Neuropathic pain related to osteoarthritis

Osteoartritis (OA) najčešća je zglobna bolest razvijenog svijeta i glavni je uzrok kronične onesposobljenosti. Prema rezultatima brojnih istraživanja procjenjuje se da oko 15% svjetske populacije boluje od OA. Dugo se OA smatrao isključivo mehaničkom bolešću, no zadnjih desetljeća upala zauzima značajno mjesto u njegovoj patogenezi. OA može zahvatiti bilo koji sinovijalni zglob iako se češće javlja na kukovima, koljenima, gležnjevima jer su to zglobovi koji podnose najveća opterećenja u tijelu. Dijagnoza OA obično se postavlja na osnovu kliničkih simptoma (bol, ukočenost) i fizikalnog pregleda (smanjen opseg pokreta, prisutnost izljeva u zglobu, krepitacije), a potvrđuje se radiološkim snimkama. Bol predstavlja dominantan simptom OA i glavni razlog zbog kojega se bolesnici s OA javljaju liječniku. Patofiziologija boli u OA još nije razjašnjena. Dugo se smatralo da je bol u OA prema mehanizmu nastanka nociceptivna i upalna. Danas prevladava mišljenje da i mehanizmi neuropatske boli pridonose nastanku osjeta boli u nekih bolesnika s OA. Cilj liječenja bolesnika s OA je smanjenje boli, poboljšanje pokretljivosti i ograničavanje funkcionalnog opterećenja. Optimalno je kombinirano nefarmakološko i farmakološko, dok je kirurško liječenje indicirano u relativno malog broja bolesnika. Prepoznavanje bolesnika s neuropatskom boli kao posebne skupine među oboljelima od OA pomoglo bi kliničarima da na ispravan način pristupe njihovom liječenju.Osteoarthritis (OA) is the most common articular disease of the developed world and a leading cause of chronic disability. Epidemiological studies suggest that about 15% of the world population suffers from OA. OA was for decades described as a mechanical disorder. Nowdays it is known that inflammation plays significant role in the pathogenesis of the disease. OA can occur in any synovial joint in the body. But it is the most common in weight bearing joints such as the hips, knees and the ankle. The diagnosis of OA can usually be made clinically and then comfired by radiography. The main features that suggest the diagnosis include pain, stiffness, reduced movement, swelling, crepitus. Pain is the most prominent symptom of OA and the most common reason why OA patients consult their general practitioner. Phatophysiology pain mechanisms in OA haven't been yet well understood. The pain of OA is believed to be driven by nociceptive and inflammatory mechanisms. Increasing evidence supports the hypothesis that neuropathic mechanisms may also be contributing to the pain associated with OA. Treatment goals for the OA patients include a reduction in pain, an improvement in joint mobility and to limit functional impairment. To properly manage OA, both nonpharmacological and pharmacological modalities may be used, while minority of patients will require surgery. Recognizing OA patients who have experienced pain with neuropathic features as a distinct subgroup will allow clinicians to improve the management of their symptoms

Primarni vaskulitis središnjega živčanog sustava - dijagnostički izazov

Primary angiitis of the central nervous system (PACNS) is a rare and severe disease confined to the central nervous system, i.e., the brain and spinal cord. The etiology, pathogenesis and immune mechanism of PACNS have not yet been completely elucidated. The diagnosis is challenging; it is based upon constellation of clinical picture, cerebrospinal fluid analysis, imaging methods or tissue biopsy as the gold standard. In differential diagnosis of PACNS, it is necessary to rule out infectious, malignant or systemic inflammatory diseases, as well as reversible cerebral vasoconstriction syndrome. Immunosuppressants are cornerstone therapy for PACNS, although evidence-based strategies for the management are lacking so far. PACNS is an entity with considerable morbidity and mortality. Awareness of this rare and heterogeneous disease is crucial for establishing early diagnosis and treatment initiation.Primarni vaskulitis središnjega živčanog sustava (PVSŽS) je rijetka i teška bolest ograničena na središnji živčani sustav, tj. mozak i leđnu moždinu. Etiologija, patogeneza i imuni mehanizam PVSŽS-a još nisu u potpunosti razjašnjeni. Dijagnoza je zahtjevna i postavlja se na temelju kliničke slike, nalaza lumbalne punkcije, slikovnih metoda ili biopsije tkiva kao zlatnog standarda. U diferencijalnoj dijagnozi PVSŽS-a potrebno je isključiti infektivne, maligne ili sistemske upalne bolesti, kao i reverzibilni vazokonstrikcijski sindrom. Imunosupresivi su temelj terapije, iako zasad nema jasnih smjernica i preporuka za liječenje ove bolesti. PVSŽS je entitet sa značajnim pobolom i smrtnošću. Svijest o ovoj rijetkoj bolesti složene kliničke prezentacije ključna je za postavljanje rane dijagnoze i početak liječenja

Tetracycline resistance in lactobacilli isolated from Serbian traditional raw milk cheeses

The aim of this study was to investigate the presence of tetracycline resistance in lactobacilli isolated from traditional Serbian white brined raw milk cheeses (Homolje, Sjenica, Zlatar). Isolation of presumptive lactobacilli was initially performed using MRS-S agar without tetracycline, or supplemented with 16 and 64 A mu g/mL of tetracycline. Rep-PCR (GTG)(5) genotyping showed a high diversity of the isolates obtained, as examination of 233 isolates resulted in 156 different Rep-PCR fingerprints. Ninety out of 156 (57.69%) of the strains, representatives with different (GTG)(5) fingerprints, were identified by MALDI-TOF MS as lactobacilli, while 66 out of 156 (42.31%) strains were identified as members of other LAB genera. All except one out of 90 Lactobacillus isolates further tested by microdilution method, demonstrated unimodal distribution of tetracycline MIC values which were equal to or lower from the breakpoint MIC values (EFSA in EFSA J 10: 1-10, 2012. Only one Lb. paracasei isolate showed the presence of tet(M) gene, while the other analyzed tet genes [tet(A), tet(B), tet(C) tet(K), tet(L), tet(O) and tet(W)] were not detected in any of the isolates. The results of this study indicates that lactobacilli from traditional Serbian raw milk cheeses do not present considerable tetracycline resistance reservoirs. For final conclusions about the safety of these autochthonous cheeses regarding the possible tetracycline resistance transferability, the assessment of the entire cheese microbiota is needed

Utjecaj pušenja na aktivnost bolesti u bolesnika s reumatoidnim artritisom - naša iskustva

The aim of this study was to investigate the association of smoking with disease activity, seropositivity, age and gender in patients with rheumatoid arthritis. We included 89 rheumatoid arthritis patients. All patients fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism rheumatoid arthritis classification criteria. Activity of the disease was measured by Disease Activity Score 28-joint count C-reactive protein (DAS28CRP). The subjects were stratified into smoking and non-smoking groups and cross-sectionally analyzed. There were 24 (27%) smokers and 65 (73%) nonsmokers. The mean age of patients was 57.1±8.8 years. The mean DAS28CRP was 5.81 in the smoking group and 5.57 in the non-smoking group, without statistically significant difference between the two groups (p=0.148). Similarly, smokers did not differ significantly from non-smokers according to age (p=0.443), gender (p=0.274), rheumatoid factor positivity (p=0.231), anti-citrullinated protein antibody positivity (p=0.754) or seropositivity (p=0.163). In this study, we found no association between smoking status and disease activity, seropositivity, age or gender in rheumatoid arthritis patients. Furthermore, disease activity was not related to age, gender or seropositivity. Additional studies on the effects of smoking on rheumatoid arthritis activity are needed.Cilj ovoga istraživanja bio je ispitati povezanost pušenja s aktivnošću bolesti, pozitivnim biokemijskim biljezima, dobi i spolom kod bolesnika s reumatoidnim artritisom. U istraživanju je sudjelovalo 89 ispitanika koji su bolovali od reumatoidnog artritisa. Svi ispitanici su ispunjavali klasifikacijske kriterije za postavljanje dijagnoze reumatoidnog artritisa Američkog reumatološkog društva i Europske reumatološke udruge (engl. European League Against Rheumatism, EULAR). Aktivnost bolesti mjerena je prema indeksu aktivnosti bolesti (engl. Disease Activity Score, DAS) koja se procjenjuje na 28 zglobova. Ispitanici su podijeljeni u dvije skupine (pušači i nepušači) koje su presječno analizirane. U ispitivanju je sudjelovalo 24 (27%) pušača i 65 (73%) nepušača. Srednja dob ispitanika bila je 57,1±8,8 godina. Srednje vrijednosti DAS28CRP u skupini pušača iznosile su 5,81, a u skupini nepušača 5,57, odnosno nije bilo statistički značajne razlike između dviju skupina (p=0,148). Također, skupina u kojoj su bili pušači nije se značajno razlikovala u parametrima dobi (p=0,443), spola (p=0,274), pozitivnog reumatoidnog faktora (p=0,231), pozitivnih anti-citrulinskih protutijela (p=0,754) ili seropozitivnosti (p=0,163) od skupine nepušača. U ovom istraživanju nismo pronašli povezanost između pušenja i aktivnosti bolesti, seropozitivnosti, dobi i spola kod bolesnika s reumatoidnim artritisom. Nadalje, aktivnost bolesti nije bila povezana s dobi, spolom i seropozitivnošću. Potrebna su daljnja istraživanja utjecaja pušenja na aktivnost reumatoidnog artritisa

BONE MINERAL DENSITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS – OUR RESULTS

Uvod. Bolesnici od sistemskog eritemskog lupusa (SLE) imaju povećani rizik za razvoj smanjene koštane mase, bilo zbog osnovne bolesti ili njezina liječenja. Osteoporoza i posljedični prijelomi kosti povezani su s povećanim morbiditetom i mortalitetom. U radu su prikazani rezultati istraživanja povezanosti duljine trajanja SLE, dobi, spola i načina liječenja s promjenama mineralne gustoće kostiju u bolesnika koji se liječe u našem Zavodu. Ispitanici i metode. Gustoća koštane mase određivana je dvoenergijskom rendgenskom apsorpciometrijom (DXA) područja lijevog kuka i lumbalne kralježnice. Osteoporoza i osteopenija defi nirane su prema kriterijima Svjetske zdravstvene organizacije iz 1994. U statističkoj analizi je upotrebljavan hi-kvadrat test, analiza varijance (ANOVA), LSD test proveden u sklopu analize varijance, regresijska analiza . Rezultati. U istraživanje je bilo uključeno 48 bolesnika od SLE (44 žene i 4 muškarca), prosječne dobi 45,8 godina i prosječnog trajanja SLE 9,8 godina. Osteoporoza je dijagnosticirana u 21 %, a osteopenija u 15 % bolesnika. Bolesnici s normalnom koštanom masom bili su prosječne dobi 41,1 godinu, bolesnici s osteopenijom imali su prosječno 47,6 godina, a oni s osteoporozom 59,0 godina. Bolesnici s urednim nalazom denzitometrije bili su statistički mlađi od bolesnika s osteoporozom ( p<0,05). Trajanje bolesti bilo je statistički znatno kraće kod urednog nalaza denzitometrije (7,3 godine) od trajanja bolesti kod osteopenije (16,1 godina) i osteoporoze (12,9 godina) (p<0,05). Gotovo svi bolesnici (47 od 48) primali su glukokortikoide. Ukupno 33,3 % bolesnika sa SLE nije uzimalo vitamin D3, a njih 56,3 % nije uzimalo kalcij. Zaključak. Etiopatogenetski mehanizmi povezanosti sistemskog eritemskog lupusa i povećanog rizika razvoja smanjene koštane gustoće mnogobrojni su i uključuju tradicionalne čimbenike rizika, kao i one povezane sa SLE. U ispitivanoj skupini bolesnika sa SLE dob i glukokortikoidna terapija glavni su rizični čimbenici za smanjenu koštanu gustoću. Nužna je pravodobna prevencija i pravodobno započinjanje liječenja smanjene koštane gustoće u bolesnika od SLE čime se, prema sadašnjim spoznajama, znatno smanjuje morbiditet i mortalitet.Introduction. Patients with systemic lupus erythematosus (SLE) are at an increased risk of developing low bone mass (LBM) or osteoporosis, either because of the disease itself or due to its treatment. Osteoporosis and osteoporotic fractures signifi cantly contribute to morbidity and mortality. We aimed to determine the associations of bone mineral density (BMD) changes with the duration of SLE, age, gender, and glucocorticoid treatment in SLE patients treated at our Department. Patients and methods. BMD measurements of the lumbar spine and total hip were performed by dual-energy Xray absorptiometry (DXA). Osteoporosis and LBM were determined according to the 1994 World Health Organization defi nition. In the statistical analysis, the independent Mann-Whitney U test and Tukey post-hoc testing were used. Results. Th e study included 48 SLE patients (44 female and 4 male), with a mean age of 45.8 years and an average SLE duration of 9.8 years. Osteoporosis was diagnosed in 21 %, and LBM in 15 % of the patients. Th e mean ages of the subgroups with normal BMD, LBM, and osteoporosis were 41.1, 47.6, and 59.0 years, respectively. Variant analysis showed a statistically signifi cant correlation between age and BMD (p<0.05). Th e duration of SLE was signifi cantly horter in patients with normal BMD (7.3 years), compared to patients with LBM (16.1 years) and osteoporosis (12.9 years) (p<0.05). Nearly all patients (47 of 48) were on longterm treatment with glucocorticoids. One third (33.3 %) of patients did not take vitamin D3, and 56.3 % did not take calcium supplements. Conclusion. Th e etiopathogenesis of decreased BMD in SLE patients is multifactorial and includes both traditional and SLE-related risk factors. In our group of SLE patients age and glucocorticoid treatment were the major risk factors for LBM. Timely prevention and treatment of LBM and osteoporosis in SLE patients, according to current knowledge, are essential for reducing morbidity and mortality