Single photon emission computed tomography myocardial perfusion imaging in patients with moderate to severe psoriasis

Background: Psoriasis is a chronic inflammatory disorder with an increased risk for coronary artery disease (CAD). This retrospective study aimed to evaluate the rate of myocardial ischaemia in patients with psoriasis subjected to myocardial perfusion imaging (MPI). Material and methods: Twelve patients with moderate to severe psoriasis that had MPI were compared to 395 MPIs randomly retrieved from our MPIs pool data. All patients had a [99mTc]tetrofosmin stress — rest single-photon emission computer tomography ([99mTc]SPECT). Summed difference scores (SDS) were calculated for stress (SSS), rest (SRS) and their difference (SDS = SSS – SRS). Results: There was no significant difference in the frequency of abnormal MPI SPECT outcomes between patients with vs. without psoriasis (6/12 vs 214/395 respectively; p = 0.778). From the evaluation of SSS, SRS and SDS, only the SDS scores of inadequately compensated resting perfusion defects were significantly lower in patients with psoriasis (p = 0.012). Conclusions: Patients with moderate-to-severe psoriasis had a similar rate of abnormal SSS scans compared to control patients. However, the SDS scans were significantly lower in patients with psoriasis indicating compromised reversibility of resting perfusion defects. Larger controlled studies are needed to verify these observations

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

ObjectivesTo investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases.MethodsForty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0–3) and a continuous quantitative measurement (“VAS echogenicity,” 0–100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall’s Tau and Pearson’s Rho coefficients.ResultsThe semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57–0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68–0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. “VAS echogenicity” showed a high reliability both in the inter-observer [ICC = 0.80 (0.75–0.85)] and intra-observer [ICC = 0.88 (0.88–0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and “VAS echogenicity” [ICC = 0.52 (0.50–0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively).ConclusionThe results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases

Επιπολασμός Σακχαρώδους Διαβήτη τύπου 2 σε νοσηλευόμενους και εξωτερικούς ασθενείς. Ποσοστό ασθενών υπό διαιτολογική παρακολούθηση και συμμόρφωση με διατροφικές οδηγίες

Εισαγωγή: Ο επιπολασμός του σακχαρώδους διαβήτη τύπου 2 έχει ήδη σημειώσει σημαντική αύξηση παγκοσμίως και αναμένεται ότι η τιμή του θα αυξηθεί ακόμη περισσότερο τα επόμενα χρόνια. Η διαιτολογική παρακολούθηση και η συμμόρφωση των ασθενών με σακχαρώδη διαβήτη τύπου 2 στις διατροφικές συστάσεις αποτελεί αποδεδειγμένα μία πρακτική που μπορεί να συμβάλλει στην αποτελεσματική διαχείριση της μεταβολικής αυτής διαταραχής. Σκοπός: Ο προσδιορισμός του επιπολασμού του σακχαρώδους διαβήτη τύπου 2 σε νοσηλευόμενους και εξωτερικούς* ασθενείς από το σύνολο των ατόμων με διαβήτη που προσήλθαν στο Γενικό Νοσοκομείο Αθηνών «Λαϊκό» ˙ ο προσδιορισμός του ποσοστού των ατόμων με σακχαρώδη διαβήτη τύπου 2 που είναι υπό διαιτολογική παρακολούθηση και της συμμόρφωσης αυτών - στις διατροφικές οδηγίες. Μέθοδοι: Για την εκτίμηση του επιπολασμού του σακχαρώδους διαβήτη τύπου 2 συμμετείχαν συνολικά 242 διαβητικοί ασθενείς, εκ των οποίων οι 205 είχαν σακχαρώδη διαβήτη τύπου 2, και από αυτό το υποσύνολο οι 130 ασθενείς ήταν υπό διαιτολογική παρακολούθηση, αποτελώντας το δείγμα της στατιστικής ανάλυσης. Όλοι οι ασθενείς του δείγματος απάντησαν σε ερωτήσεις που περιλάμβαναν ατομικές πληροφορίες, εργαστηριακές αναλύσεις, τη φαρμακευτική και ιατρική αντιμετώπιση του διαβήτη και άλλων νοσημάτων, τις επιπλοκές και τα ζητήματα αυτοδιαχείρισης του διαβήτη και τέλος ερωτήσεις για τη φυσική δραστηριότητα, τις διατροφικές συνήθειες και συμπεριφορές του ασθενούς. Αποτελέσματα: Ο επιπολασμός του σακχαρώδους διαβήτη τύπου 2 προσδιορίστηκε σε 84,71%, με το 63,73% των ασθενών αυτών να βρίσκονται υπό διαιτολογική παρακολούθηση. Η πλειοψηφία των συμμετεχόντων ακολουθεί σε μεγάλο βαθμό τις διατροφικές συστάσεις, παρόλα αυτά φαίνεται ότι το 52,76% του δείγματος ανήκει στη κατηγορία με ατομικό ποσοστό συμμόρφωσης στις διατροφικές οδηγίες μικρότερο του 70%. Παράγοντες όπως η παρουσία διαβητικής νεφροπάθειας (p = 0,037), η νοσηλεία στο νοσοκομείο (p = 0,022), ο φόβος περιορισμού της προσωπικής ελευθερίας λόγω της προτεινόμενης δίαιτας (p = 0,007) και η αποτυχία απώλειας σωματικού βάρους (p = 0,005) επιδρούν αρνητικά στο βαθμό υιοθέτησης των διατροφικών συστάσεων από τους ασθενείς. Συμπεράσματα – Συζήτηση: Αυξημένος παρατηρήθηκε ο επιπολασμός του σακχαρώδους διαβήτη τύπου 2, με το ποσοστό των ασθενών αυτών που είναι υπό διαιτολογική παρακολούθηση να είναι ιδιαίτερα χαμηλό. Πληθώρα παραγόντων επιδρούν στην ικανότητα του κάθε ασθενούς να εφαρμόσει τις διατροφικές συστάσεις που έχει υποδείξει ο διαιτολόγος του. Ο προσδιορισμός αυτών των παραγόντων προσφέρει περισσότερες πληροφορίες για την αποτελεσματική βελτίωση της συμμόρφωσης του ασθενούς στις διατροφικές οδηγίες διαχείρισης του σακχαρώδους διαβήτη τύπου 2.Introduction: The prevalence of type 2 diabetes mellitus has already experienced significant increase worldwide and the number of cases is expected to increase even more in the coming years. Practices such as dietary monitoring and compliance of patients with diabetes type 2 in their dietary recommendations have successfully demonstrated that they can contribute to the effective management of this metabolic disorder. Purpose: The determination of the prevalence of type 2 diabetes mellitus in hospitalized and non-regular patients visiting the hospital for their frequent diabetes check up - from the total number of people with diabetes who attended the Athens General Hospital “Laiko” ˙ the percentage determination of people with type 2 diabetes who are under dietary monitoring and their conformity to dietary guidelines. Methods: A total of 242 diabetic patients participated in the assessment of the prevalence of type 2 diabetes, from which 205 patients registered with diabetes type 2. Furthermore, only 130 patients registered with type 2 diabetes, were under dietary monitoring and determined the sample of the analysis for this research. All patients in the sample were given a questionnaire that had to fill in. The patients had to answer questions about their personal information, laboratory analyses, pharmaceutical and medical management of diabetes and other diseases, complications and diabetes self-management issues and finally questions about physical activity, eating habits and patient behaviors. Results: The percentage of the prevalence of type 2 diabetes mellitus was determined at 84,71%, with 63,73% of these patients being under dietary monitoring. The majority of the participants follow the dietary recommendations, however it appears that 52,76% belongs to the category which show individual compliance rate in the dietary guidelines less than 70%. Factors such as the presence of diabetic kidney disease (p = 0,037), hospitalization (p = 0,022), fear of restriction of personal freedom due to the proposed diet (p = 0,007) and failure to lose weight (p = 0,005) have affect the degree of successful adaptation of the dietary recommendations by the patients. Conclusions - Discussion: It was observed a high increase in the prevalence of diabetes mellitus type 2, whereas the percentage of patients, who were under dietary monitoring being particularly low. A plethora of factors has been demonstrated that it affects the ability of each patient to implement the dietary recommendations recommended by his/her dietician. Identifying these factors provides more information on how to improve effectively patient compliance with dietary guidelines for type 2 diabetes

Rheumatoid Arthritis Treatment. A Back to the Drawing Board Project or High Expectations for Low Unmet Needs?

Despite the significant progress in Rheumatoid Arthritis (RA) therapeutics, there are several reports in the literature claiming that the size of unmet needs in RA is large. In the era before biologics, there was indeed a significant number of patients who did not achieve low disease activity (LDA) or disease remission due to limited therapeutic choices in the doctors’ armamentarium. Treatment wise, great progress has been achieved over the last decades with the discovery and introduction in therapeutics of new molecules, such as the biological (b) disease-modifying anti-rheumatic drugs (DMARDs), and the targeted synthetic (ts) DMARDs. Today, with such a plethora of conventional synthetic (cs) DMARDs, tsDMARDs, and bDMARDs, why are we unable to successfully treat RA patients? What is wrong? However, a new drug for RA does not mean it is necessary to switch to a new treatment. It is very easy to change and switch therapies when the patient complains about pain and stiffness. In this setting, it is obligatory to rule out other comorbidities and disorders that may be the cause of the pain first. Thus, clinicians must have a deep knowledge of the drug therapy and be able to adjust the treatment when needed. A minute clinical examination must be carried out on every visit with close monitoring of the patient. A treat-to-target (T2T) approach and the application of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) recommendations and strategies should minimize the unmet needs

Golimumab for Rheumatoid Arthritis

Since the advent of infliximab for the treatment of rheumatoid arthritis (RA), new genetically-engineered molecules have appeared. This review aims to present the current data and body of evidence for golimumab (GLM). Safety, efficacy, tolerability and immunogenicity are all being investigated, not only through phase III trials (GO-BEFORE, GO-FORWARD, GO-AFTER, GO-MORE, GO-FURTHER, GO-NICE), but also through studies of real-world data. It seems that GLM in the subcutaneous form is an efficacious molecule with a good safety profile at the standard dosage scheme, but a 100 mg subcutaneous dose is associated with a higher risk of opportunistic infections, lymphoma and demyelination. Furthermore, when compared to other tumor necrosis factor-α molecules, it is non-inferior, and, at some points, such as when it comes to immunogenicity and persistence of the drug, it has a better profile. In summary, GLM is an effective, well-tolerated option for the treatment of RA, for both the clinician and patients who are seeking a convenient dosage scheme

Periocular xanthogranuloma: A forgotten entity?

Charalampos Papagoras1, George Kitsos2, Paraskevi V Voulgari1, Anastasia K Zikou3, Maria I Argyropoulou3, Aikaterini Zioga4, Alexandros A Drosos11Rheumatology Clinic, Department of Internal Medicine; 2Department of Ophthalmology; 3Department of Clinical Imaging and Radiology, 4Department of Pathology, Medical School, University of Ioannina, Ioannina, GreeceAbstract: Periocular xanthogranulomatous diseases are a rare group of disorders which are characterized by a predilection to affect the orbit and ocular adnexa and special histopathological features, in particular infiltrates comprising non-Langerhans-derived foamy histiocytes and Touton giant cells. The differential diagnosis is difficult and occasionally definite diagnosis cannot be established even after clinical and histopathological findings are taken together. We describe a case of a middle-aged man who presented with a 10-year history of voluminous eyelid swelling with concomitant late-onset atopic manifestations, namely bronchial asthma and allergic rhinitis with nasal polyps. After thorough clinical and laboratory investigation, including a biopsy of the eyelid, we classified the patient’s disease to a rare entity that has been relatively recently described: periocular xanthogranuloma associated with adult-onset asthma. In a review of the literature, no prospective trials concerning the treatment of this disease were found. The literature mainly contained case reports and case series in which corticosteroids and chemotherapy with alkylating agents have been reported to be beneficial. We treated our patient with a combination of oral corticosteroids and cyclophosphamide pulses and we observed substantial regression of the eyelid masses together with a normalization of systemic immunologic abnormalities.Keywords: periocular xanthogranuloma, adult-onset asthma, non-Langerhans histiocytoses, cyclophosphamide, methylprednisolon

Demyelinating central nervous system lesions, following the use of tumor necrosis factor alpha antagonist

Tumor necrosis factor alpha (TNFα) antagonists have been a valuable tool in treating patients with rheumatoid arthritis (RA), but reports and case series of neurological adverse events due to TNFα antagonists have been reported. Furthermore, central nervous system (CNS) lymphoma always remains a remote, yet a worrisome complication in RA patients, especially in those under treatment with methotrexate (MTX). We present a female patient with RA with tumor-like active demyelinating lesions attributed to TNFα antagonist, confirmed by an FNA biopsy, otherwise clinically and radiologically challenging to distinguish from CNS lymphoma. A 72-year-old female patient with RA under TNFα antagonist and MTX treatment was presented with neurological symptoms and signs. The brain MRI revealed four tumor-like contrast-enhancing lesions bilaterally, the demyelinating nature of which was delineated by the FNA biopsy. A full clinical and radiological recovery was achieved after the TNFα antagonist was permanently withdrawn. Patients with RA under anti-TNF agents and MTX are predisposed to complications such as CNS lymphoma and CNS demyelination. This case uniquely highlights the physicians’ vigilance in pursuing these complications and the usage of the FNA when tumor-like appearances on the brain MRI convolute the final diagnosis