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Objectives: the study aims to assess and compare the efficiency of two different kinetic programs, in order to improve the treatment of patients with ankylosing spondylitis (AS). Material and method: our study included two samples (control and cases) of 30 patients admitted for AS in the Clinic of Rheumatology and Medical Rehabilitation Iasi, in 2011. Certain parameters such as: age, body mass index, disease evolution, Schober test, index-ground test, inspiratory-expiratory index, BASDAI activity index, BASFI functional index, Health Assessment Questionnaire (HAQ), pain, morning stiffness, inflammatory tests, and general state of health were assessed for every patient. Results: the Pilates method used in the rehabilitation treatment of patients with AS could have a favorable effect on indices regarding mobility, as well as patients perception about their disease. [ABSTRACT FROM AUTHOR]

Worldwide, health care is becoming more complex and multifaceted. Nurses, who spend more time at the bedside or out in the community with patients and their families than any other health care professional, need leadership-building skills in order to navigate these challenging times. New guidelines focus on interprofessional and holistic care, emphasizing the importance of building leadership skills and abilities. The World Health Organization and the European Association for Palliative Care have shown interest in influencing the development and implementation of palliative care services globally, given the increasingly aging population, the growing incidence of cancer, and the human immunodeficiency virus/AIDS epidemic. Despite challenges in developing leadership skills in nurses throughout Central and Eastern Europe (CEE), visionary nursing leaders throughout these countries have taken the opportunity to develop the Transformational Palliative Nursing Leadership Program, which has been designed to improve the leadership abilities of palliative care nurses throughout CEE countries. The purpose of the Transformational Palliative Nursing Leadership Program education is to equip palliative care nurses with the ability to promote, develop, and sustain this specialized care in CEE countries or any other part of the world.

Objectives: Our aim was to use the opportunity provided by the European Scleroderma Observational Study to (1) identify and describe those patients with early diffuse cutaneous systemic sclerosis (dcSSc) with progressive skin thickness, and (2) derive prediction models for progression over 12 months, to inform future randomised controlled trials (RCTs)., Methods: The modified Rodnan skin score (mRSS) was recorded every 3 months in 326 patients. 'Progressors' were defined as those experiencing a 5-unit and 25% increase in mRSS score over 12 months (±3 months). Logistic models were fitted to predict progression and, using receiver operating characteristic (ROC) curves, were compared on the basis of the area under curve (AUC), accuracy and positive predictive value (PPV)., Results: 66 patients (22.5%) progressed, 227 (77.5%) did not (33 could not have their status assessed due to insufficient data). Progressors had shorter disease duration (median 8.1 vs 12.6 months, P=0.001) and lower mRSS (median 19 vs 21 units, P=0.030) than non-progressors. Skin score was highest, and peaked earliest, in the anti-RNA polymerase III (Pol3+) subgroup (n=50). A first predictive model (including mRSS, duration of skin thickening and their interaction) had an accuracy of 60.9%, AUC of 0.666 and PPV of 33.8%. By adding a variable for Pol3 positivity, the model reached an accuracy of 71%, AUC of 0.711 and PPV of 41%., Conclusions: Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in RCTs. These models will inform recruitment into the many clinical trials of dcSSc projected for the coming years., Trial Registration Number: NCT02339441., Competing Interests: Competing interests: ALH has done consultancy work for Actelion, served on a Data Safety Monitoring Board for Apricus, received research funding and speaker’s fees from Actelion, and speaker’s fees from GSK. JHWD has consultancy relationships and/or has received research funding from Actelion, BMS, Celgene, Bayer Pharma, Boehringer Ingelheim, JB Therapeutics, Sanofi-Aventis, Novartis, UCB, GSK, Array BioPharma, Active Biotech, Galapagos, Inventiva, Medac, Pfizer, Anamar and RuiYi, and is stock owner of 4D Science. OD has received consultancy fees from 4D Science, Actelion, Active Biotech, Bayer, Biogenidec, BMS, Boehringer Ingelheim, EpiPharm, Ergonex, espeRare Foundation, Genentech/Roche, GSK, Inventiva, Lilly, Medac, Medimmune, Pharmacyclics, Pfizer, Serodapharm, Sinoxa and UCB, and received research grants from Actelion, Bayer, Boehringer Ingelheim, Ergonex, Pfizer and Sanofi, and has a patent mir-29 for the treatment of systemic sclerosis licensed. WJG has received teaching fees from Pfizer. CA has served as a consultant for AbbVie, Pfizer, Roche, UCB, MSD, BMS and Novartis, and has received research funding and speaker fees from AbbVie, Pfizer, Roche, UCB, MSD, BMS and Novartis. FCH has received research funding from Actelion. MEA has undertaken advisory board work and received honoraria from Actelion, and received speaker’s fees from Bristol-Myers Squibb. NSD has done consultancy for AbbVie, Pfizer, Roche and MSD, and received speaker’s fees from AbbVie, Boehringer-Ingelheim, Pfizer, Richter Gedeon, Roche and MSD. HG has done consultancy work and received honoraria from Actelion. UM-L is funded in part by EUSTAR, EULAR and the European Community (Desscipher programme). JMvL has received honoraria from Eli Lilly, Pfizer, Roche, MSD and BMS. SP has received research grants from Actelion Pharmaceuticals Australia, Bayer, GlaxoSmithKline Australia and Pfizer, and speaker fees from Actelion. AR receives funding from AstraZeneca. CPD has done consultancy for GSK, Actelion, Bayer, Inventiva and Merck-Serono, received research grant funding from GSK, Actelion, CSL Behring and Inventiva, received speaker’s fees from Bayer and given trial advice to Merck-Serono., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objectives: The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches., Methods: This was a prospective, observational cohort study of early dcSSc (within three years of onset of skin thickening). Clinicians selected one of four protocols for each patient: methotrexate, mycophenolate mofetil (MMF), cyclophosphamide or 'no immunosuppressant'. Patients were assessed three-monthly for up to 24 months. The primary outcome was the change in modified Rodnan skin score (mRSS). Confounding by indication at baseline was accounted for using inverse probability of treatment (IPT) weights. As a secondary outcome, an IPT-weighted Cox model was used to test for differences in survival., Results: Of 326 patients recruited from 50 centres, 65 were prescribed methotrexate, 118 MMF, 87 cyclophosphamide and 56 no immunosuppressant. 276 (84.7%) patients completed 12 and 234 (71.7%) 24 months follow-up (or reached last visit date). There were statistically significant reductions in mRSS at 12 months in all groups: -4.0 (-5.2 to -2.7) units for methotrexate, -4.1 (-5.3 to -2.9) for MMF, -3.3 (-4.9 to -1.7) for cyclophosphamide and -2.2 (-4.0 to -0.3) for no immunosuppressant (p value for between-group differences=0.346). There were no statistically significant differences in survival between protocols before (p=0.389) or after weighting (p=0.440), but survival was poorest in the no immunosuppressant group (84.0%) at 24 months., Conclusions: These findings may support using immunosuppressants for early dcSSc but suggest that overall benefit is modest over 12 months and that better treatments are needed., Trial Registration Number: NCT02339441., Competing Interests: Competing interests: ALH has done consultancy work for Actelion, served on a Data Safety Monitoring Board for Apricus, received research funding and speaker's fees from Actelion, and speaker's fees from GSK. JHWD has consultancy relationships and/or has received research funding from Actelion, BMS, Celgene, Bayer Pharma, Boehringer Ingelheim, JB Therapeutics, Sanofi-Aventis, Novartis, UCB, GSK, Array Biopharma, Active Biotech, Galapagos, Inventiva, Medac, Pfizer, Anamar and RuiYi and is stock owner of 4D Science GmbH. OD has received consultancy fees from 4D Science, Actelion, Active Biotech, Bayer, Biogenidec, BMS, Boehringer Ingelheim, EpiPharm, Ergonex, espeRare Foundation, Genentech/Roche, GSK, Inventiva, Lilly, Medac, Medimmune, Pharmacyclics, Pfizer, Serodapharm, and Sinoxa and received research grants from Actelion, Bayer, Boehringer Ingelheim, Ergonex, Pfizer and Sanofi, and has a patent mir-29 for the treatment of systemic sclerosis licenced. WG has received teaching fees from Pfizer. FH has received research funding from Actelion. MEA has undertaken advisory board work and received honoraria from Actelion, and received speaker's fees from Bristol-Myers Squibb. LC has done advisory board work for Gilead and served Data Safety Monitoring Boards for Cytori and Reata. HG has done consultancy work and received honoraria from Actelion. UM-L is funded in part bu EUSTAR/EULAR. JMvL has received honoraria from Eli Lilly, Pfizer, Roche, MSD and BMS. AR receives funding from AstraZeneca. CPD has done consultancy for GSK, Actelion, Bayer, Inventiva and Merck-Serono, received research grant funding from GSK, Actelion, CSL Behring and Inventiva, received speaker's fees from Bayer and given trial advice to Merck-Serono., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Unlabelled: There is no doubt that the association between infection of the cervical epithelium by carcinogenic Human Papilloma Virus (HPV), particularly types 16 and 18, and cervical cancer (CC) is responsible for the activation of the immune response (IR). Research on tumor infiltrating lymphocytes at the primary tumor site could give us important information on how the immune cells are fighting against cancer., Aim: The aims of our study were to assess HPV status and to evaluate the significance of in situ cellular IR in CC., Materials and Methods: We performed a two-step retrospective analysis of IR in 18 CC: evaluation of HPV 16 and 18 infections by in situ hybridization and immune biomarkers (CD20, CD3, CD45) by immunohistochemistry. Immune cell profile, densities (assigned scores "0" if no inflammatory infiltrate, "1+" low, "2+" intense), tissue distribution and classical negative prognosis factors in relationship with survival and relapse were further assessed., Results: We successfully demonstrated HPV 16 and/or 18 in all cases. We reported statistical significant correlations (p<0.005) between CD3, CD20, CD45 and survival (r=0.800), relapse (r=-0.892), clinical stage (r=-0.914), tumor size (r=-1) as well as the association between survival and CC subtype (r=0.548), FIGO stage (r=-0.914), tumor size (r=-0.800) and grading (r=0.61)., Conclusions: The density of different immune cells is significantly involved in guiding prognosis of the CC in high-risk 16 and 18 HPV positive women; low cellular densities for CD3, CD20 and CD45 meaning limited immune response reflect negative disease outcomes promoting local relapse and decreased survival in such settings.

Unlabelled: Thrombotic thrombocytopenic purpura (TTP) is a rare but severe disease characterized by mechanical hemolytic anemia and consumptive thrombocytopenia leading to disseminated microvascular thrombosis that causes signs and symptoms of organ ischemia and functional damage. TTP is diagnosed by the presence of microangiopathic hemolytic anemia and thrombocytopenia in a patient who frequently presents with central nervous system involvement and, to a lesser extent, renal dysfunction., Case Report: We present the case of a 23-year-old female with TTP, diagnosed by the presence of the neurological symptoms, microangiopathic hemolytic anemia and severe thrombocytopenia (platelets 4000/μL). During the clinical evolution, the patient presented the hepatic cytolysis syndrome, following disseminated microvascular thrombosis inside the liver, representing an atypical damage. The diagnosis was difficult because it was necessary to make differential diagnosis with other diseases that evolve with microangiopathic hemolytic anemia in a short time to be able to initiate plasmapheresis. Initiation of the plasmapheresis as soon as possible was the goal of our treatment. Following the plasmapheresis combined with administration of corticosteroids was achieved complete resolution of all symptoms., Conclusions: TTP is a hematological emergency and diagnostic challenge. The critical determinant of outcome is timely diagnosis and treatment. Once the diagnosis is suspected, life-saving therapeutic plasma exchange therapy is initiated.

Unlabelled: Rheumatoid myositis (RM) is still poorly characterized, albeit the concept of muscle involvement in rheumatoid arthritis (RA) is well-recognized as being driven by a wide range of causes including inflammation, drugs, impaired joint flexibility, sedentarism., Objective: To describe clinical, serological, imaging and histological pattern of RM., Materials and Methods: This is a retrospective study on eight RM selected from a cohort of one hundred and three RA systematically assessed for skeletal muscle involvement. Data collected included clinical, serum muscle enzymes, muscle imaging and biopsy (Hematoxylin-Eosin, modified Gömöri trichrome staining)., Results: Routine muscle histology indicated both non-specific muscle fiber damage (changes in fiber size and internal structure: pleomorphic mitochondria, dilated sarcotubular system, multiple internal or subsarcommal nuclei; abnormal fiber types distribution: trend towards type II; atrophy; degenerative/regenerative modifications) and the presence of inflammatory deposits in all patients (mild to moderate, patchy B- and T-cells infiltrates, mainly perivascular and endomysial, but also in the perimysial region classified as polymyositis-like deposits). High levels of serum muscle enzymes, abnormal EMG (short duration, small amplitude, polyphasic motor unit action potentials) without insertional activity and fibrillations, active inflammation on both Doppler ultrasound and MRI were commonly reported., Conclusions: Traditional analysis of muscle biopsy specimens (Hematoxylin-Eosin, modified Gömöri trichrome staining) is faraway unsatisfactory, only documenting changes in muscle fibers size, architecture, internal structure, and, possibly, detecting perivascular, perimysial or endomysial inflammatory deposits. Upcoming research should address the value of muscle imaging for the diagnosis and evaluation of treatment response and muscle function in rheumatoid myositis.

Objectives: Biologic therapy such as Etanercept, which is a tumor necrosis factor alpha (TNF-α) inhibitor, has been extensively used as election therapy in rheumatoid arthritis. The purpose of this case presentation was to inform about the possibility that lichen planus lesions could potentially become complicated by secondary infections in patients treated with Etanercept. Furthermore, we aimed at analyzing if the complication of the cutaneous lesion was coincidental or it was due to the immunosuppressive systemic therapy, and whether the infected lesion would respond to antibiotic therapy., Case Summary: The patient was a 59-year-old woman with rheumatoid arthritis and that have had lichen planus lesions for approximately 25 years. Only recently, she had been received immunosuppressive therapy (Etanercept and Methotrexate). Further on, the lichen planus flared up with a secondary infection determined by a Methicillin-sensitive Staphylococcus aureus. Uncommon myocardial complications were also characteristic of this case., Results: While a case report described already the appearance of lichen planus following Etanercept therapy (Battistella M et al., 2008), the possibility that the lesion could become secondary complicated following this therapy was never reported before, according to our knowledge. Additionally, we describe in this case the interplay between Etanercept therapy and hypertrophic cardiomyopathy., Conclusions: Our case is not a lichen planus induced by Etanercept, but it is aggravated and secondary infected with Methicillin-sensitive Staphylococcus during the therapy. The additional cardiac complication (hypertrophic cardiomyopathy) may represent solely an evolutive sign of rheumatoid arthritis and therefore not influenced by Etanercept.

Unlabelled: Selecting the appropriate treatment decision is essential for achieving optimal results in the management of algo-dysfunctional syndrome of the temporo-mandibular joint (TMJD). The study aims to decide on the most effective (symptomatic control, preserved motility) kinetic program in patients with TMJ involvement., Material and Methods: prospective observational study on 83 consecutive patients with rheumatic diseases and TMJ dysfunction. Clinical assessment (pain, noises, muscle spasm, range of motion, ROM) was performed at baseline and after 3 months of specific kinetic rehabilitation program. Change in clinical parameters and TM3 index was reported, p<0.05., Results: over 45% TMJ involvement at baseline as defined by TMJ index (mean value of 13.56) and only 36.66% at 3 months (p<0.05). Significant improvement in pain (presence, severity) was demonstrated at 3 moths (p<0.05): 18.05% spontaneous pain, 75.9% provoked pain, with 12.11% respectively 2.41% decreased in nocturnal respectively diurnal pain. Significant decrease (p<0.05) in joint noises at movements: 27.71% when opening and 12.04% when closing the mouth, 8.43 at protrusion and 3.61% at retraction, while 18% at the side movements., Conclusions: Complex accurate kinetic reeducation is mandatory for achieving correct posture (head, neck and trunk), normal mastication, swallowing and respiration, as well as correction of neuromuscular imbalances in patients with TMJD secondary to rheumatic disorders.

Aim: The aim of this study is to perform a screening of patients diagnosed with ankylosing spondylitis (AS) in order to evaluate the static spinal disorders and correlate the results with the main clinical and functional parameters that characterize this disease., Material and Methods: Ninety-five patients diagnosed with AS according to the 1994 New York criteria were screened, and 68 of them (all males) presenting static spinal disorders and on physical therapy programs in different outpatient physical therapy units throughout 2011 entered the study., Results: The distribution of the patients according to static spinal disorders was almost even. There were no statistically significant differences in mean age and disease duration (p>0.05). The assessment oflumbosacral pain in the morning (VAS1) and daytime lumbosacral pain (VAS2) showed a higher scores in patients suffering from kyphoscoliosis than in those with scoliosis (p=0.020), (p=0.000), or kyphosis. Ott and modified Schöber index, and chest expansion, had higher mean values in patients with scoliosis compared with the other postural disorders (p<0.001). Statistically higher mean BASFI values were recorded in patients with kyphoscoliosis (p=0.038), while the mean BASMI values were lower in scoliosis patients (p<0.001). As to the quality of life of AS patients, HAQ-DI index recorded significantly lower mean values for kyphoscoliosis compared with other postural disorders (p<0.001)., Conclusions: Our study suggests that posture assessment and implicitly the correction of possible misalignments should be part of the kinetic physical therapy program. Rigorous observing of postural recommendations can prevent the respiratory system complications.

Unlabelled: The aim of our study was to evaluate the influence of aerobic training on the dyslipedemia in patients with knee osteoarthritis (KOA)., Material and Methods: Prospective observational six-month study performed on 40 patients with KOA, fulfilling the inclusion criteria, classified according to their participation in specific aerobic training program (30 minutes/day, 5 days/ week) in two subgroups. A standard evaluation protocol was followed assessing lipid parameters (total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol levels) at baseline, three and six months. Statistical analysis was performed in SPSS 16.0, p < 0.05., Results: Subgroup analysis has demonstrated a statistical significant improvement in plasma lipids levels in all patients performing regular aerobic training (cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol) (p < 0.05). Although the difference reported for total cholesterol, triglycerides and LDL-cholesterol after six months between subgroups was not significant (p > 0.05), the mean level of HDL-cholesterol was significantly higher in patients performing aerobic training, reaching the cardio-vascular protective levels., Conclusions: Regular aerobic exercise has a positive effect on plasma lipoprotein concentrations; further research is needed for the assessment of long-term effects of physical exercises for both KOA and lipid pattern.

Unlabelled: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by synovial pannus formation leading to cartilage destruction, bone erosion, and disability., Aim: To evaluate the efficiency and safety of adalimumab (ADA) in association with one or more classic remissive drugs in active established RA., Material and Methods: Prospective observational 12 months study in 33 consecutive active RA treated with ADA. Patients were assessed according to a complex protocol including both individual parameters (clinical, biological) and composite disease activity scores (DAS28, CDAI, SDAI), while response to therapy was evaluated based on EULAR and ACR response criteria., Results: Statistical significant improvement has been demonstrated in all patients under ADA (p < 0.05); after 3 months of treatment 51.5% RA fulfilled ACR20, 39.3% ACR50 and 9% ACR70 criteria; after 6 months of treatment 66.6% of patients and 33.3% fulfilled ACR20 and, respectively, ACR50 criteria. Moreover, 30.3% of all patients had good response after 6 months, 66.6% moderate response and only 3.03% displayed no response in the same period. 24.2% and 45.4% of RA achieved remission (DAS28 < or = 2.6) after 9 and 12 months of ADA, while 39.3% and 21.2% had moderate activity. Rate and type of adverse events demonstrated the safety and good tolerance of ADA., Conclusions: Our data support the efficacy and safety of ADA in active established RA in the settings of the real-life clinical practice.

Aim: Dysfunctional syndrome of the temporomandibular joint through the complexity and variability of the symptoms may result in significant structural and functional changes leading from discomfort to disability and a negative impact on quality of life., Materials and Methods: A prospective study was conducted between October 2009-December 2010, in 52 subjects diagnosed with rheumatoid arthritis and complaining of symptoms in the temporomandibular joint. The functional examination of the joint and muscle has included the assessment of the active range of motion, passive range of motion, resistance range of motions of the temporomandibular joint, dermatomes and the pain in the region of masseter, temporalis, median and lateral pterigoids, digastric, sternocleidomastoid and longus colli muscles. The ultrasound examination has included clinical aspects of alignment, shape, dynamics of the mandibular condyle, of the temporal fossa, aspects regarding the temporal and masseter muscles at rest and at contraction phases., Results: The clinical examination highlighted the presence of pain at temporomandibular jointlevel for all tested pacients. The majority complained the pain from moderate to severe level. For the majorityof cases (59,60%) the pain stars spontaneously, during the day time (80,80%) and the night time (50,60%). Over 50% from the research cases complained cracks at the temporomandibular joint level released by a movement. At the oral and dental examination of the research group 55,8% from the tested pacients presented dental cavities toothless partially or totally duet o additionally overworking temporomandibular joint. The limitation of the range of motion is not the most important detected dysfunction, affecting approximately 30% of the cases that have been studied. Pain and spasm in a very large proportion are present in the masseter and temporal muscles regions. Atrophy is present in a lesser extent. The dysfunctional index shows an involvement of the temporomandibular joint, for over 45% of patients tested. The ultrasound examination revealed degenerative inflammatory lesions at a rate of 38.46%, inflammatory lesions at a rate of 28.85% and mixed lesions at a rate of 9.62%., Conclusions: The research regarding the clinical paraclinical and functional aspects of temporomandibular joint, permited to highlight the fact that rheumatic inflamatory and degenerative, pathology, characterises it self through a high index of morbidity and disability that lowers the life quality. Establishing a treatment plan involves customizing all clinical, functional and laboratory data.

Unlabelled: Ankylosing spondylitis enigmatic from the etiologic point of view, appears with subjects who are still in school or involved in a productive activity. If detected in its early stages, under complex, constant and long-term treatment, patients have a good evolution., Aims: The objectives of the study are to describe the clinical and functional profile of patients with AS, sacroiliitis stage, and the evol ution of physical and functional parameters under traditional physio-kinetotherapy., Material and Methods: This retrospective study was performed on 40 patients with ankylosing spondylitis (AS), who were hospitalized in the Clinic of Rheumatology Iaşi, during 2008-1010, who satisfied the amended New York criteria for this. Subjects underwent an initial evaluation (first admission) and another one at the end of the study (second admission), after approximately 6 months., Results: The demographic characteristics, the clinical and functional elements of the study sample have indicated: the average age of 24.83 +/- 3.948, predominantly male (82.5%) and 62.5% were from rural areas. Most cases occurred at the age of 19-25 (57.5%), beginning at 18-25 (77.5%), with an average of 19.60 +/- 2.318. Following the radiological changes in the various stages of sacroiliitis, stage II prevailed (40%), then stage III (32.5%) and IV (15%). The evaluation of ASAS (Assessment of Spondylo Arthritis International Society) parameters and the respiratory system showed significant improvements of: BASDAI score with 31.53%, BASFI with 37.62%, BASMI with 20.66%, DIE % with 27.53 and of CV with 5.08% as well as a decrease in pain perception measured by VAS scale (p = 0.017)., Conclusions: In the early stages of the disease, as far as the sample involved in the study is concerned, when the spine and vertebrae joints were not blocked by the evolution of the disease, corrective gymnastics and respiratory exercises, stretching and a good posture are very important, along with other therapies used to prevent axial ankylosis.

Unlabelled: Corticosteroids (CS) are currently used in Rheumatoid Arthritis (RA) in conjunction with either synthetic remissive or biologic drugs., Aim: In our study we used have focused on bone mineral density assessment (BMD) in RA patients with and without low doses of CS in order to elaborate an optimal therapeutic approach., Material and Methods: prospective observational study on 55 consecutive patients with RA (1987, ACR diagnostic criteria) classified in two groups based on CS use: group A--23 RA receiving CS and subgroup B--32 RA without CS. All patients have been evaluated according to a predefined protocol including demographics, clinical, biological and therapeutic RA characteristics, BMD and T-score assessment by DXA (Hologique QDR) (1994, WHO classification). Subgroup analysis was done in SPSS-12 software, p < 0.05., Results: No significant differences in demographics and RA related parameters (p > 0.05) have been demonstrated between subgroups. However, significant changes in BMD and T-score have been reported in RA receiving CS as follows (p < 0.05): up to 74% cases with osteoporosis, 13% with fracture and 8.7% with osteopenia (A) versus 31.3% with osteoporosis, 28.1% with fracture and 15.6% with osteopenia (B). Moreover, 90% of RA under 7.5 mg CS daily and all receiving > 10 mg daily presented with osteoporosis; also, osteoporosis has been demonstrated all postmenopausal RA in group A (75%) and only 68% of group B (76%)., Conclusions: concomitant CS use in RA, even low doses, is commonly associated with low BMD, irrespective of other risk factors.

Aim: To investigate clinical and biological aspects and to evaluate potential relation with activity and damage indexes in patients with Systemic Lupus Erythematosus (SLE)., Material and Methods: Retrospective observational study in 30 consecutive SLE patients (ACR 1997 diagnostic criteria) assessed according to a standard protocol including demographic, clinical and biological (hematology, inflammatory, immunology) data, disease activity (SLEDAI) and damage (SLICC/ACR)., Results: 90% SLE women with a mean age of 45.53+13.57 years and a mean age at onset of 31.10 +/- 9.20 years, presenting mainly with skin (43.33%) and small joint (56.66%) involvement, but also with renal (26.66%), cardio-vascular (26.66%) and neurological (6.66%); high anti-DNA double stranded antibodies (30% cases; mean 40.63 +/- 71.62IU/L) and low C3 levels (26.66%; mean 100.63 +/- 26.06 IU/L) have been reported, while more than 76% SLE patients displayed a low disease activity (mean SLEDAI 4 +/- 3.64) and limited damage (mean SLICC/ACR 1.4 +/- 0.85). Statistically significant correlation (p < 0.05) have been identified between SLEDAI and SLICC/ACR (r = 0.477), anti-DNA double stranded and SLEDAI (r = 0.515) respectively SLICC/ACR (r = 0.404), age at onset respectively current age and SLICC/ACR (r1 = 0.495, r2 = 0.468)., Conclusions: The clinical and biological study based on data from consecutive SLE patients has offered a comprehensive approach of different disease subtypes in North-East Romania. The predominance of currently low disease activity and minimal damage disease profile could reflect either SLE particularities or the expected effects of early individualized therapy.

Background: In recent years, there has been a growing interest in understanding the pathogenic pathways of premature accelerated atherosclerosis (AS) in systemic lupus erythematosus (SLE). However, the role of both traditional and non-traditional, SLE-specific risk factors is still under debate., Aim: To assess surrogate biomarkers of subclinical AS in SLE and to evaluate potential relations with cardiovascular risk factors., Patients and Methods: Prospective observational study on 35 consecutive SLE women (ACR 1987 diagnostic criteria) evaluated according to a standard protocol including traditional cardiovascular risk factors (hypertension, obesity, diabetes mellitus, cigarette smoking, abnormal lipid metabolism), SLE-specific risk factors (renal disease, SLE activity and duration, corticosteroid therapy) and surrogate biomarkers of subclinical AS (carotid intima-media thickness, plaque) (B-mode color Doppler ultrasound, 7-10 MHz probe). Data were analyzed in SPSS 16 software, p<0.05., Results: Significant differences (p<0.05) among subgroups (with and without plaque, thickened and normal intima) have been registered; moreover, statistical significant correlations between cIMT and age (r=0.476), age at onset (r=0.451), VLDL (r=0.382), hsCRP (r=0.436), Framingham score (r=0.421) have been reported. In addition, significant association between homocysteine and SLE-duration (r=0.460), SLEDAI (r=0.466), SLICC÷ACR (r=0.846) has been demonstrated, while hsCRP was associated with ESR (r=0.472), C3 (r=0.396), SLEDAI (r=0.569) and age (r=-0.681). Several predictors for increased cIMT have also been identified (ANOVA): hsCRP (p=0.016), VLDL (p=0.037), Framingham (p=0.012)., Conclusions: Our data advocate for increased cardiovascular burden in SLE and support the value of cIMT and carotid plaque as surrogate AS biomarkers in women with SLE.

Unlabelled: The aim of our descriptive study was to assess a sample of patients with knee osteoarthritis., Material and Methods: A sample of 295 patients was assessed regarding demographical features, comorbidities, some laboratory investigations and therapeutically interventions., Results: The predominance of females (81.4%), urban area (51.8%), age group over 50 (90.2%), primary bilateral disease (90.1%), associated with hip osteoarthritis. coxarthrosis (13.9%), essential arterial hypertension (10.9%), osteoporosis (9.5%) or obesity (8.1%) were the most frequent features of a patient admitted for knee osteoarthritis. Among therapeutically methods, patients received ultrasounds in 61.1% of cases, and kinetotherapy in 16.6%., Conclusions: Our study presented news aspects regarding knee osteoarthritis, in a geographical area of north-east of Romania.

Aim: To evaluate health-related quality of life and disability in psoriatic arthritis (PsA) and to perform a complex biomechanical gait analysis in patients with PsA versus healthy controls., Material and Methods: Preliminary prospective study on 33 consecutive PsA (2006 CASPAR criteria), with active multiple joint involvement disease. Assessments were done according to a predefined protocol and included: rheumatology-clinical evaluation and activity scores, dermatology- Psoriasis Area and Severity Index, PASI-score; functional disability- Health Assessment Questionnaire, HAQ, quality of life score- Short Form36, SF36; biomechanical gait analysis- tridimensional VICON MX optical motion capture system in PsA versus 33 age- and sex-matched healthy controls. SPSS, EPI-INFO and MS EXCEL were used for statistical analysis., Results: While the majority of PsA patients experienced a moderate impact on the quality of life as assessed by SF36 analysis, severe disease had major impact on their physical and emotional health status. The VICON gait analysis proved the statistical significant change (p < 0.05) on several gait parameters as compared to controls, including: decreased range of motion for flexion/extension of the lower limbs joins and lower cadence, decreased walking speed and step length. Statistically si gnificant correlations (Spearman, p < 0.05) between changes in PsA gait parameters and SF36 results, but no association with HAQ (p > 0.05) has been reported., Conclusions: The PsA burden is related to both quality of life and functional impairment. Severe changes in gait parameters are essentially reflected in SF36 analysis.

Unlabelled: The aim of this study was to assess the epidemiological data on the rheumatoid arthritis in Iaşi, Romania and in North East Romania. These data are useful for informing the policy makers, the public and above all the practitioners regarding such a disabilitating disease. The epidemiology plays an important role in understanding the etiology of the rheumatoid arthritis because there are notable differences in incidence between various populations., Material and Methods: This retrospective study followed 517 patients in 2009 and 499 patients in 2010 at the Rheumatology Clinic of the Rehabilitation Hospital, Iaşi, Romania, based on the following parameters: sex, age, rheumatoid factor, anti-CCP antibodies, the Steinbrocker functional classification, the stage of the disease., Results: The highest rates of rheumatoid arthritis were recorded in the age group of 69-60 years, followed by the age group of 59-50 years. Most of the patients were in the third stage of the disease, with limited functional capacity., Conclusions: The clinical and evolutive data of the patients with rheumatoid arthritis at the Rheumatology Clinic of the Rehabilitation Hospital, Iaşi, Romania in the time interval 2009-2010 correspond to the European data in this field.

Unlabelled: Patients with rheumatoid arthritis (RA), an immune-mediated inflammatory rheumatic disease with peripheral and systemic involvement, are at increased risk of bone loss and fractures. There are many reasons for the high prevalence of osteoporosis (OP) in RA, including both traditional and specific risk factors such as pain and loss of joint function, medication (corticosteroids, methotrexate), and increased proinflammatory cytokines., Aim: To evaluate bone mineral density status in RA patients, focusing on potential relation with classical risk factors for OP., Material and Methods: One-year prospective observational study on 83 consecutive postmenopausal women, 43 diagnosed with RA (group I), and 40 healthy controls (group II) with no previous condition and medication known to affect bone metabolism and turnover. Bone mineral density (BMD) and T-score evaluated by dual X-ray absorbtiometry (DXA) at three standard skeletal sites (L1-L4 lumbar spine, hip and forearm) (Hologique QDR 100 device), and classical risk factors for osteoporosis were assessed in all patients according to a predefined protocol. Data were analyzed in SPSS-13 using ANOVA, t-Student, chi-square and ROC (Receiver Operator Characteristic)., Results: Decreased BMD was reported in the majority of RA cases, mainly in the spine and femoral neck (86%), but also in total hip (72%); moreover, osteoporosis was commonly demonstrated in lumbar spine and osteopenia at hip level. Statistically significant differences between diagnostic categories (normal, osteopenia, osteoporosis, WHO 1994) (p<0.05), while no significant differences between mean BMD levels in women with and without RA at different skeletal sites were found (t-student, p>0.05). However, considerable BMD variation (51.7% to 102.3%) was suggested in RA as compared to non-RA patients (14.3% to 27%) (ANOVA). Significant differences in mean T-score at total hip and forearm (mainly 33% radius) were noted in patients with and without RA (p<0.05). No relation between osteodensitometric parameters and classical risk factors for OP has been identified in RA, except menopause. Indirect weak statistically significant correlations were found between mean T-score and menopause duration at all skeletal levels (Pearson's rank correlation, p<0.05), except for the femoral neck (r=+0.03, p<0.05)., Conclusions: Decreased BMD is commonly seen in RA patients. Several characteristics based on DXA assessment have been identified, including preference for distinct skeletal sites (spine, hip, distal forearm), and the particular intervention of menopause.

Aim: To assess some demographic features in a series of 741 rheumatoid arthritis patients admitted to the Clinic Hospital of Rehabilitation at Iasi in different stages of disease in order to select the most adequate rehabilitation teratment., Material and Methods: Data were collected from patients' records, hospital statistical reports, and then processed and interpreted using EPI/INFO and MS Excel., Results: Sex distribution revealed that the disease was more common in females (male/female ratio 0.2). The prevalence was higher after the age of 40, from 15.4% to 33.8% between 51 and 60, and 40.2% after 61. The most important comorbidities were related to osteoporosis (48.9%), ischemic cardiopathy and essential arterial hypertension (40.1%), impaired glucose tolerance and diabetes mellitus (36.9%), viral hepatitis B and C (24.02% of all cases)., Conclusions: In selecting the most adequate rehabilitation treatment (drug therapy, kinetotherapy, and physical therapy) patient's age, and his various associated diseases have to be considered.

Background: Recent advances have suggested that periodontitis (PD), the paradigm of chronic infection in dental pathology, shares several pathogenic pathways with cardio- and cerebro-vascular disorders (CVD), based on inflammatory mediators including IL-1, IL-6, TNF-α., Aim: To assess pro-inflammatory biomarkers (C-reactive protein - CRP, IL-6) in serum and gingival crevicular fluid (GCF) in patients with PD and with transient ischemic attacks (TIAs)., Materials and Methods: Prospective observational study on 143 patients classified as follows: 40 healthy subjects (group A), 50 PD patients (group B) and 53 PD-TIAs patients (group C). The predefined assessment protocol has included: current medical data, risk factors for CRP changes, periodontal status (clinical, orthopantomography, Schei Ruler technique), inflammatory biomarkers (CRP, IL-6)., Results: High serum CRP and IL-6 have been reported in both TIAs and PD, while statistically significant increase in GCF CRP only in PD-TIAs (p<0.05). Moreover, both generalized and localized chronic PD may be at higher risk for CVD, since CRP level was higher in these subgroups. However, no significant differences were reported in serum IL-6 between generalized and localized PD. A score function was demonstrated, including bone loss degree, bleeding index, collection site depth, serum and GCF IL-6 and CRP, tooth loss, allowing the classification of PD based on risk for developing TIAs., Conclusions: CRP and IL-6 are commonly involved in the pathways of PD and TIAs. Interdisciplinary assessment should be promoted in order to implement the stratification of PD patients according to the risk for TIAs as suggested by the proposed algorithm.

Unlabelled: The study aims to assess and compare the efficiency of two different kinetic programmes, in order to improve the treatment of patients with ankylosing spondylitis (AS)., Material and Method: Our study included two samples (control and cases) of 30 patients admitted for AS and unilateral coxitis in the Clinic of Rheumatology and Medical Rehabilitation Iasi, between 2008-2009. Certain paramentres such as: age, body mass index, disease evolution, Schober test, index-earth test, inspir-expir index, BASDAI activity index, BASFI functional index, Health Assessment Questionaire (HAQ), pain, morning ankylosing inflammatory tests, and general state of health were assessed at every patient., Results: No variation with statistical significance were registered between the two samples. The Pilates method used in the rehabilitation treatment of patients with AS could have a favourable effect on indices regarding mobility, as well as patients' perception about their disease.

Unlabelled: Professional activity in dentistry account for excessive request of the spine and peripheral joints., Material and Method: We performed an observational prospective study on ten physicians (six women, four men) aiming to evaluate the time used in vicious positions during a working day and to establish a specific kinetic program directed to relaxation and rebalancing lumbo-abdomino-pelvic muscles. The working time in a typical day either using orthostatic or sitting position was assessed according to a standard protocol., Results: Left dorsal scoliosis with rotation lasting over 97 minutes of daily working time, sinistro-concave dorsal scoliosis with a typical duration of 42.5 minutes, dextro-concave kyphoscoliosis with a mean time of 37 minutes and dorsal scoliosis with right rotation lasting 31 minutes were reported. Moreover, both left and right rotations were demonstrated during the working time accounting for about 22.5 minutes and 29 minutes respectively, while a lesser time deal with the side of right-left uncombined movement., Conclusion: Almost three quarters of working time (71%) takes place in vicious positions, suggesting that, unfortunately, the ergonomic position is seldom maintained in current dentistry practice. A complex rehabilitation program is therefore mandatory in order to prevent muscle imbalance.

Unlabelled: Despite recent advances in understanding the immune mechanisms of cervical cancer (CC), relapse remains still an actual issue and recognition of new predictive biomarkers is essential., Aim: The purpose of this retrospective study was to investigate neo-angiogenesis in CC and its possible utility as prognostic biomarker., Material and Methods: Paraffin-embedded tissue samples from 61 consecutive women with CC were immunostained for CD34 and E-cadherin. Statistical analysis was performed in SPSS-12 software, p<0.05., Results: Statistically significant differences between CD34 distribution among three interest tumor regions: micro-vessels density increase from central to peripheral area (chi(2), p<0.05); statistically significant correlation between CD34 expression, particularly in stromal and peripheral sites, E-cadherin (Spearman r1=-0.321) and lymphatic invasion (Spearman r2=0.455) (p<0.05) were reported. Overall five-year survival is clearly dependent on level and distribution of tumor angiogenesis among defined area of interest as suggested by Kaplan-Meier analysis., Conclusions: Angiogenesis is essential for guiding CC evolution and prognosis, particularly in squamous invasive types.

Aim: To evaluate efficacy and safety of adalimumab (ADA), a monoclonal anti-TNFalpha antibody, in rheumatoid arthritis (RA)., Material and Method: 5 years retrospective observational study on 70 active RA (ARA 1987 modified criteria; 48 women; mean age 52.6 +/- 11.7 years; mean disease duration 6.7 +/- 3.2 years, mean DAS28 6.5 +/- 1.3) treated with ADA (classic regimen). All patients have been assessed according to a standard protocol: (i) clinical (tender and swollen joints; pain; global disease evaluation), (ii) inflammatory and (iii) immune parameters (total antinuclear and anti-double stranded DNA antibodies), (iv) activity and functional scores, (v) response to therapy (EULAR), (vi) adverse events. Evaluation was performed at baseline and every 3 months. Statistical analysis was done in SPSS-13, p < 0.05., Results: Statistical significant improve in RA activity (mean final DAS28 3.6 +/- 0.8, p < 0.05), functional scores (mean HAQ 1.3 +/- 0.3, p < 0.05) and decreased X-ray progression (Sharp score) have been reported; 60% RA were responders (mean EULAR 2.7 +/- 1.2), 35.7% in remission, while switching to another biological agent (14.28% ADA failure) was done in 20% cases, clinical, biological and radiological efficacy and favorable safety profile of ADA have been demonstrated in real life long-term administration in active RA.

Unlabelled: Despite recent advances in the immune mechanisms of cervical cancer (CC) and complex management opportunities, relapse remains still an actual issue. While predictive factors are required, current research is directed towards proliferation and tumor aggressiveness biomarkers as potential negative factors in CC. The main objectives were to assess tumor proliferation and invasiveness biomarkers (Ki-67, E-cadherin) and to identify potential correlation between biomarkers and classic prognostic factors in CC. Radical hysterectomy specimens from 61 consecutive CC were immunohistochemically investigated for Ki-67 and E-cadherin. Nuclear immunostaining for Ki-67 proliferation index was assigned scores 1 to 3, "+" meaning low (10-30%), "++" moderate (30-50%), "+++" high-proliferation rate (>50%); cell membrane E-cadherin staining was either negative or positive. Statistical analysis was performed in SPSS-13 software, p<0.05., Results: no significant correlation between Ki-67 and classical prognostic factors (p>0.05) was reported; however, in relapsed CC, Ki-67 correlates with tumor grading (r=0.386, p<0.05). Significant correlation between E-cadherin and tumor size (r=-0.280, p=0.029), relapse (r=-0.386, p=0.002) and disease free survival (r=0.374, p=0.003) were demonstrated. Indirect statistically significant moderate correlation between Ki-67 and E-cadherin (r=-0.461, p<0.00001) was shown, mainly in invasive squamous CC (r=-0.549, p=0.0001), stage IB (r=-0.578, p=0.009), IIB (r=-0.585, p=0.003), relapsed CC (r=-0.525, p<0.01), HPV-infection (r=-0.504, p=0.033)., Conclusions: CC aggressiveness, particularly in invasive squamous carcinoma, either 16 or 18 HPV-positive cases, FIGO stage IB and IIB, and cases with relapse, depends on two pivotal factors, tumor proliferation rate (Ki-67) and tumor invasiveness (E-cadherin).

Unlabelled: Despite recent advances in the immune mechanisms of cervical cancer (CC), the relapse still remains an actual issue and recognition of new predictive biomarkers is essential., Aim: The purpose of this retrospective study was to investigate possible differences in the primary, in situ, cellular immune response between cervical carcinoma with and without relapse., Material and Methods: Paraffin-embedded tissue samples from 61 consecutive women with CC (34 with and 27 without relapse) were immunostained for CD3, CD20 and CD45 cells. Immune cell profile densities were further assessed, assigning scores between 0 and 3: "0" meaning the absence of inflammatory infiltrate, "1+" low, "2+" intense and "3+" intense infiltrate with lymphoid follicles. Statistical analysis was performed in SPSS-13 software, p<0.05., Results: Statistically significant intra- and peri-tumoral low numbers of several immune cell subtypes are strongly associated with relapse of disease within three and five years in patients with CC (p<0.05); moreover, statistical significant correlations between immune cells and both free survival (CD3: r=0.382; CD20: r=0.404; CD45: r=0.376) and relapse (CD3: r=-0.408; CD20: r=-0.355; CD45: r=-0.354) have been demonstrated. Only CD3 was reported as predictive biomarker of relapse in CC (ANOVA, t-Student, p<0.05)., Conclusions: Major differences in the cellular immune response among patients with cervical cancer with and without relapse within three and five years have been demonstrated. CD3 may be used as potential prognostic biomarkers, whereas the results are promising for adjuvant immunotherapy.

Introduction: Rheumatoid myositis (RM) represents a poorly characterized entity, immune mechanism, assessment and management remaining still unclear. The aim of this study was to investigate endothelial and inflammatory cells activation in RM muscle biopsy., Material and Methods: Prospective study on 23 consecutive rheumatoid arthritis (RA) with muscle involvement as defined by clinical, biological and imagistic parameters. CD4, CD8, CD20, CD3, CD45RO and CD68 markers, HLA-DR, cytokines receptors (IL-2, TNFalpha, TGF alpha), pro-apoptotic (CD95) and adhesion molecules (CD54) were assessed by immunohistochemistry in deltoid muscle samples., Results: (1) endomysial, perivascular and perimysial inflammatory infiltrates and moderate muscle fibers involvement; predominance of activated (HLA-DR+), memory (CD45RO+) CD3+TCD8+ cells and macrophages surrounding and invading non-necrotic muscle fibers (34.78%) and TCD4+ activated cells in perivascular and perifascicular areas (65.22%); (2) up-regulation of HLA-DR, CD54 and IL-2R on both endothelial cells and lymphocytes (85%); (3) aberrant increased CD95 in endothelial cells without any other apoptotic sign (83%) have been described., Conclusion: Increased expression of activation markers, adhesion molecules and cytokine receptors may indicate early endothelial activation in RM pathogenesis, while endomysial TCD8+ activation may account for further development and perpetuation of myositis.