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Eosinophilic fasciitis is a rare disorder of unknown etiology and poorly understood pathogenesis. It may be triggered by excessive exercise, physical factors such as radiation therapy, exposure to certain medications, infections, the initiation of hemodialysis and some other medical conditions. Skin modifications appear with collagenous thickening of the subcutaneous fascia with typical aspect of “peau d’orange” and the “groove sign”. Arthritis, myalgia, myositis, neuropathies may occur. The majority of patients have peripheral blood eosinophilia. The diagnosis is confirmed with a full thickness incisional biopsy of skin and subcutaneous tissue down to the muscle surface and fascia. Systemic glucocorticoids are the mainstay of treatment, but some patients require additional immunosuppressive therapy. The long-term prognosis of this disease is unknown and in some cases the disease may releapse. We describe two patients with eosinophilic fasciitis, their evolution and complications, associating other pathologies: morphea and antiphospholipid syndrome, making the diagnosis and the treatment more challenging. [ABSTRACT FROM AUTHOR]

The major treatment issues in Antiphospholipid Syndrome (APS) include the the prevention of first thrombosis, the treatment of acute thromboembolic manifestations, the choice of anticoagulation, the duration of anticoagulation and secondary thrombosis prevention. Anticoagulation should individualized to the patient and clinical setting. Clasical anti vitamin K antagonists, warfarin and acenocumoral, carry some risks and disadvantages. Direct thrombin inhibitor and direct anti-Xa inhibitors are currently available and were approved for the prevention of stroke and systemic embolism in patients with atrial fibrillation, for the treatment of deep vein thrombosis (DVT) and for the prevention of recurrent DVT and pulmonary embolism. Besides many case series reports, there are ongoing clinical trials testing their efficiency and safety in patients with APS. In this paper we reviewed the advantages, risks and disadvantages for the use of direct oral anticoagulants in this category of patients. [ABSTRACT FROM AUTHOR]

Topical Nonsteroid anti-inflammatory drugs are efficient for the treatment of acute and chronic pain in musculo- skeletal diseases. There clinical benefit is similar to the oral form of administration, but with significant less systemic adverse events. There are many forms of topical administration such as gels, cream, spray, patches. The newly topical patch of ibuprofen is an option. The mean level of ibuprofen delivered from the topical patch is consistent with the levels required for therapeutic relief and this dose is much lower that the dose required for oral dosing. Topical nonsteroid anti-inflammatory drugs are a good choice of pain relief for older patients and for patients with cardiovascular and gastrointestinal comorbidities. [ABSTRACT FROM AUTHOR]

Biological therapies improved significantly the prognosis of autoimmune diseases. However, there are patients who do not reach the expected therapeutic response. One of the causes of non-responsiveness is the presence of anti-drug antibodies(ADA). Immunogenicity of biological therapies can be induced by different factors, many of them still unknown. We consider associated disease modifying anti rheumatic drugs (DMARD), dose escaladation and increased frequency of administration, as strategies that can decrease imunogenicity. It should be kept in mind that each biological therapy has a different pharmacokinetic mechanism, variable risk of developing ADA and that a standardized method for detecting serum active substance and ADA would be useful for monitoring biological treatment. [ABSTRACT FROM AUTHOR]

Despite therapy options for rheumatoid arthritis, obtaining clinical remission remains a challenge. Several prognostic factors for response to synthetic and biological DMARDs treatment were found, but their applicability remains controversial (1). A biomarker test that predicts response shortly after initiating a treatment, as well as an algorithm for choosing a suitable biologic DMARD were recently approved. [ABSTRACT FROM AUTHOR]

Background/Objective. Disease activity in spondyloarthritis (SpA) is evaluated through conventional scores such as BASDAI or ASDAS. The aim of this study was to determine disease activity in SpA patients under biological therapy with further assessment on the quality of each activity indicator and their clinical value together with their impact on NSAID intake. Materials and methods. Over nine months (January-August 2015) we enrolled 100 patients with SpA on anti- TNF therapy (33% IFX; 35% ADL; 32% ETA). We collected demographic, clinical (BASDAI, ASDAS, PtGA) and laboratory data (ESR, CRP). Frequency of NSAID ingestion expressed as days per week was included in a questionnaire. Considering their biologic treatment, patients were divided into disease activity groups and sample characteristics were correlated and compared. Statistical analysis was performed with SPSS 20.0, using specific tests such as Pearson, Spearman or ANOVA. Results. Patients with active disease, stated by both activity scores had an increased NSAID intake. Out of 86% of patients with a BASDAI under 4, only 82.6% had an ASDAS-CRP lower than 1.3. BASDAI correlated to both ASDAS scores (r = 0.65 and 0.71, P<0.001) and PtGA correlated to both disease activity scales, with a stronger correlation to BASDAI (r = 0.912, P<0.01) than ASDAS (r = 0.67 and 0.71, P<0.01 for both). Conclusion. We proved that disease activity scores have good discriminatory power, with a strong correlation between the subjective BASDAI and PtGA. However, ASDAS-CRP proves to be more rigorous than other variables when targeting high and low disease activity, thus indicating the need of an objective component in assessing these patients. [ABSTRACT FROM AUTHOR]

Systemic Lupus Erythematosus is the hallmark of autoimmune diseases, being characterized by multiple organ involvements and immune abnormalities, amongst which the presence of antiphospholipid antibodies with or without specific clinical manifestations (vascular thromboses and pregnancy morbidities) has a significant impact on the disease course, both short and long term, causing the accumulation of irreversible damage. This study evaluates the aforementioned impact, highlighting the importance of very early screening for these antibodies. [ABSTRACT FROM AUTHOR]

Introduction. The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results have often been observed. Material and method. We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096 . We looked at sex influence on disease characteristics at baseline and then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival. Results. 173 patients with SSc were available for the baseline analyses. In the longitudinal analysis after a mean follow-up of 3.5(±0.65) years, male sex was associated with a higher risk of scleroderma renal crisis (OR:9.45 (1.49 to 59.69); p = 0.004), digital contractures (OR:8.2 (3.1 to 21.9); p < 0.001), arrhythmias (OR: 3.37 (1.36 to 8.34); p = 0.006), pulmonary fibrosis (OR: 3.56, (1.51 to 8.41); p = 0.003), pulmonary hypertension (OR: 3.01 (1.19 to 7.59); p = 0.016), severe vascular involvement (OR:2.86, (1.22 to 6.73); p = 0.013) and low ventricular ejection fraction (OR: 2.84, (1.2 to 6.73); p = 0.014). Males had significantly reduced survival time after diagnosis (p = 0.004). The most frequent causes of death were scleroderma renal crisis in males and pulmonary hypertension in females. Conclusions. Although more common in women, SSc appears as strikingly more severe in men. Our results demonstrate a higher risk of severe organ involvement and poor prognosis in men. These results raise the point of including sex in the management and the decision-making process. [ABSTRACT FROM AUTHOR]

Objective. To evaluate sexual function in a cohort of men with rheumatic disease compared to healthy controls. Patients and methods. The study included 60 patients (ankylosing spondylitis, rheumatoid arthritis, systemic sclerosis, gout, psoriatic arthritis) and 60 healthy age-matched controls. Sexual function of patients and controls was evaluated by the Sexual Health Inventory for Men and a detailed questionnaire. Results. The mean age of study group was 45,26 (7.8) years. In 90% of the cases sexual life changed after diagnosis: only 1.67% described their sexual life as being very satisfying, while 21.67% as being satisfying, 68.33% as not satisfying and 8.33% as absent. 40% of the patients had diminished libido, significantly lower compared to the study group (p = 0.043). Most patients presented with mild erectile dysfunction (60%), while most of the systemic sclerosis patients presented with mild to moderate erectile dysfunction. Erectile dysfunction scores were significantly lower compared to controls (0.009). 55% of the patients reported no influence of the treatment on their sexual life, 38% of the patients reported that specific treatment improved their sexual life.There was no statistical difference between SHIM scores of patients using biological therapies and other drugs. Conclusions. This work suggests that men with rheumatic conditions have a worse sexual function in comparison with healthy control. However, specific disease parameters or treatments were not linked to sexual dysfunction [ABSTRACT FROM AUTHOR]

The usefulness of capillaroscopy in the follow-up of scleroderma patients and the possible prognostic role for the appearance of visceral involvement is suggested by many authors but still under debate.The aim of this study was to assess the role of monitoring capillaroscopic abnormalities (qualitative and semiquantitative) in relation with parameters of interstitial lung involvement and pulmonary arterial hypertension(PAH). A strong correlation was identified between initial capillaroscopy scores and FVC (r=-.47, p=0.002), DLCO (r=- .51, p< 0.001) and sPAP (r=0.34, p<0.001). Active and late capillaroscopic pattern were correlated with diagnosis of lung fibrosis (χ2=14, p=0.007) and PAH at follow-up examinations (χ2=14,2, p=0.007). Progression of capillaroscopic pattern at follow-up evaluations was not correlated with significant worsening of lung volumes, DLCO, sPAP. Instead, progression of microangiopathy evolution score (>1) was asociated with worsening of FVC (r=0.32,p<0.001), DLCO(r=0.21,p=0.02) and new diagnosis of lung fibrosis on HRCT (r=0,19,p=0.035). Semiquantitative scoring, rather then qualitative capillaroscopic assessment can have a predictive role for new involvement or worsening of previous lung involvement (especially interstitial lung disease) in scleroderma patients, confirming the putative role of capillaroscopy as biomarker in SSc. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which deposit within tissues and fix complement leading to systemic inflammation (1). Is a heterogeneous disease with a continuum of disease activity. Some patients can have predominant skin and joint involvement, whereas others can present with organ-threatening diseases such as nephritis, cardiac involvement or even neurologic manifestations. Relatives of patients with SLE appear to be at higher risk of SLE and other autoimmune diseases, but estimates of individual familial risks are largely unavailable or unreliable (2,3). [ABSTRACT FROM AUTHOR]

Autoimmune rheumatic disorders have a multifactorial determinism, caused by various environmental factors acting on the individual's genetic susceptibility, destabilizing the systems which regulate the immune response. Epidemiological and genetic investigations are very important to demonstrate the contribution of genetic factors to the development of these autoimmune diseases. The contribution of genetic factors in causing autoimmune diseases has been demonstrated by familial aggregation. Moreover, it was also quantified by determining heritability, expressing the proportion of genetic factors in the etiology. It is now clear that common genes underlie multiple autoimmune disorders. [ABSTRACT FROM AUTHOR]

Background. The presence of the radiographic progression in rheumatoid arthritis even in patients in clinical remission, with a high impact upon prognosis, disability and socio-economical costs led to the utilization of other imagistic measurements, that added to the clinical and biologic examinations, could be able to increase the accuracy of the patient's evaluation. Objective. The main objective of the study was identifying a correlation between ultrasonography and magnetic resonance imaging, comparing their ability to detect inflamation, erosions and structural progression at three months. A secondary objectiv was identifying imagistic predictive factors for erosions' progression. Method. This study is an analysis of 26 rheumatoid arthritis patients from „Sf. Maria" Hospital. The study is based upon the information taken from the patient's charts and upon clinical examination and imagistic assessment, at baseline and at 3 months. Statistical analysis was done by using IBM SPPS 20.0 for Windows. Results. Among the patients in this study, there was a moderate intraclass correlation in identifying erosions between ultrasonography and magnetic resonance imaging, at baseline and also at 3 months, for all the joints that were assessed, with one exception (MCP 3 at baseline). Statistically significant correlations were obtained for bone oedema identified by IRM at baseline and the presence of erosions at 3 months for all the joints that were evaluated, with one exception, MCP 3 (statistically not significant r, p). Conclusions. Recent literature data identifies bone oedema assessed by IRM as the most powerful independent prognosis factor for erosion progression at one year, a fact that was confirmed by our study at 3 months. Our study analysis also showed conformity of ultrasonography with magnetic resonance imaging in identifying erosions for the evaluated joints (exception MCP3) for both assessments. Ultrasonographic assessment of sinovitis (GS score) and the presence of PD signal is not predictive for appearance/ progression of erosions. [ABSTRACT FROM AUTHOR]

As ''Treat to target" recomandations, the main goal in treating rheumatoid arthritis is achieving remission, and implicit stopping the progression of structural damage and the evolution of the disease. For assessement of remission state we use a clinical evaluation(number of swelling joints, number of tender joints), biological test and also some composite score DAS 28, SDAI, CDAI. However it was observed that not always clinical joint examination identify joint swelling as an expression of synovitis the result of the studys from last years showing clear facts that the synovitis can be present also at the patients classified- based on parameters described as in remission. From here, the need of improving the accuracy of remission measurement with some investigations who can direct visualize and quantify synovial hypertrophy, the presence of Power Doppler, like ultrasonography. [ABSTRACT FROM AUTHOR]