Treating Rheumatoid Arthritis yesterday and today

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that mainly affects joints. It is the most common form of inflammatory joint disease, and the second commonest joint disease, osteoarthritis being the commonest. The overall prevalence of rheumatoid arthritis has generally been given as 1% - with females outnumbering males in a ratio of 3-4:1, although there is some evidence that the incidence of the disease is decreasing. 1 Apart from this, the occurrence of rheumatoid arthritis is not the same throughout the world. It is quite rare in less developed rural parts of the world - thus one study in Nigeria failed to find one single case.2 Studies in Europe have shown that there is a gradient in the prevalence of rheumatoid arthritis, starting from a low prevalence in the South (e.g. Italy 0.31%)3 to a higher prevalence in the North (e.g. Finland 0.8%)4 While no formal epidemiological studies on rheumatoid arthritis have been carried out in Malta, a total of approximately 600 patients with the disease are followed up at the Rheumatology Clinic at St. Luke's Hospital, giving a prevalence of 0.16%.peer-reviewe

The Malta Medical School Conference

The next Malta Medical School Conference, the ninth one in the series, is being held towards the end of 2015.peer-reviewe

Anti-phospholipid antibodies : case report and review of the literature

There is currently considerable interest in antibodies directed against phospholipids. Several clinical associations with these antibodies have been defined, the strongest ones being with thrombosis and recurrent foetal loss. These antibodies were originally studied in patients with systemic lupus erythematosus, but they have also been found to occur in patients who do not have this disease. This paper describes two such patients and discusses current views on antiphospholipid antibodies.peer-reviewe

The great simulator

Cardiac myxoma often simulates multisystem disease and initially defies diagnosis. In this paper, we present three cases of cardiac myxoma in adults. Their clinical features and differential diagnosis will be reviewed, with special emphasis on their insidiousness and suspicion necessary for correct and prompt diagnosis. The role of echocardiography in diagnosis and treatment will be discussed, and finally, the surgical management and prognosis is briefly outlined.peer-reviewe

Pulmonary infarction in healthy young males

It is widely recognised that the elderly immobilised, sick, traumatised or postoperative patient is the most likely candidate to develop pulmonary embolism and infarction, and that the risk increases in direct proportion to the duration of the illness and to the age of the patient. Over the past few years, a number of autopsy studies have stressed the high incidence of deep venous thrombosis and pulmonary embolism in individuals who are otherwise normal. Unfortunately, many clinicians have been slow to appreciate this point and fail to recognise the condition unless well-established predisposing factors are present. This paper reports the findings in four young male patients who developed pulmonary infarction in the absence of obvious precipitating causes.peer-reviewe

Development and Validation of a Path Length Calculation for Carotid-Femoral Pulse Wave Velocity Measurement: A TASCFORCE, SUMMIT, and Caerphilly Collaborative Venture.

Current distance measurement techniques for pulse wave velocity (PWV) calculation are susceptible to intercenter variability. The aim of this study was to derive and validate a formula for this distance measurement. Based on carotid femoral distance in 1183 whole-body magnetic resonance angiograms, a formula was derived for calculating distance. This was compared with distance measurements in 128 whole-body magnetic resonance angiograms from a second study. The effects of recalculation of PWV using the new formula on association with risk factors, disease discrimination, and prediction of major adverse cardiovascular events were examined within 1242 participants from the multicenter SUMMIT study (Surrogate Markers of Micro- and Macrovascular Hard End-Points for Innovative Diabetes Tools) and 825 participants from the Caerphilly Prospective Study. The distance formula yielded a mean error of 7.8 mm (limits of agreement =-41.1 to 56.7 mm; P<0.001) compared with the second whole-body magnetic resonance angiogram group. Compared with an external distance measurement, the distance formula did not change associations between PWV and age, blood pressure, or creatinine (P<0.01) but did remove significant associations between PWV and body mass index (BMI). After accounting for differences in age, sex, and mean arterial pressure, intercenter differences in PWV persisted using the external distance measurement (F=4.6; P=0.004), whereas there was a loss of between center difference using the distance formula (F=1.4; P=0.24). PWV odds ratios for cardiovascular mortality remained the same using both the external distance measurement (1.14; 95% confidence interval, 1.06-1.24; P=0.001) and the distance formula (1.17; 95% confidence interval, 1.08-1.28; P<0.001). A population-derived automatic distance calculation for PWV obtained from routinely collected clinical information is accurate and removes intercenter measurement variability without impacting the diagnostic utility of carotid-femoral PWV

Servitude et grandeur militaires

Ġabra ta’ poeżiji u proża li tinkludi: Notturn op. 9 nru 2 ta’ Beverly Agius – Naf ta’ Carmel Azzopardi – Ħsejjes ħajja ta’ Clifton Azzopardi – Il-ġrajja t’għasfur stramb ta’ Mario Azzopardi – Tektik...u għana ta’ Rena Balzan – Kun af li f’qiegħ għajnejk ta’ Charles Bezzina – Il-qalb imwebbsa ta’ Ġorġ Borg – Bħal ħuta mġewħa ta’ Louis Briffa – Taħt il-Mezquita, Cordòba ta’ Norbert Bugeja – Il-maskarat ta’ Alfred Degabriele – Trid mara ta’ Leanne Ellul – Id-dgħajsa ta’ Victor Fenech – Ilħna ta’ Joe Friggieri – Roulette ta’ Joe Friggieri – Għera ta’ Joe P. Galea – Ħġieġa ta’ Maria Grech Ganado – Ġenna qatt mirbuħa ta’ Karmenu Mallia – Il-fantażma tal-mara mqarba ta’ Albert Marshall – Daħlet Qorrot ta’ Daniel Massa – Granada, parque central ta’ Immanuel Mifsud – Waħda mara ta’ Immanuel Mifsud – Mors ta’ Therese Pace – Għada ta’ Alfred Palma – Emmint xejn ma jintemm ta’ Ġorġ Peresso – Tuffieħa bl-imsiemer tal-qronfol ta’ John Peter Portelli – Lil Karmenu Vassallo ta’ Andrew Sciberras – Irrid il-qamar jiddi ta’ Carmel Scicluna – Din il-biċċa ħuta ta’ Steve Borg – Karta li taret mar-riħ ta’ Lina Brockdorff – Nixtieq, u kemm nixtieq! ta’ J. J. Camilleri – Caterina ta’ Sandro Mangion – L-għajta tal-pappagall ta’ Pierre J. Mejlak – Id-destin ta’ Laurence Mizzi – L-arloġġ tal-bozza ta’ Rita Saliba – Kurżità ta’ Alfred Sant – Il-ġeneral ta’ Vincent Vella – Mirja ta’ Trevor Żahra – L-adulteri ta’ Golan Haji, traduzzjoni ta’ Clare Azzopardi u Albert Gatt – L-istennija ta’ Berislav Blagojević, traduzzjoni ta’ Kit Azzopardi – Il-qattus ta’ Ghassan Kanafani, traduzzjoni ta’ Walid Nabhan – L-iben addottat ta’ Guy de Maupassant, traduzzjoni ta’ Josette Attard – Sunett nru. 18 ta’ William Shakespeare, traduzzjoni ta’ Alfred Palma – Llanto por Ignacio Sánchez Mejías ta’ Federico Garcia Lorca, traduzzjoni ta’ Therese Pace – Servitude et grandeur militaires ta’ Alfred de Vigny, traduzzjoni ta’ Paul Zahra.peer-reviewe

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS &gt;5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p&lt;0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

Overview of Age Discrimination and Related Matters in Malta and the EU

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