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As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolves, infection management in vulnerable populations requires formalized guidance. Although low-virulence variants of SARS-CoV-2 remain predominant, they pose an increased risk of severe illness in adults with rheumatic and musculoskeletal diseases (RMDs). Several disease-specific (chronic long-grade inflammation, concomitant immunosuppression) and individual (advanced age, multimorbidity, pregnancy, vaccination status) factors contribute to excess risk in RMD populations. Various post-COVID-19 manifestations are also increasingly reported and appear more commonly than in the general population. At a pathogenetic level, complex interplay involving innate and acquired immune dysregulation, viral persistence, and genetic predisposition shapes a unique susceptibility profile. Moreover, incident cases of SARS-CoV-2 infection as a trigger factor for the development of autoimmune conditions have been reported. Vaccination remains a key preventive strategy, and encouraging active education and awareness will be crucial for rheumatologists in the upcoming years. In patients with RMDs, COVID-19 vaccines’ benefits outweigh the risks. Derivation of specialized diagnostic and therapeutic protocols within a comprehensive COVID-19 care plan represents an ideal scenario for healthcare system organization. Vigilance for symptoms of infection and rapid diagnosis are key for introducing antiviral treatment in patients with RMDs in a timely manner. This review provides updated guidance on optimal immunization, diagnosis, and antiviral treatment strategies.

Introduction This multicenter, real-world, retrospective cohort study aimed to assess the effectiveness and safety of tofacitinib (TOFA) in rheumatoid arthritis (RA). Material and methods Two hundred nine patients with active RA treated with TOFA, unresponsive to at least 2 conventional synthetic disease-modifying drugs, were recruited. Clinical characteristics were extracted from an electronic registry and supplemented with manual chart review and data linkage with ambulatory care. Drug retention and reasons for discontinuation were evaluated. Results Median (interquartile range) follow-up in the whole sample was 16.9 (5.93–31.7) months. Mean (standard deviation) age was 51.44 (±11.84) years, with female predominance ( n = 168, 80.4%). Only 30 patients (14.4%) had no pre-existing traditional cardiovascular (CV) risk factor at TOFA initiation. Tofacitinib retention rates were high, with median survival estimated at 89.3% at 6 months, 82.4% at 12 months, and 60.4% at 24 months. Ineffectiveness was the primary cause of discontinuation ( n = 50). The rate of adverse events (AEs) was relatively low, with lipid abnormalities, blood count alterations, and infectious events among the most common. No major adverse CV event was reported. The incidence rate of AEs necessitating treatment switch was 60.34 (95% CI: 37–92) per 1,000 per-son-years of follow-up. Presence of multiple (> 3) CV risk factors was associated with lower odds of TOFA retention and treatment effectiveness. Conclusions Tofacitinib demonstrated high retention rates and a favorable safety profile in RA patients, including those with traditional CV risk factors. Tofacitinib may be a valuable treatment option for RA patients when combined with individualized CV risk management. Further studies are warranted to explore the long-term effects of TOFA and its CV impact in larger populations.

A triad of symptoms characterises Felty's syndrome: seropositive rheumatoid arthritis (RA), splenomegaly and neutropenia. The treatment of Felty's syndrome is based on using classic synthetic and biological disease-modifying drugs (DMARDs). In this article, we present a case of a patient with Felty's syndrome who was treated with biologic treatment. A systematic search of the literature on the electronic medical database was conducted. The drugs from the DMARD group, despite reducing the activity of the disease, may cause significant clinical complications. It is important to know about the diagnosis, differentiation and treatment of neutropenia and the prevention of febrile neutropenia. The article discusses the current therapeutic possibilities using both classical and biologic DMARDs.

Hyperuricemia, i.e. increased serum uric acid (UA) concentration, is a common problem in clinical practice. While there are clear guidelines concerning management of symptomatic hyperuricemia in acute conditions such as gout, urolithiasis or acute urate nephropathy, less is known about their secondary prevention. Moreover, despite the ongoing debate on the role of UA in the pathogenesis of chronic kidney disease, hypertension, cardiovascular disease and heart failure, the management of asymptomatic hyperuricemia in patients with these chronic conditions is still mainly up to physicians’ judgement. Individual considerations should always be taken into account when prescribing urate-lowering therapy. In this narrative review study, we attempt to present current trends concerning treatment of patients with either symptomatic or asymptomatic hyperuricemia in the light of the available knowledge on the role of hyperuricemia in the development of gout, renal, cardiovascular and other diseases.

Dryness of mucosa and eyes is the most recognizable symptom of Sjögren’s syndrome (SS). Secondary SS (sSS) is diagnosed when symptoms of SS coexist with other systemic connective tissue disease. The sSS is often identified based on the symptoms of dryness in the presence of other connective tissue disease, making the diagnosis of sSS very subjective. The goal of this work was to summarize previously used and current criteria for the diagnosis of sSS. Classification criteria for sSS, which are universally accepted standards, do not exist. The diagnosis of sSS still depends on the experience of the investigator. Histopathological examination of minor salivary glands appears to be crucial for characterization of patients with sSS due to a specific picture of the disease and repeatability of the test.

Introduction International recommendations are intended to help rheumatologists in the effective management of rheumatoid arthritis (RA) through an evidence-based approach. This research aimed to evaluate management patterns and associated difficulties encountered by rheumatologists in daily practice. Material and methods Interviewers recruited 101 Polish rheumatologists in a random quota-based, nationwide sample of outpatient clinics. Quantitative data were input online using a computer-assisted web interview tool. Results Disease-modifying antirheumatic drugs (DMARDs) are not initiated at the time of diagnosis in 15% of RA patients, most often due to difficulties in patient-provider communication. The RA activity is assessed every 4 to 6 months by 30% of rheumatologists, and 64% of patients are reported to never achieve remission. Composite indices are the most reliable indicators of remission only for 38% of responders. Despite inadequate disease control with ≥ 2 treatment schedules with synthetic DMARDs, 34% of these patients are not considered for biological DMARDs (bDMARDs). Contraindications and reimbursement barriers are the most frequently stated reasons. Therapy with glucocorticoid (GC) lasting over 3 months is reported by 70% of rheumatologists. International recommendations are stated as the most common basis for treatment decisions. Conclusions Awareness of recommendations is not sufficient to ensure their application in clinical practice. Inadequate management of RA is quite prevalent, with a substantial contribution of non-medical factors. Daily practice mainly deviates from guidelines regarding frequency and mode of monitoring measures, time to DMARD initiation, and duration of GC treatment. Education programs and policy changes may significantly narrow the gap between evidence and practice.

Introduction There are no reliable data regarding the prevalence of rheumatoid arthritis (RA) in Poland. Material and methods The first stage was a face-to-face survey on a nationwide representative sample of 3000 people, which identified respondents with a physician-confirmed diagnosis of RA. The second stage was a survey of RA patients, which characterized the disease course and treatment. It was evaluated by analysis of a representative group of 1957 RA patients in routine clinical practice. Results The overall RA prevalence in Poland was 0.9% (95% CI: 0.6–1.2%), 1.06% for women, 0.74% for men. Seventy-eight percent were female, mean age was 56 and mean disease duration 7 years. Younger patients ( 5.1). Presently, low disease activity (DAS-28 < 3.2) was found in 38.5% of patients. In Poland, 94% of patients have been treated with non-steroid anti-inflammatory drugs, almost 80% with glucocorticoids. Meanwhile, methotrexate, as an anchor drug in Poland, has been used by 80% of patients, biological agents by 2.94% of patients. Conclusions This is the first cross-sectional population-based epidemiological study regarding prevalence of RA in the adult Polish population. The results demonstrate a high prevalence, falling within the upper boundary estimates for Europe. Despite ongoing treatment, the majority still have moderate to high disease activity, and the use of biological therapies is low.

Objective : Use of tumour necrosis factor inhibitors (TNFi) has proved to be an important step forward in the treatment of axial spondyloarthritis (axSpA), but the duration of the therapy as well as the management in case of low disease activity (LDA) or remission are not clearly established. Currently, the identification of potential predictors associated with the treatment discontinuation is the basic purpose of many clinical studies. The aim of this study was to analyze the influence of the discontinuation of TNFi therapy on the disease activity in patients with low disease activity. Material and methods : The study included 65 patients; 47 of patients (72%) were treated with etanercept, 16 (2%) with adalimumab and 2 (3%) with infliximab. Results : The mean age of the patients was 45 years, the mean BASDAI score was 6.8 and VAS for low back pain was 76 mm at baseline. 54 patients with axSpA (83%) achieved LDA after 9 months of anti-TNF therapy. During follow-up 40 patients (74% of patients with LDA) had an increase of the disease activity after mean 14 weeks and needed to restart the treatment with TNFi. After restart of the therapy LDA was regained in all patients after mean 7 weeks. 11 patients (17%) have never achieved LDA and 14 patients (22%) had LDA longer than 6 months without relapse. At baseline higher levels of CRP and ESR were observed in patients with relapse of the disease at the end of treatment and with LDA shorter than 6 months. Conclusions : Changes in the values of disease activity indicators (CRP, ESR) correlated with more stable response to TNFi therapy. Over 50% of patients who were treated with TNFi needed to restart the therapy. Treatment resumption allowed to regain a good clinical effect among affected patients.

Objectives: Report on one-year results from the Polish Spondyloarthritis Initiative registry (PolSPI), containing the cross-sectional analysis of clinical and imaging data as well as database methodology. Material and methods: The PolSPI registry includes patients with axial (axSpA) and peripheral (perSpA) spondyloarthritis according to ASAS classification criteria, and/or patients with ankylosing spondylitis according to modified New York criteria, psoriatic arthritis according to CASPAR criteria, arthropathy in inflammatory bowel disease, reactive arthritis, juvenile spondyloarthritis or undifferentiated spondyloarthritis. Epidemiologic data and history of signs, symptoms and treatment of spondyloarthritis are collected and assessment of disease activity is performed. Radiographic images of sacroiliac joint, cervical and lumbar spine, and results of bone densitometry are collected. Every 6 months blood samples for inflammatory markers, and for long-term storage are taken. Results : During a one-year period from September 2015 to August 2016, 63 patients were registered on an electronic database; 44 (69.8%) of patients were classified as axial spondyloarthritis (axSpA) and 19 (30.2%) as peripheral spondyloarthritis (perSpA) according to ASAS criteria. Statistically significant differences between axSpA and perSpA were discovered in the percentage of HLA-B27 antigen occurrence (92.6% and 50%, respectively), BASDAI (2.8% and 4.1%, respectively), DAS 28 (2.66% and 4.03%, respectively), percentage of peripheral arthritis (20% and 88.8%, respectively), enthesitis (26.7% and 70.6%, respectively), dactylitis (6.7% and 88.9%, respectively), as well as extra-articular symptoms: acute anterior uveitis (26.7% and 5.6% , respectively) and psoriasis (6.9% and 55.6%, respectively). Patients with axSpA had significantly higher mean grade of sacroiliac involvement according to New York criteria, higher mSASSS score, and lower T-score in femoral neck in bone densitometry. Conclusions : At the early stage of the disease patients with axSpA compared to those with perSpA, have more advanced structural damage of sacroiliac joints and spine, and lower bone mineral density in the femoral neck. In the upcoming years the PolSPI registry will prospectively follow-up patients with SpA, recording response to treatment and carrying out research on interaction of inflammation and bone remodelling.

Erythema nodosum is the most common form of panniculitis. It may have many aetiological factors. Erythema nodosum occurs three to five times more often in female patients. It appears as erythematous painful rounded nodules, located most often on the anterior surface of the lower extremities, and may be accompanied by systemic symptoms such as fever, malaise and arthralgia. During diagnosis, oncological vigilance should be maintained, because erythema nodosum may be a paraneoplastic symptom. It requires an interdisciplinary approach and exclusion of many underlying causes.

Objectives : The aim was to assess of the morphology, intensity, and activity of changes in the first ultrasonographic (US) examination of hands and feet in patients with early arthritis (lasting up to 12 months) who were ultimately diagnosed with rheumatoid arthritis (RA). An attempt was made to demonstrate a correlation between the intensity of lesions in US and selected laboratory parameters. Material and methods : Ultrasonographic examination was performed using a LOGIC GE 500 device on a group of 60 patients with arthritis (46 women, 14 men) aged 18–80, previously untreated. In total, 3120 hand and feet joints were examined. The assessment focused on the presence of joint effusion, synovial proliferation and power Doppler signals (assessed on a semi-quantitative scale). Each patient underwent laboratory tests, necessary for making a diagnosis. In order to analyze the correlations between changes in US and laboratory parameters, erythrocyte sedimentation rate (ESR), reactive protein test (CRP), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPAs) were used. Results : In the study group, the average duration of arthritis symptoms until the first US examination was 5.6 months. Among the 3120 examined hand and foot joints, deviations from the norm appeared in 1093 joints, synovial hypertrophy was found in 471 joints (grade 1 synovial hypertrophy was reported most frequently), while presence of signal in Power Doppler was revealed in 261 joints (grade 1 was observed most frequently). A statistically significant correlation was found between the intensity of changes in Power Doppler and CRP concentration. Conclusions : In patients with increased concentrations of CRP, we may expect arthritis of higher intensity, therefore, in order to prevent the progression of destructive changes, it is necessary to quickly implement effective disease-modifying antirheumatic treatment. The conducted research showed that the activity of joint inflammation is not affected by the values of ESR and the presence of RF or ACPAs.

Objectives: Current studies concentrate on the cytokine network and its role in the pathogenesis of spondyloarthritis (SpA). In this study, we analyzed whether the serum cytokine profile (interleukins: IL-10, IL-11, IL-12, IL-15, IL-17, IL-23 and IL-33) correlates with demographic data, clinical manifestations, disease activity and treatment outcome in a group of patients with axial spondyloarthritis. Material and methods: Forty-nine patients with an established diagnosis of axial spondyloarthritis (aSpA) and 19 healthy volunteers as controls were enrolled in the study. Clinical evaluation included patient’s medical history, 44 joint count, back pain intensity and global disease activity in the preceding week (VAS), the duration of morning stiffness and blood tests. Disease activity was assessed using BASDAI and ASDAS-CRP. Serum concentration of IL-10, IL-11, IL-12, IL-15, IL-17, IL-23 and IL-33 was determined. Results : In patients with aSpA, elevated serum concentration of IL-10, IL-15, IL-17 and IL-23 was detected. In the aSpA group we detected higher values of serum concentration of IL-23 and IL-33 in the subgroup with anterior uveitis (83.1 ±184.0 pg/ml vs. 14.0 ±17.1 pg/ml, p < 0.0001 and 45.5 ±71.9 pg/ml vs. 18.4 ±14.3 pg/ml, p < 0.0001, respectively). Additionally, in the subgroup with peripheral arthritis, elevation of serum concentration of IL-12 (249.3 ±246.9 pg/ml vs. 99.9 ±105.9 pg/ml, p = 0.0001) was detected. Patients with preradiological SpA had higher serum concentration of IL-17 than patients with established diagnosis of AS (6.37 ±8.50 pg/ml vs. 2.04 ±2.98 pg/ml, p = 0.0295). No differences in serum concentration of analyzed cytokines were found between the subgroup with low to moderate disease activity and the subgroup with high to very high disease activity. Conclusions : We report that in aSpA patients, compared to controls, elevated serum concentrations of IL-10, IL-15, IL-17 and IL-23 were observed. Some cytokines may predispose to a more severe course of aSpA.

Aim of the study : A group of psoriatic arthritis patients (PSA, 11 cases) has undergone a treatment. For each patient two serum samples were collected: before the treatment (sample before) and after the treatment (sample after). Performed investigation aimed to provide an information whether a treatment of the PSA patients improves the galactosylation of IgG N-glycans, which previously was shown for rheumatoid arthritis (RA) patients. Material and methods : Immunoglobulin G (IgG) was isolated from serum of PSA patients, before and after the treatment, using affinity chromatography on Protein A-Sepharose, and was further analyzed regarding the galactose content, using gas chromatography-mass spectrometry (GC-MS) method and ELISA test, performed with two lectins: Ricinus communis (RCA-I) and Griffonia simplicifolia (GSL-II). Based on ELISA results an agalactosylation factor (AF) was calculated for each before and after IgG sample. Results: Obtained data regarded galactose content in IgG, AF calculation and estimation of two laboratory indices of inflammation: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentration in serum. Based on statistical methods it was shown that average difference (d) of after and before measures of AF for PSA patients was Med HL = –0.097 (95% CI: –0.49–0.25), which means that applied treatment did not affect AF value for this group of patients in a statistically significant manner (p = 0.2936). Conclusions: The study demonstrated that, in the contrary to RA patients, IgG galactosylation in PSA patients, undergoing a treatment, showed no statistically significant changes.

Granulomatosis with polyangitis (GPA) is one of systemic connective tissue diseases. Necrotizing vasculitis affects small- and medium-sized vessels. Antineutrophil cytoplasmic antibodies directed against the neutrophil serine protease proteinase-3 (cANCA, PR3-ANCA) have been identified in approximately 80–95% of patients with GPA. In typical cases upper and lower respiratory tract and kidneys are involved. However GPA produce a broad spectrum of clinical symptomes, that includes: ocular and ear involvement, peripheral and central nervous system manifestations, heart and digestive tract involvement. The diffuse alveolar hemorrhage and pulmonary-renal syndrome may also occur. The diagnosis of granulomatosis with polyangiitis may cause many difficulties, specially in cases with limited organ involvement, with untypical spectrum of clinical features and in ANCA-negative patients. We attempt to present differential diagnosis of GPA in this review article.

Erythema nodosum (EN) is a well-known form of panniculitis. It may occur as an idiopathic form and also can be induced by certain clinical conditions such as infections and granulomatous diseases such as sarcoidosis. Erythema nodosum may be accompanied by general symptoms such as fever, weakness, and severe pain, but skin lesions resolve without skin damage. Erythema nodosum occurrence is for the clinician a signal for a wider diagnosis and determination of the cause of occurrence of symptoms. The article presents three cases of EN with different causes and treatment.

Systemic connective tissue diseases, notably rheumatoid arthritis and systemic lupus erythematosus, frequently affect women of reproductive age. The significant impact of the diseases on the course of pregnancy is well established, and vice versa – the course of systemic connective tissue diseases may be affected by pregnancy. The risk of developing serious pregnancy complications and obstetric failures is markedly higher in the mentioned disease group. The foundation of obstetric success, i.e. giving birth to a healthy child and pregnancy having no effect on the course of a given autoimmune disease, is cooperation between rheumatologists and obstetricians so as to plan procreation at an optimal period and provide accurate pregnancy monitoring. The article delineates recommendations relating to contraception management, obstetric supervision and fetus wellbeing monitoring, from the point of view of the obstetrician.

The antiphospholipid syndrome (APS) is an interdisciplinary condition with a clinical picture in which thrombotic complications and obstetric failures play the most significant role. It has been demonstrated on the basis of multicentre clinical observations that the most common pregnancy-related complications in the course of APS include: recurrent miscarriage in the first trimester of pregnancy, pregnancy loss in the second and third trimester of pregnancy, early preeclampsia and preterm delivery. Any APS female patient planning a pregnancy should be advised about the risk of complications which may occur in the course of pregnancy. The treatment of pregnant APS patients should be conducted by a multidisciplinary team including specialists in rheumatology, obstetrics, and in justified cases also in haematology. The most important element of the pregnant APS patient management is secondary thromboprophylaxis with low dose aspirin and heparins. The introduction of hydroxychloroquine is recommended in patients with systemic lupus erythematosus. The visits should take place every 4 weeks and starting from week 26–28 of pregnancy every 1–2 weeks. The patients should be strictly monitored for signs of preeclampsia and/or thrombosis.

The majority of patients with systemic lupus erythematosus (SLE) are at reproductive age. The mean age of SLE onset is 29 years. In contrast to rheumatoid arthritis, in pregnant patients with SLE the disease is still active or even may be exacerbated. Pregnancy – preparation for it, its course, and the breastfeeding period – is a major therapeutic and organizational challenge for doctors taking care of patients with SLE. The management of pregnancy and puerperium in a patient with SLE requires close cooperation of doctors of various specialities, including in the first place rheumatologists and obstetricians. In the paper the recommendations are presented concerning preparation for pregnancy, treatment of the underlying disease and complications during pregnancy and the breastfeeding period in SLE patients. Particular attention is paid to the treatment according to the recently published recommendations for patients with lupus nephritis.

The peak in incidence of the majority of inflammatory arthropathies (IAs) is observed in the 2 nd –4 th decades of life. Thus the diseases affect patients at reproductive age. The results of population studies have demonstrated that these diseases can exert effects on the fertility of the patients, family planning, course of pregnancy and further development of the baby. It has also been shown that female patients with IAs, compared with healthy women, less frequently decide to have the first and other babies and the interval between successive pregnancies is longer. The aim of pharmacotherapy in a patient with IA who plans to become pregnant is to effectively inhibit the inflammatory activity and to maintain remission/low activity of the disease during pregnancy and after its termination. Disease-modifying drugs suitable for administration in the preconception period and pregnancy include: chloroquine, hydroxychloroquine, sulfasalazine, azathioprine, ciclosporin A, glucocorticosteroids and non-steroidal anti-inflammatory drugs. The following should not be administered: out of the synthetic disease-modifying drugs – methotrexate, leflunomide, cyclophosphamide and mycophenolate mofetil; and out of biological drugs – abatacept, tocilizumab and rituximab.

One of the more important problems resulting from the specificity of a chronic disease, its treatment and associated adverse effects is a permanent inability or limited ability to initiate and realize the requirements relevant to a given developmental stage of the patient. For women at reproductive age this includes family planning and giving birth to babies. The problem of pregnancy in women with the diagnosis of rheumatic disease is associated not only with physical but also psychological factors. A significant percentage of women with rheumatic diseases make no attempts to conceive. It is caused among other things by lacking knowledge on the possibilities of realization of the motherhood plans and the influence of social stereotypes concerning limitations resulting from disability. Therefore, an important element of influencing the patients’ attitudes is solid education providing information and instrumental support including practical training in precise ways of management of a given situation.

Granulomatosis with polyangiitis (GPA) is characterized by necrotic vasculitis of the medium and small vessels, granuloma formation and presence of antineutrophil cytoplasmic antibodies against proteinase-3 in serum. The upper respiratory tract, lower respiratory tract and kidneys are usually involved in the disease. Atypical clinical presentation may generate problems. In this report we present a case in which the diagnosis of GPA was possible, but was verified during in further clinical observation. We present the medical history of a 70-year-old woman with ocular symptoms, nasal discharge, progressive hearing impairment, craniofacial inflammatory infiltrates, lymphadenopathy, and microscopic haematuria in laboratory tests. Histopathology did not confirm GPA. cANCA tests were also negative. Finally, after mediastinoscopy and histopathological evaluation of the lymph nodes, the diagnosis of B-cell lymphoma was established.

Wostatnich latach wyprodukowano i oceniono w wielu badaniachlaboratoryjnych i klinicznych nowy lek hamujący funkcje biologiczneczynnika martwicy nowotworu (tumour necrosis factor – TNF) –certolizumab pegol. Dzięki pegylacji (dołączeniu do fragmentuFab przeciwciała neutralizującego TNF cząsteczki glikolu polietylenowego)związek ten wykazuje nieco odmienne właściwościw porównaniu z innymi lekami blokującymi TNF. W artykule przedstawionopodobieństwa i różnice mechanizmów działania, farmakokinetyki,metabolizmu, skuteczności klinicznej, wpływu na progresjęradiologiczną i bezpieczeństwa stosowania certolizumabuw porównaniu z innymi lekami biologicznymi hamującymi funkcjebiologiczne TNF w leczeniu chorych na reumatoidalne zapaleniestawów (tab. I–III). Badania kliniczne wykazały bardzo szybkąodpowiedź kliniczną na zastosowany certolizumab (tab. II, ryc. 1).Dodatkowo można z dużym prawdopodobieństwem przewidziećdługoterminową skuteczność tego leku, co może mieć istotnywpływ na farmakoekonomikę leczenia.

Pacjenci, u których stosuje się terapie lekami biologicznymi, wymagająszczególnej opieki. W trakcie licznych, systematycznie powtarzanychwizyt monitorujących w dokumentacji pacjentów groma dzonajest ogromna liczba danych na temat pacjenta, jego choroby i terapii.Analiza tych danych może służyć wielokierunkowej ocenie skutecznościi bezpieczeństwa terapii. Fakt ten stał się inspiracją do powstaniapolskiego naukowego elektronicznego rejestru dzieci leczonych lekami biologicznymi: „Długoterminowa ocena bezpieczeństwa i skutecznościleczenia młodzieńczego idiopatycznego zapalenia stawów”.Rejestr rozpoczął działanie w kwietniu 2009 r. Po roku funkcjonowaniaw rejestrze znalazły się dane dotyczące 218 pacjentówchorujących na młodzieńcze idiopatyczne zapalenie stawów (MIZS),u których stosowano terapie biologiczne: etanercept zastosowanou 210 pacjentów, a adalimumab u 8 pacjentów. Główne cele prowadzeniarejestru to: 1) długoterminowa ocena bezpieczeństwa stosowanegoleczenia przez prowadzenie rejestracji i analizy zdarzeń niepożądanych,2) długoterminowa ocena skuteczności leczenia napodstawie oceny aktywności choroby oraz jakości życia pacjentów.W rejestrze zawarte są dane z wywiadu pacjenta, dotyczącepoczątku i przebiegu MIZS, uprzedniego leczenia, oceny jego skutecznościi tolerancji, aktywności choroby, występowania choróbautoimmunizacyjnych w rodzinie oraz ocena jakości życia przedrozpoczęciem terapii biologicznej. Na podstawie danych zebranychw czasie wizyt kontrolnych lekarz uzupełnia elektroniczny kwestionariusz,składający się z 35 pytań dotyczących rozwoju somatycznegooraz prowadzonego leczenia. Oceniana jest aktywność choroby(wg Gianinniego) i wyliczany wskaźnik poprawy ACR Ped.Dodatkowo skuteczność leczenia oceniają lekarz, pacjent i jegorodzice, pod uwagę bierze się absencje w szkole i liczbę hospitalizacji.Bezpieczeństwo jest określane przez odnotowywanie zdarzeńniepożądanych.W pracy przedstawiono główne założenia rejestru, jego strukturę,kierunki analizy zebranych danych oraz listę uczestniczących w nimośrodków (tab. I i II).

Wstęp: Układ przekaźnikowy Jak/Stat (kinaza tyrozynowaJanus/sygnał transdukcji i aktywacji transkrypcji) jest wykorzystywanyprzez wiele cytokin, czynników wzrostu i hormonów regulującychmechanizmy transkrypcji genów oraz aktywacji, proliferacji,różnicowania i apoptozy komórek. Wyniki dotychczasowych badańwskazują, że kinaza Jak3 odgrywa istotną rolę w patogeneziereumatoidalnego zapalenia stawów (RZS). Cel pracy: Ocena ekspresji Jak3 oraz aktywacji Stat3 w leukocytachkrwi obwodowej (LKO) i komórkach płynu stawowego (KPS)u chorych na RZS i spondyloartropatie zapalne (SpaZ) oraz analizazwiązku badanych parametrów ze wskaźnikami aktywności chorobyużywanymi w praktyce klinicznej. Ponadto analizie poddanozależności między ekspresją Jak3 a aktywacją Stat3. Materiał i metody: Do badania zakwalifikowano 19 chorych na RZSoraz 22 chorych na SpaZ (zesztywniające zapalenie stawów, łuszczycowezapalenie stawów, spondyloartropatia niezróżnico wana).Grupę kontrolną stanowiły 23 zdrowe osoby. W badanych grupachw LKO metodą immunocytochemiczną oznaczono ekspresję kinazyJak3 i aktywację białka Stat3. Tą samą metodą oznaczono ekspresjęJak3 i aktywację Stat3 u 11 chorych na RZS i u 12 chorych na SpaZw KPS. U chorych zostały oznaczone warto ści parametrów stanuzapalnego oraz wskaźników aktywności choroby DAS28 i BASDAI.Wykonano rentgenogramy stawów zajętych procesem chorobowym. Wyniki: Ekspresja Jak3 oraz aktywacja Stat3 były znacząco wyższeu chorych na RZS i SpaZ w porównaniu z grupą kontrolną. War to -ści te były wyższe w KPS niż w LKO. U chorych na RZS zaobserwowanododatnią korelację między aktywnością Stat3 w KPSa wartością CRP. Nie wykazano korelacji między ekspresją Jak3a aktywacją Stat3. Wnioski: Funkcja Jak3 i Stat3 jest związana z procesem immunolo -gicznym w przebiegu RZS i SpaZ. Wydaje się, że zablokowanie ichfunkcji może stanowić cel terapeutyczny w obydwu grupach chorych.

Możliwość przewidywania odległych konsekwencji reumatoidalnegozapalenia stawów ma zasadnicze znaczenie dla podejmowaniawłaściwych decyzji terapeutycznych u danego chorego. Markeryprognostyczne są pomocne w identyfikacji chorych o dużym ryzykuszybkiej progresji radiologicznej. Utwierdzają one lekarzaw decyzji o rozpoczęciu intensywnego leczenia u chorych z możliwąznaczną destrukcją stawów w ciągu następnych kilku lat.W artykule zaprezentowano pilotażowy model ryzyka dla przewidywaniaszybkiej progresji radiologicznej. W celu stworzenia tegomodelu posłużono się danymi, w tym wynikami badań radiologicznychpochodzącymi z badania ASPIRE, w którym porównywanomonoterapię metotreksatem z leczeniem skojarzonym metotreksatemi infliksymabem. W tym modelu wybrano wyjściowe parametry,które są łatwe do uzyskania w rutynowej praktyce klinicznej,takie jak: stężenie białka C-reaktywnego, wartość odczynuopadania krwinek czerwonych, liczbę obrzękniętych stawów orazmiano czynnika reumatoidalnego. Ten macierzowy model ryzykamoże być przydatny w ocenie ryzyka postępującego uszkodzeniastawów, szczególnie u chorych z wczesnym zapaleniem stawów.

Wstęp: Obecnie dużą nadzieję wiąże się z indywidualizacją leczeniachorych na reumatoidalne zapalenie stawów (RZS). Opróczczynników klinicznych pomocna w ustaleniu indywidualnych zaleceńmoże być predyspozycja genetyczna. Celem pracy było okreś -lenie roli i wpływu polimorfizmów genu reduktazy metyleno -tetrahydrofolianowej: MTHFR C677T i A1298C na skutecznośći działania niepożądane w trakcie terapii metotreksatem (MTX)chorych na RZS. Materiał i metody: Badaniem zostało objętych 273 chorych na RZSspełniających kryteria American Rheumatism Association (ARA)z 1987 r. Wszyscy chorzy byli leczeni MTX (15–25 mg tygodniowo)minimum 6 miesięcy lub lek został u nich odstawiony wcześniejz powodu wystąpienia działań niepożądanych. Oceniano klinicznąi biochemiczną aktywność choroby. Biorąc pod uwagę działanianiepożądane, wyróżniono trzy grupy chorych: bez działań niepożądanych,z lekkimi i średnimi oraz ciężkimi działaniami niepożądanymi.Genomowe DNA było izolowane z limfocytów krwi obwodowej,a następnie amplifikowane metodą reakcji łańcuchowejpolimerazy (polymerase chain reaction – PCR). W kolejnym etapieprodukty reakcji zostały poddane działaniu enzymów restrykcyjnych. Wyniki: Ostateczne wyniki analizowano w grupie 240 chorych.Dobrą odpowiedź na leczenie stwierdzono w 6. miesiącu u 33%,umiarkowaną poprawę u 43%, a brak poprawy u 24% chorych.Działania niepożądane wystąpiły łącznie u 53% chorych, a u 16,5%były przyczyną odstawienia leku. Badając skuteczność terapii MTXw zależności od badanych polimorfizmów, nie wykazano istotnościstatystycznej. Biorąc pod uwagę wszystkie działania niepożądane,to istotnie statystycznie częściej występowały one u chorychz genotypem MTHFR 677TT i 677CT w porównaniu z 677CC(OR = 1,97, p < 0,01). Częściej stwierdzono zwiększenie aktywnościaminotransferaz u chorych z genotypem MTHFR 677CT i 677TTw porównaniu z MTHFR 677CC (p = 0,02, OR = 3,4). Wnioski: Polimorfizm MTHFR 677CC był związany z mniejszą liczbądziałań niepożądanych. Badania polimorfizmów genów mogąpozwolić na wyróżnienie grupy pacjentów predysponowanych dowystąpienia działań niepożądanych. Badania farmakogenetycznemogą przyczynić się do skuteczniejszej indywidualizacji leczeniachorych na RZS.

Cel pracy: Celem pracy była ocena związku pomiędzy obecnościąprzeciwciał anty-HSP70 w surowicy chorych na toczeń rumieniowatyukładowy (systemic lupus erythematosus – SLE) a występowaniemwczesnych zmian miażdżycowych. Materiał i metody: Do badania zakwalifikowano 16 chorych naSLE w wieku 27–60 lat (średnia wieku 44,4 roku). Grupę kontrolnąstanowiło 13 zdrowych ochotników w wieku 24–57 lat(średnia wieku 43,1 roku). U chorych na SLE oraz w grupie kontrolnejwykonano badanie ultrasonograficzne tętnic szyjnychw celu oceny grubości kompleksu błony środkowej (intima-mediathicknes – IMT) oraz oceniono stężenie przeciwciał anty-HSP70w surowicy żylnej. Wyniki: W grupie chorych na SLE stwierdzono obustronnie istotniewiększą wartość IMT w tętnicy szyjnej wspólnej, tętnicy szyjnejwewnętrznej oraz opuszce tętnicy szyjnej wewnętrznej, coświadczy o istnieniu bardziej zaawansowanych zmianmiażdżycowych w tej grupie. W grupie chorych na SLE IMT korelowałaistotnie statystycznie z wiekiem. Ponadto, w grupiepacjentów z SLE stwierdzono ujemną korelację pomiędzystężeniem cholesterolu frakcji HDL a średnią IMT prawej tętnicy szyjnej wspólnej (RP = –0,54, p < 0,05). Grubość kompleksu intima-media w grupie chorych na SLE również korelowała istotniestatystycznie z dawką przyjmowanych glikokortykosteroidów.Stężenia przeciwciał skierowanych przeciwko białku wstrząsucieplnego HSP70 nie różniły się w badanych grupach istotnie statystycznie(116,5 ±188,0 μg/ml vs 236,3 ±319,5 μg/ml; p > 0,05).Nie wykazano także związku pomiędzy IMT a stężeniem przeciwciałanty-HSP70 w badanych grupach. Wnioski: W przedstawionej pracy nie stwierdzono opisywanegow piśmiennictwie związku pomiędzy obecnością przeciwciałprzeciwko HSP70 a rozwojem miażdżycy u chorych na SLE.