Subclinical atherosclerosis and cardiovascular risk in inflammatory rheumatic diseases

Various inflammatory rheumatic diseases (IRDs) are associated with accelerated atherosclerosis, increased cardiovascular morbidity and mortality. Cells, chemokines, cytokines, proteases, autoantibodies, adhesion molecules, and the OPG/RANKL/RANK signaling pathway involved in autoimmune inflammation can directly affect all structures of the cardiovascular system, including the myocardium, cardiac valves, pericardium, conduction system, and vessels. The interaction between inflammatory factors and conventional cardiovascular risk factors leads to the activation of the atherosclerotic process. None of the risk assessment models developed so far are universal and suitable for all patient groups, and their application in patients with IRD carries the risk of underestimating the possibility of developing cardiovascular events and complications. In this review, we focus on the relationship between chronic inflammation, atherosclerosis, and cardiovascular diseases (CVDs), as well as the impact of conventional and newly discovered risk factors, and their interaction, which is particularly important for assessing cardiovascular risk. We draw attention to some markers available in routine practice for the early diagnosis of atherosclerotic changes in patients with IRD, their applicability, and the amount of information they carry. Multidisciplinary collaboration and risk factor assessment in the preclinical stage are beneficial for early diagnosis and prevention in patients with IRD

Kinesitherapy for Patients on Hemodialysis

Introduction: Chronic kidney disease (CKD) is a huge challenge for GPs and nephrologists. Physiotherapists are increasingly included in the multidisciplinary teams dealing with CKD around the world to improve the quality of life and prevent a number of complications of patients undergoing the most common treatment for CKD, namely hemodialysis.Aim: The aim of this article is to present the possibilities for optimizing and supporting the motor activity of hemodialysis patients.Materials and Methods: Review of medical literature from the last 10 years, published in the scientific databases: Pubmed, Google Scholar, PubMed Central, and ScienceDirect, has been conducted.Results: Numerous independent studies have shown that kinesitherapy is a reliable aid in the prevention of cardiovascular diseases and in improving the overall condition of patients with CKD on hemodialysis. The implementation of specialized devices for kinesitherapy during hemodialysis and the selection of appropriate exercises to practice at home also show a significant improvement in mental health (motivation for a better and more active life) of hemodialysis patients.Conclusion: The inclusion of kinesitherapy during hemodialysis and acquainting chronically ill patients with the opportunities for improving their physical activities would lead to improved health status and quality of life of these patients

Research on the Participation of Humoral Factors of Congenital Immunity in the Pathogenesis of Activated Osteoarthritis // Изследване участието на хуморалните фактори на вродения имунитет в патогенезата на активираната остеоартроза

The thesis examines the role of humoral factors of innate immunity in the pathogenesis of activated osteoarthritis (OA) of the knee joint. Data from numerous studies indicate that the question of whether the complement cascade plays a role solely as a cleansing system or also as a leading pathogenic factor in activated OA remains unanswered in science. The participants in the study are 156 patients with OA of the knee joint according to the ACR criteria from 1991. Levels of CRP, C3, and C4 complement fractions are examined in blood plasma and synovial fluid. Statistical analysis of the collected data shows that the average percentage of CRP levels in synovial fluid is 42.14% of plasma levels, higher than the normal 20%. The average percentages of C3 and C4 levels in synovial fluid are 34.90% and 30.97% of plasma levels, above the normal 10% for both C3 and C4. In other words, the average percentages of all three indicators in synovial fluid in activated gonarthrosis are significantly higher than those in blood plasma. The conclusions of the study emphasise the significant role of CRP and the complement system as humoral factors of innate immunity in the pathogenesis of activated OA of the knee joint. The results argue for the application of drugs affecting low-grade inflammation as a disease-modifying treatment model and confirm the need for therapeutic control of inflammation in the arthritic joint at an early radiological stage of the disease.Дисертационният труд изследва ролята на хуморалните фактори на вродения имунитет в патогенезата на активирана остеоартроза (ОА) на колянна става. Данни от множество проучвания сочат, че пред науката все още стои недоизяснен въпросът дали каскадата на комплемента играе роля само на очистваща система или и на водещ патогенетичен фактор при активирана ОА. Участници в изследването са 156 пациенти с ОА на колянна става според ACR от 1991 г. Изследват се нивата на CRP, C3 и С4 фракциите на комплемента в кръвна плазма и синовиална течност. Статистическият анализ на събраните данни показва, че средният процент на нивата на CRP в синовиалната течност е 42,14% от плазмените нива, т.е. по-висок от нормата от 20%. Средните проценти на нивата на С3 и С4 в синовиалната течност са съответно 34,90% и 30,97% от плазмените нива, което е над нормата от 10% за С3 и С4. Т.е. средните проценти на нивата и на трите показателя в синовиалната течност при активирана гонартроза са по-високи от тези в кръвната плазма. Заключенията от проучването подчертават значителната роля на CRP и системата на комплемента като хуморални фактори на вродения имунитет в патогенезата на активираната ОА на колянна става. Резултатите аргументират необходимостта от приложението на лекарствени препарати с ефект върху нискостепенното възпаление като болестопроменящ модел на лечебно поведение и потвърждават необходимостта от терапевтичен контрол на възпалението в артрозната става на ранен рентгенологичен стадий от болестта

Diagnosing rheumatoid arthritis in outpatient care

Rheumatoid arthritis (RA) is a chronic, progressive systemic immune-mediated inflammatory disease of the connective tissue engaging mainly the peripheral joints. Its course is mainly as a symmetric erosive polyarthritis. In patients with persisting inflammation due to delay of diagnosis or due to inadequate therapy behaviour, the probability of disability is increased, the cardiovascular risk is increased, and the survival rate is reduced. There is more than enough scientific evidence that the earlier the patients with RA are diagnosed and treated, the better their prognosis is. There is a growing number of medicines, including biological ones, that are relatively safe and highly efficient in the control of synovial inflammation, especially when therapy with them is started early. Irrespective of this, the studies analysing the time from the onset of the symptoms until the start of the disease modifying anti-rheumatic drug (DMARD) therapy show that there are significant delays that vary from 6 to 57 months, depending on the geographic region. The review examines the main reasons for the diagnostic delay and the consequences from it. The emphasis is on the role of the GP in the strategy for early diagnosis of RA. The suggested recommendation for early referral is an instrument of the doctors in the outpatient care to identify the potential patients with an active RA at the beginning of the disease. The early referral to a rheumatologist for a final diagnosis and early treatment with DMARD should improve the long-term outcome of RA