63 research outputs found
Capillaroscopy - an insufficiently known and underused method in rheumatology
Kapilaroskopija je neinvazivna i neÅ”kodljiva metoda prikaza morfoloÅ”ke strukture kapilara ležiÅ”ta noktiju u bolesnika sa sumnjom ili veÄ utvrÄenom sustavnom upalnom reumatskom boleÅ”Äu. Najkorisnija je u razlikovanju bolesnika s primarnim i sekundarnim Raynaudovim sindromom. Zbog brojnih prednosti kapilaroskopija bi trebala naÄi svoje mjesto u dijagnostiÄkim algoritmima i praÄenju u svakodnevnoj reumatoloÅ”koj praksi.Capillaroscopy is a noninvasive and harmless morphological method for examination of the nailfold capillaries in both suspected and already diagnosed patients with systemic connective disease. The most useful aspect is in discrimination between the patients with primary and secondary Raynaudās phenomenon. Many of the mentioned features should make capillaroscopy a part of the diagnostic algorithm and follow-up in everyday rheumatologic practice
Terapijske moguÄnosti lijeÄenja intersticijskih bolesti pluÄa u sklopu sistemskih reumatskih bolesti ā primjer sistemske skleroze
Sistemska skleroza je sustavna bolest vezivnog tkiva autoimunosne etiologije karakterizirana stvaranjem fibroze, prvenstveno kože, ali i pluÄnog parenhima. Intersticijska bolest pluÄa jedna je od najtežih manifestacija bolesti te ujedno i vodeÄi uzrok smrti oboljelih od sistemske skleroze. Prikazan je kratak pregled terapijskih moguÄnosti lijeÄenja intersticijske bolesti pluÄa kod bolesnika sa sistemskom sklerozom i srodnim autoimunosnim bolestima. Terapijske moguÄnosti prvenstveno ukljuÄuju imunosupresive i bioloÅ”ke lijekove (ciklofosfamid, mikofenolat mofetil te rituksimab i tocilizumab), a potom i lijekove koji djeluju na patogenezu remodeliranja fibroznog tkiva (antifibrotici). Sve je viÅ”e dokaza da bi kombininacija imunosupresivne i antifibrotske terapije mogla imati povoljan uÄinak na pluÄnu komponentu bolesti. U zadnje se vrijeme transplantacija autolognih krvotvornih matiÄnih stanica nudi kao terapijski izbor za skupinu bolesnika s progresivnim tijekom bolesti, no metoda je ograniÄena na centre koji imaju iskustva s transplantacijom
Rare myositides and myopathies
Upalne bolesti miÅ”iÄa obuhvaÄaju dermatomiozitis, polimiozitis, miozitis s inkluzijskim tijelima te sekundarne upalne miopatije u sklopu sistemskih bolesti vezivnog tkiva, malignih bolesti, sarkoidoze i BehƧetove bolesti. U Älanku se prikazuje miozitis s inkluzijskim tijelima.
Diferencijalna dijagnoza proksimalne miÅ”iÄne slabosti ukljuÄuje i niz neupalnih miopatija. Kao primjer miopatije koju izazivaju lijekovi prikazuje se statinska miopatija. U skupini infekcijskih miopatija izdvojene su parazitske miopatije. Ukratko su prikazane endokrine miopatije.Inflammatory myopathies comprise dermatomyositis, polymyositis, inclusion body myositis, secondary myopathies associated with connective tissue diseases, malignancies, sarcoidosis and BehƧetās disease. In the article the inclusion body myositis is presented.
Differential diagnosis of proximal muscle weakness also includes certain non-inflammatory myopathies The statin myopathy, as an example of the drug-induced myotoxicity, is elaborated. The infectious myopathies are described with the emphasis on parasitic myopathy. The endocrine myopathies are overviewed
CAPILLAROSCOPY IN RHEUMATOLOGICAL PRACTICE ā ONE CENTER EXPERIENCE
Kapilaroskopija je metoda kojom se pod poveÄanjem dobiva uvid u morfoloÅ”ke karakteristike kapilara ležiÅ”ta noktiju. Jednostavnost, neinvazivnost i lagana izvedivost omoguÄuju ovoj metodi gotovo svakodnevnu primjenu u reumatoloÅ”koj praksi. Glavna je indikacija za kapilaroskopiju Raynaudov sindrom (razlikovanje primarnog od sekundarnog oblika bolesti) i rano prepoznavanje sistemske skleroze (uz postojanje tipiÄnoga sklerodermijskog kapilaroskopskog uzorka). Vjerojatno je struÄno opravdano uvrstiti kapilaroskopiju u algoritam obrade bolesnika s difuzno oteÄenim Å”akama i Raynaudovim sindromom. Ostale autoimunosne bolesti koje imaju patoloÅ”ki, ali nekarakteristiÄan kapilaroskopski uzorak jesu sistemski eritemski lupus, dermatomiozitis/polimiozitis, mijeÅ”ana bolest vezivnog tkiva, antifosfolipidni sindrom te ostale bolesti koje zahvaÄaju mikrovaskulaturu. U tekstu su analizirani rezultati vlastite prakse u punih godinu dana izvoÄenja pretrage.Capillaroscopy is a method for evaluating morphological characteristics of nailfold capillaries. The simplicity, noninvasiveness and easiness-to-perform make the method accessible in everyday rheumatological practice. Raynaudās phenomenon is the main indication for performing capillaroscopy (differentiating between primary and secondary Raynaudās phenomenon) and diagnosing early stages of systemic sclerosis. According to some authors capillaroscopy should be included in the work-up algorithm for patients with puffy fingers and Raynaudās phenomenon. Other autoimmune conditions (systemic lupus erythematosus, polymyositis/dermatomyositis, mixed connective tissue disease, antiphospholipid syndrome and other diseases which affect microvasculature ā diabetes mellitus, thromboangiitis obliterans) can have some abnormalities of the capillaroscopic pattern. We present the results of the capillaroscopies performed in our center during the period of one year
Solitary pulmonary amyloidoma mimicking lung cancer on 18F-FDG PET-CT scan in systemic lupus erythematosus patient
Localized amyloid deposits (tumoral amyloidosis or amyloidoma) are uncommon form of amyloidosis and nodular pulmonary amyloidomas are rarely found. This incidental finding can mimic a bronchopulmonary neoplasm and may occur secondarily to an infectious, inflammatory or lymphoproliferative disease. We report a case of a 62-year-old female with long-standing systemic lupus erythematosus (SLE) with low compliance who presented with radiologically-verified solitary pulmonary nodule. Work-up included positron emission tomography-computed tomography (PET-CT) scan, which revealed hypermetabolic uptake of (18)F-fluorodeoxyglucose, and lobectomy was performed. Staining of the tissue was positive for Congo red and was green birefringent under polarized light. Immunohistochemical methods excluded lymphoproliferative disease and confirmed amyloidoma. SLE was controlled with antimalarials and glucocorticoids. Pulmonary amyloidoma should be considered in the differential diagnosis of solitary lung nodules
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