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Background: IgA vasculitis (IgAV) is a small vessel vasculitis occurring predominantly in childhood. Studies concerning the genetic background of IgAV have confirmed that susceptibility to the disease may be influenced by Human Leukocyte Antigens (HLA), with HLA-DRB1 gene showing a strong association with the disease. Objectives: We aimed to investigate HLA-DRB1 polymorphism among Croatian patients with IgAV and to determine if there are associations with disease susceptibility and clinical heterogeneity. Methods: 123 IgAV patients, fulfilling the diagnostic EULAR/PRINTO/PRES criteria from three pediatric rheumatology centers and 202 unrelated healthy individuals were enrolled. Genomic DNA was extracted from whole peripheral blood. The HLA- DRB1 alleles were analysed using the Next Generation Sequencing (NGS) method. Results: Among 123 patients with IgAV, 68 were girls and 55 were boys with median age 6.3 (4.5- 8.2) years at the time of diagnosis. All patients had purpuric rash, 75.7% had arthralgia or arthritis, 32.5% had affected gastrointestinal (GI) system, while 25.2% patients developed IgA vasculitis nephritis (IgAVN). The HLA-DRB1*12:01 allele was associated with an increased risk for IgAV (OR 4.45, 95% CI=1.17-16.95, P=0.03), while HLA-DRB1*11:01 allele was associated with an increased risk for GI involvement in patients who developed IgAV (OR 3.29, 95% CI=1.2-8.98, P=0.031). A marginally significant (P=0.068) higher frequency of the HLA DRB1*10:01 allele in patients with GI symptoms was observed. No significant differences were found in the distribution of HLA DRB1 alleles between patients with IgAVN and those who did not develop nephritis. Conclusion: Our results demonstrated that HLA- DRB1*12:01 allele was associated with susceptibility to IgAV in the Croatian children, while HLA-DRB1*11:01 allele showed association with GI manifestations of the disease. SUPPORT: Croatian Science Foundation Project IP- 2019-04-8822.

Coronavirus SARS-CoV-2 is an RNA virus responsible for COVID-19 disease that has rapidly become a major public health concern. In addition to viral pneumonia, which is the most common manifestation of the disease, infected patients increasingly presented with post-COVID-19 syndrome. Post-COVID- 19 syndrome is characterized by various general symptoms and multi-organ manifestations 4 to 12 weeks after acute phase. Rheumatoid arthritis is a systemic and chronic inflammatory disease that causes joint damage, and it can occur as a part of post-COVID-19 syndrome. A 62-year-old male presented with symptoms of rheumatoid arthritis after moderate COVID-19 infection. Patient complained of morning joints stiffness, pain and swelling in bilateral radiocarpal joints, then in bilateral metacarpophalangeal joints and in right knee and right talocrural joint. His laboratory findings revealed negative rheumatoid factor, anti-CCP negative, negative antinuclear antibody, anti-dsDNA negative and C-reactive protein slightly elevated. Ultrasound revealed synovial effusion, synovitis and hypertrophy of affected joints. Diagnosis of seronegative rheumatoid arthritis was established. Glucocorticoids and methotrexate therapy was initiated. The patient responded well to therapy and reported a reduction of symptoms. Rheumatoid arthritis, which is thought to occur in genetically predisposed individuals when exposed to an external factor, such as viral, bacterial disease or stress, may occur as a manifestation of the post-COVID-19 syndrome. Ultrasound of the locomotor system plays an important role in the diagnosis. Rheumatoid arthritis issuccessfully treated with disease modifying therapies in addition to regular monitoring by a rheumatologist.

This study aimed to determine whether patients with active rheumatoid arthritis (RA) regularly take non-steroidal anti-inflammatory drugs (NSAIDs) and to clarify whether their decision to take NSAIDs depends on disease activity, intensity of pain, or functional status. The study also aimed to identify the risk factors for gastrointestinal side effects. Over 6 months, we conducted a cross-sectional single-center study of consecutively hospitalized patients with confirmed RA. Activities of daily living, pain intensity, and disease activity were evaluated by the Health Assessment Questionnaire, visual analog scale, and disease activity score, respectively, in 28 joints. Of 73 patients diagnosed with RA, 48 (66%) regularly took NSAIDs. Compared to non-users, NSAID users used glucocorticoids less frequently. The decision to use NSAIDs was independent of disease activity, pain intensity, degree of functional impairment, or presence of gastrointestinal risk factors. However, a higher degree of functional impairment was associated with a longer duration of continuous NSAID and glucocorticoid use. NSAIDs are still relevant for RA treatment. The decision to use them is not necessarily affected by disease activity or pain intensity, but their prolonged use is required in patients with a higher degree of functional disability. NSAIDs enable exclusion of glucocorticoid use, sparing patients of glucocorticoid-related side effects., Ovo istraživanje imalo je za cilj utvrditi uzimaju li bolesnici s aktivnim reumatoidnim artritisom (RA) redovito nesteroidne protuupalne lijekove (NSAID) i razjasniti ovisi li njihova odluka o uzimanju NSAID-a o aktivnosti bolesti, intenzitetu boli ili funkcionalnom statusu. Istraživanje je također imalo za cilj utvrditi čimbenike rizika za gastrointestinalne nuspojave. Tijekom 6 mjeseci proveli smo presječnu studiju u jednom centru uzastopno hospitaliziranih bolesnika s potvrđenim RA. Svakodnevne životne aktivnosti, intenzitet boli i aktivnost bolesti procijenjeni su upitnikom za procjenu zdravlja, vizualnom analognom ljestvicom, odnosno rezultatom aktivnosti bolesti u 28 zglobova. Od 73 bolesnika s dijagnosticiranim RA njih 48 (66%) redovito je uzimalo NSAID. U usporedbi s ne-korisnicima, korisnici NSAID-a rjeđe su uzimali glukokortikoide. Odluka o primjeni NSAID-a bila je neovisna o aktivnosti bolesti, intenzitetu boli, stupnju funkcionalnog oštećenja ili prisutnosti gastrointestinalnih čimbenika rizika. Međutim, viši stupanj funkcionalnog oštećenja bio je povezan s duljim trajanjem kontinuirane primjene NSAID-a i glukokortikoida. NSAID su još uvijek relevantni za liječenje RA. Na odluku o njihovoj primjeni ne mora nužno utjecati aktivnost bolesti ili intenzitet boli, ali je njihova produljena primjena potrebna u bolesnika s višim stupnjem funkcionalne nesposobnosti. NSAID-i omogućuju isključivanje uporabe glukokortikoida, pošteđujući bolesnika nuspojava povezanih s glukokortikoidima.

Recent findings suggest that aetiology of Behçet’s disease (BD) is between autoimmunity and autoinflammation. In common with other autoimmune diseases BD shares class I MHC (HLA-B51) association, but BD has mostly autoinflammatory clinical features. In BD different clinical phenotypes can be distinguished (Bettiol 2020). Prevalence in Croatia is unknown, and far as we know, only 6 BD case reports (CR) have been published for our population. Case 1. A 32-year- old-woman with a history of recurrent oral aphthae, migratory arthralgias, and acneiform lesions was referred after being diagnosed with bilateral retinal vasculitis (RV). Workup showed positive HLA B51. The ICBD criteria were fulfilled. After induction of 0.5 mg/kg/day of methylprednisolone (MP) and 2.5 mg/ kg/day of azathioprine (AZA) RV resolved. Case 2. A 59-year- old-woman has been suffering from BD for the past 20 years. She was treated by her rheumatologist with NSAR, topical and systemic MP in exacerbations of arthritis and uveitis. Now, after first examination in our clinic, colchicine was administered due to orogenital aphthae, erythema nodosum and arthralgias with a good clinical response. She is now without signs of uveitis. Discussion: Until now, as far as we know, a total of 6 CR (Tekavec 2015, Boban 2016, Barešić 2018, Borić 2019, Krečak 2020, Kardum 2021) and no research on BD were published in last 10 years for our population. Analysing these 8 patients in total, we can conclude that in Croatia dominates parenchymal neurological/ocular, followed by peripheral vascular phenotype. Recommended therapy is high dose of MP and AZA for both ocular and parenchymal manifestations and anti-TNFα in case of severe ocular and parenchymal CNS involvements. This recommendation is in accordance with therapy used in published CR with a good response. Often seen delay in BD diagnosis is due to lack of pathognomonic clinical findings, specific laboratory test and the small number of BD patients. It would be useful to establish BD registry in Croatia because tailoring the treatment on patient’s specific phenotype which is a consequence of the genetic background and the influence of external factors, rather than on single disease manifestation, could be a valid strategy for a personalized therapeutic approach to BD. Also, the registry would enable earlier detection of the disease.

Background. Macrophage activation syndrome (MAS) or secondary hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory state that occurs as a complication of autoimmune diseases and requires prompt diagnosis and treatment. It shares similar clinical presentation with primary (p)HLH. Unlike pHLH which is hereditary autoinflammatory disorder, pathophysiology of MAS is unclear, although recent studies have found that MAS and pHLH share significant genetic overlap. Case 1. A 65-year-old male without history of autoimmune disease was admitted due to NSTEMI. During hospitalization patient developed high fever, pancytopenia, liver damage, splenomegaly, lymphadenopathy, rash, irritability, confusion, high ferritin (FER) and triglycerides (TG). After diagnostic workup a diagnosis of MAS secondary to Sjogren’s syndrome was made. HSscore was 204 showing an 88–93% probability of HLH. Treatment with methylprednisolone (MP) 2 mg/kg/day and hydroxychloroquine (HCQ) 200 mg/day have led to a rapid resolution of symptoms and normalization of laboratory findings. Case 2. A 28-year-old SLE patient was hospitalized due to high fever, pancytopenia, liver damage, rash, aphthae, hepatosplenomegaly, lymphadenopathy, high FER, and TG. The diagnosis of MAS with visual loss due to retinal vasculitis (RV) was made. HS score was 219 showing an 93–96% likelihood of HLH. Treatment with MP 2 mg/kg/day, HCQ 400 mg/day and mycophenolate mofetil 2000 mg/day improved his clinical condition and laboratory findings, however, due to further active RV without visual recovery and in agreement with ophthalmologist, treatment with rituximab 1 g on day 0. and 14. and local anti VEGF bevacizumab was started with an excellent response: complete recovery of vision acuity and clinical and laboratory immunological remission of SLE. Conclusion. In patients with fever refractory to antibiotics and high FER, we should suspect a hyperinflammatory state and perform HS score. MAS diagnosis is constellation of clinical features and clinical judgment. Prompt intervention with corticosteroids (GC) to suprress cytokine storm followed by identification and appropriate treatment of the underlying autoimmune disease is needed. Early immunosuppression primary with GC in MAS can be lifesaving and more aggressive treatment as in pHLH in our opinion is usually unnecessarily if MAS is recognized in time.

Interleukin-6 (IL-6) je potentni proinflamatorni citokin važan za imunološku obranu organizma, kao i za razvoj imunološki posredovanih bolesti. Pojavom pandemije COVID-19 došlo je do preklapanja s već postojećom pandemijom šećerne bolesti tipa 2. U prospektivno istraživanje uključeno je 106 osoba oboljele od teškog oblika Covid infekcije, 77, 4% muškaraca i 22, 6% žena, prosječne dobi 72, 83 godine, 34, 9% dijabetičara, a 63, 2% nedijabetičara. Nije bilo statistički značajne razlike u težini kliničke slike COVID-19 infekcije, tjelesnoj temperature (80, 6% vrs 84, 1%, p=0, 65), kašlju (69, 7% vrs 81%, p=0, 213), trajanju bolesti dužem od 10 dana (20% vrs 25, 8%, p=0, 614), gubitku njuha (87, 1% vrs 89, 8%, p=0, 695), razini C-reaktivnog proteina (CRP) (CRP preko 100 mg/L, 75, 7% vrs 78, 8%, p=0, 716), plućnim manifestacijama COVID-19 infekcije (bilateralni infiltrati 97, 2% vrs 89, 6%, p=0, 166), saturaciji hemoglobina kisikom (SpO2 preko 93%, 97, 3% vrs 97%, p=0, 934) u bolesnika sa šećernom bolešću u usporedbi s bolesnicima koji nemaju šećernu bolest. Nije bilo statistički značajne razlike u ishodima bolesti u bolesnika sa šećernom bolešću u usporedbi s bolesnicima koji nemaju šećernu bolest. Uočena je statistički značajna viša razina interleukina-6 (IL-6) pri prijemu u bolesnika sa šećernom bolešću u usporedbi s bolesnicima koji nemaju šećernu bolest (IL-6 100 pg/mL, 58, 1% vrs 25%, p=0, 002). S obzirom na mali broj ispitanika svakako su nužna daljnja istraživanja.

Introduction Several histologic classifications are used in the evaluation of IgA vasculitis nephritis (IgAVN), however, to date, no studies have determined which one has the strongest association with the severity of IgAVN and, as a consequence, its outcomes. Materials and methods Patients included in the study were diagnosed with IgAV and IgAVN in seven tertiary university medical centers in Croatia, Italy and Israel. The International Study of Kidney Disease in Children (ISKDC), Haas, Oxford, and Software Quality Control (SQC) classifications were used in the analysis and description of renal biopsy. Time from biopsy to outcome evaluation was a statistically significant factor in outcome prediction that was used to define the base model, and was a covariate in all the tested models. Results Sixty-seven patients were included in this study. The SQC classification proved to be the best one in outcome prediction, followed by the Oxford classification. The ISKDC and Haas classifications could not predict renal outcome. The Oxford parameters for mesangial hypercellularity and tubular atrophy, as well as the SQC parameters for cellular crescents showed an independent statistically significant contribution to outcome prediction. High level of twenty-four hour protein excretion was associated with a higher grade in the Oxford, SQC and ISKDC classifications. Endocapillary proliferation was positively associated with the Pediatric Vasculitis Activity Score (PVAS) at diagnosis, while tubular atrophy was negatively associated. Conclusion The SQC, followed by the Oxford classification were found to provide the best classifications of renal biopsy analysis in patients to predict the outcome in patients with IgAVN. Cellular crescents, mesangial hypercellularity and tubular atrophy showed significant contributions, indicating that active and chronic variables should be included in the estimation.

IgA vasculitis nephritis (IgAVN) is almost the only cause of morbidity and mortality among children suffering from this most common childhood-vasculitis. Several histological classifications are used in the analysis of renal biopsy findings in IgAVN, but it remains unknown which one is the best predictor of severity and disease outcome. The aim was to compare the four most commonly used histologic classifications for IgAVN and to establish which variables of each histological classification have the strongest association with unfavorable outcome. The cross- sectional study included 74 patients with IgAVN (diagnosed by EULAR/PRES/PRINTO criteria) and available renal biopsy specimens for analysis using the four histological classifications for IgAVN (the International Study of Kidney Disease in Children (ISKDC) classification, the Oxford classification, the Haas histologic classification of IgA nephropathy and the modified semi- quantitative classification (SQC), developed by Koskela et al.). The clinical outcome was defined through four categories, graded according to the modified classification of Counahan (physical examination, hematuria, proteinuria, urine albumin-tocreatinine ratio, hypertension and eGFR). The linear relationships between outcome and histological classifications were analysed using ordinal regressions using the first-order of polynomial orthogonal contrasts. The SQC classification proved to be the best, reducing the deviation (of the model-predicted outcome value from the observed value) by 9.5% (c21=13, 89, p

The pilot study showed that the SQC classification, developed by Koskela et al., has the strongest association with the severity and outcome of HSPN, followed by the Oxford classification, while other classifications are less related to the outcome of the disease.

Uvod: Henoch-Schönleinov purpurni nefritis (HSPN) najvažniji je uzrok pobola i smrtnosti u ovom najčešćem dječjem vaskulitisu. Postoji nekoliko histoloških klasifikacija HSPN-a, ali nije poznato koja je najbolje povezana s ishodom bolesti. Cilj je rada usporediti četiri najčešće histološke klasifikacije za HSPN, odrediti koja najbolje predviđa ishod te utvrditi povezanost pojedinih histoloških varijabli s ishodom bolesti. Ispitanici i metode: Presječna studija uključila je 72 bolesnika s HSPN-om. Biopsije bubrega analizirane su prema četiri dostupne histološke klasifikacije: ISKDC-ova (engl. International Study of Kidney Disease in Children), Oxfordska, Haasova te modificirana semikvantitativna klasifikacija Koskele i sur. (engl. Modified Semiquantitative Classification – SQC). Klinički ishod definiran je kroz četiri kategorije prema modificiranoj Counahanovoj klasifikaciji. Linearni odnosi između ishoda i histološke klasifikacije analizirani su metodom ordinalne regresije koristeći prvi red polinomnih ortogonalnih kontrasta. Rezultati: Najboljom se pokazala SQC- ova klasifikacija koja je smanjila devijaciju (modelom predviđene vrijednosti ishoda u odnosu na stvarnu vrijednost ishoda) za 9, 5% (Χ21 = 13, 89, p < 0, 001), nakon nje Oxfordska sa smanjenjem devijacije za 8, 0% (Χ21 = 11, 76, p = 0, 001), zatim ISKDC-ova sa smanjenjem devijacije za 3, 3% (Χ21 = 4, 89, p = 0, 027), a najlošijom se pokazala Haasova klasifikacija sa smanjenjem devijacije za 2, 1% (Χ21 = 3, 06, p = 0, 080). Uočeno je da porast vrijednosti intersticijske fibroze (t66 = 3, 23, p = 0, 002), tubularne atrofije (t66 = 2, 94, p = 0, 005) i tubularne dilatacije (t66 = 2, 40, p = 0, 019) u SQC-ovoj klasifikaciji te endokapilarne hipercelularnosti (t66 = 3, 14, p = 0, 003) i polumjeseca (t66 = 2, 07, p = 0, 043) u Oxfordskoj klasifikaciji pogoršava ishod bolesti. Zaključak: Pilot studija pokazala je da SQC-ova klasifikacija ima najbolju povezanost s lošim ishodom HSPN-a. Iako se smatralo da su polumjeseci u bioptatima bubrega najvažniji pokazatelj ishoda, ovo istraživanje sugerira da bi tubulointersticijske promjene mogle biti važnije u predviđanju lošeg ishoda. Tubulointersticijske promjene u HSPN-u trebaju se dalje istraživati kako bi se ustanovilo imaju li bolju prediktivnu vrijednost u ishodu bolesti i prema tome ih ugraditi u postojeće ili nove klasifikacije. Potpora: Projekt Hrvatske zaklade za znanost, IP- 2019-04-8822

Background: It has been demonstrated that bioavailability of oral (P.O.) MTX reaches plateau at doses ≥15 mg QW, and that subcutaneous (S.C.) form has a better efficacy. Alongside with less side-effects this might translate into improvement in quality of life (QoL) and better adherence. Objectives: An academic-induced observational longitudinal study of patients with RA and peripheral form of PsA on csDMARDs who were switched from oral (P.O.) to subcutaneous (S.C.) MTX was conducted. Previously we reported on the better efficacy of S.C. compared to P.O. MTX. The objective of this part of the study we are presenting was to evaluate the 6-month changes in quality of life (QoL), adverse events and adherence in these patients. Methods: Forty-eight consecutive patients (79.2% women) with established diagnosis of RA (77.1%) and peripheral PsA were enrolled from the outpatient clinics in six centres in Croatia. Median age was 61 (39-79) years, and the median of disease duration was 120 (3-528) months. Data were collected at baseline (T0) (on P.O. MTX), at day 90 (±10 days) (T1) and at day 180 (±10 days) (T2), during S.C. MTX treatment. Median dose of MTX remained stable during the study (15mg QW). At each visit QoL was measured using EuroQuol-5D (EQ- 5D), adverse events related to MTX use were recorded, and adherence by the number of missed dose. Results: EQ-5D global health assessment showed significant improvement in quality of life of patients on S.C. MTX during the 6 month follow-up (change from T0 to T2 8.6 ; 95%CI 4.00, 13.3), and the same trend was observed in each of its five component. Number of patients who experienced adverse events related to MTX use has decrease after switching from P.O. to S.C.MTX – from 52.1% during the last 3 months on P.O. MTX to 33.3% during the first 3 months and 18.2% during the last 3 months of S.C. MTX use. During the follow- up adherence to MTX therapy improved, with 25% of patients who missed dose during the last 3 months on P.O. MTX use, to 6, 3% and 2.3% with missed dose in the first and the last 3 months on S.C. MTX, respectively. Conclusion: In our group of patients with RA and peripheral PsA who switched from P.O. to S.C. MTX there was a consistent improvement in QoL, less adverse-events and better adherence.

Background: Rheumatoid arthritis (RA) is a chronic and disabling disease with a great impact on the quality of life (QOL). The aim of this study was to assess QOL and health in RA patients treated with biological disease-modifying drugs (bDMARDs) as opposed to those treated with conventional synthetic DMARDs (csDMARDs). We analysed four domains of QOL: physical health (D1), mental health (D2), social relationships (D3) and one's surroundings (D4); as well as general quality of life (W1), general state of health (W2), and disease activity and physical disability. Subjects and methods: Seventy-seven RA patients (group A=29 on bDMARDs, group B= 48 on csDMARDs) were enrolled in the study. QOL was evaluated using WHO questionnaire (WHOQOL-BREF), disease activity using Disease ActivityScore28C-reactive protein (DAS28CRP) and functional status using Health Assessment Questionnaire (HAQ). Results: There was no statistically significant difference of mean values in the four domains of QOL, nor in the general QOL, between groups A and B. There was also no statistically significant difference regarding RA activity (3.51 vrs 3.54, p=0.56). However, we have found that the variable of the general state of health domain was statistically significantly higher in group B (2.66 vrs 2.89, p=0.001), while HAQ was statistically significantly higher in group A (1.19 vrs 1.07, p=0.018), as well as the duration of RA (6.25vrs 3.75 years, p=0.0006). Statistically significant correlation was found between HAQ and W2, disease duration and D3 in group A and DAS28CRP and D1, D2, W2 and HAQ and D1 and D2 in group B. Conclusion: These findings suggest that the inclusion of bDMARDs in the treatment regimen was overdue, with RA already advancing with developed functional disability, which prevented the achievement of the primary goals of treatment: low disease activity or remission and the improvement of patient's QOL.

Background: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic debilitating infl ammatory rheumatic conditions with the major impact on quality of life (QoL). csDMARDs are the basic pharmacological option for these patients, and choice of DMARDs depends on many factors. Objectives: Th e objective of this study was to evaluate the changes in disease activity, QoL, adverse events when switching from oral to subcutaneous methotrexate (MTX) in patients with RA and PsA, addressing also the adherence to treatment. Methods: Th is was an observational prospective longitudinal study of patients with RA and PsA on csDMARDs who switched from oral to s.c. MTX. Consecutive patients with established diagnosis of RA and PsA were enrolled from the outpatient clinics of 6 centres in Croatia. Th ere were 48 patients (79.2% women), of median age 61 (range 39–79), and with the median of disease duration of 120 months. Data were collected at baseline (T0) including retrospective data collection for the previous 3 months (on oral MTX), at day 90 (±10 days) (T1) and at day 180 ((±10 days) (T2) for the previous periods (both of them during s.c. MTX treatment). Dose of MTX remained stable during the study. Domains of interest were: DAS28, level of pain, PtGHA and PhGHA, QoL (EQ 5Q) and physical function (HAQ-DI). Adherence to treatment and safety data were recorded, too. Results: In a comparison between T0 and T1/T2 there was more chance for patients having low to moderate dis ease activity aft er 3 and 6 moths of s.c. MTX (8.0 ; 95%CI 1.9- 32.0) and less chance to have high disease activity (0.25 ; 95%CI 0.11-0.48) in comparison to the baseline DAS 28 (on oral MTX). Adjusted mean values for intensity of pain, PtGHA and PhGHA showed signifi cant decrease for T1 and T2 versus T0 assessment (– 1.46 ; 95%CI –1.55 to –0.35 ; – 1.12 ; 95%CI –1.50 to – 0.73 ; –1.15 ; 95%CI –1.50 to –0.80, respectively). Also, in the same com parison EQ-5D global health showed signifi cant improvement (8.6 ; 95%CI 4.00 to 13.3), as well as HAQ-DI (–0.25 ; 95%CI –0.32 to –0.17). In the retrospective analysis there were more missed doses of oral compared to s.c. MTX, while on the other hand adverse events were less frequent with s.c. compared to oral MTX. Conclusions: In the group of patients with RA and PsA who switched from oral to s.c. MTX improvement was observed in multiple outcomes including disease activity, QoL and safety as well as better adherence.

Rezultati ovog opservacijskog istraživanja iz stvarnog života ukazuju na multiple pozitivne ishode prelaska s oralnog na potkožni oblik MTX.

Tranzitorna migrirajuća osteoporoza rijetka je, nedovoljno prepoznata bolest kostiju, nejasne etiologije. Češće obolijevaju žene u trećem trimestru trudnoće. Obično su zahvaćeni zglobovi koji podnose najveća opterećenja u tijelu. Tijek bolesti je samoograničavajući. Prikazujemo 38.-godišnju bolesnicu u 8. mjesecu trudnoće koja se javlja na prvi pregled u reumatološku ambulantu zbog bolova u gležnjevima koji su započeli 4 mjeseca ranije. Unatoč terapiji NSAR- om su u značajnoj progresiji i bolesnica je vrlo teško pokretna. Inicijalnom obradom utvr-den je blago povišen CRP (6, 1 g/L) dok su ostali rutinski nalazi uredni. Klinički su utvrđene blaže otekline oba TC zgloba, a ultrazvučno mala količina izljeva. Započeto je liječenje glukokortikoidima u niskoj dozi. Bolesnica ih samoinicijativno isključuje zbog neučinkovitosti. Daljnja obrada odgođena je do završetka trudnoće. Po porodu, koji je protekao uredno, bolovi u gležnjevima su i dalje prisutni, a javljaju se i bolovi u koljenima. Radiološki su utvrđene suspektne ostelitičke, mrljaste lezije distalnog femura i proksimalne tibije te stopala. MR-om prikazane su mrljaste, difuzne, konfluirajuće zone koštanog edema distalnog dijela tibije, talusa i tarzalnih kostiju, koje prvenstveno upućuju na regionalnu migrirajuću osteoporozu. Maligna bolest je isključena. Postupno u bolesnice dolazi do spontanog oporavka. Dijagnosticirana tranzitorna migrirajuća osteoporoza ubraja se u skupinu bolesti čija je karakteristika koštani edem. Diferencijalno dijagnostički potrebno je isključiti malignitet, osteomijelitis, stres frakture i avaskularnu nekrozu te ostalu rjeđu patologiju.

The aim of the study was to evaluate the efficacy and safety of biosimilar Inflectra in patients with AS.

Granulomatosis with polyangiitis (Wegener's granulomatosis) is one of the anti-neutrophil cytoplasmic anti-body-associated small vessel vasculitides. Upper and lower respiratory system and kidneys are most commonly affected. The disease is characterized by granulomatous inflammation of the respiratory tract and necrotizing vasculitis of small to medium-sized blood vessels. Most patients show involvement of more than one organ systems at the time of diagnosis, and constitutional symptoms may be present. In around a quarter of patients the disease is initially localised, with involvement of upper respiratory tract or lungs. We report a 21-year-old female patient with chronic rhinitis, saddle nose deformity and subglottic stenosis who presented with inspiratory stridor and impending respiratory failure. Initially, urgent tracheotomy was performed. The patient was diagnosed with granulomatosis with polyangiitis limited to upper respiratory tract. Treatment with glucocorticoids and methotrexate was followed by clinical improvement.

Granulomatoza s poliangiitisom (Wegenerova granulomatoza) ubraja se u vaskulitise malih krvnih žila povezane s antineutrofilnim citoplazmatskim protutijelima. Najčešće su zahvaćeni gornji i donji dišni sustav te bubrezi. Obilježja bolesti uključuju granulomatoznu upalu dišnog sustava i nekrotizirajući vaskulitis malih do srednje velikih krvnih žila. U većine je bolesnika pri postavljanju dijagnoze zahvaćeno više organskih sustava te mogu biti prisutni i opći simptomi, dok je u oko četvrtine bolesnika inicijalno prisutan lokalizirani oblik bolesti sa zahvaćanjem najčešće gornjega dišnog sustava ili pluća. U radu smo prikazali dvadesetjednogodišnju bolesnicu s kroničnim rinitisom, razvojem sedlaste deformacije nosa i subglotičnom stenozom traheje koja je hospitalizirana zbog inspiratornog stridora. Zbog respiratorne insuficijencije učinjena je hitna traheotomija. U bolesnice je dijagnosticirana granulomatoza s poliangiitisom ograničena na gornji dišni sustav. Liječenje glukokortikoidima i metotreksatom dovelo je do kliničkog poboljšanja.

Uvod Liječnik i bolesnik su partneri u procesu liječenja u kojem međusobno razumijevanje i suradnja dovode do boljitka. Pušenje je veliki javnozdravstveni problem koji pred stavlja rizični faktor za pojavu i progresiju reuma toidnog artritisa. CILJ. Ocijeniti partnerski odnos liječnik- bolesnik i suradnjivost bolesnika istražujući učinko vitost usmenog savjeta liječnika na prestanak pušenja bolesnika pušača s reumatoidnim artritisom. VRSTA ISTRAŽIVANJA. Opservacijsko, multicentrično Ispitanici i metode Istraživanje je provedeno u suradnji dva reumatološka odjela. U istraživanje je uključeno devedesetšest bolesnika od reumatoidnog artritisa, 14 muškaraca i 82 žene. O ukupnog broja bolesnika bilo je dvadeset pušača (20.8%) i sedamdesetšest nepušača (79.2%). Pušači su educirani o štetnosti pušenja s naglaskom na činjenicu da pušenje predstavlja rizični čimbenik za pojavu i progresiju reumatoidnog artritisa. Potom im je dat savjet o prestanku pušenja. Rezultati učinkovitosti usmenog savjeta o prestanku pušenja pušača s RA su ana lizirani nakon 1 i 12 mjeseci te su deskriptivno prikazani. Rezultati Nakon usmenog savjeta liječnika o prestanku pušenja u periodu od jednog mjeseca, a potom i nakon godinu dana prestala su pušiti dva bolesnika (10%). Zaključak Usmeni savjet liječnika za prestanak pušenja kod bolesnika, pušača s reumatoidnim artritisom bio je učinkovit kod malog broja bolesnika što potiče pitanje suradljivosti bolesnika. Odnos liječnik- bolesnik je partner ski i može postati još bolji.

Osobe oboljele od sistemskog eritemskog lupusa imaju povećani rizik razvoja smanjene koštane mase zbogosnovne bolesti ili liječenja iste.

Od vrućice nejasne etiologije do visceralne lišmanijaze:prikaz bolesnika

Ponavljajući polihondritis rijetka je progresivna sustavna upalna bolest u kojoj recidivirajuće epizode upale hrskavičnih struktura prouzročuju razaranje hrskavice uha, nosa, dišnog i kardiovaskularnog sustava.

The etiology and epidemiology of obstructive jaundice in Continental Croatia has been studied in 174 patients. The objective of this research was also to explore the importance and efficiency of endoscopic retrograde cholangiopancreatography (ERCP) as a non-surgical method of treatment of obstructive jaundice in the population of Continental Croatia. Obstructive jaundice is the illness of elderly population which is also confirmed by the information on the average age of our patients. The frequency of illness is higher among female population, and the most frequent cause of obstructive jaundice are gallstones (54.1% of patients). In 29.8% of patients the primary or secondary malignant disease was the cause of blockage in gall flow and subsequent jaundice, and the most frequent malignant cause of obstructive jaundice is pancreas cancer in 11.5% of patients. The mean value of serum concentrations of total bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and gamma glutamiltransferase 24 hours before the biliary decompression by ERCP has been significantly above the upper referential value, and 24 hours after the ERCP it has dropped to normal with their statistically significant difference (p < 0.0001). The normal values of markers for synthetic liver function (total proteins and prothrombin time) have been noticed as well as elevated values of inflammatory markers in obstructive jaundice independently of etiology. Out of the total number of patients, 37.7% required the surgical treatment while 60.3% of patients were treated by ERCP, i.e. either the stone extraction or the implantation of endobiliary stent was performed.

Uvod ASAS kriteriji za aksijalne i periferne spondiloartititise su prvi koji uključuju nalaze magnetske rezonancije (MR) sakroilijakalnih (SI) zglobova. Za dijagnozu sakroiliitisa potrebna je prisutnost subhondralnog koštanog edema. Sinovitis, kapsulitis ili entezitis bez koštanog edema nije dovoljan za dijagnozu. Cilj rada Usporediti short tau inversion recovery (STIR) sekvenciju s T1 fat sat (T1 FS) sekvencijom nakon primjene kontrastnog sredstva. Metode i materijali U istraživanje je uključeno 45 pacijenata koji su prezentirani na reumatološko*-radiološkim sastancima te potom upućeni na MR SI zglobova u KB "Dubrava".Snimanje je obavljeno na aparatu od 1, 5 Tesla (Magnetom Avanto, Siemens, Erlangen , Njemačka). Retrospektivno su uspoređene dvije gore navedene sekvencije te su analizirane akutne upalne promjene prema ASAS kriterijima. Rezultati Osam od 45 pacijenata je ispunilo kriterije za dijagnozu sakroiliitisa prema ASAS kriterijima. Od 8 pozivitivnih pacijenata kod 7 nije se dobilo dodatne informacije s upotrebom kontrastnog sredstva. Kod jednog se vidi sinovitis koji se nije prikazao na STIR-u, no osteitis se vidi na obje sekvencije. Zaključak U 44 od 45 pacijenata T1 FS s kontrastim sredstvom nije dao dodatne informacije, a kod jednog pacijenta vidljiv je sinovitis no uz obostani osteitis vidljiv na obje sekvencije. Zaključujemo stoga da je sama STIR sekvencija dovoljna za postavljanje vjerodostojne dijagnoze i kvantifikaciju akutnih upalnih promjena kod sakroileitisa. Stoga bi primjena samo STIR sekvencije pojednostavila pretragu, a ujedno i smanjila (nepotreban) rizik od posljedica primjenjenog kontrastnog sredstva.

Prikazana je 54.godišnja bolesnica sa SLE u koje je utvrđen sekundarni vaskuzlitis velikih krvnih žila kako bismo naglasili važnost preporznavanja i adekvatnog liječenja.

Učinkovitosti i sigurnost primjene TNF-alfa inhibitora u bolesnika s ankilozantnim spondilitisom i totalnom spinalnom ankilozom u Hrvatskoj -jednogodišnje praćenje

U vaskulitise velikih krvnih žila ubrajamo gigantocelularni i Takayasuov arteritis.Gigantocelularni arteritis najčešći je oblik vaskulitisa u odraslih. Glukokortikoidi su osnova liječenja.Takayasuov arteritis je kronični panarteritis aorte i njezinih glavnih grana koji se javlja u mladih osoba. Premda sve velike arterije mogu biti zahvaćene, najčešće su zahvaćene aorta, arterije subklavije i karotidne arterije. Rana dijagnoza i liječenje značajno poboljšavaju ishod bolesti.

Ultrazvuk u dijagnostici i praćenju dermatomiozitisa -prikaz bolesnice

Raynaudov fenomen kao prvi znak maligne bolesti.

Intenzivirana inzulinska terapija dio je standardnih terapijskih protokola za liječenje bolesnika u Jedinicama intenzivnog liječenja. Međutim, intenzivirana inzulinska terapija značajno povećava rizik od hipoglikemije u tih bolesnika. Brojne studije potvrdile su povećanu smrtnost bolesnika koji su tijekom boravka u JIL-u imali jednu ili više epizoda hipoglikemije. upravo stoga trebalo bi izbjegavati hipoglikemije u kritičnih bolesnika u svrhu smanjivanja mortaliteta i morbiditeta kritičnih bolesnika.

Stresna hiperglikemija je definirana kao tranzitorno povišene koncentracije glukoze u plazmi iznad 11, 1 mmol/L. Rezultati brojnih studija govore u prilog povećane bolničke smrtnosti bolesnika sa stresnom hiperglikemijom. Cilj ovog kratkog pregleda je ukazati na važnost uzimanja hiperglikemije pri prijemu bolesnika u bolnicu u obzir kao bitnog prognostičkog čimbenika.

Debljina predstavlja važan javnozdravstveni problem u Hrvatskoj i u svijetu. Smrtnost kritično bolesnih osoba smještenih u Jedinicama intenzivne skrbi značajno varira. Pri tome čini se da, među ostalim, važnu ulogu ima i ndeks tjelesne mase. Rezultati objavljenih studija su kontradiktorni. Međutim, prema svemu sudeći, izrazito mršavi i pretili bolesnici imaju povećani rizik od smrtnosti u Jedinicama intenzivne skrbi. Mjerenje tjelesne težine, odnosno određivanje indeksa tjelesne mase trebalo bi postati standard u Jedinicama intenzivne skrbi.

Introduction: Primary neoplasms of the retroperitoneum are rare and maypose difficulty for the preoperative ethiologic diagnosis. Only a few cases of extragastrointestinal stromal tumor involving mesentery, retroperitoneum and the bladder have been reported. We report a patient with EGIST of the retroperitoneum. Case report: A6 years old man was hospitalised for evaluation of palpable mass in the abdomen. He had history of dyspeptic symptoms standard byochemistry was normal. Diagnostic work up disclosed a large septated cystic mass in retroperitoneal space. Intraoperative evaluation disclosed a well definded mass of 22cm in diameter not adhering to the surrounding tissues and unable a complete resection. Histology and immunohistochemistry disclosed relatively uniform large round sized cells positive for CD 34, vimentin, NSE, CGA and negative for S-100, actin, citokeratin and EMA. These findings were compatible with EGIST. Conclusion: EGIST represents a rare neoplasms, usually appearing as circumscribed masses, but our case presented as a huge cystic mass with solid portion. The diagnosis is confirm with histology and immunohistochemistryof the resected specimen. The reported patient is with large sized EGIST and low mitotic rate, that is significant for clinical outcome of EGIST. After the surgical resection the patient remaind well, during the follow up period of 2 years, without any additional specific drug treatment.

Reumatoidni artritis (RA) je kronična, sistemska, autoimuna upalna bolest nepoznatog uzroka koja zahvaća sinovijalne zglobove, ali i druge organske sustave. Tipično je simetrično zahvaćanje perifernih zglobova s oštećenjem hrskavice i kosti, što može dovesti do teških deformiteta. U oboljelih od RA depresija i depresivni simptomi su česti, a kvaliteta života je niža nego u općoj populaciji. Cilj liječenja RA je postizanje remisije ili niske aktivnosti bolesti uz poboljšanje kvalitete života te smanjenje pojavnosti depresije. U ovom radu ispitana je razlika u kvaliteti života i depresiji između grupe bolesnika koja je postigla remisiju ili nisku aktivnost bolesti i grupe s umjerenom ili visokom aktivnosti bolesti. Istraživanje je provedeno na uzorku od 21 odraslog bolesnika iz Kliničke bolnice Dubrava na Zavodu za kliničku imunologiju, alergologiju i reumatologiju. Određena je aktivnost bolesti pomoću DAS28-CRP indeksa. Prikupljeni su podatci o spolu, dobi, bračnom stanju i stečenoj razini obrazovanja. Kvaliteta života ispitana je pomoću WHOQOL-BREF upitnika koji uključuje domene fizičkog zdravlja, psihičkog zdravlja, društvenih odnosa i okoline, kao i ispitanikovu procjenu općenite kvalitete života i zadovoljstva općim zdravljem. Depresija je ispitana pomoću MADRS upitnika. Rezultati statističke analize nisu pokazali statistički značajnu veću razinu kvalitete života ili nižu razinu depresije u grupi s remisijom ili niskom aktivnosti bolesti u usporedbi s grupom umjerene ili visoke aktivnosti bolesti, što nije u skladu s dosadašnjim istraživanjima., Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disease of unknown cause that affects the synovial joints as well as other organ systems. Symmetrical involvement of peripheral joints with cartilage and bone damage is typical, which can lead to severe deformities. Depression and depressive symptoms are common in RA patients and the quality of life is lower than in the general population. The goal of RA treatment is to achieve remission or low disease activity while improving quality of life and reducing the incidence of depression. In this research, the difference in quality of life and depression between the group of patients who achieved remission or low disease activity and the group with medium or high disease activity was examined. The study was conducted on a sample of 21 adult patients from the Clinical Hospital Dubrava at the Department of Clinical Immunology, Allergology and Rheumatology. Disease activity was calculated using the DAS28-CRP index. Data on gender, age, marital status, and level of education were collected. Quality of life was examined using the WHOQOL-BREF questionnaire which includes the domains of physical health, psychological health, social relationships, and the environment, as well as the respondent's assessment of overall quality of life and satisfaction with general health. Depression was examined using the MADRS questionnaire. The results of the statistical analysis did not show a statistically significant higher level of quality of life or lower level of depression in the group with remission or low disease activity compared to the group with medium or high disease activity, which is not consistent with previous research.

Pojavom pandemije COVID-19, uzrokovane virusom SARS-CoV-2 došlo je do preklapanja s već postojećom pandemijom šećerne bolesti tipa 2, koja je danas jedan od vodećih javnozdravstvenih problema u svijetu. Cilj ovog istraživanja bio je ustanoviti razvijaju li oboljeli od šećerne bolesti težu kliničku sliku s lošijim ishodom infekcije SARS-CoV-2 u usporedbi s bolesnicima koji ne boluju od šećerne bolesti. U prospektivno istraživanje uključeno je 106 osoba, 77,4% muškaraca i 22,6% žena, prosječne dobi 72,83 godine, 34,9% dijabetičara, a 63,2% nedijabetičara. Nije bilo statistički značajne razlike u težini kliničke slike COVID-19 infekcije, tjelesnoj temperaturi ( 80,6% vrs 84,1%, p=0,65), kašlju ( 69,7% vrs 81%, p=0,213), trajanju bolesti dužem od 10 dana ( 20% vrs 25,8%, p=0,614), gubitku njuha ( 87,1% vrs 89,8%, p=0,695), razini C-reaktivnog proteina (CRP) (CRP>100 mg/L, 75,7% vrs 78,8%, p=0,716), plućnim manifestacijama COVID-19 infekcije ( bilateralni infiltrati 97,2% vrs 89,6%, p=0,166), saturaciji hemoglobina kisikom ( SpO2100 pg/mL, 58,1% vrs 25%, p=0,002). Navedeno možemo objasniti jačim imunološkim odgovorom na SARS-CoV-2 infekciju dijabetičara u usporedbi s nedijabetičarima uz hiperprodukciju proupalnog citokina IL-6. S obzirom na mali broj ispitanika svakako su nužna daljnja istraživanja., The outbreak of the COVID-19 pandemic, caused by the SARS-CoV-2 virus, coincided with the already existing pandemic of type 2 diabetes, which is today one of the leading public health problems in the world. The aim of this study was to determine whether diabetics develop a more severe clinical picture with a poorer outcome of SARS-CoV-2 infection compared with non-diabetic patients. The prospective study included 106 people, 77.4% men and 22.6% women; mean age 72.83 years; 34.9% diabetics, and 63.2% non-diabetics. There was no statistically significant difference in the severity of the clinical picture of COVID-19 infection, body temperature (80.6% vs 84.1%, p = 0.65), cough (69.7% vs 81%, p = 0.213), duration disease longer than 10 days (20% vs 25.8%, p = 0.614), olfactory loss (87.1% vs 89.8%, p = 0.695), C-reactive protein (CRP) levels (CRP> 100 mg / L, 75.7% vs 78.8%, p = 0.716), pulmonary manifestations of COVID-19 infection (bilateral infiltrates 97.2% vs 89.6%, p = 0.166), hemoglobin oxygen saturation (SpO2 100 pg / mL, 58.1% vs 25%, p = 0.002 ). There was a statistically significant higher level of interleukin-6 (IL-6) when administered to diabetic patients compared to non-diabetic patients (IL-6> 100 pg / mL, 58.1% vrs 25%, p = 0.002 ). This can be explained by a strong immune response to SARS-CoV-2 infection in diabetics compared with non-diabetics with hyperproduction of the pro-inflammatory cytokine IL-6. Given the small number of respondents, further research is certainly needed.

Imunoglobulin A vaskulitis (IgAV) je sistemski vaskulitis kojeg obilježava taloženje imunoglobulina A (IgA) imunokompleksa u stijenkama malih krvnih žila. Najčešće obolijevaju djeca, dok je u odraslih incidencija znatno niža. Kliničkom slikom dominira palpabilna, netrombocitopenična purpura uz artralgije ili artritis, abdominalnu bol i bubrežnu bolest. Cilj ovog rada bio je istražiti kliničke karakteristike, tijek bolesti i liječenje bolesnika s IgAV u odrasloj dobi. U retrospektivno, kohortno istraživanje uključeno je 18 bolesnika s dijagnozom IgAV prema EULAR/PRINTO/PRES kriterijima koji su liječeni u Kliničkoj bolnici Dubrava na Zavodu za kliničku imunologiju, alergologiju i reumatologiju. U istraživanju je bilo 7 muškaraca i 11 žena, prosječne dobi 56 ± 20 godina, najveće pojavnosti IgAV od 45 do 75 godina. Purpura je bila lokalizirana na donjim ekstremitetima u svih bolesnika, u 7 bolesnika na gornjim ekstremitetima (39%), u 4 bolesnika po trupu (22%), bule je imalo 3 (17%), artralgije 12 (67%), bubrežnu bolest 14 (78%), a bol u trbuhu 6 bolesnika (33%). Recidiva je bilo u 2 bolesnika (11%). Glukokortikoidima (GK) su se liječili svi bolesnici (100%), nesterodinim antireumaticima (NSAR) 10 (56%), topičkim GK 6 (33%), ciklofosfamidom 3 (17%), azatioprinom 1 (6%), dapsonom 1 (6%), inhibitorima angiotenzin-konvertirajućeg enzima (ACEi) 13 (67%), blokatorima angiotenzin II receptora (ARB) 3 bolesnika (17%). Arterijsku hipertenziju je imalo 12 bolesnika (66%), a šećernu bolest 6 (33%). U 11 bolesnika učinjena je biopsija bubrega (61%). Pogoršanja bubrežne funkcije i smrtnih ishoda nije bilo. Rezultati ovog istraživanja su u skladu su s rezultatima dosadašnjih istraživanja prema kojima je IgAV u odraslih rijetka bolest, teže kliničke slike, s najvećom pojavnošću u dobi od 45 do 75 godina, sa češćim zahvaćanjem bubrega, a rjeđim zahvaćanjem zglobova i trbuha u usporedbi s djecom. Bolest je prema dosadašnjim rezultatima češća u muškaraca, dok je u našem istraživanju učestalija u žena. GK su temelj u liječenju IgAV uz rjeđu primjenu imunosupresiva. Često se u terapiji koriste ACEi i ARB zbog IgA nefritisa i arterijske hipertenzije kao najčešćeg komorbiditeta. U istraživanje nismo uključili odrasle oboljele od IgAV s blažom kliničkom slikom koji su provodili liječenje u kućnim uvjetima, što je uz mali broj bolesnika glavni nedostatak ovog istraživanja. U skrbi odraslih oboljelih od IgAV nedostaju podaci kliničkih istraživanja o karakteristikama bolesti kao i preporuke i jednoglasni stavovi krovnih društava vezano za obradu i liječenje., Immunoglobulin A vasculitis (IgAV) is a systemic vasculitis characterised by immunoglobulin A (IgA) immunocomplex deposits found in the walls of small blood vessels. The incidence of IgAV is significantly higher in children compared to adults. Patients mainly present with palpable non-thrombocytopenic purpura that can be followed by arthralgia or arthritis, abdominal pain and kidney disease. The aim of this paper was to investigate the clinical features, disease progression and treatment of adult IgAV patients. This retrospective cohort study included a total number of 18 patients diagnosed according to the EULAR/PRINTO/PRES criteria and treated in Clinical Hospital Dubrava at the Division of Clinical Immunology, Allergology and Rheumatology. The study included 7 men and 11 women. The age average was 56 ± 20 years. The highest incidence was in the group between 45 and 75 years. All patients presented with purpura of the lower extremities, whereas 7 had purpura of the upper extremities (39%) and 4 had purpura of the corpus (22%). Bullae were reported in 3 patients (17%), arthralgia in 12 patients (67%), kidney disease in 14 patients (78%) and abdominal pain in 6 patients (33%). A relapse occured in 2 patients (11%). All patients (100%) were treated with glucocorticoids, 10 patients with nonsteroidal anti-inflammatory drugs (56%), 6 patients with topical glucocorticoids (33%), 3 patients with cyclophosphamide (17%), 1 patient with azathioprine (6%) and 1 with dapsone (6%), 13 patients (67%) with angiotensin-converting enzyme inhibitors (ACEi) and 3 patients (17%) with angiotensin II receptor blockers (ARB). Arterial hypertension was reported as a comorbidity in 12 patients (66%) and diabetes in 6 patients (33%). Kidney biopsy was performed in 11 patients (61%). There were no deaths or kidney disease exacerbations. The results of this paper are in line with other recently conducted studies, according to which IgAV in the adult population is a rare disease with a relatively worse clinical presentation than in children, with the greatest risk at the age between 45 and 75y. Furthermore, kidney disease is more common, whereas abdominal or joint involvement is less common in adults than in children. According to other literature available, IgAV is more common in men, however, in this research it is more common in women. Glucocorticoids are the basis of IgAV patient treatment with a comparatively less frequent use of immunosuppressive drugs. The study did not include adult IgAV patients with milder clinical presentations treated in home conditions, which is, alongside a small number of patients, the main limitation of this research. There is a lack of clinical research regarding the clinical characteristics of adult IgAV, as well as recommendations of an optimal diagnostic and treatment plan.