Preliminary report on a study of health-related quality of life in patients with rheumatoid arthritis

There are studies about health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA), but few studies prospectively assessed HRQoL. The main purpose of this study was to analyze HRQoL in patients hospitalized due to RA exacerbation and observed over a planned 2-year follow-up in an outpatient setting. The study involved 42 women and 9 men, at mean age of 62.5 years (SD ± 12.6). The mean duration of the study was 22–23 months. The HRQoL analysis was performed using the SF-36 survey. At the beginning of the study, basic data on age, sex, selected biochemical (ESR, CRP, GFR, hemoglobin, plasma albumin, plasma protein), and clinical parameters (the duration of RA, VAS, DAS28, BMI, the presence of cardiovascular disease, diabetes, osteoporosis, osteoporotic fractures, osteoarthritis, neoplasm) were collected. Questionnaires were completed at the beginning and end of the study. Statistically significant reductions in HRQoL scores were observed in social functioning (SF; 0.42 vs 0.32, P < 0.05), whereas role-emotional health (RE; 0.48 vs 0.59, P < 0.05) and mental health (MH; 0.47 vs 0.54, P < 0.05) scores were increased. A decrease in the SF was positively correlated with the lack of osteoporosis at baseline (r = 0.35, P > 0.02). An increase in the MH was inversely correlated with BMI (r = −0.31, P < 0.05), and the level of hemoglobin (r = −0.32, P < 0.028) and positively correlated with the presence of osteoarthritis at baseline (r = 0.29, P < 0.05). In RA patients, dimensions of HRQoL as SF, RE, and MH could change within 2 years and these changes could be related to comorbidities. Although preliminary findings are promising, further studies are needed

Zastosowanie radiosynowektomii w leczeniu chorób reumatycznych

Radiosynowektomia to metoda miejscowego leczenia przewlekłychstanów zapalnych stawów, wykorzystująca zjawiskoodbudowy błony maziowej pod wpływem promieniowania β,emitowanego przez radiofarmaceutyk podany dostawowo. Stanowiona alternatywę dla chirurgicznej synowektomii, jest stosowanaw przypadku nieskuteczności standardowych form terapiioraz dostawowych iniekcji glikokortykosteroidów. W pracy przedstawionojej miejsce w leczeniu wybranych chorób reumatycznychoparte na dotychczasowych doświadczeniach klinicznych

Sex-Related Predisposition to Post-Traumatic Stress Disorder Development&mdash;The Role of Neuropeptides

Post-traumatic stress disorder (PTSD) is characterized by re-experiencing a traumatic event, avoidance, negative alterations in cognitions and mood, hyperarousal, and severe functional impairment. Women have a two times higher risk of developing PTSD than men. The neurobiological basis for the sex-specific predisposition to PTSD might be related to differences in the functions of stress-responsive systems due to the interaction between gonadal hormones and stress peptides such as corticotropin-releasing factor (CRF), orexin, oxytocin, and neuropeptide Y. Additionally, in phases where estrogens levels are low, the risk of developing or exacerbating PTSD is higher. Most studies have revealed several essential sex differences in CRF function. They include genetic factors, e.g., the CRF promoter contains estrogen response elements. Importantly, sex-related differences are responsible for different predispositions to PTSD and diverse treatment responses. Fear extinction (the process responsible for the effectiveness of behavioral therapy for PTSD) in women during periods of high endogenous estradiol levels (the primary form of estrogens) is reportedly more effective than in periods of low endogenous estradiol. In this review, we present the roles of selected neuropeptides in the sex-related predisposition to PTSD development

Jakość życia zależna od zdrowia u pacjentów z reumatoidalnym zapaleniem stawów

Celem związanym z leczeniem reumatoidalnego zapalenia stawów(RZS) jest poprawa zdrowia w wymiarze fizycznym, społecznym i psychicznymoraz dbałość o jakość życia zależną od zdrowia. Celembadania była analiza jakości życia zależnej od zdrowia (health-relatedquality of life – HRQoL) pacjentów hospitalizowanych z powoduzaostrzenia RZS z uwzględnieniem chorób współistniejącychi wybranych parametrów biochemicznych. W badaniu brało udział 51osób, 42 kobiety i 9 mężczyzn. Średnia wieku wynosiła 62,5 roku (SD±12,6). Analizę HRQoL wykonano z użyciem kwestionariusza SF-36.Wyniki badania wykazały istotny statystycznie związek wybranychskal SF-36 z parametrami demograficznymi (starszy wiek, płeć żeńska),klinicznymi (czas trwania RZS, obecność choroby niedokrwiennejserca, osteoporozy, złamań patologicznych w przebiegu osteoporozy,choroby zwyrodnieniowej stawów, nowotworów złośliwych), biochemicznymi(OB, CRP, GFR, Hb, albuminy osocza) i wizualną skaląanalogową (visual analogue scale – VAS). Nie wykazano istotnegostatystycznie związku pomiarów HRQoL z takimi zmiennymi, jakobecność cukrzycy, stężenie białek osocza, wskaźnik aktywnościchoroby (DAS28), wskaźnik masy ciała (body mass index – BMI).Dodatkowo przeprowadzono analizę psychometryczną stosowanegoinstrumentu oceny HRQoL – SF-36, gdzie potwierdzono jego rzetelnośćoraz dobre parametry trafności, co wskazuje na przydatnośćtego instrumentu do oceny HRQoL u pacjentów z RZS. Otrzymanewyniki mogą być pomocne w dalszych badaniach nad HRQoL pacjentówz RZS i podejmowaniu decyzji ukierunkowanych na poprawęjakości życia

Osteoporosis and diabetes – possible links and diagnostic difficulties

Objectives In this review, the authors aimed to clarify the relationship between the occurrence of osteoporosis and diabetes, analyze the differences between the pathogenesis of osteoporosis in different types of diabetes and propose the most effective diagnostic strategy and fracture risk assessment in diabetic patients. Material and methods A analysis of publications in MEDLINE, COCHRANE and SCOPUS databases was performed, searching for reports on the diagnostics, fracture risk assessment, prevention, and treatment of osteoporosis in patients with diabetes mellitus (DM) published in the years 2016–2022. The key words for the search were: diabetes, osteoporosis, and low-energy fracture. Results Bone complications of T1DM are more severe than T2DM, because of the lack of anabolic effect of insulin on bones. In T2DM the risk of fractures is elevated; however, identifying the mechanisms underlying the increased risk of fractures in T2DM is not clear. The FRAX tool is not appropriate for assessing the fracture risk in young patients with T1DM. It is quite useful in older patients with T2DM, but in these patients the calculated fracture risk may be underestimated. In T2DM the fracture risk often does not correspond to BMD value as measured by dual-energy X-ray absorptiometry (DXA). Diagnostic tools such as the trabecular bone score may play a significant role in this group of patients. Conclusions Optimal strategies to identify and treat high risk individuals require further research and proper definition. The diagnostic criteria for osteoporosis should be clearly defined as well as fracture risk assessment and choice of anti-osteoporotic medication. In all cases of secondary osteoporosis, treatment of the underlying disease is the most important. The relationship between high risk of fractures and diabetes is inseparable, and its full understanding seems to be the key to effective management

The Clinical Utility of Dual-Energy Computed Tomography in the Diagnosis of Gout—A Cross-Sectional Study

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806–0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878–0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924–0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout

Heart disease in the course of systemic sclerosis – an observational study

Introduction Cardiac involvement is one of the major mortality factors in systemic sclerosis (SSc). This observational study aimed to compare patients with and without heart involvement in the course of SSc. Material and methods Electronic medical records of patients treated between January 2021 and August 2022 in the Department of Rheumatology were searched for the diagnosis of SSc (ICD-10 code M47). The clinical characteristics of patients with and without heart involvement in the course of SSc were compared. Results Out of 36 patients with SSc, 7 patients were diagnosed with heart disease in the course of SSc. The major type of cardiac involvement was myocarditis (71%). The majority of patients with heart involvement had elevated troponin (86%) and NT-proBNP (71%) concentrations. The most common finding observed in echocardiography was diastolic failure (71%). The most frequent abnormality found in 24-hour Holter ECG was isolated supraventricular extrasystoles (100%). Risk factors for developing heart disease in the course of SSc were male gender (p = 0.018), diffuse type of SSc (p = 0.03), higher values of modified Rodnan skin score (p < 0.001), gastrointestinal tract involvement (p = 0.027) and myositis (p = 0.018). Conclusions Optimal screening for heart disease is needed in this group of patients