh of one year, contracture of the 3rd, 4th and 5th proximal interphalangeal joints, arthritis of the left wrist, skin induration of the dorsum of the left hand involving the 4th and 5th finger and extending to the wrist and skin and induration of the anterolateral aspect of the left thigh. Her blood tests showed an erythrocyte sedimentation rate (ESR) at 20 mm/h, an ANA titre of 1:2560, a negative anti-Scl 70/anti-centromere antibodies, a normal complete blood count and serum electrolytes/urea/creatinine. A diagnosis of linear scleroderma was made, the patient had prednisolone, methotrexate and folic acid, in addition to topical emollients. She improved clinically as observed during follow up visits six weeks after initiation of treatment but later defaulted from the clinic due to unknown reason. Case 2 A 4-year-old girl presented with constitutional symptoms, swollen hands and feet, sclerodactyly, narrowing of oral aperture, ulcers at tips of the fingers, inflammatory pain of the large joints, hypopigmented macules on the face, trunk, abdomen and back and also abnormal capillaroscopy. Erythrocyte sedimentation rate was 22 mm/h with normal levels of electrolytes/urea/creatinine, thrombocytosis, ANA titre of 1:640 and negative anti-centromere and anti-U1RNP antibodies. A diagnosis of diffuse systemic sclerosis was made. She started prednisolone, methotrexate, nifedipine and omeprazole and was asked to do an ECG, an Echocardiogram, a spirometry and a chest HRCT but she couldn’t afford to do these investigations due to severe financial constraints. She was clinically stable for four months until she presented at the emergency room with sudden loss of consciousness and congestive cardiac failure. She died during resuscitation attempt. Case 3 An 11-year-old girl known patient of haematology unit with sickle cell anaemia, presented with inflammatory arthritis of the small joints of the hands, elbows and knees of nine-month duration, sclerodactyly, contractures of the PIP of the fingers, narrowing of oral aperture, generalized hypopigmented macules and abnormal nailfold capillaroscopy. Investigation showed an ANA titre of 1:640, positive anti-Scl 70 antibodies, negative anti-centromere antibodies, ESR of 130 mm/h and thrombocytosis. The echocardiogram showed a normally structured heart with severe restriction on spirometry and features of interstitial lung disease on HRCT of the chest. She started mycophenolate mofetil, prednisolone and nifedipine. She later received 2 doses of rituximab due to slow clinical improvement. She is being followed up.ConclusionMost data on scleroderma are from adult studies, we reported these three cases due to the rare occurrence of scleroderma in children, thus increasing its awareness.

Sociodemographic and clinical factors associated with poor COVID-19 outcomes in patients with rheumatic diseases: data from the SAR-COVID Registry.

Background/objectiveThis study aims to describe the course and to identify poor prognostic factors of SARS-CoV-2 infection in patients with rheumatic diseases.MethodsPatients ≥ 18 years of age, with a rheumatic disease, who had confirmed SARS-CoV-2 infection were consecutively included by major rheumatology centers from Argentina, in the national, observational SAR-COVID registry between August 13, 2020 and July 31, 2021. Hospitalization, oxygen requirement, and death were considered poor COVID-19 outcomes.ResultsA total of 1915 patients were included. The most frequent rheumatic diseases were rheumatoid arthritis (42%) and systemic lupus erythematosus (16%). Comorbidities were reported in half of them (48%). Symptoms were reported by 95% of the patients, 28% were hospitalized, 8% were admitted to the intensive care unit (ICU), and 4% died due to COVID-19. During hospitalization, 9% required non-invasive mechanical ventilation (NIMV) or high flow oxygen devices and 17% invasive mechanical ventilation (IMV). In multivariate analysis models, using poor COVID-19 outcomes as dependent variables, older age, male gender, higher disease activity, treatment with glucocorticoids or rituximab, and the presence of at least one comorbidity and a greater number of them were associated with worse prognosis. In addition, patients with public health insurance and Mestizos were more likely to require hospitalization.ConclusionsIn addition to the known poor prognostic factors, in this cohort of patients with rheumatic diseases, high disease activity, and treatment with glucocorticoids and rituximab were associated with worse COVID-19 outcomes. Furthermore, patients with public health insurance and Mestizos were 44% and 39% more likely to be hospitalized, respectively.Study registrationThis study has been registered in ClinicalTrials.gov under the number NCT04568421. Key Points• High disease activity, and treatment with glucocorticoids and rituximab were associated with poor COVID-19 outcome in patients with rheumatic diseases.• Some socioeconomic factors related to social inequality, including non-Caucasian ethnicity and public health insurance, were associated with hospitalization due to COVID-19.

Biologic therapies for juvenile idiopathic arthritis-associated uveitis.

Juvenile idiopathic arthritis (JIA) is the most frequent rheumatic disease of childhood and uveitis is its most common extra-articular manifestation. JIA-associated uveitis (JIA-U) is one of the main causes of visual impairment in children and represents a major challenge for pediatrician and ophthalmologist, due to its insidious onset and sight-threatening complications. Topical glucocorticoids are the first line of treatment, followed by conventional disease-modifying anti-rheumatic drugs (DMARDs), usually methotrexate (MTX). In recent years, new biological drugs targeting specific molecules involved in disease pathogenesis, have significantly improved the prognosis of the disease, especially for cases refractory to conventional therapies. In this review we discuss the role of biological agents in JIA-U, focusing on cytokine blockers and cell-targeted therapies aimed to control ocular inflammation.

Epidemiological characteristics and outcomes of SARS-CoV-2 infection in patients with rheumatic diseases: first report from the Argentine SAR-COVID registry

In order to assess the impact of SARS-CoV-2 infection in patients with rheumatic diseases, the Argentine Society of Rheumatology has developed the National Registry of Patients with Rheumatic Diseases and COVID-19 (SAR-COVID). The aim of this study was to evaluate the sociodemographic and clinical characteristics of patients with rheumatic diseases and SARS-CoV-2 infection included in the SAR-COVID registry and to describe the complications and outcomes of COVID-19 in this population. Methods: SAR-COVID is a national, multicenter and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had SARS-CoV-2 infection are consecutively included. Sociodemographic data, comorbidities, underlying rheumatic disease and treatment, clinical characteristics, complications, laboratory and treatment of the SARS-CoV-2 infection were recorded. Results: a total of 525 patients were included, with a mean age of 51.3 years (SD 15.2). The most frequent rheumatic diseases were rheumatoid arthritis (40.4%), systemic lupus erythematous (14.9%) and spondyloarthritis (8.2%). At the time of the infection, 72.9% were receiving immunosuppressive or immunomodulatory treatment and 36.9% glucocorticoids. Most of the patients were diagnosed using RT-PCR (95%), at outpatient consultation (39.4%), at the emergency room (32.2%) or during hospitalization (14.7%). Symptoms were present in 96% of the patients, the most frequent being fever (56.2%), cough (46.7%) and headache (39.2%). During infection, 35.1% were hospitalized, 11.6% were admitted to the ICU and 6.9% died due to COVID-19. Most of them (75.1%) recovered completely. Conclusions: in this first report of the SAR-COVID registry we found a wide distribution of rheumatic diseases. Most of the patients had a good evolution of the infection, however 7% died as a result of it, comparable to other Latin American registries with similar populations.

Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population

Juvenile idiopathic arthritis is the most frequent rheumatic disease in the pediatric population, followed by systemic lupus erythematosus, juvenile scleroderma syndromes, juvenile dermatomyositis, chronic recurrent multifocal osteomyelitis, and juvenile vasculopathies. The imaging approach to inflammatory connective tissue diseases in childhood has not changed dramatically over the last decade, with radiographs still the leading method for bony pathology assessment, disease monitoring, and evaluation of growth disturbances. Ultrasonography is commonly used for early detection of alterations within the intra- and periarticular soft tissues, assessing their advancement and also disease monitoring. It offers several advantages in young patients including nonionizing radiation exposure, short examination time, and high resolution, allowing a detailed evaluation of the musculoskeletal system for the features of arthritis, tenosynovitis, enthesitis, bursitis, myositis, as well as pathologies of the skin, subdermis, vessels, and fasciae. In this pictorial essay we discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis.

Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America: data from the Covid-19 Global Rheumatology Alliance physician-reported registry

Objective: To compare the characteristics of patients with rheumatic diseases and COVID-19 reported from Latin American countries with those from the rest of the world. Methods: Patients from the COVID-19 Global Rheumatology Alliance Physician-Reported Registry were included. Details regarding demographics, rheumatic disease features, comorbidities, COVID-19 diagnosis and treatment, and outcomes were examined. Chi-squared and t-tests were used to compare associations between groups (Latin America vs. rest of the world). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalization (yes/no) and ventilatory support (not hospitalized or supplementary oxygen only vs. non-invasive, invasive ventilation, or ECMO); Poisson models were used to estimate ORs and 95% CIs of mortality. Results: Seventy-four patients from Latin America and 583 patients from the rest of the world were included. The most frequent rheumatic diseases in both groups were rheumatoid arthritis (35% and 39%, respectively) and systemic lupus erythematosus (22% and 14% respectively). Mortality was similar between groups (12% Latin America vs 11% rest of the world, p=0.88. However, Latin American patients in the registry had a higher odds of requiring non-invasive or invasive ventilation, after adjustment [OR= 2.29, 95%CI (1.29, 4.07), p less than 0.01].. Conclusion: Latin American patients with rheumatic disease and COVID-19 reported to this global registry presented a higher need for ventilatory support, however experienced a similar mortality than patients from the rest of the world.

Pharmacovigilance of Biopharmaceuticals in Rheumatic Diseases, Adverse Events, Evolution, and Perspective: An Overview.

Since we have gained an understanding of the immunological pathophysiology of rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus, treatment based on biological drugs has become a fundamental axis. These therapies are oriented towards the regulation of cytokines such as tumour necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1, and the modulation of cell-mediated immunity (B cells and T cells) by anti CD20 or anti CTAL-4 agents, and can increase the risk of associated infections or adverse events (AE). In this context, the entry of biotherapeutics represented a challenge for pharmacovigilance, risk management and approval by the main global regulatory agencies regarding biosimilars, where efficacy and safety are based on comparability exercises without being an exact copy in terms of molecular structure. The objective of this review is divided into three fundamental aspects: (i) to illustrate the evolution and focus of pharmacovigilance at the biopharmaceutical level, (ii) to describe the different approved recommendations of biopharmaceuticals (biological and biosimilars) and their use in rheumatic diseases (RDs) such as rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE) and other less frequent RD like cryopyrin-associated autoinflammatory syndromes (CAPS), and (iii) to identify the main AE reported in the post-marketing phase of RD biopharmaceuticals.

Artrite idiopatica giovanile

Juvenile idiopathic arthritis, Cytokines, Lymphocytic subset, Biologic drugs, Treat-to-target Juvenile idiopathic arthritis is the most frequent rheumatic disease in childhood. Its diagnosis is still clinical and recently new classification criteria have been proposed. Over the past twenty years, there have been significant improvement in understanding the pathogenetic mechanisms leading to the implementation of targeted therapies. Indeed, the introduction of biological drugs has changed the quality of life of these children, with a rapid control of the disease activity and a reduction in the complications related to the disease and to the use of steroids, which is today very limited. The way of evaluating patients has also changed: joint ultrasound has become a fundamental tool of the daily practice of the paediatric rheumatologists. This article aims to highlight the new discoveries that have changed the management and prognosis of patients affected by juvenile idiopathic arthritis.

P1703RESULTS OF RENAL TRANSPLANTATION IN PATIENTS WITH RHEUMATIC DISEASES

Abstract Background and Aims Rheumatic diseases often involve the kidneys and it might lead to chronic kidney disease (CKD). In its final stage it must be treated with renal replacement methods such as dialysis (hemodialysis or peritoneal dialysis) or renal transplantation. Kidney transplantation is the preferred and most cost-effective treatment for the end-stage renal disease, it offers a better quality of life than dialysis. The most common types of renal pathology in rheumatic diseases include glomerular (systemic lupus erythematosus), vascular (ANCA-associated vasculitides) and tubulointerstitial (goat) diseases. According to a research conducted in 2010 at the Minsk Rheumatological Department, 25% of patients had clinical or laboratory features of CKD. The aims were to reveal the most frequent rheumatic diseases affecting the kidneys and evaluate the post-transplant period in these patients. Method 94 medical case were studied retrospectively. All these patients had the end-stage renal disease with GFR of &amp;lt;15 ml/min/1.73m2 and underwent renal transplantation between January 2011 and September 2019. Results A retrospective study of 94 kidney transplant patients was conducted on renal transplantation centers in Belarus. Among the patients that underwent renal transplantation from January 2011 till September 2019, the percentage of recipients with rheumatic diseases was 3.64%. The majority of the recipients (52 %) were females. The mean age was 44.36 years (range, 16-78 years). Of the sample, 90% of kidney allografts were received from brain-dead donors, whereas only 10% of recipients got a new kidney from living-donors. Systemic lupus erythematosus was the most common causative disease in patients with rheumatic diseases (31 cases, 33%) followed by goat (28 cases, 30%) and secondary amyloidosis (17 cases, 18%) that complicated the course of rheumatoid arthritis and seronegative spondylarthritis. The remaining part of patients suffered from ANCA-associated vasculitides (10 cases, 10.6%), anti-glomerular basement membrane disease (6 cases, 6.4%), and single cases were represented by progressive systemic sclerosis and antiphospholipid syndrome (2%). In the post-transplant period, the most common complications were arterial hypertension (38%), anemia (20%), infectious diseases (27%), among them the most frequent were urinary tract infection (20%) and cytomegalovirus infection (7%). The 1-year allograft survival rate was 86%, the 5-year rate was about 82%. The main reasons for failed outcomes were acute renal allograft rejection, postoperative complications and infection. The patient survival rate after 1 and 5 years after transplantation was 93% and 86%, respectively. Infectious diseases (44%) such as nosocomial pneumonia, sepsis and cardiovascular disease (33%) are still the two most important reasons of death. Conclusion 1. The most common rheumatic diseases causing the end-stage renal disease are systemic lupus erythematosus (33%), goat (30%), rheumatoid arthritis, and seronegative spondylarthritis that lead to secondary amyloidosis (18%). 2. The 1-year allograft survival rate was 86%, the 5-year rate was about 82%, the patient survival rate after 1 and 5 years after transplantation was 93% and 86%, respectively. 3. The survival of patients with rheumatic diseases who underwent renal transplantation is comparable to patient survival after transplantation with another kidney pathology. 4. The main causes of death following renal transplantation are infectious and cardiovascular complications. Acute renal allograft rejection, postoperative complications, and infection are the main reasons of allograft failure.

Health-economic analysis of tocilizumab in patients with rheumatoid arthritis and systemic juvenile arthritis

Rationale . Rheumatoid arthritis (RA) and systemic juvenile arthritis (sJA) are the most frequent rheumatic diseases in adults and adolescents, consequently. Biologics disease modifying antirheumatic drugs (bDMARDs) are eff ective in treatment of RA and s JA. Aim . To perform health-economic analysis of tocilizumab for subcutaneous and intravenous injections in patients with RA and sJA comparing to TNF-α inhibitors. Materials and methods . Cost-minimizing analysis was used from the perspective of healthcare system (accounting for direct medical costs) with the modelling horizon — 1 year. We included into the model cost of RA and sJA bDMARDs, cost of adverse events correction and costs of laboratory and instrumental diagnostic. Results . Cost minimizing ratio of tocilizumab (subcutaneous form) in RA patients comparing to adalimumab (Humira), сertolizumab pegol, golimumab were 111 536; 129 094; 85 244 RUR, consequently favour to tocilizumab. Tocilizumab was less costly comparing to adalimumab (Humira), certolizumab pegol, golimumab by 12.8, 14.5, 10,0 %, consequently. Cost minimizing ratio of tocilizumab in RA patients comparing to adalimumab (Dalibra), etanercept, infl iximab (Remicade) were 40 497; 54 355; 28 419 RUR in favour to comparators. Tocilizumab was more costly comparing to adalimumab (Dalibra) etanercept, infl iximab (Remicade) by 5.6; 7.7; 3.9 %, consequently. Cost minimizing ratio of tocilizumab in sJA patients comparing to kanakinumab, adalimumab (Humira) and adalimumab (Dalibra) were 6 535 234; 478 297 and 323 263 RUR. Tocilizumab was less costly comparing to kanakinumab, adalimumab (Humira) and adalimumab (Dalibra) by 93.3; 50.6 and 41.1 %, consequently. Conclusions . Tocilizumab is economically reasonable comparing to others TNF-α inhibitors in patients with RA and sJA.

Prevalence of Musculoskeletal Manifestations and Related Disabilities in a Peruvian Urban Population Living at High Altitude. COPCORD Study. Stage I

ObjectiveEstimate the prevalence of musculoskeletal manifestations and related disabilities of an urban population living at high altitude in Juliaca, Puno, Peru, using the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and Health Assessment Questionnaire (HAQ) Disability Index. MethodsA cross-sectional study was performed in a sample of 1095 people. In each interview, the COPCORD methodology and the HAQ were applied. The city was divided into 8 sectors. ResultsIn all, 614 (56.1%) women were evaluated; 44% were from the Quechua community and 5.1% were Aymara. Before the final 7 days of the study, 132 people (12.05%; 95% CI 9.99–14.11) reported musculoskeletal pain. During the final 7 days of the study, 347 people (31.69%; 95% CI 28.36–35.02) who were predominately women (218; 35.5%; 95% CI 30.8–40.2) reported musculoskeletal pain. The most frequent rheumatic diseases were rheumatoid arthritis (1.27%), gout (0.64%), hand osteoarthritis (OA) (2.83%), knee OA (1.55%), hip OA (0.37%), fibromyalgia (1.09%), and soft tissue rheumatism (8.86%). The HAQ showed an incremental increase proportional to age. The HAQ average for the population was 0.18 (±0.36). Ten people (5.71%) of 175 with rheumatic disease received the services of a shaman. ConclusionIt is the first COPCORD study in an urban native population living at high altitude in Peru. The population affected by chronic rheumatic disease preferred professional rather than traditional care; this population had access to limited medical services. Impaired functional capacity measured by HAQ was associated with advanced age.

Scleroderma in children.

Juvenile scleroderma with its two varieties, juvenile localized scleroderma and systemic sclerosis (SSc), represents the third most frequent rheumatic disease in childhood. In juvenile SSc, new developments have been recently reported in the fields of classification and monitoring. The introduction of new classification criteria for adult SSc has stimulated new ideas on how to improve the performance of the provisional 2007 PRES/ACR/EULAR pediatric criteria. The introduction of a multidimensional severity score, named "J4S," which includes parameters on growth, skin, and internal organ involvement, has improved the approach to the patients in the daily practice to guide decision-making. In localized scleroderma, the wider application of clinical and instrumental scoring systems has greatly improved both assessment and monitoring. Finally, a multicenter consensus statement and long-term follow-up studies have confirmed the important role of methotrexate for the treatment.

JUVENILE IDIOPATHIC ARTHRITIS AND VACCINE PREVENTABLE DISEASES – A SHORT REVIEW

Juvenile idiopathic arthritis is the most frequent rheumatic disease in pediatrics. Immunosuppressive drugs, either conventional or biologic, used for its treatment, pose higher infectious risks. A short literature review is presented. Even though still safe while being on immunosuppressive drugs, vaccination is advisable to be completed for tuberculosis, hepatitis B, measles, varicella and pneumococcus before such treatment is used. As these vaccines are expensive and at times not available on market, they should all be offered by the national health insurance system to JIA patients.

THE INFLUENCE OF ENVIRONMENTAL FACTORS ON THE ONSET OF RHEUMATOID ARTHRITIS

The cause of rheumatoid arthritis, which is the most frequent inflammatory rheumatic disease, affecting between 0.5 and 1% of the general population, still remains unknown. However, as with all autoimmune disorders, it is assumed that rheumatoid arthritis is the consequence of the influence of environmental factors on a genetically predisposed host. Regional variations in disease prevalence support the environmental influence theory: geographical and climatic conditions, industrialization and pollution, socioeconomic status or lifestyle. For the time being, with a few exceptions, such as smoking, the vast majority of factors that can influence the onset of the disease remain unclear, although their contribution is most probably significant.

Clinical manifestations in uveitis patients with and without rheumatic disease in a Chinese population in Taiwan.

Uveitis can be a local eye disease or a manifestation of systemic rheumatologic disorders. However, the differences of clinical manifestations between uveitis patients with or without systemic rheumatologic disease have been seldom described in literature. We investigated the clinical features and complications of rheumatic disease-related uveitis, and compared the characteristics in patients with and without rheumatic disease in a Chinese population in Taiwan. A retrospective review was performed for all patients who had been diagnosed with uveitis between January 2009 and June 2014 at the Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. A total of 823 uveitis patients were enrolled in the study, including 123 patients with rheumatic diseases. The most frequent rheumatic diseases included ankylosing spondylitis (5.8%), followed by Behçet's disease (2.8%), sarcoidosis (1.4%), psoriasis (1.1%), and juvenile idiopathic arthritis (1.1%). Compared with patients without rheumatic disease, those with rheumatic disease-related uveitis had a lower mean age at onset (35.1±15.8 years vs. 44.0±17.5 years), a longer follow-up period (27.1±25.3 months vs. 22.2±23.0 months), a higher incidence of anterior uveitis (69.0% vs. 46.3%), less frequent posterior uveitis (4.9% vs. 21.4%), a higher incidence of recurrence (26.8% vs. 14.1%), more frequent bilateral involvement (53.7% vs. 38.8%), and more frequent posterior synechiae (17.2% vs. 9.4%). The disease course and clinical manifestations of rheumatic disease-related uveitis were different from those unrelated. Patients with rheumatic disease-related uveitis had a higher recurrent rate and more frequent posterior synechiae than patients without rheumatic diseases.