Cardiovascular diseases and rheumatoid arthritis

Morbiditet i mortalitet bolesnika od reumatoidnog artritisa (RA) je veći nego u općoj populaciji. RA je udružen s povećanim rizikom od kardiovaskularnih (KV) bolesti. Sve srčane strukture mogu biti zahvaćene tijekom trajanja RA. Reumatoidni artritis, zasebno, je rizični čimbenik za kardiovaskularne bolesti jednako kao hipertenzija, dislipidemija, šećerna bolest i drugo. Usprkos saznanju o povećanom riziku za kardiovaskularne bolesti u bolesnika od RA i dalje je nedostatna pozornost posvećena pronalaženju i liječenju kardiovaskularnih komorbidnih stanja. Rano utvrđivanje KV rizičnih čimbenika te njihovo adekvatno zbrinjavanje i praćenje od izuzetne je važnosti u smanjenju KV bolesti. Također, i u cilju smanjenja KV rizika, neophodno je adekvatno liječenje artritisa.Morbidity and mortality rates are higher in rheumatoid arthritis (RA) patients than in the general population. RA is associated with an increased risk of cardiovascular disease. All of the cardiac structures can be affected during the course of RA. Rheumatoid arthritis, per se, is a cardiovascular (CV) risk factor as arterial hypertension, dyslipidemia and diabetes etc. Although the increased CV risk is acknowledged, limited attention is paid to detecting and managing CV comorbid conditions. Early identification, adequate CV risk management and ongoing monitoring of risk factors are mandatory to reduce the CV risk. Also, adequate control of arthritis disease activity is necessary to lower CV risk

Cardiovascular disorders in rheumatoid arthritis

Reumatoidni artritis (RA) je udružen s povećanim rizikom od kardiovaskularnih bolesti. Tradicionalni kardiovaskularni rizični čimbenici, uključujući muški spol, nasljeđe, dob, dislipidemiju, arterijsku hipertenziju, šećernu bolest, pretilost, pušenje, nisu dostatni za objašnjenje učestalosti kardiovaskularnih bolesti u RA. Patogeneza ubrzane ateroskleroze u RA nije jasna. Prevladava mišljenje da u nastanku i razvoju ateroskleroze primarnu ulogu ima upala. Endotelna disfunkcija najranije je očitovanje ateroskleroze. Hipertenzija je značajan rizični čimbenik za razvoj kardiovaskularnih bolesti, a prevalencija hipertenzije veća je u RA bolesnika nego u općoj populaciji. Usprkos visokoj prevalenciji hipertenzije i važnosti njenih komplikacije, kontrola hipertenzije daleko je od adekvatnog kako u općoj populaciji tako i u RA bolesnika.Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease. Traditional cardiovascular risk factors (including male sex, family history for cardiovascular disease, age, dyslipidaemia, arterial hypertension, diabetes mellitus, smoking and obesity) do not adequately accunt for the extent of cardiovascular disease in RA. The pathogenesis of accelerated atherosclerosis in RA is not celar. Increasing evidence suggests a key role of inflammation in the onset and progression of atherosclerosis. Endothelial dysfunction represents the earliest manifestation of atherosclerosis. Hypertension prevalence in patients with RA is higher than that in the general population. It is attributable risk to the development of future cardiovascular events. Despite its serious complications, control of hypertension is far from adequate in the general population and even more so in rheumatoid arthritis patients

Preface - Symposium Musculoskeletal Diseases in the elDerly

The scientific symposium entitled Musculoskeletal Diseases in the Elderly was organised by the Department of Medical Sciences of the Croatian Academy of Sciences and Arts, the Academy of Medical Sciences of Croatia, and the Croatian Medical Associa- tion. The Symposium was held on 15 October 2021 at the Library of the Croatian Academy of Sciences and Arts in Zagreb, Croatia. The meeting started with welcoming speeches from Vida De- marin, F.C.A., Secretary of the Department of Medical Sciences of the Croatian Academy of Sciences and Arts, and Prof. DSc Alemka Markotić, President of the Academy of Medical Sciences of Croatia. The next speaker, Marko Pećina, F.C.A., speaking on behalf of the organisers, stressed that this Symposium is follow- ing the yearlong tradition of organising scientific and professional meetings at the Croatian Academy of Sciences and Arts, dedicated to the topics from the domain of gerontology. He thereby remind- ed the audience of the publication entitled (in translation) Sym- posium on Gerontology, published in 1958 and edited by Franjo Kogoj, F.C.A., at the time Secretary of the Academy Department of Medical Sciences. This publication includes papers by the then most esteemed professors of the Faculty of Medicine in Zagreb from the fields of basic and clinical medical sciences. The title of this Symposium – Musculoskeletal Diseases in the Elderly – might justly be broadened to Symposium on Gerontology, considering the fact that plenary speeches were concentrated on general geron- tology issues. Prof. DSc Jadranka Morović-Vergles, speaking on behalf of the organisers as well, stressed the importance of paying attention to the problem issues of musculoskeletal diseases within the domain of gerontology. She continued by emphasising major importance of launching residency in geriatric medicine in the EU and introducing practical implementation of residency in geriatric medicine in Croatia. The beginning of the Symposium was marked by keynote lecture given by Prof. DSc Nenad Bogdanović from Karolinska Univer- sitetssjukhuset in Stockholm. Professor Bogdanović started with an overview presentation entitled Geriatric Medicine – the Youngest Specialization for the Oldest Population. Stjepan Gamulin, F.C.A., in his lecture entitled The Pathophysiology of Ageing, stressed that though ageing cannot be stopped, the process of ageing may be de- celerated. Prim. DSc Spomenka Tomek Roksandić held a lecture on Gerontology – Sustainable Development of Health Care for the El- derly. Prof. DSc Ivana Kolčić from the Faculty of Medicine in Split spoke of the influence of healthy life on “healthy” ageing. The following four lectures addressed more narrowly the main topic of the Symposium. Prof. DSc Jadranka Morović-Vergles presented the newest knowledge on polymyalgia rheumatica and giant cell arteritis. The lecture by Vanda Eđed, M.D., resident in geriatric medicine at the Dubrava Clinical Hospital in Zagreb, addressed this topic based on a case report from clinical practice. Painkill- ers prescribed for elderly patients, with the emphasis on musculo- skeletal diseases, was the topic of the lecture by Prof. DSc Duška Martinović-Kaliterna from the Faculty of Medicine in Split. In their lecture entitled Elective Joint Replacement in Elderly Patients, Prof. DSc Alan Ivković from the Sveti Duh Clinical Hospital in Zagreb and Marko Pećina, F.C.A., stressed the fact that a patient’s old age does not represent a counter indication for the subject operations. The concluding speech, entitled Postgraduate Specialty Training in the European Union and Croatia, was dedicated to the problem issues relating to the establishing of various residencies in the EU and in Croatia, as well as to the launching of residency in geriatric medicine. This speech was held by Prof. DSc Nada Čikeš from the Faculty of Medicine in Zagreb, who has for years participated in drafting medical residency programmes in the EU. The round table discussion held after the lectures was moderated by Prof. DSc Jadranka Morović-Vergles. It covered two topics: first systematic education in geriatric medicine (undergraduate study programmes; permanent education courses) was tackled, with regard to the fact that it is estimated that in 2030, Croatia will have nearly 30% citizens aged over 60; and second, a discus- sion followed addressing the importance of establishing systematic communication channels between family physicians and rheuma- tologists/clinical immunologists, with the aim of conducting early interventions, i.e. timely medical check-ups, as well as early and appropriate treatment of patients suffering from systemic inflam- matory rheumatic diseases, in particular those of elderly age

Extraskeletal manifestations of seronegative spondyloarthropathies

Seronegativne spondiloartropatije (SS) skupina su upalnih reumatskih bolesti nepoznatog uzroka u koje ubrajamo ankilozantni spondilitis, psorijatični artritis, reaktivni artritis, enteropatski artritis i nediferenciranu spondiloartropatiju. Zajedničko im je obilježje odsustvo reumatoidnog faktora u krvi, česta pojavnost bolesti među bliskim srodnicima i visoka zastupljenost HLA B27 antigena među bolesnicima. Klinička obilježja SS jesu periferni artritis, zahvaćenost kralježnice i sakroilijakalnih zglobova te tetivnih hvatišta s ili bez izvankoštanih obilježja tj. promjena na koži, sluznicama, aorti, srcu, očima i bubrezima.Spondyloarthropathies constitute a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases of unknown etiology that include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis and undifferentiated spondyloarthritis. These diseases are not associated with rheumatoid factor, they occur in genetically predisposed individuals and show a strong association with HLA-B27. The primary pathologic sites include the entheses, the sacroiliac joints and the axial skeleton with or without some nonarticular structures, such as the skin, eye, aortic valve, heart and kidney