Importance of Concomitant Fibromyalgia in Rheumatoid Arthritis and Systemic Lupus

Souhrn Úvod: Fibromyalgie (FM) je chronický syndrom charakterizovaný dysfunkcí zpracování a regulace bolesti. Poměrně často se vyskytuje v konkomitanci s difuzními nemocemi pojiva (DNP), zejména revmatoidní artritidou (RA) a systémovým lupus erythematodes (SLE). FM se tak může podílet na jejich výsledném klinickém obraze a mít významné důsledky pro diagnostiku a léčbu. Cíl: Zjistit frekvenci FM u vybraných DNP, vliv FM na jejich klinickou manifestaci a vztah FM ke klinickému hodnocení aktivity DNP v regionální, monocentrické, průřezové, deskriptivní studii. Metody: Hodnocené soubory tvoří 120 dospělých pacientů s RA, 91 s SLE, 30 s polymyozitidou/ dermatomyozitidou (PM/DM) a 28 se systémovou sklerózou (SSc). Každý z pacientů byl vyšetřen na přítomnost konkomitující FM podle klasifikačních kritérií American College of Rheumatology (ACR 1990). U všech vyšetřených osob byly zaznamenány následující údaje: sociodemografická data, podrobná anamnéza zahrnující komorbidity, současná imunosupresivní terapie a analgetická léčba, vybrané laboratorní parametry (sérové zánětlivé markery, autoprotilátky). Bolest, únava a ztuhlost (za posledních 24 hodin) byly hodnoceny na horizontální 100 mm vizuální analgové škále. Funkční stav pacientů byl posouzen pomocí dotazníku HAQ (Health Assessment Questionnaire) a kvalita života...Background: Fibromyalgia (FM) is a chronic syndrom characterized by dysfunction of pain processing and regulation. It occurs relatively often in concomitance with the connective tissue diseases (CTD), in particular rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). FM may be involved in their final clinical manifestation and may have important consequencies for diagnosis and treatment. Objectives: To examine frequency of FM in the prime CTD, FM impact on their clinical manifestation and relationship to assessment of the clinical activity in regional, monocentric, cross- sectional, descriptive study. Methods: Study groups of 120 adult patients with RA, 91 with SLE, 30 with polymyositis/ dermatomyositis (PM/DM) and 28 with systemic sclerosis (SSc) were evaluated. Each patient was examined on the presence of concomitant FM according to ACR (American College of Rheumatology) classification criteria (1990). The following data were recorded: sociodemographic data, history including comorbidities, contemporary immunosupressive and analgesic therapy, laboratory parameters (serum inflammatory markers, relevant autoantibodies). Pain, fatigue and muskuloskeletal stiffness were assessed on horizontal 100 mm visual analogue scale. Patients' function status was evaluated using HAQ (Health...2nd Department of Internal Medicine - GastroenterologyII. interní gastroenterologická klinikaLékařská fakulta v Hradci KrálovéFaculty of Medicine in Hradec Králov

Whipple’s Disease: Our Own Experience and Review of the Literature

Whipple’s disease is a chronic infectious systemic disease caused by the bacterium Tropheryma whipplei. Nondeforming arthritis is frequently an initial complaint. Gastrointestinal and general symptoms include marked diarrhoea (with serious malabsorption), abdominal pain, prominent weight loss, and low-grade fever. Possible neurologic symptoms (up to 20%) might be associated with worse prognosis. Diagnosis is based on the clinical picture and small intestinal histology revealing foamy macrophages containing periodic-acid-Schiff- (PAS-) positive material. Long-term (up to one year) antibiotic therapy provides a favourable outcome in the vast majority of cases. This paper provides review of the literature and an analysis of our 5 patients recorded within a 20-year period at a tertiary gastroenterology centre. Patients were treated using i.v. penicillin G or amoxicillin-clavulanic acid + i.v. gentamicin for two weeks, followed by p.o. doxycycline (100 mg per day) plus p.o. salazopyrine (3 g per day) for 1 year. Full remission was achieved in all our patients

Importance of Concomitant Fibromyalgia in Rheumatoid Arthritis and Systemic Lupus

Background: Fibromyalgia (FM) is a chronic syndrom characterized by dysfunction of pain processing and regulation. It occurs relatively often in concomitance with the connective tissue diseases (CTD), in particular rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). FM may be involved in their final clinical manifestation and may have important consequencies for diagnosis and treatment. Objectives: To examine frequency of FM in the prime CTD, FM impact on their clinical manifestation and relationship to assessment of the clinical activity in regional, monocentric, cross- sectional, descriptive study. Methods: Study groups of 120 adult patients with RA, 91 with SLE, 30 with polymyositis/ dermatomyositis (PM/DM) and 28 with systemic sclerosis (SSc) were evaluated. Each patient was examined on the presence of concomitant FM according to ACR (American College of Rheumatology) classification criteria (1990). The following data were recorded: sociodemographic data, history including comorbidities, contemporary immunosupressive and analgesic therapy, laboratory parameters (serum inflammatory markers, relevant autoantibodies). Pain, fatigue and muskuloskeletal stiffness were assessed on horizontal 100 mm visual analogue scale. Patients' function status was evaluated using HAQ (Health..

Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscop

Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE