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Introduction: Thyroid abnormal function and and/or autoimmune thyroid disease (ATD) are observed in 6% to 33.8% patients with rheumatoid arthritis (RA)., Objectives: The aim of the study was to determine whether ATD is more prevalent in patients with RA compared to the control group involving age and sex-matched subjects without RA and whether these patients should be screened for thyroid disease., Patients and Methods: In 100 patients with RA and 55 patients without RA (control group) hormonal thyroid function and antithyroid antibodies were assessed., Results: ATD was more prevalent (16%) in patients with RA than in the control group (9%). The difference was no statistically significant. The RA patients with concomitant ATD had lower RA activity than non-ATD RA patients. Antithyreoglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies were present in similar percentage of patients with RA (12% and 15%, respectively) and in the control group (9% and 18%, respectively). The most common thyroid dysfunction observed in both groups was subclinical hypothyroidism. An association between thyroid dysfunction and clinical symptoms suggestive of thyroid disease in RA patients was not demonstrated. In patients with RA low free triiodothyronine concentrations were significantly more common., Conclusions: A higher prevalence of ATD in female RA patients compared with controls indicates the need for screening not only of thyroid function, but also of the presence of anti-TPO antibodies as the ATD marker in RA patients. Their presence does not correlate with the occurrence of thyroid disorders in RA patients. Monitoring of thyroid function is of particular importance since as already shown the course of thyroid disease in RA patients is often asymptomatic.

Reactive arthritis (ReA) is a non-purulent joint inflammation that usually follows bacterial gastrointenstinal or urogenital infections. The classic presentation of ReA is characterized by an asymmetric arthritis usually in the lower limbs associated with urethritis, conjunctivitis and occurrence of other articular or extra-articular manifestations. ReA is classified as a type of seronegative spondyloarthopathy. Approximately 65-85% of patients with ReA are HLA-B27 positive. Regardless of the preceding infection, the clinical picture is similar, but management can differ according to the triggering infection. Treatment of Chlamydia-induced ReA should be started with antibiotics because of several mechanisms by which Chlamydia can cause persistent infection. The disease may have an acute or self-limited course, however some patients develop chronic arthritis.

Elderly-onset rheumatoid arthritis (EORA), defined as rheumatoid arthritis (RA) with the onset at the age > or =60 differs sligthy at presentation from younger-onset RA (YORA) by a more equal sex distribution, a higher frequency of an acute onset, more frequent involvement of large joints, especially of the shoulder, and higher disease activity. Longitudinal studies have shown greater disease activity, more severe radiographic damage and functional decline in patients with EORA than in those with YORA. These differences were only found in seropositive patients. In seronegative EORA patients a less severe course of the disease and a better outcome have been observed, with the clinical manifestations of polymyalgia rheumatica or remitting seronegative symmetrical synovitis with pitting edema. This article is a review of available data concerning differences between EORA and YORA.

Polymyalgia rheumatica is a rheumatic disease which mainly affects the elderly, and is seldom diagnosed in patients <50 years of age. The prevalence of polymyalgia rheumatica is approximately 16.8 to 53.7 per 100,000 of the population >50 years of age. Patients may present with spiking fever, malaise, fatigue, weight loss and other features suggesting inflammation, which in each case requires differential diagnosis from malignancies. Neoplastic disease in turn can manifest itself in symptoms resembling those of polymyalgia, which are named "polymyalgia-like syndrome" and are in fact paraneoplastic syndromes presenting as polymyalgia rheumatica. These observations suggest that a careful clinical evaluation and a long term follow-up are necessary for a correct diagnosis of polymyalgia rheumatica.

Published data were reviewed to evaluate the occurrence of antiphospholipid antibodies (aPL) in rheumatoid arthritis (RA) patients and to investigate their clinical relevance in this population. The mean prevalence of aPL in RA patients was calculated at 28%. Few studies have found a relationship between aPL and thrombosis, particularly in combination with other risk factors. Conflicting results have been reported on the association of anticardiolipin antibodies (aCL) positivity and neurologic symptoms, Reynaoud's phenomenon, radiologic erosions, extra-articular RA manifestations, rheumatoid factor, and atherosclerosis. Some studies, however, suggest that there is a correlation present between those antibodies and C-reactive protein levels, rheumatoid factor (RF) and antinuclear antibodies. Tumor necrosis factor blocking agents may cause an induction of aCL, but it seems like they do not cause any clinical features related to the antiphospholipid syndrome.

Unlabelled: The aim of the study was 2 years follow-up observation of clinical course in RA patients with the presence of anticardiolipin antibodies (aCL)., Methods: Among 395 patients with RA hospitalized in the Clinic of Rheumatology from January 2003 to December 2004 (2 years), in 39 patients with suspicion of antiphopspholipid syndrome the aCL antibodies were determined. In 7 cases we confirm the presence of aCL antibodies. Patients positive for antiphospholipid antibodies were invited to the Clinic on the beginning of 2006 (after 2 years from previous hospitalization) to analyze clinical course of disease and to perform laboratory examination., Results: In the group of patients with RA positive for antiphospholipid antibodies, 3 had active RA with vascular changes. Aggressive therapy with disease modifying antirheumatic drugs (DMARDs) and corticosteroids caused conversion of anticardiolipin antibodies. Analogically antibiotic therapy in 2 patients with concomitant infections (urinary tract, respiratory system) caused conversion of aCL antibodies. 1 patient developed blastic coat cell lymphoma. 1 patient died because of cardiovascular complications., Conclusion: Presence of anticardiolipin antibodies can be the indicator of serious prognosis, it can predict vasculitis, persistent infections, cardiovascular complications or neoplasmatic disease. We suggest that antiphospholipid antibodies should be measure in patient with aggressive course of rheumatoid arthritis.