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Objective. The primary aim of this study is to underline the inflammation-lowering effect of oral antidiabetic drugs, namely the CRP, ESR and DAS28 levels. The secondary aim was to show that these effects are dependent on the dose of the antidiabetic drug. Methods. The study has an observational, case-control design. The information was gathered from the case reports of the patients that were admitted in Sf. Maria Clinical Hospital in Bucharest, beginning with 2010 and until May 2016. It included a case group of 20 subjects and a control group of 20 subjects who were followed approximately 3 years from the diagnosis of RA. Results. There were no significant group differences at baseline. During the follow-up, the medians of DAS28, CRP and ESR were significantly lower in the group treated with oral glucose lowering agents (p<0.005). Secondly, the presence of metformin both as monotherapy and in combination with other antidiabetic drugs was associated with a statistically significant decrease in the medians of the three mentioned variables (p<0.05). The metformindose can predict the value of CRP (p=0.005), accounting for 18.9% of the variation of CRP. Moreover, there is a negative correlation between CRP level and metformin, r=-0.434, p=0.003. This negative correlation was also seen between metformin and CRP value (p=0.027), when metformin was used in monotherapy. Conclusion. The main insights achieved in this study relate to the ability of metformin to significantly lower both DAS28 and CRP level in patients with RA and T2DM, when compared to those that are affected only by RA. An element that needs further study is if these benefits can also extend to RA patients without T2DM, but with impaired glucose tolerance or important cardiovascular risk factors. [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]

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]

B cell hyper-reactivity implied in the pathogenesis of Sjö gren's syndrome (SS) justifies the therapy that involves B cell depletion. Ultrasound of salivary glands demonstrated alterations during disease progression. Objective. To evaluate changes in salivary gland parenchyma with ultrasound after rituximab treatment in patients' with secondary SS (sSS). Methods. 7 patients evaluated at baseline (under treatment with rituximab) and after 6 months, underwent ultrasonography of major salivary gland (submandibular and parotid). Clinical data as dryness, pain and diseases activity evaluated with ESSDAI were registered. Salivary gland ultrasound (SGUS) was performed to asses echogenity (using a semiquantitative score from 0-4, with improvement defined as an at least 1 point decrease), size of gland and glandular borders. Results. Of 7 patients, 14% had clinically detectable bilateral parotid tumefaction at baseline. 6 patients (85.71%) showed ultrasonographic alterations at baseline. Parotid parenchyma echostructure improved in 42.85% of patients versus 14.28% in control group (p=0.05). At the submandibular glands, both submandibular glands showed changes in 28.57% of patients, while control group showed no changes. 42.85% patients showed parotid tumefaction which changed in 66.6% of patients at 6 months. Conclusion. Ultrasonography showed improvement in salivary gland echostructure in secondary Sjogren Syndrome with rituximab. [ABSTRACT FROM AUTHOR]

Objective. The study aimed at observing drug survival and determining potential predictors of anti-TNFα switch among ankylosing spondylitis (AS) patients. Methods. The study retrospectively recorded clinical data of patients fulfilling modified New York criteria in a single university clinic. The data were analyzed using appropriate statistical test, which were considered significant if p < 0.05. Results. A total of 120 patients met the inclusion criteria. Switchers had a median BASFI score of 2.7, a median ASDASCRP of 1.59 and a 41.7% prevalence of uveitis, compared to non-switchers which had a median BASFI score of 2.0, a median ASDASCRP of 1.20 and a uveitis prevalence of 22.9% respectively (p = 0.009; p = 0.025; p = 0.043). After a median of 7.0 years of observation, 96 patients (80.0%) were still being treated with their first antiTNFα agent, with a Kaplan-Meier survival time estimate of 11.5 (10.1-12.9) years. The Kaplan-Meier study of the time of treatment until switch of the first biologic agent according to ASDASCRP categories revealed 9.3 (8.8-9.8) years for inactive disease, 10.6 (8.8-12.5) years for moderately active disease and 7.1 (5.7-8.5) years for highly active disease. The switch hazard ratio for CRP was 1.019 (1.007-1.031; p = 0.002), for BASDAI 1.226 (1.0171.477; p = 0.032), for BASFI 1.264 (1.057-1.513; p = 0.010) and for ASDASCRP 1.592 (1.173-2.159; p = 0.003). Conclusion. Romanian AS patients on anti-TNFα agents exhibit high retention rate and drug survival of antiTNFα agents. Switchers have significantly higher baseline disease activity indices which, along baseline acute phase reactants, can significantly predict switching of the first anti-TNFα agent. Patients with AS treated with antiTNFα agents had a higher prevalence of uveitis than those who did not therapeutic switch. [ABSTRACT FROM AUTHOR]

Introduction: Leukotriene C4 synthase (LTC4S) gene -444A/C polymorphism has been implicated in susceptibility to asthma, but a large number of studies have reported inconclusive results. The aim of this study was to investigate the association between the -444A/C polymorphism of LTC4S gene and asthma, asthma phenotypes (aspirin intolerant/tolerant asthma) and different characteristics of the patients. Material and methods: We included 106 patients with asthma (60 with aspirin tolerant asthma - ATA, 46 with aspirin intolerant asthma - AIA) and 103 controls. All the subjects were genotyped for LTC4S-444 A/C by Real-Time PCR. We assessed the association of LTC4S promoter polymorphism with asthma and its phenotypes and with clinical and biological characteristics of asthmatic patients. Results: We did not find a significant association between the studied polymorphism and asthma, but the minor allele tended to be more frequent in AIA patients. We found a significant association between the minor allele C and lower levels of serum total immunoglobulin E and eosinophils, suggesting a possible role of -444A/C LTC4S polymorphism as modulating factor of allergic inflammation in asthma. Conclusion: The results show that LTC4S -444A/C SNP is not associated with susceptibility to asthma in Romanian patients, but could influence asthma phenotype, namely aspirin intolerant asthma. [ABSTRACT FROM AUTHOR]

A 49-year-old patient initially admitted to the Rheumatology Clinic for arthralgias, swelling in the fists, knees and ankles, at a bilateral level, with RM>1h, dot-like necrotic lesions on the back side of his fingers and toes, extensive hemorrhagic lesions on the backside of his hands and feet, and, from a biological point of view, intense inflammatory syndrome and increased IgG are detected, so the patient was transferred to the Fundeni Hematology Clinic on the presumption of a monoclonal gammapathy diagnosis. The tests performed revealed IgG kappa monoclonal cryoglobulinemia and multiple myeloma stage IIIA. The skin biopsy confirmed the clinical suspicion of cryoglobulinemia vasculitis. The patient received bortezomib-based induction therapy with the multiple myeloma achieving complete remission and disappearance of rheumatoid syndrome/vasculitis. Subsequently, remission was consolidated with an autologous bone marrow transplant. Rheumatoid syndrome and cryoglobulinemia vasculitis are rare onset manifestation in multiple myeloma. The association of multiple myeloma with symptomatic monoclonal cryoglobulinemia is an indication of chemotherapy and autologous bone marrow transplant, even in multiple myeloma stage I or II. [ABSTRACT FROM AUTHOR]

Background: rheumatoid arthritis (RA) is a systemic inflammatory disease with an unknown etiology and an autoimmune pathogenesis characterized by a deforming and destructive arthritis, but with multiple systemic manifestations. Nowadays, there is a trend in treating earlier and more aggressive RA taken into account the highly intense and erosive forms of disease. Aims: to assess the efficacy and safety of Rituximab (RTX) associated with Methotrexate (MTX) in patients with active RA that had an inadequate response to one or more anti TNFα therapy. Material and method: this study included 57 patients aged between 23 and 77 years old, diagnosed with RA according to the ACR 1987 criteria, admitted in a rheumatology service clinic from Bucharest from April 2008 to August 2011. Results: selected patients have a mean age of 54.5±12.9 years, 49 women, with a mean disease duration of 12.07±6.2 years, 85.9% had positive rheumatoid factor and 57.9% were positive for anti CCP antibodies. The response to the treatment with RTX, evaluated periodically after initiation through DAS28 score, is not influenced by the prior TNFα inhibitor, nor by the number of prior TNFα agents used. Conclusion: choosing the treatment with RTX as an alternative to patients with RA that have had an inadequate response to anti TNFα therapy represents one of the most appropriate method of optimizing the treatment of these patients. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis (SSc) is a complex disease, skin thicness being the most obvious involvement. The "gold standard" method for the evaluation of dermal thickness is the modified Rodnan skin (mRSS). Many authors have reported correlations of this score with visceral involvement and prognosis. Objectives: To evaluate the correlation between mRSS and organ involvement in the two subset of SSc. Methods: Data from 55 SSc patients were collected during one year: demographics, visceral involvement according to MEDS evaluation sheet, lab tests. The mRSS was performed by 2 independent trained examiners. Statistical analysis was done with EpiInfo and SPSS 17.0 b Results: In the diffuse cutaneous group mean disease duration was 7. 8 years, mean mRSS was 17.5. We found a significant correlation of the mRSS with pulmonary fibrosis (p=0, 04), diastolic dysfunction (p=0, 03) and renal crisis (p=0, 00001). In the limited cutaneous group mean disease duration was 7. 23 years, mean mRSS was 8.2.. We found a signification correlation between mRSS and arrhythmias (p=0, 04). Conclusions: Although it is known that Rodnan skin score is a prognostic tool useful in the first 3 years of the disease we still found a significant correlation with pulmonary fibrosis, diastolic dysfunction and renal crisis in the diffuse SSc group and with arrhythmias in the limited SSc group even after several years of disease. [ABSTRACT FROM AUTHOR]

Background: Immunological abnormalities in rheumatoid arthritis (RA) imply several antibodies, among which anti-cyclic cytrullinated peptide antibodies (anti-CCP) have the highest sensitivity and specificity. Their diagnostic and prognostic value in RA is well known, although their value as markers of the disease activity has not been established yet., Objectives: The aim of this study is to evaluate the correlation between anti-CCP antibodies and RA activity which eventually leads to the best treatment of choice., Patients and Methods: 217 consecutive patients hospitalized in the Department of Internal Medicine and Rheumatology, "Sf Maria" Clinical Hospital between 01.01-31.06 2007 were retrospectively studied. They were divided into two groups: group A-111 patients with RA (ACR criteria fulfilled) and group B-106 patients with other rheumatic diseases. The following parameters taken out of the patients files were studied: parameters of the clinical activity of disease (C reactive protein, fibrinogen), rheumatoid factor (RF) and anti-CCP antibodies. Disease activity score (DAS) using 4 variables (number of tender joints, number of swollen joints, erythrocyte sedimentation rate and assessement of the disease activity) was also studied. Data were processed with SPSS program using linear functions, Pearson correlation coefficient and Hi2 test of interdependency., Results: The sensitivity of anti-CCP antibodies in patients with RA was 56.75%. The specificity of anti-CCP antibodies in patients with RA was 90.56%. Low seric levels of anti-CCP antibodies were also found in patients without RA, but with other conditions like: osteoarthritis, viral polyarthritis, infectious myositis and Still disease; moderate to high seric levels were found in patients with psoriatic arthritis. Significant correlations were found between anti-CCP antibodies and DAS (r = 0.437), between anti-CCP and fibrinogen (r = 0.32) between anti-CCP antibodies and C reactive protein (r = 0.237) as well as between anti-CCP and RF (r = 0.38)., Conclusions: Anti-CCP antibodies are highly specific but moderately sensitive for RA, their highest frequencies and seric levels being found in seropositive RA. Anti-CCP can be used in patients with RA not only as a diagnostic marker but also as a reliable test for assessing the activity of the disease.

Objective: To compare the efficacy, safety and tolerability of different therapies in Caucasian patients with osteoarthritis (QA) of the knee., Methods: Seventy-five cases (90 knee joints) of osteoarthritis were randomly divided into 3 groups, western medicine group, traditional Chinese medicine (TCM) group, integrated Chinese and western medicine group. The western medicine group were treated with oral administration of Glucosamine Sulfate, oral administration and external application of non-steroid anti-inflammatory agent, ultrasound physiotherapy, etc. The TCM group were treated with oral administration of J uanbi Decoction, acupuncture and moxibustion, cupping, massage of acupoint and ear acupuncture. The integrated Chinese and western medicine group were treated with oral administration of Glucosamine Sulfate, oral administration and external application of non-steroid anti-inflammatory agent, acupuncture and moxibustion, cupping, massage of acupoint and ear acupuncture. The intensity of knee joint pain on walking, resting and standing, the nocturnal pain, stiffness, the maximum walking distance and the daily living ability were monitored after 30 days, 60 days and 90 days of treatment., Results: After 90 days of treatment, the integrated Chinese and western medicine group was better than other two groups in improvement of percentages in self pain assessment with visual analog scale (VAS), pain and stiffness measured by WOMAC scale, pain and maximum walking distance measured by Lequesne scale (P < 0.05 or P < 0.01). There were no significant differences in the therapeutic effects between the TCM group and the western medicine group. All of these three treatments were well tolerated, and no severe adverse events were found., Conclusion: Combined TCM and western medicine treatment has rapid and definite therapeutic effect in reducing pain and improving mobility of knee joints and daily living ability in Caucasian patients of knee osteoarthritis.