Próba oceny wpływu leczenia infliximabem na sprawność ruchową chorych z reumatoidalnym zapaleniem stawów : badania wstępne

Wstęp: W patogenezie reumatoidalnego zapalenia stawów (RZS) ważną rolę odgrywa czynnik martwicy guzów alfa (TNFa). Lekiem neutralizującym biologiczną aktywność TNFa jest infliximab (Remicade) Celem pracy było określenie dynamiki zmian sprawności ruchowej pacjentów chorych na RZS w trakcie leczenia infliximabem. Metodyka: Infliximab podawano w dawkach 3 mg/kg w postaci 2 godzinnego wlewu dożylnego przez 14 tygodni; początkowo stosowano infuzje co 2 tygodnie, następnie co 4 tygodnie. Grupę badawczą stanowiło 8 kobiet ze średnio zaawansowanym, lub zaawansowanym RZS (IIo i IIIo gr wg Steinbrockera) leczonych na Oddziale Reumatologii Szpitala im J Dietla w Krakowie. Średnia wartość CRP w surowicy tych chorych wynosiła 3,15 mg%, a OB 55,5 po 1 godz. Zakres ruchów badano za pomocą Mechanical Joint Score (MJS), oceniając ruchomość w stawach rąk, nadgarstkowych, oraz w stawach łokciowych, barkowych, biodrowych, kolanowych i skokowych. Oceniano siłę chwytu rąk przy pomocy mankietu do pomiaru ciśnień, oraz nasilenie procesu zapalnego, ból i sztywność stawów używając kwestionariuszy Western Ontario Mc Master University Index (WOMAC) oraz Rheumatoid Arthritis Disease Activity Index (RADAI). Wyniki: Już po pierwszych 2 tygodniach leczenia nastąpiła istotna statystycznie poprawa sprawności ruchowej w stawach mierzona za pomocą MJS, oraz jakości życia mierzona kwestionariuszami RADAI i WOMAC. Wyraźnie zmniejszyły się dolegliwości bólowe i znaczącej poprawie uległa siła chwytu rąk. Zaobserwowano normalizację wartości CRP i OB. Największą poprawę wszystkich parametrów zaobserwowano po pierwszym wlewie infliximabu. W ciągu kolejnych tygodni poprawa postępowała znacznie wolniej. W 14 tygodniu leczenia stwierdzono wyraźne zaostrzenie procesu chorobowego, związane prawdopodobnie z dłuższym odstępem pomiędzy kolejnymi dawkami leku, nie osiągające jednak nasilenia takiego jak przed rozpoczęciem leczenia.Introduction: Tumour necrosis factor alpha (TNFa) plays an important role in the pathogenesis of rheumatoid arthritis (RA). Infliximab (Remicade) is an agent with neutralising effects on the TNFa biological activity. The aim of the study was to assess the dynamics of changes in motor function of patients with RA during infliximab treatment. Methods: Infliximab was administered at doses of 3 mg/kg in a 2-hour intravenous infusion for 14 weeks; initially, the infusions were given every 2 weeks, subsequently every 4 weeks. Eight women at moderately advanced or advanced stages of RA (stages IIş and IIIş according to Steinbrocker Staging System) hospitalised in the Rheumatology Ward of the Józef Dietl Hospital in Cracow were enrolled in the study. Mean serum CRP level in these patients was 3.15 mg%, and the 1-hour sedimentation rate was 55.5. The range of motion was evaluated using the Mechanical Joint Score (MJS) via mobility assessment in the joints of the hands, wrists, and in the elbow, shoulder, hip, knee and ankle joints. Grasp force of the hands was assessed by means of a sphygmomanometer cuff, and the intensity of the inflammatory process, pain and joint stiffness using the questionnaires Western Ontario Mc Master University Index (WOMAC) and Rheumatoid Arthritis Disease Activity Index (RADAI). Results: Statistically significant improvement in the motor function of the joints assessed using MJS and in the quality of life measured by means of RADAI and WOMAC occurred as early as after 2 weeks of the therapy. Pain was markedly alleviated and the grasp force of the hands significantly improved. Normalisation of the CRP concentration and the sedimentaion rate was observed. The most pronounced improvement of all parameters was demonstrated after the first infliximab infusion. During the subsequent weeks, the improvement was significantly slower. In the 14th week of treatment, a marked exacerbation of the disease, yet not exceeding the pre-treatment intensity, was noted, likely due to the increased interval between the successive doses of the preparation. Conclusions: Administration of infliximab in patients with RA induces a quick and significant improvement in patients’ motor function; however, beneficial effects of this agent were attenuated during the subsequent phases of infliximab therapy. This effect may have been caused by the reduction of administration frequency of the preparation (initially every 2 weeks, then every 4 weeks). Therapy-associated occurrence of infliximab-neutralising antibodies resulting in a reduced efficacy of the treatment with this agent cannot be excluded either

Adipokines as biomarkers of atopic dermatitis in adults

Atopic dermatitis (AD) is characterized by chronic, relapsing, pruritic skin inflammation and does not have a well-understood pathogenesis. In this study, we addressed the contribution of adipokines to AD eczema based on the assessment of blood levels of adiponectin, resistin, leptin, lipocalin-2, and vaspin in adult non-obese patients suffering from chronic extrinsic childhood-onset AD. We investigated 49 AD patients with a median age of 37 years. The control group consisted of 30 age-matched healthy subjects. Adipokines were assessed in the serum by ELISA assays and the severity of AD with the SCORing Atopic Dermatitis (SCORAD) index. We found that adiponectin and resistin decreased and leptin appreciably increased in AD patients when compared to those in healthy subjects. Further, the levels of adiponectin and resistin were inversely related to the intensity of eczema. In conclusion, apart from the formerly investigated role of leptin in AD, this study points to adiponectin and resistin as the potential candidate adipokine biomarkers involved in shaping eczema intensity and severity, which may help predict disease exacerbations and enable the development of effective targeted therapeutic interventions

Pityriasis lichenoides-like secondary syphilis and neurosyphilis in a HIV-infected patient

Papulo- and vesiculo-necrotic lesions are rare manifestations of secondary syphilis. Until now it has been described only in HIV-infected patients with advanced stages of immunosuppression. This case report describes an unusual case of PLEVA-like syphilis in a 33-year-old man with newly diagnosed HIV infection. Despite that the CD4 cells level and viral load did not indicate the advance stage of immunosuppression, the unusual manifestation of syphilis and neurosyphilis occurred. The presented case indicates the need for HIV screening in every patient with syphilis especially when the clinical manifestation is unusual. Importance of syphilis testing in every case with atypical rashes should be also highlighted

Protective Effect of Melatonin on Acute Pancreatitis

Melatonin, a product of the pineal gland, is released from the gut mucosa in response to food ingestion. Specific receptors for melatonin have been detected in many gastrointestinal tissues including the pancreas. Melatonin as well as its precursor, L-tryptophan, attenuates the severity of acute pancreatitis and protects the pancreatic tissue from the damage caused by acute inflammation. The beneficial effect of melatonin on acute pancreatitis, which has been reported in many experimental studies and supported by clinical observations, is related to: (1) enhancement of antioxidant defense of the pancreatic tissue, through direct scavenging of toxic radical oxygen (ROS) and nitrogen (RNS) species, (2) preservation of the activity of antioxidant enzymes; such as superoxide dismutase (SOD), catalase (CAT), or glutathione peroxidase (GPx), (3) the decline of pro-inflammatory cytokine tumor necrosis α (TNFα) production, accompanied by stimulation of an anti-inflammatory IL-10, (4) improvement of pancreatic blood flow and decrease of neutrophil infiltration, (5) reduction of apoptosis and necrosis in the inflamed pancreatic tissue, (6) increased production of chaperon protein (HSP60), and (7) promotion of regenerative process in the pancreas. Conclusion. Endogenous melatonin produced from L-tryptophan could be one of the native mechanisms protecting the pancreas from acute damage and accelerating regeneration of this gland. The beneficial effects of melatonin shown in experimental studies suggest that melatonin ought to be employed in the clinical trials as a supportive therapy in acute pancreatitis and could be used in people at high risk for acute pancreatitis to prevent the development of pancreatic inflammation

Stress coping mechanisms in patients with chronic dermatoses

Objective. The results of numerous studies of today confirm that persons suffering from psychosomatic disorders are not able to effectively cope with stress. The experience of stress is also frequently combined with the occurrence or aggravation of various skin diseases. The goal of our study was to identify the predominant ways of coping with stress in the group of patients with chronic dermatoses. Methods. The group under study included patients receiving treatment in the Dermatology Clinic of Collegium Medicum, Jagiellonian University. They were either hospitalized patients or those who came for control examinations at the Outpatient Clinic. Evaluation of the forms of coping with stress was conducted with the help of the Endler and Parker Questionnaire - CISS. Results. They significantly more often apply the style of coping focused on avoiding (p-value= 0.0056). It also turned out that the patients in the dermatological groups manifested a constant tendency to get involved in vicarious activities (p-value=0.0247). Discussion. The results of the presented study indicate that there is a statistically significant difference between the patients with dermatological disorders and those in the control group as regards their ways of coping with stress. Conclusion. The results obtained in the discussed study may be a starting point for designing a complex support for the patients with skin diseases. The therapeutic technique that may prove helpful for this group of patients is the cognitive-behavioral therapy (CTB)

Erythema ab igne as a side effect of working in a flower shop : case report and literature review

Introduction . Erythema ab igne (EAI) is a rare skin disease (since the common use of central heating) characterized by reticular, erythematous and hyperpigmented patches resulting from chronic exposure to infrared radiation. Although the condition is generally benign, chronic heat exposure can induce dysplasia and, rarely, squamous cell carcinoma. The pathogenesis of the disease is not yet fully understood. Objective . Presentation of the diagnostic and therapeutic difficulties in a patient with EAI. Case report. The patient had erythema ab igne that developed on the shins, due to the effect of a heating device used in the flower shop. The clinical presentation, differential diagnosis and available treatment options of the disease are described. Conclusions . Erythema ab igne is a rare skin disease, but there is a need for special oncological observation of these patients

Emollient therapy in children with atopic dermatitis : a pilot study.

Wprowadzenie: Atopowe zapalenie skóry (AZS) to przewlekła i nawrotowa dermatoza zapalna cechująca się obecnością świądu oraz suchości skóry. Kluczowym czynnikiem decydującym o sukcesie terapeutycznym jest właściwa relacja chorego z lekarzem prowadzącym. Na każdym etapie terapii AZS zaleca się aplikowanie emolientów. Cel pracy: Ocena preferencji, przekonań oraz adherence opiekunów dzieci z AZS w zakresie zalecanej terapii emolientowej i ich związku z nasileniem objawów choroby u dzieci. Materiał i metody: Badanie ma charakter pilotażowy. Zgromadzono odpowiedzi pochodzące z anonimowych kwestionariuszy dotyczące preferencji, przekonań i adherence w zakresie emolientoterapii uzyskane od 50 rodziców dzieci chorych na AZS. Każdy opiekun dokonywał oceny świądu skóry u dziecka w skali wizualno-analogowej oraz stanu skóry dziecka. Porównanie zmiennych nominalnych wykonano za pomocą testu c2 lub 2-stronnego testu Fischera. Przy porównaniu grup posłużono się testem U Manna-Whitneya oraz testem Kruskala-Wallisa. Wyniki: Najczęściej wybieraną formą emolientu był płyn lub emulsja kąpielowa. Pozytywny wpływ emolientu na skórę dziecka obserwowało 39 opiekunów. Największy odsetek ankietowanych stosował emolienty 2 razy dziennie. Jako istotny czynnik przy wyborze emolientu wskazywano najczęściej nasilenie zmian. Opiekunowie, którzy zauważyli poprawę w zakresie stanu skóry i świądu skóry u dzieci, częściej preferowali emolienty w formie kremów i maści. Najważniejszym elementem emolientoterapii według większości uczestników badania było regularne stosowanie preparatów. Regularne stosowanie emolientów było istotnym czynnikiem związanym z poprawą stanu klinicznego. Wnioski: Preferencje oraz przekonania opiekunów mogą istotnie wpływać na adherence w terapii emolientowej AZS u dzieci i w konsekwencji na powodzenie leczenia. Współpraca lekarza i opiekunów chorego dziecka stanowi podstawę wypracowania zindywidualizowanego schematu terapeutycznego

Reakcja fitofototoksyczna ze współistniejącymi zmianami odpowiadającymi erythema multiforme związana z ekspozycją na barszcz Sosnowskiego

Introduction. dermatitis bullosa pratensis (phytophotodermatitis) is an acute phototoxic reaction caused by photosensitizing substances present in different kinds of plants, activated by ultraviolet radiation exposure. An acute phototoxic reaction manifests as erythema, vesicles and even blisters with morphology of burns. Objective. We present a case report of phytophotodermatitis due to Heracleum sosnowskyi . Heracleum sosnowskyi was discovered in 1772 and described as a separate species in botanical literature in 1944 by I. P. Mandenova. Case report . In our case, skin lesions coexisted with erythema multiforme . Implemented therapy – corticosteroids, antihistamines and topical medications – was successful. After clinical resolution post-inflammatory hyperpigmentations were observed. Conclusions . Appropriate diagnosis of phytophototoxic reaction may constitute a challenge in everyday practice