The Risk of Infection in Dry Eye Syndrome Accompanying Primary Sjögren’s Syndrome

Primary Sjögren’s syndrome (pSS) is an autoimmune disease, which dominates the symptoms resulting from inflammatory infiltrates in exocrine glands. Frequently, patients complain of a feeling of sand under the eyelids, eye irritation, and red eye caused by a decrease in tear secretion. The ophthalmic examination beyond lowering the secretion of tears in Schirmer’s test evaluation in cases with a significant intensification of dry eye disease (DED) can be visualized by measuring ocular staining score (OSS) using lissamine green and fluorescein staining. OSS can demonstrate the degree of damage to the corneal surface. It is known that keratoconjunctivitis sicca (KCS) in pSS is not only limited to the complaints of unpleasant feeling of sand under the eyelids but also can lead to serious corneal damage and decreased vision even to blindness. And between the others, complications of KCS in pSS must be replaced with an increased susceptibility to infection. We should also pay attention to possible co-infection with Epstein-Barr virus (EBV) virus and bacterial co-infections, e.g., Chlamydia pneumoniae, Staphylococcus aureus, or latent conjunctival infections Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in group of patients with DED, not only in pSS group. Another issue is simultaneous with hepatitis C virus (HCV) infection coexistance of clinical and laboratory features of Sjogrens syndrome and accompanying this situation clinical signs of KCS. To sum up symptoms of KCS in primary Sjögren’s syndrome and in all patients with DED should be evaluated individually and should take into account the increased risk of infection among these patients

Primary Sjögren’s Syndrome and Autoantibodies

The presence of certain autoantibodies in the serum of patients facilitates the diagnosis of particular autoimmune diseases. Some antibodies may also be significant for the prognosis of the disease development and internal organs involvement. In the case of Sjögren’s syndrome, it is known that overactivity of B-lymphocytes leads to the production of a number of autoantibodies—both markers for pSS (such as antibodies to ribonucleoproteins) and nonspecific antibodies (such as rheumatoid factor). The range of autoantibodies found in pSS is constantly expanding, but their significance is not fully established. At present, only anti-SS-A antibodies are introduced to the criteria for the pSS diagnosis. However, this does not stop an interest in other autoantibodies and the significance of their presence for the course of this disease. This chapter outlines the autoantibodies found in pSS and discusses their importance in clinical practice

Steps towards standard medical treatment of rheumatoid arthritis: A practical guide

Rheumatoid arthritis (RA) is the most common inflammatory rheumatic disease, involving the longterm use of drugs that act by different mechanisms to treat this disease in an effective way. Current eligibility criteria enable early diagnosis of RA, which should result in early treatment. An important component of therapy is good cooperation with a patient, who has an impact on modifiable factors that affect the course of RA and the efficacy of treatment, such as treatment of periodontal infections, weight reduction and smoking cessation. RA treatment should follow the treat-to-target (T2T) strategy, according to which patients should be continuously monitored for treatment efficacy and therapy should be adjusted to achieve improvement after 3 months and disease remission after 6 months. There is an increasing number of drugs available that allow a more precise choice of therapy, however, there is still little availability of drugs reimbursed under the B.33 Drug Program.During the course of therapy, it is also necessary to monitor the safety of the treatment used

Inflammatory low back pain: diagnostic and therapeutical recommendations for family doctors

Low back pain (LBP) or pain of the lumbo-sacral region of the vertebral column is a polyetiological clinical state. LBP is a common medical condition and has a recurrent nature. The incidence of the first LBP episode in life varies from 6.3 to 15.4% a year, while the total annual LBP incidence is estimated at up to 36%. The cause of LBP can be located in the osseous structures and the joints of the vertebral column, the intervertebral discs, as well as the muscles, ligaments and nerves of the lumbo-sacral region. Commonly, the disease mechanism is complex. Differential diagnosis is an important part of the management of LBP patients due to a number of potential causes. Some forms of LBP need emergency management, and their features are known as “red flag symptoms”. Such LBP forms occur at night and lack any connection with physical activity (especially in the early stage of the disease). Rapidly deteriorating LBP also needs to be considered as an emergency. Inflammatory LBP occurs in patients with inflammatory spondyloarthropathies (in 70–80% of the patients). The presented recommendations are designed to facilitate the identification of patients with inflammatory LBP. They also describe rules of referring to a rheumatologist, as well as focus on the cooperation of a family doctor and a rheumatologist in the treatment of these patients. In most patients LBP is the first symptom of inflammatory spondyloartropathy. The classification criteria of inflammatory LBP are as follows: 1) onset at the age below 40; 2) insidious onset; 3) an improvement after physical exercise; 4) the lack of improvement after rest; 5) pain at night with improvement after getting up from bed. Non-pharmacological (kinesiotherapy, patient education) and pharmacological methods (non-steroidal anti-inflammatory drugs, TNF -alpha blockers) are used in the management of patients with inflammatory spondyloartropathy

Lipodystrophy syndrome in HIV-infected patients -a cohort study in Lower Silesia, Poland

Abstract Introduction: Human immunodeficiency virus (HIV)-associated lipodystrophy syndrome (LS) is defined as a redistribution of adipose tissue, metabolic and endocrine abnormalities, resulting from combined antiretroviral therapy (cART). Aim of this study was to evaluate LS in HIV-infected patients from Lower Silesia, Poland

Rheumatoid arthritis - clinical aspects: 134. Predictors of Joint Damage in South Africans with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) causes progressive joint damage and functional disability. Studies on factors affecting joint damage as clinical outcome are lacking in Africa. The aim of the present study was to identify predictors of joint damage in adult South Africans with established RA. Methods: A cross-sectional study of 100 black patients with RA of >5 years were assessed for joint damage using a validated clinical method, the RA articular damage (RAAD) score. Potential predictors of joint damage that were documented included socio-demographics, smoking, body mass index (BMI), disease duration, delay in disease modifying antirheumatic drug (DMARD) initiation, global disease activity as measured by the disease activity score (DAS28), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and autoantibody status. The predictive value of variables was assessed by univariate and stepwise multivariate regression analyses. A p value <0.05 was considered significant. Results: The mean (SD) age was 56 (9.8) years, disease duration 17.5 (8.5) years, educational level 7.5 (3.5) years and DMARD lag was 9 (8.8) years. Female to male ratio was 10:1. The mean (SD) DAS28 was 4.9 (1.5) and total RAAD score was 28.3 (12.8). The mean (SD) BMI was 27.2 kg/m2 (6.2) and 93% of patients were rheumatoid factor (RF) positive. More than 90% of patients received between 2 to 3 DMARDs. Significant univariate predictors of a poor RAAD score were increasing age (p = 0.001), lower education level (p = 0.019), longer disease duration (p < 0.001), longer DMARD lag (p = 0.014), lower BMI (p = 0.025), high RF titre (p < 0.001) and high ESR (p = 0.008). The multivariate regression analysis showed that the only independent significant predictors of a higher mean RAAD score were older age at disease onset (p = 0.04), disease duration (p < 0.001) and RF titre (p < 0.001). There was also a negative association between BMI and the mean total RAAD score (p = 0.049). Conclusions: Patients with longstanding established RA have more severe irreversible joint damage as measured by the clinical RAAD score, contrary to other studies in Africa. This is largely reflected by a delay in the initiation of early effective treatment. Independent of disease duration, older age at disease onset and a higher RF titre are strongly associated with more joint damage. The inverse association between BMI and articular damage in RA has been observed in several studies using radiographic damage scores. The mechanisms underlying this paradoxical association are still widely unknown but adipokines have recently been suggested to play a role. Disclosure statement: C.I. has received a research grant from the Connective Tissue Diseases Research Fund, University of the Witwatersrand. All other authors have declared no conflicts of interes

Skuteczność ketoprofenu stosowanego miejscowo w postaci żelu

Niesteroidowe leki przeciwzapalne są bardzo często stosowane w leczeniu bólu ostrego i przewlekłego. Wśród chorób, w których znajdują zastosowanie, wymienia się między innymi choroby reumatyczne, a szczególnie chorobę zwyrodnieniową, która jest trzecią co do częstości chorobą przewlekłą występującą w populacji ogólnej. Przy wyborze niesteroidowych leków przeciwzapalnych należy brać pod uwagę wiele czynników, takich jak wiek pacjenta, rodzaj choroby, rodzaj bólu (ostry, przewlekły), występowanie schorzeń współistnie‑ jących oraz leki przyjmowane przez chorego. Częstość choroby zwyrodnieniowej wzrasta z wiekiem – wystę‑ puje ona u około 50–60% osób >75. roku życia. W tej grupie wiekowej często występują również inne scho‑ rzenia i przyjmowane są leki, które w istotny sposób mogą ograniczać lub uniemożliwiać stosowanie ogólne niesteroidowych leków przeciwzapalnych. U takich chorych zalecane są przede wszystkim – w pierwszej linii – niesteroidowe leki przeciwzapalne podawane miejscowo. Ketoprofen w żelu cechuje największa siła działania przeciwbólowego i przeciwzapalnego oraz duży profil bezpieczeństwa. Ponieważ stężenie tego leku w postaci żelu w skórze, chrząstce stawowej i łąkotce jest duże, a w surowicy krwi małe, ketoprofen jest również zalecany w bólach urazowych