Search

TRAPS is a very rare disease with an estimated prevalence of about one per million. We present a 53-year-old patient from Bulgaria. The clinical features of the disease are periodic fever, arthralgia, myalgia, rash, abdominal pain and hepatosplenomegaly. Laboratory studies yield leukocytosis, highly elevated levels of CRP, significantly high ESR. Secondary amyloidosis AA is determined. The genetic analysis found a heterozygous T>C nucleotide substance (c.250T>C) in exon 3 of TNFRSF1A gene which is associated with ТRAPS (MIM*191190). The presented case of genetic changes and clinical manifestations in the autoinflammatory syndrome TRAPS due to a mutation in the gene encoding the receptor for tumour necrosis factor alpha (TNFRSF1A) is the first documented case of the disease reported in Bulgaria.

Introduction: Osteoporosis is a metabolic bone disease caused by a decrease in the bone mineral density. It is a major public health threat as it weakens bones, especially those in the wrist, spine, or hip, and causes them to break easily., Aim: The study aimed to find how strictly postmenopausal women with osteoporosis adhere to a long-term therapy with bisphosphonates., Patients and Methods: The study was conducted over a 24-month period. It included a total of 341 randomized patients with postmenopausal osteoporosis; the diagnosis was made on the basis of clinical and radiological evidence and a DXA T-score of the axial skeleton and the left hip less than -2.5 SD. Therapy included per os administration of alendonate 70 mg once a week or 50 mg of ibandronate once a month., Results: The patient medication persistence at the end of month 12 was 86.80%, and at the end of month 24 month - 58.94%. The medication possession ratio (MPR) in the bisphosphonate therapy at 6, 12, 18, and 24 months varied from 0.93 to 1.00. This suggests that there was a very good patient medication adherence of the study subjects to the 24-month treatment with bisphosphonates. The patient medication persistence dropped significantly at the end of month 12., Conclusion: Compliance of patients with antiresorptive therapy depends on the specific socio-economic conditions and the attending physician's behaviour. Very rarely, treatment is discontinued because of adverse effects exerted by the drugs or because patients may not be convinced that they have osteoporosis.

Unlabelled: The aim of the study was to analyze the type and incidence of major and minor complications resulting from arthroscopy with arthroscopic synovectomy of the knee joint performed by rheumatologist in different rheumatological diseases., Methods: In a prospective study the incidence of complications in arthroscopic subtotal synovectomy with subsequent tidal flow lavage was analyzed in 201 rheumatic patients. The arthroscopic synovectomies were performed by one team of rheumatologists in the operation room of the University Clinic of Rheumatology in the town of Plovdiv for a period of 8-9 years., Results: The major complications related to the arthroscopic synovectomy included septic arthritis (0.5%) and rupture of the joint capsule with edema of the thigh and leg (1.5%). The minor postarthroscopic complications were infection of the operative skin incision (2.0%), hemarthrosis (3.5%), severe postoperative pain (1.5%) and gout relapse (0.5%). Complete recovery was achieved after complications were treated and the result of the synovectomy was not compromised., Conclusion: Arthroscopic synovectomy of the knee joint performed by rheumatologist in in-patients involves low risk of complications among which minor operative and postoperative ones are prevalent. These do not compromise near and late results of the arthroscopic synovectomy.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects symmetrically multiple joints. Recent therapeutic strategy has been focusing on the symptoms of the disease and the ways to prevent its progression as early as possible. Thus, early diagnosis is crucial since early therapy with disease-modifying anti-rheumatic drugs reduces the severity of joint damage. It is the early period of the development of the disease that a specific and sensitive serologic test is needed. The RA patient sera contains a lot of antibodies. Some of them are not specific for RA occurring also in other diseases, others are highly specific and detectable only in rheumatoid arthritis. Rheumatoid factor (RF) is a very sensitive but poorly specific marker which makes it rather an unsuitable antibody for rheumatoid arthritis. RA-specific antibodies can be very useful for early diagnosis and prognosis of the disease. Among the antibodies described in recent years the most promising candidates are the autoantibodies to antigens containing one or more than one citrulline residues (cyclic citrulline peptides, CCP) - the anti-CCP antibodies. They have been shown in recent research to play an important role in the diagnosis, prognosis and therapeutic approach to patients with RA. Their high specificity, the ability to diagnose RA early in its development and distinguish it from other nonerosive type of arthritis, make the anti-CCP a key serologic marker in the future.

Unlabelled: Correlation and agreement between the diagnostic results of arthroscopic and histological examinations of the synovial membrane in rheumatoid synovitis of the knee joint have been discussed in small number of studies with contradictory conclusions., Aim: The aim of the present study was to determine the correlation between the arthroscopic characteristics and histology of the synovial membrane in patients with rheumatoid arthritis and synovitis of the knee joint., Methods: Sixty-four arthroscopies of the knee joint with guided multiple synovial biopsies were performed in patients with rheumatoid synovitis. Biopsy samples were taken under visual control from the evidently inflamed synovia in four regions of the knee joint. Arthroscopic assessment of the rheumatoid synovitis was done according the standard system of ACR including 6 criteria. The histological assessment of the synovitis met the EULAR criteria including 6 morphological variables., Results: High positive correlation (r = +0.76) was established between the arthroscopic and histological assessment of the rheumatoid synovitis in the examined patients. High values were also found for the k coefficient for agreement (k = 0.70). The mean value of synovitis extent according to VAS was 43.16 mm and the mean value of intensity of the inflammatory process according to VAS was 54.31 mm., Conclusion: The agreement between the arthroscopic and histological diagnosis of the synovitis is in the range of high but not absolute correlation. The two methods are not contradictory and should be used concurrently in patients with chronic rheumatoid synovitis.

Unlabelled: Leflunomide (LFL) is a modern immunomodulating medication belonging to the group of drugs that favourably affect the course of rheumatoid arthritis (RA). We present in this study the results of an open prospective trial on the effectiveness and side effects of LFL in clinically followed up patients with active RA refractory to other disease modifying anti-rheumatic drugs (DMARDS). At the onset of treatment with LFL the patients had at least 8 swollen and tender joints, the disease severity being assessed by both patients and physicians as over 3 cm VAS. ESR was higher than 40mm/lh. In all patients previous treatment with disease modifying drugs received for at least 3 months was insufficiently effective. It was discontinued prior to the therapy with LFL. Assessment of the therapeutic results was made at 3, 6 and 12 months after onset of LFL therapy. The following parameters were followed-up: 1) Number of tender joints, 2) Number of swollen joints, 3) Morning stiffness (min), 4) Global assessment of the patient (VAS 1-10 cm), 5) Global assessment of the physician (VAS 1-10 cm); 6) ESR - mm/lh; 7) Mean HAQ - the sum of all scores (0-3), divided by the number of the questions5; 8) SDAI index of RA activity6; 9) ACR20% and ACR50% positive therapeutic effect2., Results: 82 patients (mean age 53.9 yrs, age range 20-70, 12 males, 70 females) were studied. RA was diagnosed in 80 (97.6%); RA combined with spondyloarthritis was diagnosed in 2 patients (2.4%). The mean duration of RA was 5.1 +/- 3.4 yrs. 70 patients (85.4%) were rheumatoid factor positive. The therapeutic effect from the administration of LFL was markedly good as early as at 3 months from beginning of treatment and was sustained significantly favourable at 12 months. The therapeutic effect of LFL referring to ACR20% is high - 36% at 3 months from onset of therapy and increased to 51% at 12 months. A grave side effect - leucopenia with granulocytopenia was observed in one female patient. LFL is a novel effective disease-modifying drug used to treat refractory RA. In a short term period - 3 to 6 months, LFL leads to a significant clinical and functional improvement of the patients.