Recommendations of the Croatian Society for Rheumatology for prevention, diagnostics and treatment of post-menopausal osteoporosis

Osteoporoza je bolest karakterizirana smanjenom koštanom masom i poremećenom mikroarhitekturom što za posljedicu ima krhkost kostiju i povećani rizik za nastanak prijeloma. Prevencija osteoporoze i nastanka osteoporotičnih prijeloma uključuje adekvatan unos kalcija i vitamina D, primjerenu fizičku aktivnost i izbjegavanje rizičnih čimbenika na koje se može utjecati. U dijagnostici osteoporoze dvoenergetska apsorpciometrija X zraka (DXA) ili denzitometrija skeleta je i dalje zlatni standard. U liječenju osteoporoze nefarmakološki postupci su integralni dio liječenja. Bisfosfonati koji sadrže dušik u tjednom ili rjeđem doziranju su lijekovi prvog izbora i standardna terapija osteoporoze. Općenito, podjednako su djelotvorni na smanjenje rizika za nastanak vertebralnih prijeloma, a mogu se razlikovati u prevenciji nevertebralnih prijeloma i prijeloma kuka te prijeloma u osteoporozi uzrokovanoj glukokortikoidima. Ispred Hrvatskog reumatološkog društva HLZ-a iznosimo preporuke za prevenciju, dijagnozu i liječenje postmenopauzalne osteoporoze.Osteoporosis is a disease characterized by loss of bone mass and the structural deterioration of bone tissue leading to increased bone fragility and fractures. Preventive measures for osteoporosis and osteoporotic fractures include adequate calcium and vitamine D intake, adequate physical activity and reduction of the risk factors can be influenced. Currently, measurement of bone mineral density using dual energy x-ray absorptiometry (DXA) is still the gold standard for the diagnosis of osteoporosis. Non-pharmacological therapy is the integral part of the management of osteoporosis. Nitrogen-containing bisphosphonates in weekly or more prolonged (monthly) dosing intervals are now the first-line osteoporosis therapy. Oral bisphosphonates show, generally, similar efficacy on vertebral fractures risk reduction. There, might be some differences among bisphosphonates, regarding risk reduction of non-vertebral, hip and glucocortiocoid related fratures. On behalf of Croatian Society of Rheumatology of Croatian Medical Association we propose recommendations for the prevention, diagnosis and management of postmenopausal osteoporosis

Fever of unknown origin – Adult onset Still´s disease

O sindromu vrućice nepoznatog uzroka (VNU) govorimo kada se u bolesnika javlja vrućica iznad 38,3 °C (u nekoliko prigoda) u trajanju od najmanje tri tjedna čija je etiologija nepoznata i nakon jednog tjedna bolničkih pretraga. Jedan od češćih uzroka tog sindroma, iz skupine bolesti vezivnog tkiva, je Stillova bolest odrasle dobi (SBOD). SBOD je rijedak sistemski upalni poremećaj nepoznate etiologije karakteriziran intermitentnom vrućicom, artralgijama ili artritisom, prolaznim osipom, grloboljom, limfadenopatijom, hepatosplenomegalijom te leukocitozom, povišenim vrijednostima proteina akutne faze, povišenim vrijednostima jetrenih enzima i feritina u serumu. Dijagnozu SBOD-a postavljamo na temelju dijagnostičkih kriterija uz prethodno isključivanje zaraznih, malignih i reumatskih bolesti kao mogućih uzroka VNU. Autori opisuju bolesnika s vrućicom, poliartralgijom, grloboljom, osipom, limfadenopatijom te leukocitozom, hiperferitinemijom i povišenim vrijednostima transaminaza, kojemu je dijagnosticirana Stillova bolest odrasle dobi, te započeto liječenje kortikosteroidima na što je ubrzo došlo do subjektivnog poboljšanja uz normalizaciju laboratorijskih nalaza.Fever of unknown origin (FUO) is a syndrome which includes fever higher than 38.3 °C (on several occasions) persisting without diagnosis for at least 3 weeks inspite of at least 1 week of hospital investigation. Among connective tissue diseases, adult onset Still´s disease (AOSD) is one of the most frequent cause of FUO. AOSD is a rare systemic inflamatory disorder of unknown etiology characterised by intermittent fever, arthralgia or arthritis, evanescent rash, sore throat, lymphadenopathy, hepatosplenomegaly, leukocytosis, elevated levels of hepatic enzymes and hyperferritinemia. Diagnosis of AOSD is made according to the diagnostic criteria, and by previously excluding infectious, malignant or reumatic diseases as possible causes of FUO. The authors report a patient with fever, arthralgia, sore throat, rash, lymphadenopathy, leukocytosis, hyperferritinemia and elevated levels of hepatic enzymes for whom the diagnosis of AOSD was made and whose condition and laboratory findings improved soon after the initiation of corticosteroid treatment

Proposal for biologic drugs therapy in rheumatoid arthritis

Reumatoidni artritis je kronična upalna reumatska bolest s prevalencijom od oko 1 %, karakterizirana sinovitisom, erozivnim promjenama zglobova, bolovima i oštećenjem funkcije. Etiologija bolesti nije poznata ali nastajanje takve autoimune bolesti je, zasigurno, posljedica genetskih i okolišnih čimbenika. Većina bolesnika s reumatoidnim artritisom liječi se standardnim lijekovima koji mogu modificirati bolest. Bolje razumijevanje bolesti dovelo je do razvoja bioloških lijekova s kojima želimo postići remisiju bolesti umjesto simptomatskog poboljšanja. Biološki lijekovi imaju brz i kontinuiran učinak, uz prihvatljiv sigurnosni profil. U ime Hrvatskog reumatološkog društva iznosimo prijedlog primjene bioloških lijekova u reumatoidnom artritisu.Rheumatoid arthritis is a chronic, inflammatory disease with the prevalence about 1 %. Rheumatoid arthritis is characterized with synovitis, often evolve erosions of the joints, pain and functional deficit. Etiology is unknown, but the development of such autoimmune disease is due to genetic and environmental factors. Most of the patients with diagnosis of rheumatoid arthritis use nonbiologic disease modifying antirheumatic drugs. Advances in the undersstanding of the disease process have led to the development of biological agents to treat rheumatoid arthritis. With the use of biologic agents we wish to evolve the goal of therapy from that of symptomatiic relief to clinical remission. Biologic drugs have documented, fast and continuous efficacy with generaly well accepted safety profile. On behalf of Croatian Society for Rheumatology we propose recommendations for the biologic therapy in rheumatoid arthritis

Guidelines of the Croatian Society for Rheumatology for the treatment of knee and hip osteoarthritis

Osteoartritis kuka i koljena pripadaju bolestima s najvećom onesposobljenošću. Ciljevi liječenja za te bolesnike su smanjenje boli, poboljšanje pokretljivosti i ograničavanje funkcionalnog oštećenja. Odgovarajuće liječenje osteoartritisa uključuje nefarmakološke (neintervencijske) i farmakološke metode, dok manji broj bolesnika zahtijeva kirurško liječenje. Sukladno dosadašnjim znanstvenim dokazima o dostupnim mogućnostima liječenja te na temelju mišljenja stručnjaka predstavljene su smjernice liječenja bolesnika s osteoartritisom kuka i koljena u Hrvatskoj.Osteoarthritis of the hip and the knee belongs to one of the most disabiliting conditions. Treatment goals for these patients include a reduction in pain, an improvement in joint mobility and to limit functional impairment. To properly manage osteoarthritis, both nonpharmacologic (non-interventional) and pharmacologic modalities may be employed, while minority of patients will require surgery. According to the available evidence for available therapies and experts’ opinion here we present guidelines for the treatment of hip and the knee osteoarthritis in Croatia

The Proposal of the Croatian Society for Rheumatology for the treatment of adult rheumatoid arthritis patients with biologics, 2013

Standardiziran pristup bolesnicima s reumatoidnim artritisom (RA) jedan je od uvjeta dobre reumatološke kliničke prakse. Hrvatsko reumatološko društvo (HRD) Hrvatskog liječničkog zbora (HLZ) ažuriralo je Prijedlog liječenja RA biološkim lijekovima u skladu s novijim spoznajama u reumatologiji kroz posljednje 3 godine. Poštivanjem dogovorenog standarda liječenja izbjegava se nesavjesno liječenje i neracionalna potrošnja, a većini bolesnika pruža veća šansa za povoljan ishod.Standardized approach to the patients with rheumatoid arthritis (RA) is one of the requirements of good clinical practice. Croatian Society for Rheumatology (HRD) of Croatian Medical Association (HLZ) updated the Proposed treatment of rheumatoid arthritis (RA) with biologic agents in line with recent findings in rheumatology for the last 3 years. By complying with the agreed standards of treatment we can avoid malpractice and irrational consumption, and to the most patients provide a greater chance for a favorable outcome