Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Sarcoidosis: A Different Disease or a Paradoxical Effect on Etanercept Treatment?

The 50-year-old patient presented to our clinic for the first time in March 2019, complaining of an altered general condition, inflammatory pain in the small joints of her left hand, right fist and bilateral forefoot, morning stiffness of over 60 minutes, swelling of the right carpal and bilateral metatarsophalangeal joints and finger III left hand dactylitis. The patient is an employee and denies alcohol and tobacco use. From the hereditary antecedents we point a sister diagnosed with psoriasis vulgaris, another sister who died of a gastric neoplasm and her father having cardiovascular diseases.</jats:p

THE SIGNATURE OF INTESTINAL DYSBIOSIS IN INFLAMMATORY RHEUMATIC DISEASES

The study of intestinal microbiota is an important and current subject. It is well known that the gut microbiota plays a decisive role in the development of intestinal function, contributes to the defense against different infections, gives tolerance to ingested foods, regulating and maintaining the function of the intestinal barrier. The gut microbiota is different from individual to individual, determining, through the molecular profile, an “individual profile”. Intestinal dysbiosis is associated with multiple diseases such as IBD, irritable bowel syndrome, nosocomial infections or rheumatic inflammatory disorders. By characterizing intestinal dysbiosis in patients, a link could be made between these bacteria and the pathogenic mechanisms of the diseases, assigning these structures key roles in the onset of systemic disorders. This allows a better understanding of the pathophysiological mechanisms of the diseases and allow having a targeted treatment aimed at improving dysbiosis and restoring the normal microbial gut profile

ETIOPATHOGENIC MECHANISMS OF TOBACCO CONSTITUENTS IN RHEUMATOID ARTHRITIS

Active smoking is considered a risk factor for rheumatoid arthritis. Smokers show respiratory extra-articular manifestations and complications, such as interstitial lung disease and chronic obstructive pulmonary disease. Smokers may receive a more intensive drug therapy than non-smokers, but they have a poor prognosis. Smoker’s resistance to therapy may be caused by the pharmacokinetic interactions between drugs and tobacco constituents. The present account of some of those thousands of components of the gas and tar phase of cigarette smoke (polynuclear aromatic hydrocarbons, quinones, cyanide, heavy metals, bacterial endotoxins, nicotine and carbon monoxide) may help explain the inconclusive incrimination of tobacco use in the development of rheumatoid arthritis and convince more clinicians to recommend smoking cessation

PSORIATIC ARTHRITIS “SINE PSORIASIS” – A RARE FORM OF DISEASE THAT RAISES POSITIVE AND DIFFERENTIAL DIAGNOSIS PROBLEMS

Psoriatic arthritis is part of the big group of spondylarthropaties, presenting numerous clinical forms and having both musculoskeletal and extraarticular manifestations. Usually, the disease diagnosis is set after the presence of clinical signs of skin psoriasis. In that case, the diagnosis is made quite easily. The condition puts a lot of problems regarding differential diagnosis especially in the situation when it precedes the onset of skin lesions. Regarding the presented case, a correct diagnosis of psoriatic arthritis “sine psoriasis” was made after about 20 years of disease evolution, at which time the specific nail lesions of psoriasis appeared

Ischemic Heart Disease and Rheumatoid Arthritis—Two Conditions, the Same Background

Rheumatoid arthritis (RA) is one of the most frequent inflammatory rheumatic diseases, having a considerably increased prevalence of mortality and morbidity due to cardiovascular disease (CVD). RA patients have an augmented risk for ischemic and non-ischemic heart disease. Increased cardiovascular (CV) risk is related to disease activity and chronic inflammation. Traditional risk factors and RA-related characteristics participate in vascular involvement, inducing subclinical changes in coronary microcirculation. RA is considered an independent risk factor for coronary artery disease (CAD). Endothelial dysfunction is a precocious marker of atherosclerosis (ATS). Pro-inflammatory cytokines (such as TNFα, IL-1, and IL-6) play an important role in synovial inflammation and ATS progression. Therefore, targeting inflammation is essential to controlling RA and preventing CVD. Present guidelines emphasize the importance of disease control, but studies show that RA- treatment has a different influence on CV risk. Based on the excessive risk for CV events in RA, permanent evaluation of CVD in these patients is critical. CVD risk calculators, designed for the general population, do not use RA-related predictive determinants; also, new scores that take into account RA-derived factors have restricted validity, with none of them encompassing imaging modalities or specific biomarkers involved in RA activity

On the Chameleonic Behaviour of Cholesterol through a Fractal/Multifractal Model

An increasing number of studies are beginning to show that both low-density lipoprotein and high-density lipoprotein cholesterol can constitute risk factors for myocardial infarction. Such a behaviour has been called by experts in the field the “chameleonic effect” of cholesterol. In the present paper, a fractal/multifractal model for low-density lipoprotein and high-density lipoprotein cholesterol dynamics is proposed. In such a context, a fractal/multifractal tunneling effect for systems with spontaneous symmetry breaking is analyzed so that if the spontaneous symmetry breaking is assimilated to an inflammation (in the form of a specific scalar potential), then a coupling between two fractal/multifractal states can be observed. These two states, which have been associated to biological structures such as low-density lipoprotein and high-density lipoprotein, transfer their states through a fractal/multifractal tunneling effect. Moreover, in our opinion, the widely used notions of “good” and “bad” cholesterol must be redefined as two different states (low-density lipoprotein and high-density lipoprotein) of the same biological structure named “cholesterol.” In our work, for the first time in the specialized literature, low-density lipoprotein and high-density lipoprotein have been regarded as two different states of the same biological structure (named “cholesterol”), such as in nuclear physics, the neutron and proton are two different states of the same particle named nucleon.</jats:p

Nutritional Decline in Scleroderma Patients Data from a single Romanian center

Malnutrition has been known to provide poor survival outcomes in systemic sclerosis (SSc). We recruited a series of 40 consecutive SSc patients, 22 (55%) with limited cutaneous involvement and 18 (45%) with the diffuse form of disease. The study group was evaluated using the modified Rodnan skin score (mRSS), anthropometric measurements, the EPIC-Norfolk Food Frequency Questionnaire, the Malnutrition Universal Screening Tool (MUST) as well as circulating albumin and vitamin D. MUST scores were correlated with mRSS and serum albumin (R=0.40, p=0.010, and R=-0.46, p=0.003, respectively). Serum vitamin D values were inversely related to mRSS (R=-0.35, p=0.026). We recorded a greater number of daily gastrointestinal symptoms associated with diets rich in sodium, fat, sugars and snacks, carotene, and �-tocopherol equivalents (vitamin E) in our study population. Scleroderma patients might benefit from nutritional counseling in order to follow a diet tailored to their specific needs. </jats:p