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Background. DLS is defined as the slippage of one vertebra over the one below, in association with intervertebral disc degeneration and arthritis of the facet joints of the involved vertebrae, which will cause canal stenosis. Purpose. The primary objective of this study is to compare the outcome after surgical intervention (with neural decompression, fusion and fixation) in proved patients with lumbar degenerative spondylolisthesis (DLS). Patients and methods. Fifty patients with symptomatic DLS, in the period between October 2021 and March 2023, graded using Myerding scale, operated on by instrumented posterolateral fusion and decompression. Mean patients’ age at surgery was 50 years (range, 49–69). Surgical results were evaluated using ODI. Lumbar spine radiographs were used to evaluate the status of fixation constructs, the sagittal balance and the status of fusion. Results. Intraoperative and postoperative complications were encountered, but all were relatively not significant. Follow up time was 18 months. Clinical outcome was good or very good in 30 patients and satisfactory in 13 patients. This research showed that surgical intervention in patients with DLS is a valid option for addressing the clinical symptoms, surgical outcome, planned pain relief and return to daily activity. Conclusion. DLS is a common pathology, many treatment options are available including conservative and surgical, surgery is a valid option for candidates with DLS as it aims to decompress the neural tissue and correct sagittal balance.

Introduction. Total hip replacement (THR) has revolutionized the management of various hip pathologies, including acetabular fractures, which pose significant challenges due to their complex nature and debilitating effects. Acetabular fractures, resulting from high-energy trauma, present with severe pain and functional limitations, constituting a small percentage of all fractures worldwide. While THR offers promising outcomes, variability exists in functional improvement rates and postoperative complications. Aim. This prospective observational study aims to estimate the functional outcomes and complications associated with THR in patients following acetabular fractures, with a focus on guiding clinical practice and optimizing patient care. Methodology. The study included 30 patients undergoing THR after acetabular fractures or post-primary acetabular fixation. Surgical techniques involved the Kocher-Langenbeck approach and meticulous fracture management strategies. Clinical evaluation utilized the Harris Hip Score, while radiographic assessments monitored component positioning, stability, and osteolysis. Postoperative care included pain management and rehabilitation protocols. Results. The majority of patients presented with segmental defects, with intraoperative bone grafting required in 87% of cases. Significant improvements in Harris Hip scores were observed postoperatively, indicating favorable functional outcomes. A majority of patients experienced good to excellent recovery, although postoperative complications such as pain, limping, and heterotrophic ossification were noted in some cases. Radiographic evaluations revealed satisfactory component positioning and long-term survival rates. Conclusion. These findings support the role of THR in restoring functionality and improving the quality of life for affected individuals. Continued advancements and research efforts are crucial to further optimize outcomes in this challenging patient population.

Background and objectives. Cervical spondylosis is an age-related condition that influences the various components of the spine. Attributed to its exceptional tissue contrast, magnetic resonance imaging (MRI) is the preferred diagnostic modality for assessing cervical spondylosis. Dynamic MRI examination adds diagnostic information obtained from imaging the patient in flexion and extension. Our study had the purpose of evaluating the flexion-extension MRI’s diagnostic utility. Materials and methods. 40 patients with cervical spondylosis joined our prospective cross-sectional study. The patients were examined by flexion and extension sagittal T2 weighted images (Dynamic MRI) in addition to static MRI cervical spine protocol. The study was carried out in our department and lasted for two years. Results. Total central spinal stenosis (TCSS) was considerably higher in extension in comparison to neutral MRI (Mean ± SD =6.1± 1.45 compared to 4.7 ± 1.29) (p

Systemic lupus erythematous (SLE), a chronic autoimmune disease with a wide range of manifestations such as, skin rashes, arthritis, fatigue, neurologic symptoms, stroke, glomerulonephritis, cardiovascular symptoms, and involvement of the lungs. Diffuse alveolar hemorrhage (DAH) is not common among SLE patients, but the mortality rate of DAH associated with SLE is reported to be significant. We report a 35 years old woman that diagnosed systemic lupus erythematous presenting with diffuse alveolar hemorrhage.

Background. Globally, the LBP prevalence among the general population varies from 15-45%. Work-related LBP is estimated to cause 818,000 disability-adjusted life years lost (DALYs) annually. Aim of study. To determine the prevalence and factors associated with LBP among Iraqi Healthcare workers. Methodology. This is a cross-sectional study that included 220 participants and was conducted at Baghdad during the period from 5/7/2023 to 25/11/2023. Lower back pain was assessed using an Arabic version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ). Results. The life, annual, and weekly prevalence of LBP were 92.7%, 90.9%, and 58.2%, respectively. A statistically significant associated was detected between weekly prevalence of LBP and each of female gender, long working hours, BMI, and occupation. Conclusion. LBP is a highly prevalent condition among Iraqi HCWs and it caused considerable reduction to the quality of life and work performance. Risk factors for weekly prevalence were female gender, longer working hours, obesity, and working as a dentist.

Background and objectives. Forward head posture is associated with weakness in deep cervical short flexor & shortening of the opposing cervical extensor & Pectoralis muscles. Deep cervical flexor (DCF) has a major postural function in supporting and straightening the cervical lordosis. There were few studies on the correlation between craniovertebral angle & vertical mandibular opening. So there was a need to evaluate the effect of deep cervical muscle strengthening on forward head posture and vertical mandibular opening and find out the correlation between vertical mandibular opening (VMO) and craniovertebral angle(CVA). Materials and methods. A total of 84 subjects were included in an experimental study. Subjects were screened according to the inclusion and exclusion criteria. Selected CVA were assessed using MB ruler software (ICC= 0.88). Selected VMO was measured using a ruler (ICC= 0.95-0.96). Subjects received DCF strengthening using pressure biofeedback, 2 sets of 10 repetitions, 5 days per week for 4 weeks. “Paired t test” was used within the group to test the change in quantitative data, pre-intervention and post-intervention. For the correlation between VMO & CVA, Pearson’s correlation coefficient test was used. Results. Strengthening of DCF using pressure biofeedback was effective in improving CVA & VMO (p value

Objectives. To assess autoimmune thyroiditis prevalence in subclinical and clinical psoriatic arthritis (PsA). Materials and methods. 45 female adult Egyptian patients with psoriatic disease were classified into 3 equal groups: PsA, subclinical PsA, and psoriasis. A full assessment was done including Health Assessment Questionnaire, Psoriasis Area Severity Index (PASI), Leeds Enthesitis Index (LEI), PsA disease activity score (DAPSA), MAdrid Sonographic Enthesitis Index (MASEI), thyroid hormones (TSH, FT4, and FT3), thyroglobulin and thyroid peroxidase antibodies (Tg and TPO Abs), and thyroid ultrasound. Results. Thyroid abnormalities prevalence was: 33.3% with subclinical hypothyroidism, 80% with positive TPO Ab, and 46.7% with positive Tg Ab in PsA group, 26.7% with subclinical hypothyroidism, 60% with positive TPO Ab, and 33.3% with positive Tg Ab in subclinical PsA group and none in psoriasis group. PsA patients had higher TPO Ab levels compared to psoriasis patients with high statistical significant difference and lower FT3 levels compared to psoriasis patients with statistical significant difference. In subclinical PsA group, MASEI was positively correlated with TPO Ab with high statistical significance and with FT3 and Tg Ab with statistical significance, FT4 was negatively correlated with LEI with high statistical significance, and FT4 was correlated with PASI with statistical significance. In PsA group, TPO Ab was correlated with DAPSA with statistical significance. Conclusions. Autoimmune thyroiditis is more common in PsA than subclinical PsA patients. PsA patients are advised to be tested for TPO and Tg Abs. Musculoskeletal ultrasound is a screening tool to detect enthesitis in psoriasis patients.

Neuropsychiatric systemic lupus erythematosus (NPSLE) affects the brain, spinal cord, or other nerves and leads to neurological and psychiatric symptoms directly related to SLE. We report a series of four female patients with NPSLE as the first presentation for SLE. None of them were previously diagnosed with SLE. The first case involved a 50-yearold patient who presented with back pain and lower limb weakness for three weeks associated with numbness. A lumbar puncture was done, and CSF analysis showed high WBC and normal glucose levels with negative CSF cultures for bacteria. The patient was diagnosed with aseptic meningitis and treated with antibiotics and antiviral medication without improvement. So she was treated as a case of SLE aseptic meningitis with steroids. In the second case, a 20-yearold patient had a generalized tonic-clonic seizure with the acute manifestation of hypertensive urgency. Magnetic resonance imaging (MRI) was done and suggested posterior reversible encephalopathy syndrome (PRES). The third case was for a 38-year-old patient who complained of dizziness, general weakness, and convulsion. On review of the systems, the patients had positive symptoms of SLE. Anti-nuclear antibody (ANA) and double-stranded ds-DNA were positive. Computed tomography (CT) scans were done and showed a thymoma. The patient was diagnosed with SLE in association with focal seizures and thymoma. In the last case, a 44-year-old patient presented with tongue heaviness and right-side weakness. MRI revealed small acute lacunar infarction scattered at both cerebral hemispheres and the right side of the cerebellum, and chest CT showed pulmonary embolism (PE). The patient was diagnosed with an acute ischemic stroke and PE related to SLE. In conclusion, the neurological manifestations of SLE are a significant issue for both patients and clinicians. Here we report a unique case series and describe the prognosis and outcome of the treatment in these cases.

Autoimmune inner ear disease (AIED) is a rare rheumatological cause of sensorineural hearing loss, accounting for less than 1% of worldwide hearing loss. It presents with rapidly progressive, unilateral or bilateral SNHL, often fluctuating. The progression is over weeks to months, along with vestibular symptoms. Diagnosing the condition is challenging because no adopted standardized tests are available. Hence, AIED is a challenging diagnosis based on exclusion. Clinical characteristics and how the patients respond to immunosuppressive agents are used for the diagnoses of AIED. Only a few cases have been reported in India till now. Here, we present a rare case of Autoimmune Ear Disease without any underlying systemic autoimmune disease.

Background. Musculoskeletal diseases like osteoarthritis (OA) are widespread. OA affects the knees, makes the joints wear out and hurt, and makes it hard to move around. Body mass index (BMI) is a way to measure obesity, which is linked to a higher chance of getting OA and making it worse. The main aim of this cross-sectional study was to find out how body mass index (BMI) is related to how lousy knee osteoarthritis is. Methods. One hundred people at the Shri Guru Ram Rai Institute of Medical and Health Sciences in Dehradun met the study’s requirements and were enrolled. The Kellgren-Lawrence grading method was used to find the severity of knee osteoarthritis (OA), and standard measurements were used to calculate body mass index (BMI). A correlation study was done to examine the link between BMI and the severity of OA. Results. The sample included 100 participants on average of 60 years old. The typical knee OA symptoms lasted five years. A body mass index distribution analysis showed 35% obese, 40% overweight, and 25% underweight or average weight. Twenty percent of knee OA patients were mild, 35 percent intermediate, 30 percent severe, and 15 percent progressed. The association investigation revealed a significant positive correlation between BMI and knee osteoarthritis severity (r = 0.65, p < 0.001). Conclusion. Our results show that being overweight can worsen knee OA, proving that people with this problem need to watch their weight. If we treat obesity as a risk factor that can be changed, we might be able to improve the results of OA.

Pyoderma gangrenosum (PG) is a noninfectious, inflammatory, ulcerative neutrophilic dermatosis that mainly involves the extensor surfaces of the legs. PG characteristically presents as a painful wound with suppurative as well as attenuated borders. PG-like wounds have been rarely reported in patients with APS and systemic lupus erythematous (SLE) patients. Rituximab can be effective in the treatment of PG. We report the case of a woman with SLE and APS who developed extensive and progressive lesions consistent with PG that showed rituximab can be a potential treatment for it.

This is a case of multiple autoimmune syndrome with the co-occurrence of vitiligo, pernicious anemia, celiac disease and autoimmune hepatitis is extremely rare. We are presenting a case is a 40-year-old woman with autoimmune hepatitis who is suffering from poor appetite, weight loss and skin lesions. Laboratory investigation shows hypochromic microcytic anemia, B12, and iron deficiency. The testing for parietal cell antibody was positive so pernicious anemia was diagnosed with positive Tissue transglutaminase antibody IgA so the diagnosis of celiac disease was confirmed.

Background and aim. This study aims at emphasizing specific aspects of prosthetic treatment for rheumatoid arthritis patients that are completely edentulous. Material and method. In December 2023, a search was conducted through three medical databases: PubMed, Scopus, and Web of Science. Results. Concerning their unique signs and symptoms, the management of edentulous patients with rheumatoid arthritis with removable dentures has several unique features throughout the clinical stages. Some patients have difficulty keeping dental appointments from the initial phase of treatment due to mobility issues, particularly in severe forms where several joints are impacted, resulting in stiffness that can restrict the ability to move. In such situations, the dental professional must insist on a thorough examination of the oral tissues that are going to sustain the prosthetic device or come into its proximity. In cases in which temporomandibular joint damage limits mouth opening, it can also be challenging to examine the denture’s supporting tissues and take impressions because rheumatoid arthritis patients have been shown to have modifications in the joint’s elements and function. Conclusion. To improve the outcomes and overall well-being of rheumatoid arthritis patients who are completely edentulous, it is essential to thoroughly consider the options for treatment when utilizing prosthetic devices and additional therapies.

Objective. Novel inflammatory indices are a potential substitute for traditional markers which their correlation and clinical application in different autoimmune diseases are still in question. In this study, we evaluated the association of platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) with systemic lupus erythematosus (SLE) activity. Methods. We included 103 SLE patients in our study, compared to a matched pair of 103 healthy individuals. A blood sample was drawn to measure SII, PLR, NLR, C-reactive protein, erythrocyte sedimentation rate, autoantibodies, and complement levels. Independent sample t-test, chi-square, and Mann-Whitney U test were implemented for variables as appropriate. Linear regression was used to evaluate the factors that predict SLE activity. Results. Our study revealed that NLR, PLR, and SII between SLE patients and the control group were significantly different. SII and NLR were correlated with renal manifestations of SLE. PLR was correlated with SLEDAI, and an independent factor of SLE activity after adjusting for multiple factors, but not NLR and SII. Conclusion. We demonstrated that only PLR was an independent predictor of SLE activity. This may suggest that NLR and SII are more nonspecific inflammatory markers, compared to PLR being prognostic of SLE activity.

Background. The evolution of the therapeutic arsenal in inflammatory rheumatic diseases has dramatically improved their evolution and prognosis. On the other hand, the information of the safety data, especially for conditions that may appear in a longer time of exposure, are not reflected by clinical trials, due to their limited time design. Patient registries are a valuable source of safety data applicable to real-world (unselected) patients. The evaluation of these data completes the evidence from the various development programs, with the aim of more concrete knowledge of each therapeutic class (therapeutic agent). Aim. The present report descriptively presents the adverse events (AE) of special interest, recorded by the Romanian Registry of Rheumatic Diseases (RRBR), during 2022, in relation to the dynamics of the recent years. Methods. The observational study included all AEs reported in the RRBR in 2022, their severity class, the relationship with exposure to the therapeutic agent. Results. For a cohort of 10676 patients who were exposed to at least one course of treatment, with data in the RRBR during 2022, there were 669 AEs reported: 432 reports for patients with rheumatoid arthritis (RA), 195 records for patients with ankylosing spondylitis (AS) and 42 reports for patients with psoriatic arthritis (PsA). The most common AEs were infections, especially in RA patients. Of all AEs, 94 (14%) were serious AEs, the majority reported in the RA group (16%). A number of 15 MACE, 13 solid malignancy and 19 deaths were reported in the last year. Conclusion. The distribution of EA by disease, the dominance in RA, as well as the distribution by therapeutic groups is in accordance with scientific data, with the exception of breast cancer, which is more frequently reported in RRBR. EA are underreported in the destinated section in the RRBR, an aspect that gives a limit of this report. This represents an unmet need in terms of safety data reporting, that calls for increased knowledge of EA reporting requirements.

Objective. The objective of this cross-sectional study was to analyze data available in the Romanian Registry of Rheumatic Diseases (RRBR) in 2022 for axial spondyloarthritis (axSpA) patients treated with biologic disease modifying anti-rheumatic drugs (bDMARDs). Methods. From the RRBR electronic database were collected multiple variables, including patient’s demographic and clinical characteristics, treatment characteristics, patterns of treatment use (initiations, continuations, switching, tapering), and treatment efficacy data of axSpA patients, from 1 January 2022 to 31 December 2022. Results. In 2022, a total of 4315 axSpA patients were registered in the RRBR database: 70% were men, 48.4 years mean age, 13.3 years mean disease duration, 90% with radiographic axSpA, with high prevalence of extra-musculoskeletal manifestations and cardiovascular comorbidities. Most patients (88%) were treated with a tumor necrosis factor inhibitor (TNFi), usually in monotherapy. The most frequently prescribed bDMARDs were adalimumab (36%), etanercept (32%) and secukinumab (12%). The uptake of biosimilars reached one third of patients from molecules with available biosimilars in 2022. Most patients had a good clinical response, irrespective of clinical form, disease duration, type of medication or line of treatment. Medication switching was needed in 10% of patients, the main reason for switching was secondary loss of efficacy. Medication tapering was implemented in 11% of patients, and it was successful in 90% of cases. Conclusion. Data from RRBR provide a valuable real-world view of clinical practice at the national level regarding biologic treatment of axSpA patients.

Vasculitis occurs frequently in systemic lupus erythematosus (SLE) patients with an active disease and poor prognosis. Nervous system vasculitis – specifically, multiple mononeuropathy, seizures, and transverse myelitis – is among the most severe complications in SLE that need timely aggressive therapy. Unfortunately, no robust literature is available to guide their management, and therapeutic recommendations are commonly based upon other autoimmune conditions or case reports, case series, and expert opinions. We hereby present a case of a 27-year-old female patient with SLE that sequentially developed an asymmetric distal axonal sensorimotor neuropathy in her limbs and digital ischemic lesions of the hands, that progressed despite maximal treatment with standard therapies, thus requiring several sessions of plasmapheresis.

Rheumatoid arthritis (RA) is a systemic inflammatory disorder mainly involving joints but almost 50% of the patients develop extra-articular manifestation, one of the most common being lung involvement. While essentially any of the lung compartments can be involved, interstitial lung disease (ILD) is associated with significant morbidity and mortality. In this review, we discuss main current concepts in the screening, diagnostic and monitoring strategies of RA-ILD as well as therapeutic recommendations.

Background. Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE) and often occurs within the first five years after diagnosis. Case report. A 33-year-old woman with SLE (arthritis; cutaneous involvement; Raynaud phenomena, vasculitis, pleural effusion, hematological and immunological abnormalities), under treatment with glucocorticoids and hydroxychloroquine developed focal proliferative LN, which progressed under treatment with belimumab. Consequently, intravenous cyclophosphamide and low-dose rituximab were used to induce LN remission, while maintenance therapy relied on mycophenolate mofetil. Conclusions. The case illustrates an uncommon succession of therapies for SLE and LN, with belimumab preceding cyclophosphamide. The decision to induce remission with cyclophosphamide was based on histological aspects of the renal biopsy. Although current recommendations permit the association of belimumab and cyclophosphamide, there is very little practical experience to support it.

Objectives. To assess the lipid profile, neutrophil-lymphocyte ratio(NLR) and platelet-lymphocyte ratio(PLR) in different rheumatic diseases and to study their relation to disease activity and/or severity. Patients and methods. 257 patients (47 rheumatoid arthritis (RA), 100 systemic lupus erythematosus (SLE), 49 systemic sclerosis (SSc), 33 axial spondyloarthritis (axSpA) and 28 vasculitis (21with primary vasculitis and 7 with Behçet’s disease ‘BD’) and 70 controls were recruited. The disease activity and/or severity were assessed for each disease. The lipid profile was measured including: total cholesterol (TC), high-density lipoprotein (HDL),triglycerides (TG), low-density lipoprotein (LDL), very-low density lipoprotein (VLDL) and the LDL:HDL was calculated. The NLR and PLR were recorded. Results. In RA, NLR, PLR and HDL were significantly higher (p

Gitelman syndrome (GS) is an autosomal recessive familial disorder characterized by hypokalemia and metabolic alkalosis. Rhabdomyolysis due to hypokalemia is extremely rare. The presentation of GS leading to rhabdomyolysis is extremely rare as well. This case report describes a situation in which GS mimicked inflammatory myositis. A 30-year-old woman presented to the rheumatology outpatient clinic with an inability to walk and severe muscle weakness. Her creatine kinase level was elevated at 9900 U/L and her potassium level was low at 2.6 mmol/L. A myositis panel was ordered on suspicion of inflammatory myositis, and the results showed a positive anti-Jo-1. A muscle biopsy, performed with a presumptive diagnosis of inflammatory myositis, yielded pathology results inconsistent with myositis. Despite persistent low potassium levels during follow-up, potassium replacement was administered. The patient’s clinical condition improved significantly with potassium replacement, leading to a reduction in muscle weakness.

The most frequent neurological manifestation in SLE (Systemic Lupus Erythematosus) is cognitive disorder, so lumbar disc herniation in SLE is uncommon. Disc herniation is a degenerative disc disorder (DDD) that is often correlated with aging. However it can caused by an inflammatory reaction. TNF-α (Tumor Necrosis Factor-alpha) is an essential pro-inflammatory cytokine in DDD-related SLE. We present the case of a 26‐year‐old female with SLE and disc herniation L5-S1.

Background. The diffusing capacity of the lungs for carbon monoxide (DLCO) represents the most sensitive independent factor for highlighting the interstitial lung disease associated with rheumatoid arthritis (RA-ILD). Many studies have analyzed this association between RA and lung modifications because it correlates with a decrease in the patients’ quality of life and a higher mortality. Objective. This study aimed to highlight the importance of DLCO as a predictor of ILD progression in RA, beside the pattern on high-resolution chest CT (HRCT) and the double seropositivity of the disease. Patients and method. This prospective cohort study, carried out between august 2022 and may 2023, included 48 RA patients with ILD, fulfilling the 1987 ACR or 2010 ACR/EULAR classification criteria. Important attention was paid to respiratory functional tests, immunological changes, and specific lung pattern on HRCT. Patients with current malignancies, active infections or Overlap syndrome were excluded from the study. Results. 48 RA patients, mostly women (81%) with a mean age of 65.54±10.58 years old and a median age of RA onset of 52.58±11.36 years, were included. The proportion of patients with a decreased DLCO was 64.6%. Using statistical tests, we found significant correlations between DLCO and age, double seropositivity and a specific pulmonary pattern on HRCT. Conclusion. ILD, an underrecognized disease, may be considered one of the most serious of all extra-articular manifestations in RA, the risk for mortality being triple in these cases. Our results are in correlation with the published data and support the key role of DLCO in the diagnosis and follow-up of these patients.

Background. Pain is a prominent manifestation in chronic immune-inflammatory rheumatic disorders, encompassing both nociceptive and non-nociceptive elements, the latter potentially resulting from central sensitization. The connection between inadequate sleep quality and the onset of central sensitization in individuals with chronic rheumatic diseases has been documented. Objectives. This study aimed to analyze the characteristics of pain, sleep quality, and their correlation with pain intensity and disease activity in adults with rheumatoid arthritis and ankylosing spondylitis. Methods. A prospective observational study was conducted, involving patients with RA, AS, and osteoarthritis. We evaluated pain intensity, pain characteristics, and sleep quality. Results. The study group included 152 patients. RA was primarily characterized by nociceptive pain, but AS exhibited a higher prevalence of neuropathic pain. Significant associations were found between PD-Q scores and disease activity in patients with RA, but no such correlations were identified in patients with AS. Individuals with AS showed a significant inverse correlation between PD-Q scores and pain intensity. The PSQI scores did not show any notable variations among the three groupings. The quality of sleep was found to be connected with disease activity in RA but not in AS. A substantial and noteworthy correlation was found between the overall PSQI score and the scores obtained from the PD-Q in both subgroups of RA and AS. Conclusion. Notable connections can be found between disease activity, pain characteristics, and sleep quality in chronic immune-inflammatory rheumatic diseases.

Background. Gene polymorphisms affect etanercept’s pharmacokinetics, pharmacodynamics, and side effects. This effect is evidenced by the extensive genetic variation in the drug’s targets. Objectives. This study aims to find the association between different genotypes of the promoter region of the TNF-α gene at -308G/A(rs1800629), -857C/T(rs1799724), -863 C/A(rs1800630), -1031 T/C (rs1799964), -806 C/T (rs4248158) and -376 G/A (rs1800750) and the side effects of ETN that occurred to Iraqi RA patients. Method. The trial included patients with rheumatoid arthritis who had been using ETN for at least six months. The participants were from the Baghdad Teaching Hospital Rheumatology Unit. The PCR was sequenced to determine the polymorphism in the TNF- promoter region at sites -308 G/A (rs1800629), -857 C/T (rs1799724), -863 C/A (rs1800630), -1031 T/C (rs1799964), and -376 G/A (rs4248158) (rs1800750). The link between the genetic variation at these loci and the etanercept’s most frequent adverse effect was then investigated. Results. The only genotype of (-376 G/A) significantly related to an increased risk of upper respiratory tract infection is the GG genotype, according to the results of this study. However, genotypes for the remaining SNPs did not demonstrate a statistically significant association between ETN and an increased risk of upper respiratory tract infections, injection site response, or skin rash in patients. Conclusion. This study revealed that only the GG genotype of (-376 G/A) was significantly associated with an elevated risk of upper respiratory tract infection.

Background. Pulmonary arterial hypertension (PAH) is a very severe consequence that may arise in individuals diagnosed with Systemic Scleroderma (SSc). Transthoracic echocardiography (TTE) is an important screening method for PAH. A new useful echocardiographic marker has been noted: the ratio between the tricuspid annular plane systolic excursion and the systolic pulmonary arterial pressure (TAPSE/sPAP). This ratio correlates with invasive measurements. Objectives. In the present study, we aim to evaluate the new echocardiographic marker and correlate it with other echocardiographic markers specific to assessing PAH, with age, with form of disease, and with high risk of PAH according to the DETECT algorithm. Material and methods. An observational study that included 27 patients diagnosed with SSc according to the ACR/EULAR 2013 criteria was conducted between November 2022 and June 2023. The patients were clinically and paraclinically evaluated in the first Rheumatology Clinic, Iasi. TTE evaluation was performed in the third Internal Medicine Clinic, Iasi. The threshold value of TAPSE/CPAP was 30 mmHg, and 8 of them had a value >2.8 m/s in tricuspid regurgitation velocity assessment. According to DETECT algorithm, seven patients were identified as having a high risk of PAH. They all had a TAPSE/sPAP ratio

Objective. The study aimed at determining whether RA patients starting or stopping biosimilars differ in any regard from those starting or stopping originals. Methods. Data on RA patients was obtained from the Romanian Registry of Rheumatic Diseases (RRBR) database between January 1st, 2022, and December 31st, 2022, encompassing all Romanian RA patients fulfilling the national criteria for bo/bsDMARD initiation, continuation or switching. Results. Etanercept and adalimumab predominated for initiations of biosimilars. Most entries on biosimilars originated from originals (including non-medical switches) and from bDMARDs without biosimilars. A historical effect of accumulation of patients was observed, manifested in the fact that originals still dominated the group of patients continuing their treatment, with the exception of infliximab, while biosimilars tended to be continued in younger patients and in patients with shorter disease duration. Cases categorized more severe by both patients, their doctors and their disease activity were preferably reserved for originals. In patients continuing their previous bDMARD, biosimilars exhibited higher DAS28 and SDAI remission rates. Conclusion. RRBR data from 2022 confirm the market rise of biosimilars in RA, but also physicians’ prudence in prescribing them to highly active cases. In the Romanian RA cohort, biosimilars are overall more effective in holding remission than originals.

Objective. The study aimed at characterizing the evolution of RA treatment with b/tsDMARDs in Romania, since the end of the SARS-CoV-2 pandemic and the national approval of JAKi. Methods. Data on RA patients was obtained from the Romanian Registry of Rheumatic Diseases database between January 1st, 2022, and December 31st, 2022, encompassing all Romanian RA patients fulfilling the national criteria for b/ tsDMARD initiation. Results. The RRBR database contained 5396 active RA patients: 83.2% female, 59.9 years mean age, 13 years median disease duration, 86.7% RF positive, 81.7% ACPA positive, with a high prevalence of cardiovascular comorbidities, 89.8% receiving at least one csDMARD, most often methotrexate (48.7%), with 6.3% on glucocorticoids, 78.8% on bDMARDs (especially etanercept - 27.6%, adalimumab - 18.1% and tocilizumab - 14.0%) and 21.2% on JAKi (most often on baricitinib - 11.4%), with a 58.2% DAS28-defined remission rate and a 34.3% SDAI-defined remission rate. Conclusion. The Romanian cohort of RA patients on b/tsDMARDs observed the both classical phenotypic characteristics of RA and local cohort characteristics. JAKi prescription has gained a significant increase. Capturing data on real-world patients filtered by stringent criteria for high disease activity and poor prognosis factors, the RRBR database proves to be an extremely useful insight into the evolution of RA pharmacologic treatment.

Background. Relapsing polychondritis (RP) is characterized by recurrent episodes of progressive inflammation that lead to the destruction of cartilaginous structures. The etiopathogenesis is not fully elucidated, but it seems to be an immunemediated mechanism directed against type 2 collagen. Case reports. We present a series of 3 clinical cases, which associate RP and spondylarthritis – a woman with psoriatic arthritis (PsA) and two men with ankylosing spondylitis (AS). All cases presented with auricular chondritis, which is the emblem of RP. In the PsA case, RP presented typically, with recurrent auricular chondritis, manifested clinically with a cauliflower-like appearance of the ears. In one of the AS cases, a paradoxical immune reaction related to biological therapy was considered in the differential diagnosis of RP. In the other AS case, the patient had a single episode of chondritis, the recurrence of the disease remains to be proved. Conclusions. The diagnosis of RP is usually based on clinical evidence and the elimination of differential diagnoses, since there is no specific laboratory or imaging test. In 20-30% of cases, RP is associated with other conditions, most frequently with vasculitis, but the association of RP with spondylarthritis is rare.

Hyperferritinemic syndrome represents a common nosological classification for systemic inflammatory syndromes, including Catastrophic antiphospholipid syndrome, in which hyperferritinemia (> 500 ng/mL) is present. Recent studies suggest that in this syndrome, ferritin is more than a passive marker of inflammation, playing an active role in the process. We present the case of a 74-year-old female patient with elevated serum ferritin levels (above 1000 ng/mL), along with an intense inflammatory syndrome, non-immune thrombotic microangiopathy, and multisystem involvement (pulmonary, cardiac, hepatic, pancreatic, neurological and renal changes), outlining the picture of a hyperferritinemic syndrome that is hard to classify otherwise. This underlines the necessity for diagnostic and classification criteria for this pathology.

Polymyositis is a rare disease that belongs to the idiopathic inflammatory myopathies (IIMs) group, characterized by chronic muscle inflammation, and in rare cases a life-threatening condition due to extra-muscular involvement. Even though steroids constitute the building block of treatment of this disease, in severe cases, escalation treatment should be considered in order to obtain good clinical outcomes. We report a clinical case of a 22-year-old female who developed progressive severe systemic muscular weakness, dysphagia and dysphonia, accompanied by elevated serum muscle enzymes, positive myositis-specific antibodies, and muscle biopsy suggestive of inflammatory myopathy. The clinical features and laboratory results led us to the diagnosis of polymyositis. On additional laboratory tests the patient tested positive for Borrelia burgdorferi (Borrelia b) specific antibodies. Due to life-threatening organ involvement the immunosuppressive treatment, immunoglobulin intravenous infusion and pulse therapy with methylprednisolone were initiated and she needed nasogastric tube in order to be fed. Furthermore antibiotic treatment was administrated. The patient improved almost completely after 3 months of treatment.

Although both systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are autoimmune diseases, their simultaneous presence in the same patient is rare. Case report. We present the case of a 26-year-old woman who was diagnosed with MS and underwent treatment with interferon beta 1-alfa. After 2 years, she developed cutaneous lesions subsequent to a systemic disorder. After multiple serological tests were conducted, the diagnosis of SLE was established and hydroxychloroquine was added to the patient’s treatment. Conclusion. The presented case report is one of only a few cases published on the association of the two autoimmune diseases.

Background and objectives. Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPL) in the blood. Antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2 glycoprotein I antibodies. These antibodies target phospholipids-binding proteins and can leading to various clinical manifestations and complications of thromboembolic nature. Also, the antiphospholipid syndrome is strongly linked to adverse pregnancy outcomes, including recurrent miscarriages, fetal growth restriction, preeclampsia, and preterm birth. Placental dysfunction, impaired blood flow to the fetus, and thrombotic events within the placenta contribute to these complications. The purpose of this review was the research of consequences of antiphospholipid syndrome in pregnancy. Materials and methods. This research involves systematically reviewing and analyzing existing literature on consequences of antiphospholipid syndrome in pregnancy. For relevant literature, academic databases like Pub Med, Scopus, Web of Science, and Google Scholar were used. Search terms and keywords that were used to search for relevant literature in databases was: antiphospholipid syndrome; pregnancy; consequences, and Boolean operator (AND, OR). The criteria used to include literature in this review were; publication date, language, study objectives, study design, research methodology, key findings, and relevance to my research question. For citation and referencing were used the appropriate citation style (e.g., APA, MLA, Chicago, Harvard and Vancouver). Results. The main findings in this review were that antiphospholipid syndrome (APS) of characterizing by dysregulation of the immune system and the production of autoantibodies. These autoantibodies can target various cells and proteins, leading to inflammation, tissue damage, and disrupted physiological processes. This syndrome is associated with a prothrombotic state, increasing the risk of blood clots in veins and arteries. Antiphospholipid syndrome (APS) can affect multiple organs and systems, including the skin, kidneys, heart, and central nervous system. Thrombotic events can occur in various organs, leading to deep vein thrombosis, pulmonary embolism, strokes, and other thromboembolic complications. Also, the antiphospholipid syndrome is strongly linked to adverse pregnancy outcomes, including recurrent miscarriages, fetal growth restriction, preeclampsia, and preterm birth. Placental dysfunction, impaired blood flow to the fetus, and thrombotic events within the placenta contribute to these complications. Manifestations may include skin rashes (livedo reticularis), kidney involvement (glomerulonephritis), heart valve abnormalities, and neurological symptoms etc. Conclusions. We come to the conclusion that it is essential for the pregnant women with antiphospholipid syndrome to receive close monitoring and appropriate management to reduce the risk and severity of these pregnancy complications. This may include interventions such as anticoagulation therapy, regular prenatal care, monitoring of fetal growth and wellbeing, and prompt management of complications. A multidisciplinary approach involving obstetricians, rheumatologists, and other healthcare professionals is often necessary to optimize outcomes for both the mother and the baby.

Background. Early initiation of Rheumatoid Arthritis (RA) treatment leads to better outcomes and low disease activity. In spite of these, there is a significant delay between symptom onset and the initiation of therapy. Objective. This study aimed to investigate this diagnostic delay and to analyze its associated factors and outcomes. Patients and method. This cross sectional study included 167 RA patients fulfilling the 2010 American College of Rheumatology/ European League against Rheumatism (ACR/EULAR) classification criteria. All patients were subjected to full clinical, laboratory and radiological assessment and treatment received, also; Disease Activity Score (DAS-28) &functional disability evaluation using Modified Health Assessment Questionnaire (MHAQ) MHAQ were reported. Diagnostic delay was assessed regarding duration, associated factors and outcomes. Furthermore, RA patients were divided into early and late diagnosis group with cutoff of one year and were compared regarding different disease parameters. Results. The median (IQR) lag in diagnosis of RA patients was 12 months (4 24), MHAQ score was significantly positively correlated with delay in diagnosis (P=0.02). Early diagnosis group patients were statistically significantly urban resident (P= 0.01), employed (P= 0.02), with higher educational level (P=0.02), lower functional index MHAQ (P= 0.02), and were significantly visiting Rheumatology specialty early in the disease compared to late diagnosis group (P=

Lung disease is the second most frequent extra articular manifestation in rheumatoid arthritis (RA) patients. It can be present in up to 80% RA cases and represents a major cause of morbidity and mortality. One of the most common types of lung involvement in RA patients is the interstitial lung disease (ILD). Computed tomography studies show evidence of ILD in a large proportion of patients with RA (over 50% in some studies) and it can be clinically symptomatic in 5% of cases. The CT aspect classifies four forms of ILD, listed in order of frequency: usual interstitial pneumonia (UIP) - the most common form, non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP) and diffuse alveolar damage (DAD) which is the least common form. We present a long-standing case of rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease.

Ankylosing spondylitis is one of the global top health burdens and patients affected by it frequently require surgery related to disease progression, such as orthopedic surgery. These patients may prove difficult to manage from an anesthetic standpoint, regardless of the anesthetic technique employed, mainly given the potential for difficult airway access and related comorbidities. We present the case of a 52-year-old male posted for urgent cemented total hip arthroplasty with associated bilateral pulmonary fibrosis and an anticipated difficult airway in whom regional anesthesia was performed with satisfactory results, with a favorable intraoperative and postoperative course. The literature review explores the anesthetic techniques employed when a tailored approach is required in managing patients with ankylosing spondylitis.

Sjogren’s syndrome (SSj) is a chronic autoimmune disease mainly targeting the exocrine glands, but sometimes associating extra-glandular manifestations. Xerosis, purpura, Raynaud’s phenomenon, cutaneous vasculitis, annular erythema are the main forms of skin involvement. A 26-year-old female patient was admitted for diffuse erythematous rash and angioedema, xerophthalmia and symmetrical arthralgia of hand joints. Anti-nuclear antibodies, anti-SSA and anti-Ro52 antibodies were identified, Schirmer’s test was positive, thus the diagnoses of primary SSj and associated urticarial vasculitis were established. Treatment with oral methylprednisolone, azathioprine and hydroxychloroquine was initiated, with favourable response over the next week. Patients with primary SSj that develop cutaneous vasculitis, lymphadenopathies or lymphopenia may be at risk for additional extra-glandular manifestations, including non-Hodgkin lymphoma.

Systemic lupus erythematosus (SLE) is the prototype of autoimmune diseases with multiorgan involvement, most commonly targeting the skin, joints and kidneys. The existence and type of renal involvement influence the prognosis and this information may be crucial when it comes to establishing the optimal therapy. We present the case of a patient with SLE with skin involvement (vasculitis), joint manifestations and immunological markers remitted under synthetic remissive treatment but with severe renal damage diagnosed at the renal biopsy as a glomerulosclerosis type focal segmental podocytopathy (FSGS) collapsing variant associated with a possible ultrastructural defect of the glomerular basement membrane in the context of the disease with a severe prognosis.

This article aims to establish, on the basis of medical literature and of the authors’ experience, whether bisphosphonates still have a role in treating skeletal diseases, with increased bone resorption. The effects of bisphosphonates on the bone tissue, as well as the diseases in which they are recommended and the benefits obtained are reviewed. Possible side effects are emphasized, both the immediate ones, which are better known and the late ones, occurring after a long-term administration. It is shown that the benefit/risk ratio remains favorable. The conclusions highlight the fact that nowadays bisphosphonates still have an important place in the treatment of skeletal diseases.

Physical inactivity is a major 21st century public health problem for people with disabilities. The practice of sport in an augmented reality environment appears to be an interesting alternative to promote physical practice for people with disabilities. In this article, our research study will be based on the one hand on the impact and the capacity to increase motivation in rehabilitation by augmented reality (AR) with this population and on the other hand on the degree of acceptability of physical activity (PA) using avatars modeled in three dimensions (3D).

Total knee arthroplasty is a frequently met replacement procedure for patients with degenerative knee disease. The main purpose of the intervention is to provide pain relief and to promote range of motion and joint stability for patients in which conservative options such as pharmacological treatment or physical therapy can’t accomplish any more an adequate symptom alleviation. Most guidelines regarding the first stage of the rehabilitation process recommend early mobilization in order to gain as quickly as possible functional independence, and also to promote muscle strength and coordination. This should be done from the first day post surgery, depending on the patients compliance. In the subacute stage, the emphasis is put on maintaining a progression of the weight-bearing status, and promoting normal walking without the use of an assistive device. Patient education will be focused on changes that need to be made in a domestic environment and also modifications regarding social and professional activities. The third phase of the rehabilitation process focuses on limb symmetry and equal weight bearing which represent absolute objectives that need to be obtained. Balance exercises will include progression from bilateral to unilateral, and integration of unstable surfaces if possible associated with cardiovascular training. This phase of the rehabilitation process is considered to be completed once all realistic functional goals are achieved.

Cutaneous disease is one of the most frequent manifestations of systemic lupus erythematosus (SLE), being classified as LE-specific and LE-nonspecific. LE-specific skin lesions are divided into acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). The association with systemic involvement varies between each clinical subtype, with non-specific lesions being more frequent associated with active SLE than cutaneous specific lesions. The treatment consists of topical agents (glucocorticoids, topical calcineurin inhibitors) as well as systemic therapies (glucocorticoids, hydroxychloroquine, quinacrine, methotrexate, retinoids, dapsone, mycophenolate mofetil or even biologics). In the presence of strictly cutaneous involvement, periodic patient follow-up and monitoring for the progression to systemic disease remains an important mission for the dermatologist and the rheumatologist.

The purpose of the study was to identify any evidence of different patterns of disease for Ehlers Danlos Syndrome (EDS) and Hypermobility Syndrome (JHS) in the White British and South Asian communities in England. The numbers of hospital in-patients in ten NHS Trusts, between 2016 and 2020, in whom a diagnosis of EDS or JHS had been recorded were identified through Freedom of Information (FOI) requests. The condition was either the primary diagnosis or a secondary one, incidental to the reason for admission. The ten Trusts were selected because they served areas with a significant South Asian population and had been involved in previous studies of discrimination in the delivery of care. The study also assessed whether there was evidence of any of the Trusts underserving their South Asian community with lesser levels of recognition of EDS and JHS. Overall South Asian patients were almost four times more likely to have been diagnosed as having JHS. This proportion was statistically significant (z = -11.69, p

The introduction of the COVID-19 vaccine amidst the pandemic has heralded a paradigm shift. Healthcare students in nursing, medicine, and dentistry must have positive attitudes owing to their future role in vaccine recommendations to the public and patients. This meta-regression analysis assessed the differences in COVID-19 vaccination intention (VI) of nursing, medical, and dental students. Medline/PubMed, EMBASE, CINAHL, Cochrane Library, and Korean MBASE were searched for eligible studies. Quality was assessed by the Joanna Briggs Institute’s quality appraisal. Forty-one studies were included in the final analysis, and the estimation of pooled prevalence (68%) and relevant factors were assessed. Dental students were found to have the lowest VI (57%), which significantly (p = .018) differed from that of nursing students (64%). Countries in South-East Asia and those with high income levels were found to have high VI. Therefore, global vaccine programs for healthcare students should be prepared considering their geographical and economic status.

Hydroxychloroquine (HCQ) is an antimalarial used in the treatment of patients with systemic lupus erythematosus (SLE). HCQ has a good safety profile and favorable results in terms of controlling clinical manifestations in SLE. In addition to known side effects such as retinal toxicity and neuromusculopathy, prolongation of the QT interval is mentioned in multiple studies. The QT interval can be prolonged due to comorbidities, medication or dyselectrolytemia. QT corrected interval (QTc) durations greater than 470ms for women and greater than 450ms for men are prolonged according to the European Medicines Agency (EMA). QTc interval duration greater than 500ms predisposes to Torsades des Pointes (TdP), a cause of sudden death. The aim of the present work was to present a case of a SLE patient who was treated with HCQ for over 20 years and who showed a prolongation of the QT interval on the electrocardiogram (ECG).

Osteomyelitis pubis (OP) is a rare type of infection involving the pubic bones that often poses diagnostic and consecutive therapeutic problems. The infection can be mono or polymicrobial, bacterial, mycotic or bacillary with Staphylococcus aureus being the most common infectious agent involved. OP is generally seen in immune-suppressed patients of oncologic and diabetic population or in pediatric and geriatric subjects. The main symptom is represented by local pain with radiation to thighs which in later stages is accompanied by general non-specific symptoms such as malaise, fever and loss of appetite. The specificity-lacking initial presentation often leads to diagnostic delays which furthermore decrease the effectiveness of drug therapy, leading to higher chances of bone and joint destruction. Initial therapy consists of empirical antibiotherapy that should cover Staph. aureus; depending on culture results, the scheme should be changed accordingly. Moreover, symptomatic treatment of pain and inflammation consisting of NSAIDs, small dose glucocorticoids and minor opioids should be considered. Selected cases may benefit from surgical intervention when improvement or remission is considered improbable under drug therapy or when severe bony destructions are present.

Adult-onset polymyositis (PM) belongs to the idiopathic inflammatory myopathy (IIM) group and manifests with proximal muscle weakness, elevated muscle enzymes and positive myositis- specific antibodies. The subset of autoantibodies can indicate a higher risk for cancer association. An 82-year-old diabetic patient, with multiple cardio-vascular comorbidities, was hospitalized for muscle weakness of the upper girdle, dysphagia and dysphonia, accompanied by elevated serum muscle enzymes. Muscle biopsy showed an inflammatory infiltrate while immunological assays found positive ANA and anti-NXP2 antibodies. The diagnosis of PM was established, thus a screening for underlying neoplasia was required. Upper endoscopy visualized an area of ectopic mucosa in the esophagogastric junction and the biopsy confirmed a squamous cell carcinoma in situ. Patient had favorable muscle outcome under methylprednisolone pulse therapy. It is worth noting that polymyositis is more rarely associated with cancers as compared to dermatomyositis (DM). In conclusion, the type of antibodies identified in myositis can represent an alarm signal for oncologic screening, making possible an early diagnosis and efficient treatment of a hidden tumor.

Isolated lesser tuberosity fracture avulsion without an associated posterior shoulder dislocation or in the context of a three- or four-part proximal humerus fracture are extremely rare, with an estimated incidence rate of only 0.46 persons per 100,000. Diagnosis remains challenging, often leading to delayed treatment. In contrast with fractures of the greater tuberosity, there are no displacement guidelines to assist the surgeon in treatment decision-making for lesser tuberosity fractures. The aim of this study was to highlight diagnostic features as well as surgical treatment. We present a case of a 54-year-old male with an isolated lesser tuberosity fracture avulsion. We performed open reduction and osteosynthesis of the lesser tuberosity fragment with suture anchors and transosseous sutures. At 11-month follow-up the patient was able to normally perform his daily living and professional activities, had full, painless range of motion of the affected shoulder and regained almost full strength.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made a considerable global effect, posing notable challenges for clinicians, the pandemic becoming one of the most imperative international health emergencies lately. Among other more frequent manifestations, SARS-CoV-2 disease may also give rise to skeletal muscle involvement. Viral-induced skeletal muscle involvement is a potentially severe manifestation of COVID-19 (Coronavirus Disease 2019) and may be either acute, or in the context of “long-COVID”. The present review aimed to illustrate few aspects about pathomechanisms, clinical and paraclinical frames, and treatment options for SARS-CoV-2-induced muscle involvement. Notably, it has been stated that SARS-CoV-2 may have the ability to invade muscle myocytes directly, the disease having a variety of clinical manifestations, from myalgia and muscle weakness to rhabdomyolysis. Nevertheless, it is also important to take into account that most of patients with severe forms receiving mechanical ventilation for more than one week may have complications such as CIM (critical illness myopathy) and/or CIP (critical illness polyneuropathy) that may be clinically similar to SARS-CoV-2-induced myositis, yet may be differentiated paraclinical from it. Additionally, it was hypothesized that SARS-CoV-2 infection may constitute a trigger for autoimmune diseases such as polymyositis/dermatomyositis. Presently, there are no diagnosis criteria and no specific therapeutic strategy for SARS-CoV-2-induced myositis.

Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only one had a markedly improved elbow function with a 90° arc of motion; elbow stiffness had recurred in the other two patients. Of the 5 patients who underwent total elbow arthroplasty, 3 were lost to follow-up; the other 2 patients had a stable elbow, with a fair arc of motion of 60° and 70° respectively, both with a flexion contracture of 20°. Complications included 2 superficial infections, which healed following conservative treatment, and one fracture following remodeling of a malunited distal fracture of the humerus. In the treatment of the posttraumatic stiffness of the elbow, the arthrolysis and the arthroplasty are indicated in dependence on the existent (extrinsic or intrinsic) lesions and on their severity.