PERICARDIAL FEATURES OF IN-HOSPITAL RHEUMATOLOGY PATIENTS: AN OBSERVATIONAL STUDY

Reumatske bolesti mogu biti povezane s perikarditisom, ali su teži oblici te bolesti rijetki. Cilj ovog opservacijskog istraživanja bio je proučiti obilježja perikarda u bolesnika s različitim reumatskim bolestima. Uklju čeno je trideset i pet bolesnika hospitaliziranih u Klinici za reumatologiju Sveučilišnoga kliničkog centra Kosova od 1. do 21. listopada 2014. Prikupljeni su demografski podaci, anamnestički podaci, učinjeni su EKG i ehokardiografi ja s posebnim naglaskom na perikard. Ehokardiografi ja je bila posebno usmjerena na količinu perikardijalnog izljeva i njegovu debljinu u stražnjoj srčanoj ovojnici. Srednja dob bolesnika bila je 51,5 ± 13,8 god., a 65,7% njih bile su žene. Među analiziranim bolesnicima bilo je 88,6% s upalnim reumatskim bolestima, od čega njih 11,3% s blagim simptomima, 68,7% s umjerenim i 20% s teškim simptomima. U svih je bolesnika naglašena perikardijalna hiperehogenost sa srednjom debljinom perikarda od 4,68 ± 1,66 mm. Perikardijalni izljev manje količine bio je prisutan u 57,1% bolesnika s količinom od 3,3 ± 1,9 ml. Težina reumatske bolesti bila je značajno i pozitivno povezana s prisutnošću perikardijalnog izljeva (r = 0,29; p = 0,04) i količinom perikardijalnog izljeva (r = 0,28; p = 0,05). Bolesnici nisu znali da imaju perikardijalni izljev niti su imali kliničke simptome u tom smislu. Zaključno, u ovome kratkotrajnom malom opservacijskom istraživanju promjene perikarda bile su čest nalaz u bolesnika s reumatskim bolestima. Ipak, najčešće se radilo o perikarditisu supkliničkog oblika i s malom količinom izljeva. Aktivnost bolesti može biti povezana s perikarditisom. Potrebne su studije s većim brojem bolesnika i dužeg trajanja da bi se dalje istražilo ovo područje.Rheumatic disorders can be associated with pericarditis, but severe forms of pericarditis are rare. Th e aim of this observational study was to evaluate pericardial features in patients with diff erent rheumatic diseases. Th irty-fi ve patients hospitalized at the Clinic of Rheumatology, University Clinical Center of Kosovo, from October 1 to October 21, 2014 were included in the study. Demographic data, history, laboratory, ECG, and echocardiography data, with special emphasis on the analysis of the pericardium, were obtained from each patient. Echocardiography was especially focused on the amount of pericardial fl uid and pericardial thickness in the posterior wall of the heart. Mean patient age was 51.5 ± 13.8 years. 65.7% of the patients were women. Out of the patients that we analyzed, 88.6% had an infl ammatory rheumatologic disease. 11.3% of the patients had mild symptoms, in 68.7% the symptoms were moderate, and in 20% severe. In all patients, pericardial hyperechogenicity was marked, with a mean pericardial thickness of 4.68 ± 1.66 mm. Pericardial eff usion in a small amount was present in 57.1% of patients, with a mean pericardial fl uid amount of 3.3 ± 1.9 mm. Th e severity of rheumatic disease had a positive and signifi cant correlation with the presence of pericardial eff usion (r= 0.29, p=0.04) and its amount (r= 0.28, p=0.05). Th e patients had not been aware of the pericardial involvement and did not have any clinical symptoms. In conclusion, in this short-term small observational study pericardial changes were a frequent fi nding in the rheumatology patients. In general, the pericarditis was subclinical and with small amounts of eff usion. Th e disease activity of rheumatic disorders can be associated with pericarditis. Further studies with larger samples of patients and of longer duration are needed to further explore this issue

Učinci kombinirane terapije reumatoidnog artritisa na reaktante akutne faze

The paper presents the results of studies of acute phase reactants in the 60 treated patients with rheumatoid arthritis. Patients were divided into two groups, depending on the applied treatment: group I (n=30) was treated with methotrexate, sulfasalazine and hydroxychloroquine, and group II (n=30) with methotrexate. The results of our study shows that there is a statistically significant reduction in the value of acute phase reactants and clinical parameters after treatment in both investigated groups of patients, and also a significant statistical difference between the first and second group of treated patients.U radu su prikazani rezultati ispitivanja reaktanata akutne faze u 60 liječenih bolesnika s reumatoidnim artritisom. Bolesnici su bili podijeljeni u dvije skupine, ovisno o primijenjenoj terapiji: I. skupina (n=30) je liječena metotreksatom, sulfasalazinom i hidroksiklorokinom, a II. skupina (n=30) metotreksatom. Rezultati našega istraživanja pokazuju da postoji statistički značajno smanjenje vrijednosti reaktanata akutne faze i kliničkih parametara nakon liječenja u obje ispitivane skupine bolesnika, a također i značajna statistička razlika između prve i druge skupine liječenih bolesnika

Evaluation of the Efficacy of Combined Therapy of Methotrexate and Etanercept versus Methotrexate as a Mono-Therapy

AIM: This study aims to evaluate the efficacy of Methotrexate (MTX) alone and combined therapy with Etanercept (ETN) and Methotrexate in patients with active rheumatoid arthritis (RA).METHODS: In the randomised control study, conducted in the period from March 2014 until March 2016, we evaluated the efficacy of the treatment of patients with RA with MTX as monotherapy and combination treatment with MTX and ETN. In the Clinic of Rheumatology in Prishtina, 90 adult patients with RA were treated in combination with ETN (doses of 50 mg subcutaneously/weekly), with oral MTX (doses up to 20 mg weekly), and MTX alone (doses up to 20 mg weekly) during this period of two years. Clinical response was assessed using European League against Rheumatism (EULAR)/American College of Rheumatology (ACR) Criteria and the Disease Activity Score (DAS28). Radiographic changes were measured in the beginning and at the end of the study using Larsen’s method.RESULTS: Of the cohort groups of 90 patients, mean age of 55.63, 15 patients, (16.6 %) were treated with combined therapy (ETN plus MTX) and 75 patients (83.3%) with monotherapy (MTX). After two years of treatment the group with combined therapy resulted with improvement of acute phase reactants as erythrocyte sedimentation rate (ESR) for the first hour (41.1 vs. 10.3 mm/hour) and C - reactive protein (CRP) (40.8 vs. 6 mg/liter), and compared to the group treated with monotherapy, there were no significant changes (ESR: 45.7 vs 34.3 mm/hour; CRP: 48 vs 24 mg/liter). Before the treatment, the severity of the disease was high, wherein the group with combined therapy DAS28 was 5.32, compared to the monotherapy group whom DAS28 was 5.90. After 2 years of treatment, we had significant changes in the results of DAS28, wherein the group treated with ETN plus MTX DAS28 was 2.12 ± 0.15, while in the group of patients treated with MTX DAS28 were 3.75 ± 0.39 (t = 13.03; df = 58; p < 0.0001). The group with combined therapy showed no evidence of radiographic progression comparing to the group of patients with monotherapy.CONCLUSIONS: Based on our results achieved during 2 years we can conclude that ETN in combination with MTX reduced disease activity, slowed radiographic progression and improved clinical manifestations more effectively than MTX alone. No serious adverse events were noticed in the group with combination treatment

REUMATOIDNI ARTRITIS KASNOG NASTUPA: OPSERVACIJSKA STUDIJA

Reumatoidni artritis (RA) može imati početak u starijoj životnoj dobi. Nastup bolesti sa 60 i više godina naziva se RA kasnog početka (engl. Late-Onset Rheumatoid Arthritis – LORA). Cilj ove studije bio je analizirati klinička, laboratorijska, radiološka obilježja i obilježja liječenja u bolesnika s LORA-om u usporedbi s RA ranijeg početka (engl. Early-Onset Rheumatoid Arthritis – EaORA) s tim da su pacijenti u obje grupe bili približno jednakog trajanja bolesti. Radi se o opservacijskoj studiji provedenoj u jednome reumatološkom centru, koja je uključila 120 bolesnika s utvrđenom dijagnozom RA podijeljenih u dvije grupe: 60 bolesnika s LORA-om (istraživana grupa) i 60 bolesnika s EaORA-om (kontrolna skupina). Aktivnost bolesti, mjerena Disease Activity Score 28 (DAS28SE) bila je značajno viša u grupi LORA u odnosu prema grupi EaORA (p < 0,05). Značajno više bolesnika u grupi LORA imalo je zahvaćena ramena (LORA vs. EaORA, 30% vs. 15%; p < 0,05) i koljena (LORA vs. EaORA, 46,7% vs. 16,7%; p < 0,05). Radiološke erozivne promjene bile su značajno češće vidljive u grupi LORA u usporedbi s grupom EaORA (p 0,05), dok je broj pacijenata s pozitivnim nalazom anticitrulinirajućih protutijela (ACPA) bio značajno veći u grupi EaORA (p < 0,05). Vrijednosti C-reaktivnog proteina (CRP) i brzina sedimentacije eritrocita (SE) bile su značajno više/brže u grupi LORA u odnosu prema grupi EaORA. Hemoglobin je bio niži u grupi LORA (11,96 ± 1,64 g/dl) nego u grupi EaORA (12,18 ± 1,56 g/dl). Najčešće primijenjeni lijekovi koji mijenjaju tijek upalnih reumatskih bolesti bili su metotreksat i sulfasalazin, dok biološki lijekovi nisu bili upotrijebljeni. U zaključku, na temelju rezultata iz našeg istraživanja, bolesnici s LORA-om imaju neka obilježja koja se razlikuju od onih u bolesnika s EaORA-om, kao što su viša aktivnost bolesti, češća zahvaćenost velikih zglobova i veće strukturne promjene. Ovo se mora uzeti u obzir u kliničkom radu, napose u odabiru terapije.Rheumatoid arthritis (RA) may have an onset at older age. Th e onset of the disease at the age of 60 and over is called late-onset rheumatoid arthritis (LORA). Th e aim of this study was to analyze the clinical, laboratory, radiological, and treatment characteristics of patients with LORA compared to those with early-onset RA (EaORA), provided that all the patients had an approximately equal duration of the disease. Th is is an observational single-center study, which involved 120 patients with an established diagnosis of RA, of which 60 patients had LORA, and 60 patients EaORA. Th e disease activity, measured by the Disease Activity Score 28 (DAS28-ESR), was signifi cantly higher in the LORA group compared to the EaORA group (p<0.05). Signifi cantly more patients with LORA had involvement of the shoulders (LORA vs. EaORA, 30% vs. 15%; p <0.05) and knees (LORA vs. EaORA, 46.7% vs. 16.7%; p <0.05). Radiological erosive changes were signifi cantly more frequent in the LORA group in comparison with EaORA (p <0.05). Th ere was no diff erence between the groups regarding rheumatoid factor (RF) positivity (p>0.05), while the number of patients positive for anti-citrullinated protein antibody (ACPA) was signifi cantly greater in the EaORA group (p<0.05). Th e values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were signifi cantly higher in the LORA than in the EaORA group. Hemoglobin levels were lower in the LORA group (11.96±1.64 g/dL) than in the EaORA group (12.18±1.56 g/dL). Th e most used disease-modifying antirheumatic drugs (DMARDs) were methotrexate and sulfasalazine, while biological drugs were not used. In conclusion, based on the results of our study, LORA has some features that distinguish it from EaORA, such as higher disease activity, more frequent involvement of large joints, and more pronounced structural damage. Th is should be taken in account in clinical practice, especially regarding treatment choices