The importance of early arthritis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies

The importance of early arthritis in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies

Stress-induced traps in multilayered structures

The trap parameters of defects in Si/CaF2 multilayered structures were determined from the analysis of optical charging spectroscopy measurements. Two kinds of maxima were observed. Some of them were rather broad, corresponding to "normal" traps, while the others, very sharp, were attributed to stress-induced traps. A procedure of optimal linear smoothing the noisy experimental data has been developed and applied. This procedure is based on finding the minimal value of the relative error with respect to the value of the smoothing window. In order to obtain a better accuracy for the description of the trapping-detrapping process, a Gaussian temperature dependence of the capture crosssections characterizing the stress-induced traps was introduced. Both the normal and the stress-induced traps have been characterized, including some previously considered as only noise features.Comment: 37 pages, 9 figure

HEPATORENAL SYNDROME: A REVIEW

Hepatorenal syndrome (HRS) is defined as a functional renal failure in patients with liver disease that features morphologically intact kidneys, where regulatory mechanisms have minimized glomerular filtration and maximized tubular resorption and urine concentration. The syndrome occurs almost exclusively in patients with ascites. Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Type 2 HRS is characterized by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure, but refractory ascites, and its impact on prognosis is less negative. Liver transplantation is the most appropriate therapeutic method, nevertheless, only a few patients can receive it. The first line treatment includes terlipressin plus albumin. Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term. Other therapies include transjugular intrahepatic portosystemic shunts (TIPS), dialysis and peritoneovenous shunts which are most commonly done when patients are awaiting a liver transplant or when there is the possibility of improvement in liver function

Pulmonary involvement in rheumatoid arthritis – Another face of the coin

Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes progressive, symmetric, erosive destruction of cartilage and bone, which is usually associated with autoantibodies production. It is common that articular signs and symptoms develop long before extraarticular signs, but sometimes lung involvement is the first manifestation of RA and the most aggressive feature of the disease. Respiratory symptoms can precede the articular symptoms in 10–20% of cases. However, they may be masked by the poor functional status from joint disease or chronic inflammation. The pulmonary involvement can be due to the chronic inflammation caused by the disease or it can be secondary to immune-modulating medication. The pulmonary disease due to the disease itself includes: interstitial lung diseases, airways involvement (large and small airways), pleural involvement, rheumatoid pulmonary nodules and vascular pathology. The most used medication in patients with RA, such as metotrexate, leflunomide, TNF alpha blockers, but also other used drugs, may cause pulmonary diseases