Rheumatic Pathology Research Articles

Use of rituximab in the of immunoinflammatory rheumatic diseases combined with Graves' disease (autoimmune polyglandular syndrome in adults): case report and literature review

Rituximab (RTM) is a chimeric (murine and human) monoclonal antibody against B-lymphocytes (CD20). RTM is widely used in hematology for lymphoproliferative diseases and in rheumatology for rheumatoid arthritis, Sjögren's disease, some types of vasculitis and systemic connective tissue diseases. The administration of RTM is associated with a depletion of B-cells mediated by the regulation of apoptosis and cytotoxic effects via complement-dependent and antibody-dependent mechanisms. Considering the pathogenesis of autoimmune damage in Graves' disease (GD), an autoimmune thyroid disease associated with thyrotoxicosis, the use of RTM could be effective in this pathology. We present three patients with a combination of diffuse toxic goiter and rheumatic pathology treated with RTM; different outcomes of GD were observed.

Features of the reproductive function of girls and women with rheumatoid arthritis: A review

Rheumatoid arthritis is one of the most common and severe autoimmune diseases. The prevalence of rheumatoid arthritis among adults in different geographical areas of the world ranges from 0.5 to 2%. The prevalence of juvenile rheumatoid arthritis is approximately 6 per 10 thousand children. The disease occurs 2 times more often in girls than in boys. Some studies have demonstrated a possible effect of high cumulative doses of methotrexate on ovarian function in patients with systemic lupus erythematosus, but further studies are needed to confirm this effect. The analysis of literature data allowed us to identify prognostically significant factors in the development of autoimmune ovarian failure in patients of reproductive age with rheumatic pathology, and to note the fact that there is missing information about the state of the reproductive system in female patients with juvenile arthritis.

Whole-body cryotherapy in orthopaedics: current concepts.

The use of whole-body cryotherapy (WBC) for musculoskeletal ailments is growing. WBC, involving brief exposure to extremely low temperatures, is increasingly used for its analgesic, anti-inflammatory, and antioxidant effects. The paper examines the physiological impacts of WBC on cardiovascular, musculoskeletal, hematologic, hormonal, and metabolic systems. Specific orthopaedic applications discussed include its role in the management of fractures, osteoarthritis, osteonecrosis of the femoral head, osteomyelitis, adhesive capsulitis, tendinopathies, rheumatic pathologies, chronic pain syndromes, and fibromyalgia. The study also highlights the benefits and drawbacks of WBC, including its potential to improve athletic performance, recovery, mood, and well-being, while noting risks like frostbite and impaired muscle strength. Clinical evidence from various studies is evaluated, revealing a spectrum of outcomes. For instance, WBC shows promise in enhancing bone health in athletes and providing relief in osteoarthritis and fibromyalgia patients. However, evidence for its efficacy in conditions like chronic pain syndromes and osteomyelitis is less robust. The paper underscores the need for further research to establish standardised protocols and understand long-term effects. While WBC offers significant benefits in orthopaedics, understanding its limitations and potential risks is crucial for its safe and effective clinical application.

Sex Differences in Epidemiological Distribution and Outcomes of Surgical Mitral Valve Disease.

Mitral valve (MV) disease is the most common form of valvular heart disease. Findings that indicate women have a higher risk for unfavorable outcomes than men remain controversial. This study aimed to determine the sex-based differences in epidemiological distributions and outcomes of surgery for MV disease.Methods and Results: Overall, 18,572 patients (45.3% women) who underwent MV surgery between 2001 and 2018 were included. Outcomes included in-hospital death and all-cause mortality during follow up. Subgroup analysis was conducted across different etiologies, including infective endocarditis (IE), degenerative, ischemic, and rheumatic mitral pathology. The overall MV repair rate was lower in women than in men (20.5% vs. 30.6%). After matching, 6,362 pairs (woman : man=1 : 1) of patients were analyzed. Women had a slightly higher risk for in-hospital death than men (10.8% vs. 9.8%; odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.99-1.24; P=0.075). Women tended to have a higher incidence of de novo dialysis (9.8% vs. 8.6%; P=0.022) and longer intensive care unit stay (8 days vs. 7.1 days; P<0.001). Women with IE had poorer in-hospital outcomes than men; however, there were no sex differences in terms of all-cause mortality. Sex-based differences of MV intervention still persist. Although long-term outcomes were comparable between sexes, women, especially those with IE, had worse perioperative outcomes than men.

Новая коронавирусная инфекция (COVID-19) и нозологическая структура больных ревматологического отделения. Взгляд из региона

Based on the analysis of 670 archival patients' case histories of the disease, patients discharges in 2021 from the rheumatological department (there are excluded cases of repeated short-term hospitalizations in order to conduct supporting therapy of genetically engineering biological drugs), the question of the connection of rheumatic pathology with coronaviral infection and its influence on the formation of the characteristics of clinical clinicals forms of this pathology. Coronavirus infection, which occurred in the period of 6 months before hospitalization, is registered in every tenth (76–11.3 %). Three groups are highlighted: I. Patients with the diagnosis of Covid diagnosed/verified in the department and who later transferred to the specialized infectious department – 18 people (2.7 %). II. Patients who have clinical features of the disease can be interpreted as part of the so -called post-covid syndrome – 35 people (5.2 %). A clear chronological relationship of post-covid asthenia and other symptoms with subsequent (after 4 weeks) events make the role of the virus in the induction of this pathology undoubted. III. Patients with a previously established rheumatic diagnosis, and the exacerbation of a previously diagnosed disease was undoubtedly induced by coronavirus infection – 23 people (3.4 %) among those patients. The relationship of the development and exacerbation of chronic rheumatic pathology with coronavirus is actually much more often than the numbers cited in this study, but many cases of light infection were not recorded as COVID. Post-covid syndromes in rheumatology, developing at different times from the beginning of the infection, from the so called long-covid is up to six months, have a wide range of clinical manifestations. It can be assumed that the most characteristic feature of patients with post-covid syndromes who find themselves in the hospital is their uncertainty in terms of specification of the nosological form. It is significant that in 80 % of patients in whom the clinical features can be considered as part of the post-covid syndrome, such “transitional” diagnoses as inflammatory arthropathy, undifferentiated or mixed connective tissue syndrome, RS3PE syndrome and others, and only less than a smaller part of the patients examined had more outlined signs of a specific rheumatic disease.

Relief for Long-standing Postchikungunya Viral Myalgic and Arthralgic Pains Effected by Neuromodulation of Ultrasound-Guided Dry Needling of Affected Muscles and Steroid-Based Interventions

Abstract Chronic myalgias and arthralgias occur after Chikungunya virus infections (pCHIKV- M&amp;A). We report details of treating a 6-years lasting CHIKV-M&amp;A pains with a combination of medications and interventions. The patient had severe pain in bilateral shoulders and elbows; right thumb and back. Response to steroids, sulphasalazine and methotrexate was poor. Examination revealed M&amp;A pains. Medications initiated included Pregabalin, Paracetamol, Tramadol and vitamin D. At two weeks, despite improvement, there were residual pains in bilateral shoulders and elbows. Four weekly sessions (two on each side), of ultrasound-guided dry needling (USGDN) of all muscles of the upper limb was done. Patient reassessment revealed moderate, residual pains at bilateral supraspinatus muscles, bicipital tendons and radio-humeral joints. These pains were addressed by USG guided steroid injection of bilateral- suprascapular nerves, bicipital tendons and radio-humeral joints. Medications reduced pains especially of back and thumb. USGDN of muscles further reduced it by 60%. The interventions at the nerves, entheses and joints gave 90%-100% relief. The pre-intervention Disability of Arm, Shoulder and Hand (DASH) score of 52.7 reduced to 5.4. At fifth month follow-up, the DASH was15.8, but patient reported satisfaction over pain relief, improvement in daily activities and quality-of-life. There are no evidence-based treatment guidelines or corroborative evidence for rheumatic pathology (most times) for persistent CHIKV-M&amp;A pains. This case-report highlights the successful management of CHIKV-M&amp;A pains by multi-modal approach. USGDN and steroids have neuro-modulatory effects. We have proposed that USGDN aids pain relief by an integrative role with the biologically inherent “chaos theory.”

Implementation of artificial intelligence models in magnetic resonance imaging with focus on diagnosis of rheumatoid arthritis and axial spondyloarthritis: narrative review.

Early diagnosis in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is essential to initiate timely interventions, such as medication and lifestyle changes, preventing irreversible joint damage, reducing symptoms, and improving long-term outcomes for patients. Since magnetic resonance imaging (MRI) of the wrist and hand, in case of RA and MRI of the sacroiliac joints (SIJ) in case of axSpA can identify inflammation before it is clinically discernible, this modality may be crucial for early diagnosis. Artificial intelligence (AI) techniques, together with machine learning (ML) and deep learning (DL) have quickly evolved in the medical field, having an important role in improving diagnosis, prognosis, in evaluating the effectiveness of treatment and monitoring the activity of rheumatic diseases through MRI. The improvements of AI techniques in the last years regarding imaging interpretation have demonstrated that a computer-based analysis can equal and even exceed the human eye. The studies in the field of AI have investigated how specific algorithms could distinguish between tissues, diagnose rheumatic pathology and grade different signs of early inflammation, all of them being crucial for tracking disease activity. The aim of this paper is to highlight the implementation of AI models in MRI with focus on diagnosis of RA and axSpA through a literature review.

Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial.

The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students' perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student's perspective using a questionnaire with 16 questions covering six subject areas. The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach. The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.

Clinical considerations on nutrition and lifestyle in old people with osteoporosis and sarcopenia by the CReI-Food study group of the Italian College of Rheumatologists

Osteoporosis is considered the most frequent rheumatic pathology in the elderly population. It is often accompanied by sarcopenia, defined as the progressive loss of skeletal muscle mass and strength. Together, these conditions increase the risk of falls, fractures, disability, lower quality of life, and frequent hospitalization. This means increased healthcare costs for all European countries, due to the increase in the average age and elderly population. Multiple pharmacological therapies are available for osteoporosis, but the prevention seems to be an important tool to reduce the risk of fracture and hospitalization of patients. A healthy lifestyle, consisting of the right amount of nutrients and micronutrients and physical exercise can help prevent the development of osteoporosis and sarcopenia in the elderly. This review brings together the information present in the literature on the benefits that nutrients and micronutrients, naturally present in foods, have on the prevention of these pathologies. it is suggested that a correct intake of proteins, calcium, phosphorus, magnesium, vitamin.D, vitamin C and antioxidants, vitamin K and omega 3, associated with constant physical exercise, can help to contain osteoporosis. It also indicates the right physical exercise for older osteoporotic adults. This document drawn up by the CReI-Food study group of the Italian College of Rheumatologists aims to provide, based on the most recent scientific evidence, indications on correct nutrition and lifestyle for the prevention and treatment of osteoporosis in older people.

Lupus eritematoso sistémico en la unidad de cuidados intensivos de urgencias

ObjectivesTo compare the characteristics of patients who died versus those who survived with systemic lupus erythematosus (SLE) in the emergency intensive care unit (UCIE). Material and methodsRetrospective collection of clinical and laboratory findings of clinical histories of patients with SLE in the UCIE of the Hospital Clínico Quirúrgico de Holguín in the period from January 2016 to January 2021. A descriptive statistical study and univariate analysis were carried out for continuous and discrete variables. The APACHE II score was calculated. ResultsThere were 23 patients with SLE during the period worked. The frequency of SLE in the ICU of the Hospital Clínico Quirúrgico de Holguín is 1.5%, it is the most frequent rheumatic pathology in ICU. Mortality in the ICU was 39.13%. The most frequent reason for admission was respiratory failure (52.4%), mostly due to an infectious cause. The variables that were significantly associated with mortality in the UCIE were: high erythrocyte sedimentation rate (ESR), severe anemia, severe hypoalbuminemia, the relationship arterial oxygen pressure between the fraction of inspired oxygen (PaFi)<200 on admission. The APACHE II score in the deceased group was significantly higher (19.9) (P<.01). Acute renal failure requiring hemodialysis and the need for invasive mechanical ventilation in different modalities for variable times were significantly associated with higher mortality in ICU. ConclusionsSLE in the ICU of the Hospital Clínico Quirúrgico de Holguín has a high mortality rate, higher than that reported in previous studies. Poor prognostic factors were high ESR, severe anemia, severe hypoalbuminemia, PaFi<200, high APACHE II score, need for hemodialysis and invasive mechanical ventilation.

Analyse du profil des salariés déclarés inaptes au poste de travail : quelle place pour les facteurs sociétaux ou extra-professionnels et quelles conséquences sur l'emploi ?

IntroductionProfessional career can be modified by health problems. Professional impairment, certified by an occupational health physician, can be followed by a redeployment or occupational disintegration. ObjectivesTo describe the profiles of workers declared unfit for their workplace and the profiles of those who have no remaining work capacity (RWC). MethodsThe workers followed by an inter-enterprise occupational health service composed of 20 occupational physicians. The characteristics of workers declared unfit for work were extracted from the medical files: age, gender, activity sector (Naf), socioprofessional category (PCS), pathology leading to professional impairment (CIM10), status of obligation to employ disabled workers (BOETH). Factors associated with unfitness to work due to no remaining work capacity (RWC) were identified by logistic regression models. ResultsIn 2019, 82678 workers in France were followed by the SPSTI and 554 (0.67%), of whom 162 had no RWC, were declared unfit to work by an occupational health physician. Professional impairment rates were highest for women and workers > 55 years old. Psychological (29%) and rheumatic (50%) pathologies were the most frequent causes of professional impairment. BOETH status was identified among 63%. Age > 45 and psychological pathology were significantly associated with absent RWC, whereas gender, activity sector and PCS were not. DiscussionNo comprehensive public administration records of professional impairment exist in France. While past studies have described the profiles of workers who were unfit for their workplace, none have characterized those without RWC, who are high risk of precarity. ConclusionsPsychological pathologies generate the most professional impairment in persons without RWC. Prevention of these pathologies is essential. While rheumatic disease is the first cause of professional impairment, the proportion of workers with these diseases who have no remaining work capacity is relatively low; this may be due to the efforts made to facilitate their return to work.

An Atlas of the Knee Joint Proteins and Their Role in Osteoarthritis Defined by Literature Mining

Osteoarthritis (OA) is the most prevalent rheumatic pathology. However, OA is not simply a process of wear and tear affecting articular cartilage but rather a disease of the entire joint. One of the most common locations of OA is the knee. Knee tissues have been studied using molecular strategies, generating a large amount of complex data. As one of the goals of the Rheumatic and Autoimmune Diseases initiative of the Human Proteome Project, we applied a text-mining strategy to publicly available literature to collect relevant information and generate a systematically organized overview of the proteins most closely related to the different knee components. To this end, the PubPular literature-mining software was employed to identify protein-topic relationships and extract the most frequently cited proteins associated with the different knee joint components and OA. The text-mining approach searched over eight million articles in PubMed up to November 2022. Proteins associated with the six most representative knee components (articular cartilage, subchondral bone, synovial membrane, synovial fluid, meniscus, and cruciate ligament) were retrieved and ranked by their relevance to the tissue and OA. Gene ontology analyses showed the biological functions of these proteins. This study provided a systematic and prioritized description of knee-component proteins most frequently cited as associated with OA. The study also explored the relationship of these proteins to OA and identified the processes most relevant to proper knee function and OA pathophysiology.

Bioaccessibility by perspiration uptake of minerals from two different sulfurous peloids

The risks associated with the use of peloids in thermal centers, spas, or at home, must be tested to develop appropriate safety guidelines for peloids formulations and the release of substances of high concern. Additionally, the beneficial effects of some elements on human health should be assessed to aid in interpreting the therapeutic action and effectiveness of pelotherapy on dermatological or osteomuscular disorders. Therefore, a methodology was developed to better understand the biogeochemical behavior of the elements in formulated peloids. Two peloids were formulated with the same clay and two different sulfurous mineral-medicinal waters for 90 days, with light stirring every 15 days. Bentonite clay, with a high content of smectite and Ca and Mg as the main exchangeable cations, and high heat capacity, was used. The selected mineral-medicinal waters were collected from two Portuguese thermal centers with recognized therapeutic efficacy for rheumatic, respiratory and dermatological pathologies. The peloids were used without drying and withdrawn directly from the maturation tank, and a mixture of bentonite and demineralized water was prepared as a reference sample. A stabilized, ready-to-use, artificial perspiration test was used to simulate the peloids’ interaction with skin. Thirty-one elements extracted from the two prepared peloids were analyzed using ICP-MS. The data were analyzed and related to the mineralogical composition of the original clay and supernatant composition of the maturation tanks. The content of some potentially toxic elements and metals’ bioaccessibility by perspiration showed very low solubility and undetectable amounts extracted from the studied samples. This analytical method provided reliable information on dermal exposure and the identification of some elements that may enter the systemic circulation, requiring implementation of surveillance and control measures.Graphical abstract

Partie 6. Amylose

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when X-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.

Partie 2. Orthopedie – Traumatologie

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when x-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.

Partie 7. Spécificités pédiatriques

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when X-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.

Partie 5. Pathologies tumorales

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when X-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.

Partie 3. Infections osseuses (hors greffe sur matériel)

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when X-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.

Partie 4. Rhumatologie

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when X-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.

Partie 1. Généralités

Bone scintigraphy is a nuclear imaging scan using a radiopharmaceutical composed of a bisphosphonate coupled to a radionuclide (technetium 99m). Radiopharmaceutical uptake is particularly important at the level of the bone structures having a strong osteoblastic activity. These uptakes can be due to a benign pathology (fracture, loosening of prosthesis, rheumatic pathologies, etc.) or to a malignant pathology (primary or secondary bone lesion). The high sensitivity of bone scintigraphy makes it particularly interesting at the initial stage of the pathology, especially when x-rays are normal. In addition, its specificity has clearly improved in recent years with the increasingly use of tomoscintigraphy coupled with X-ray scanning (SPECT/CT). We describe the operating principle of bone scintigraphy, normal uptakes with its variants as well as pathological uptake features in traumatic, rheumatic, prosthetic or cancerous pathologies.