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Circle of Willis (CoW) is located at the base of the brain, around the optic chiasm and other structures of the interpeduncular fossa. There are other studies in which the „circle of Willis" is not considered a circle, but an arterial polygon with a variable number of sides (from six to ten) depending on the author. Circle of Willis is composed of an anterior arch, which derived from the internal carotid artery and is made of the two paired anterior cerebral arteries and anterior communicating artery, and a posterior arch, made of posterior cerebral artery originating in the vertebrobasilar system, and the two paired posterior communicating arteries, having their origin in the internal carotid system. In this paper we present a comprehensive review of the data regarding the anatomical course and morphological aspects of each of the arteries constituting the circle of Willis, along with their anatomical variants and the pathology that emerged from these anomalies, pointing out their significance for the clinicians. [ABSTRACT FROM AUTHOR]

The white adipose tissue is no longer regarded as merely a means of storing excess energy. Presently recognized for their active and dynamic secretory activity, adipocytes are capable of releasing a plethora of molecules involved in maintaining global homeostasis. Connective tissue diseases, such as systemic lupus erythematosus, idiopathic inflammatory myopathies and systemic sclerosis encompass potentially severe multi-system involvement achieved through intricate pathogenic mechanisms. Autoimmunity holds a clear and central part in the development of these conditions. Adipokines (or adipocytokines) are peptides or proteins released by the adipose tissue. Data regarding the influence of adipokines on the pathogenesis of connective tissue diseases is currently insufficient, studies often reporting discrepant results. However, the proven impact of adipokines on the modulation of inflammatory processes raises the issue of developing new therapeutic solutions with potentially beneficial effects on disease-related changes under autoimmune conditions. [ABSTRACT FROM AUTHOR]

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Connective tissue diseases (CTD) are a clinically and serologically diverse group of chronic immuno-inflammatory conditions whose complex pathomechanisms remain largely undefined. Adipokines (adipocitokines) are peptides or proteins which exhibit potential immunomodulatory properties. Recently, it has been stated that the secretory activity of white adipose tissue could play a notable role in the development or progression of certain types of disease-related organ injury in CTD, as demonstrated in both human subjects as well as animal models. In systemic lupus erythematosus, cathepsin-S and chemerin titers have been found to be higher in patients with neuropsychiartric manifestations, whereas omentin-1 levels has been found to have a lower expression in patients without kidney involvement. Moreover, the blockade of the cathepsin-S signaling pathway has been shown to associate with favorable outcomes in murine models of lupus nephritis. Research showed that patients with dermatomyositis may exhibit elevated circulating values of adiponectin and resistin, but not leptin. Additionally, visfatin gene expression was found to be higher in both adult and pediatric patients with dermatomyositis compared to healhy controls. In animal models of systemic sclerosis, adiponectin (which is thought to be a predominantly anti-inflammatory adipokine) has been associated with reduced fibrotic changes. While the results reported in the currently available literature do not imply causation, the issue of elucidating the link between adipokine expression and CTD pathogenesis remains intriguing. [ABSTRACT FROM AUTHOR]

Alkaptonuria is a rare disorder, an autosomal recessive condition with genetic determinism and hereditary transmission, having a prevalence of 1 per 1 million population in USA. The pathogenesis includes the deficiency of the homogentisate 1,2-dioxygenase (HGD) enzyme, an intermediary enzyme in phenylalanine and tyrosine catabolism. Mutations in HGD gene leads to deficient levels of functional HGD and an excess of homogentisic acid (HGA). Although HGA is rapidly excreted by the kidneys, it slowly accumulates in various tissues. Due to HGA oxidase deficiency, HGA turns into melanin- like pigment which determines: alkaptonuria, accumulation in the connective tissues, in the joints, or can make cardiovascular and genitourinary deposits. The chronic accumulation of HGA destroys the affected tissue, leading to the characteristic black-blue colour and to clinical symptoms of alkaptonuria. The aim of this paper is to investigate the particularities of rheumatic manifestations in a rare metabolic disease and to support the correct diagnosis. A 58-year-old male patient was admitted to our clinic in 2019 for bilateral knee and left shoulder pain. In 2008 he was diagnosed with polyarticular ochronosis having dorsal and lumbar pain, mixed scapulohumeral pain, lumbar intervertebral disk calcifications; at that time, a diagnosis of ankylosing spondylitis or Forestier disease was excluded. At the current admission, the patient has been thoroughly reassessed to obtain a proper diagnosis and to determine the severity of the disease. The ochronotic axial damage caused important differential diagnosis problems with ankylosing spondylitis. Pigment deposition in the eyes, ears and skin does not cause problems to patients, but cardiovascular and genitourinary deposition leads to important complications. Kinetotherapy and NSAIDs are beneficial for pain symptoms. There is no specific medication for stopping the disease progression. Conclusions. Ochronosis is a rare disease which can cause a lot of problems regarding a proper diagnosis and treatment. When differential diagnosis with AS is difficult, the HLA-B27 genotyping is recommended. Final diagnosis is based on qualitative and quantitative urinary tests. The treatment includes only symptomatic drugs such as NSAIDs and kinetotherapy to improve joint mobility and muscle toning. [ABSTRACT FROM AUTHOR]

Aim. The present study aimed primarily to assess COVID-19 (COronaVIrus Disease 2019) course and management in unvaccinated patients with rheumatoid arthritis (RA). Secondary objectives included an analysis of the impact of RA disease activity, age, comorbidities, and DMARD treatment on COVID-19 course. Materials and methods. We performed a prospective observational study on RA patients in the 1st Rheumatology Clinic of the Clinical Rehabilitation Hospital between February and July 2021. The criteria for inclusion in the study cohort were: confirmed RA diagnosis and SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection confirmed by rapid antigen test and/or RT-PCR (Real-Time Polymerase Chain Reaction) during hospitalization in our department. We excluded the patients who were vaccinated against SARS-CoV-2 and those with incomplete data regarding COVID-19 clinical features and management. Demographic characteristics, DAS28 (Disease Activity Score 28) and the treatment prior to SARS-CoV-2 infection, as well as the patients’ comorbidities were taken from the subjects’ charts completed on presentation in the 1st Rheumatology Clinic. COVID-19-related data were collected from the patients’ release forms from specialized departments. Results. The study group included 28 unvaccinated patients with RA who tested positive for SARS-CoV-2. All patients over 65 years of age were symptomatic for COVID-19. Moreover, this subgroup had an increased risk of pneumonia (p = 0.047) and a 217% risk increase for desaturation. Comorbid type 2 diabetes mellitus was associated with COVID-19 pneumonia (p = 0.048). Women needed less antiaggregant and anticoagulant medication (p = 0.029), antitussives (p = 0.014) and oxygen therapy (p = 0.044) compared to men. Patients with comorbid heart failure, valvulopathies and cardiac ischemia were more likely to require antiaggregant or anticoagulant medication during hospitalization for COVID-19 (p = 0.003, p = 0.013, and p < 0.001). DAS28 ≥ 5.1 prior to infection was associated with Tocilizumab therapy for COVID-19 pneumonia, results approaching statistical significance in this respect. Conclusions. In the present study group, we found significant associations between COVID-19-related changes and advanced age, as well as certain comorbidities. Large comprehensive longitudinal studies may provide a more accurate representation of COVID-19 outcomes in unvaccinated patients with RA. [ABSTRACT FROM AUTHOR]

Since the first case was reported to the World Health Organization (in late December 2019 in Wuhan, Hubei Province, China), by mid-June 2021, there have been 175,541,600 confirmed cases of COVID-19 globally, including 3,798,361 reported deaths. Many of those infected with SARS-CoV-2 have an asymptomatic form of the disease or mild flu-like symptoms. In another category of patients, the disease may be more aggressive, with a severe form that can lead to acute respiratory distress syndrome (ARDS), respiratory failure, and even death with a negative impact on patients. The COVID-19 pandemic has arisen serious concerns in the rheumatology community regarding the management of immunosuppressed patients diagnosed with inflammatory rheumatic diseases. It has been stated that severe forms of COVID-19 occur as a result of exacerbated inflammation status and cytokine production. Nevertheless, it remains unclear whether the use of biological agents subjects the patient to a higher risk, or rather protects them against severe forms of the disease. According to the American College of Rheumatology, rheumatic diseases were not identified as a risk factor that predicted poor outcome in patients with COVID-19. However, various studies have certified that corticosteroid treatment in patients with chronic rheumatic diseases at a dose >10 mg/day is associated with an increased risk of infection as well as the possibility of developing more severe COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

Objective: The study was conducted to determine the conditions that may impair the quality of life in patients with rheumatoid arthritis. Material and Method: 75 subjects with the established diagnosis of rheumatoid arthritis according to American College of Rheumatology revised criteria were included in the study. Demographic data, duration of illness and number of hospital admissions were recorded. Patients were psychological tested in order to assess quality of life, depression and anxiety level. Results: Sociodemographic data and duration of disease did not significantly influence the quality of life in patients with rheumatoid arthritis. Statistical analyses showed that the presence of anxiety and depression inversely correlate with the domains of quality of life. Moreover, it seems that dimensions of quality of life instrument predict depression and anxiety. Conclusion: Considering that both anxiety and depression are treatable medical conditions and that there are frequently associated with rheumatoid arthritis, a screening for anxiety and depression in rheumatoid arthritis may be mandatory. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the rate of serious infections in rheumatic patients treated with tumour necrosis factor (TNF)α blockers, in daily practice. Methods. Retrospective, observational study was conducted in 11 centres (27 rheumatologist) of all patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis receiving at least one TNFα blocker, between January 1990 and June 2010. Serious infections were defined as life-threatening, requiring parenteral antibiotics and/or hospitalisation. Results. Among the 693 patients treated with at least one TNFα blocker, 71% had rheumatoid arthritis, 19.8% had ankylosing spondylitis and 9.2% had psoriatic arthritis; 31 infections in 27 patients [3.9% (95%CI 2.6-56.3)] fulfilled the definition of serious infections. The prevalence rate is 4.67% (95% CI 3.05-7.11) in rheumatoid arthritis patients, 2.19% (95% CI 0.07-6.56) in psoriatic arthritis and 1.56% (95% CI 0.02-7.79) in ankylosing spondylitis group. Mean duration was 22.9 months from TNFα blockers initiation to onset of severe infections. During the first six months of biological treatment were diagnosed 32% of these infections. The most frequent sites were lower respiratory tract (35.5%) and skin (16.1%). Bacterial agents were identified in 46% of infections. Index number used for reporting severe infections per 1000 patient-years, it was 2.62/1.60, respectively 0.72 for adalimumab / infliximab, etanercept, respectively, in the group with RA. Adalimumab and etanercept respectively, introduced recently in clinical practice, were responsible for 11.11 patient-years severe/1000 infections in ankylosing spondylitis group and 58.82 respectively cazuri/1000 patient-years in patients with AP group. Conclusion: Serious infections during TNFα blockers treatment are frequent in daily practice and close monitoring is required. [ABSTRACT FROM AUTHOR]

LDL-Cholesterol (LDL-C) is a well-known risk factor for cardiovascular disease. Although statins are the mainstream treatment for lowering LDL-C level, additional LDL-lowering therapies are needed to reduce residual cardiovascular risk, especially in patients at very high risk, or with hereditary lipid disorderes or statin intolerance. The proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator for LDL-Receptor activity and an attractive target for the treatment of hypercholesterolaemia. From its discovery in 2003, several therapeutic approaches to the inhibition of PCSk9 have been proposed. Monclonal antibodies that bind to PCSJ9 received marketing approval in 2015 (alirocumab and evolucumab) or are being evaluated in phase III trials (bococizumab). Many other molecules are in preclinical studies, phase I or II clinical trials. Another point of interest carefully investigated is the cardiovascular benefit of reducing LDL-C using these new molecules. High hopes are invested in them.

Aim of the Study: to gather clinical and laboratory data on rheumatoid arthritis patients with cervical spine damage (incidence and prevalence, correlation between duration of disease and the time of lesion onset, to assess signs and symptoms and the role of laboratory investigations). The spine is an axial organ with an important role in support and resistance. It is a pillar with a very complex morphological and functional structure. The vertebral column is crossed by many kinematic chains. The main problem of the cervical spine caused by rheumatoid arthritis is cervical instability which describes all cervical lesions that can lead to neurovascular damage or major disturbance of pain generating statics at movement. The evolving disease shows chronic inflammation of the synovium, which is a self-maintained process and an immunologically induced phenomenon. The chronic inflammation of the synovium forms granulation tissue that invades peripheral joints towards the center and causes ligament cartilage and bone damage., Material and Methods: The present paper investigated cervical spine lesions in 107 rheumatoid arthritis patients who were admitted to the 1st Rheumatology Clinic of Iasi Rehabilitation Hospital between January 2013 and December 2014. Our study focused on assessing signs and symptoms seen in spine affected by rheumatic disease., Results and Discussions: the disease causes destructive lesions due to granulomatous infiltration of rachidian structures and medullary sheaths. These lesions lead to damaged discs and instability that produces subluxations and dislocations. The suboccipital region is most affected; in other regions of the spine, high lesions of C4-C5 prevail, where osteolysis damage of spinal apophyses are found. In atlas and axis joints, rheumatoid arthritis causes the inflammation of bursa, synovium and joint capsule and leads to synovial pannus formation. This causes the destruction of cartilage and subchondral bone. Atlantoaxial dislocation is caused by erosive synovitis of atlanto-epistrophic joint, atlanto-odontoid joint and serous bursitis separating the odontoid process from the transverse ligament., Conclusions: The dominant symptom of cervical spine damage was pain associated with stiffness and limited joint mobility, muscle stiffness, poor posture.

Polymyositis is an idiopathic inflammatory myopathy of unknown aetiology that affect skeletal muscles causing symmetrical, proximal muscle weakness, and also other internal organs. The investigations reveal elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Pulmonary involvement in polymyositis includes respiratory muscle weakness, aspiration pneumonia, interstitial lung disease, infection and drug-induced pneumonia. We expose the case of a young woman (47 years old) who presented to the Pulmonology Clinic with fever, cough, purulent sputum, discrete myalgia, being diagnosed at that moment with interstitial lung disease and treated with antibiotics, low dose of corticosteroids and symptomatic drugs. The evolution was slowly favorable for the respiratory impairment, but the patient developed exacerbated myalgia, muscle weakness, reaching even the impossibility of maintaining orthostatism, and also joint pain. Biological investigations revealed an important hepatocytolysis syndrome and also increased levels of muscle enzyme. The hypothetical diagnosis was polymyositis and to sustain this theory it was performed a muscle biopsy. The patient was transferred afterwards to the Rheumatology Clinic, in order to perform other specific investigations. In our clinic the patient maintained elevated levels of skeletal muscle enzymes and the muscle biopsy revealed polymyositis findings. Also immunological investigations objectified the presence of Jo1 antibodies. Therefore we pleaded for the diagnosis of idiopathic polymyositis, acute form. A multidisciplinary approach is needed in order to establish an accurate diagnosis and to institute a proper treatment.

The current view is that systemic inflammation, which is specific to all chronic inflammatory rheumatic diseases (CIRD), accelerates atherogenesis; this hypothesis is supported by the high cardiovascular (CV) morbidity and mortality rates and the high prevalence of all atherosclerosis stages and complications in CIRD patients. The assessment of traditional CV risk factors underestimates the actual risk in patients with CIRD. A comprehensive evaluation and follow-up of both traditional and non-traditional CV risk factors, as well as the correct classification of risk reduction categories are necessary. Imaging techniques (e.g. carotid intima-media thickness and flow-mediated vasodilation) can be used for the early diagnosis of endothelial dysfunction. Immunologic and metabolic markers (anti-cyclic citrullinated peptide (CCP) antibodies, IgM rheumatoid factor, circulating immune complexes, proinflammatory cytokines, TH0/TH1 lymphocytes and homocysteine) may be involved in the atherosclerotic disease development specific to CIRD. A modern therapeutic approach should include the early diagnosis of endothelial dysfunction and atherosclerosis, treatment of CIRD, specific medication designed to control atherosclerosis, changes in patient lifestyle and periodic follow-ups. The assessment and diagnosis of traditional and non-traditional CV risk factors, followed by aggressive prevention and therapy, are necessary to achieve efficient control over the inflammation, immunologic and metabolic disorders specific to CIRD.

Aim: The paper aims to determine the prevalence of clinical cases with acute gout attacks and normal serum uric acid levels., Material and Methods: This retrospective study was conducted between October, 2013 and June, 2014 in 30 patients diagnosed with acute gout attack admitted to the 1st Clinic of Rheumatology of Iasi. The diagnosis was based on clinical manifestations and positive response to therapeutic test with colchicine., Results: Normal serum uric acid levels were found in 63.3% of the patients with acute gout attack. The inflammatory syndrome was detected in 76.6% of patients with high erythrocyte sedimentation rate (ESR) levels and in 30% of patients who had elevated C-reactive protein levels. The urinary excretion of uric acid was measured in 11 patients and it was found increased in 55% of them., Conclusions: The diagnosis of acute gout attack should not be excluded in the presence of normal serum uric acid levels if the clinical manifestations or the positive response at colchicine are suggestive of gout. The low uric acid level is correlated with increased inflammatory factors and urinary excretion of uric acid.

Unlabelled: Some epidemiological studies have begun to show a possible correlation between systemic and vascular inflammation and the presence of essential hypertension, especially if it is associated with metabolic risk factors (obesity, dyslipidemia, diabetes mellitus)., Objectives: The objective of this study was to evaluate the levels of C-reactive protein and fibrinogen as markers of inflammation in patients with essential hypertension, with or without associated metabolic risk factors., Material and Methods: The retrospective study included 200 patients separated into five groups (control, hypertension, and respectively hypertension associated with obesity, or diabetes mellitus type II non-obese or obese type II diabetes). Anamnestic and anthropometric data, blood pressure and heart rate, blood glucose, lipid profile, fibrinogen, quantitative C-reactive protein and echocardiographic parameters have been reported and compared between groups., Results: Our study evaluated a total of 110 women and 90 men, each of the five groups comprising a total of 22 (55%) women and 18 (45%) males. Study of the inflammatory syndrome found the highest values of CRP in hypertensive and obese patients: 1.56 +/- 3.08 (p = 0.014) in group 3 and 0.92 +/- 1.11 (p = 0.001) in group 5 versus control group (0.30 +/- 0.36). Fibrinogen values were significantly elevated in all groups of hypertensive, demonstrating the existence of an inflammatory syndrome, even in the absence of obesity or diabetes., Conclusions: All the patients showed a statistically significant relationship between elevated CRP and fibrinogen levels and the presence of hypertension, isolated, or in combination with obesity and diabetes mellitus.

Chronic virus C hepatitis records high prevalence, almost 170 million people worldwide being infected. Systemic involvement is frequent and the implication of the osteoarticular system raises various problems in properly diagnosing and treating it. Rheumatoid arthritis is the most frequent type of inflammatory polyarthritis, with a prevalence of 0.8% in the general population. The rheumatoid factor recorded high values at virus C hepatitis patients (19-80%) even in the absence of articular manifestations, its sensitivity and specificity being reduced for the rheumatoid arthritis diagnosed simultaneous with virus C hepatitis. We report a case of chronic virus C hepatitis patient which, after 30 years of evolution, presents the onset of senile rheumatoid polyarthritis. The authors discuss the usefulness dosage of anti-cyclic citrullinated peptide antibodies for establishing the differential diagnosis between rheumatoid arthritis and hepatitis C-related arthropathy and the particularities of the specific treatment when there is a hepatitis C virus associated infection.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), doesn't affect only the intestinal tract, but also involve other organs such as: eyes, skin, joints, liver and biliary tracts, kidneys, lungs, vascular system. It is difficult to differentiate the true extraintestinal manifestations from secondary extraintestinal complications. The pathogenetic autoimmune mechanisms include genetic susceptibility, antigenic display of autoantigen, aberrant self-recognition and immunopathogenetic autoantibodies against organ-specific cellular antigens shared by colon and extra-colonic organs. An important role is owned by microbes due to molecular mimicry. This paper reviews the frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases.

Unlabelled: Nowadays gait analysis represent a modern technique used as a useful tool in the assessment of patients with locomotors disease., Aim: To make a differentiation of patients with chronic sciatica due to disc hernia using gait analysis techniques., Material and Method: Study was prospective, with consecutive selection of subjects according to eligibility criteria, using a control group. The number of subjects was 47: 28 patients and 19 healthy subjects. The patients were characterized clinically, imagistically and biomechanically. The biomechanically evaluation was made with VICON MX optical motion capture system. Our data of interest were: temporo-spatial and kinematic parameters. These data were factorial analyzed with a principal component extraction technique, resulting 10 variables, which characterized the system variability in 94.67%. Next step was represented by a hierarchical cluster analysis for sub-group identification., Results: We have differentiated two clusters. The two clusters were individualized regarding the temporo-spatial parameters (opposite foot contact, step width) as well as the kinematic parameters (maximum upward rotation in stance of pelvis, maximum adduction of the hip in stance, maximum abduction of the hip in swing, maximum plantar flexion angle in swing, total sagittal plane excursion of the ankle)., Conclusions: The two clusters can be defined as following: cluster 1: reduced stance phase and mainly distal problems (of the ankle); cluster 2: normal stance phase duration, severely low step width and mainly proximal problems (pelvic belt).

Tuberculosis remains one of the most important infectious disease worldwide and skeletal form has an incidence between 3% and 10%, depending on geographic area. The thoracolumbar junction is the most commonly involved in vertebral tuberculosis; some radiologic features are specifics, but other could be indistinguishable from that of lymphoma or metastases. We discuss the case of a 80-year-old man presented with a 2-month history of thoracolumbar pain, fatigability and fever. The vertebral radiography showed narrowing of the intervertebral disc space between T1 and T12, adjacent irregularity, erosion and lisis of vertebres, features visibles also on computed tomography. After the exclusion of the other causes of osteolisis, we started a standard regimen of tuberculostatic treatment and after one month of treatment the symptoms of patient improved noticeably. Other problems of diagnostic and treatment modalities of spinal tuberculosis are discussed.

Unlabelled: The authors present the results of some evaluations on the efficiency of pharmacologic therapy for 111 pacients suffering from ankylosing spondylarthritis (AS)., Results: The pacients have been assisted for five years in a specialized hospital. 63.9% out of all were over 30 years old and 46.8% were workers in industry and agriculture. Regarding the frequency of usage, the therapy included the following medicine: movalis, salasopyrine, diclophenac, flamezin, aulin, tilcotil, almiral, and others. After the therapy, during the study period, cumulative, the condition of 62.2% of the pacients improved. The condition of 22.5% remained stationary, and 6.3% got worse.

Material and Method: A retro-prospective study was carried out on a sample of 678 patients suffering from ankylosing spondilitis (AS), admitted in the Clinic of Rheumatology, Rehabilitation Hospital, Iaşi., Results: The analysis highlighted that 86.8% were males, with a soft predominance of urban area (57.1%). Over 50% of the entire sample was exposed to risk factors from industrial area; 11.6% from agriculture; 10.5%--various categories of intellectuals, and 17.8% included domestic and socioeconomic activities, difficult to estimate. Analysis of temporal interval between onset and diagnosis establishment attested that it was been performed during the first year for 42.7%; next 2-9 years, for 40.1%, and in 17.5% of cases, 10 and over 21 years., Conclusion: Difficulties in early diagnosis achievement, in order to obtain optimal therapeutic results and, consequently, reduce the important impact on patient, family and society, placed AS among diseases with serious medical, social and economic involvements.

Unlabelled: Numerous studies demonstrate the high specificity (90-98%) of the anticyclic citrullinated antibodies (antiCCP) in rheumatoid arthritis (RA) and their correlation with the erosive arthritis, these antibodies being a disease activity marker and a prognostic factor., Material and Methods: A total of 53 RA patients (48 women, 5 men), mean age 47.3 years old, diagnosed according to the ACR criteria were evaluated. The clinical evaluation was centered upon: tender joint count, swollen joint count, patient pain (VAS), morning stiffness and disease activity score (DAS28). The laboratory tests had in view: the inflammatory syndrome, blood count, immunological syndrome (antinuclear antibodies, rheumatoid factor, antiCCP antibodies), radiographs of the hands and feet., Results: The high levels of the anti-CCP antibodies founded in 28 patients with RA were correlated with severity of the inflammatory syndrome, the immunological abnormalities and with the precocity appearance of the joint erosions., Conclusions: The presence of the anti-CCP antibodies at patients with RA are correlated with severe joint destruction and it represents a marker of the disease activity and progression.

In rheumatic diseases there can appear deteriorations of the thrombocytes number in the sense of increase or decrease of this number.Thrombocytosis has 3 major causes: (1) reactive or secondary thrombocytosis; (2) family thrombocytosis and (3) clonal thrombocytosis. Thrombocytopenia, that is, decrease of the thrombocytes number below 150000/mmc is unusually in rheumatic diseases. Their mechanism of production can be central and peripheral. In the connective tissue disorders and vasculitis thrombocytopenia can has different causes: (1) decrease thrombocytes production; (2) splenic platelets sequestration; (3) peripheral platelets consumption; (4) peripheral immune mediated destruction of platelets. Thrombocytopenia is present in the following rheumatic diseases: systemic lupus erythematosus, antiphospholipid syndrome, rheumatoid arthritis, Felty syndrome, vasculitis. Steroids are the conventional first line therapy for immune thrombocytopenia. Corticosteroid resistance can develop as a result of deteriorations that appear to the any level of pathway action of corticosteroids.

A 39-years-old woman was admitted to our hospital with musculoskeletal complaints (myalgias and symmetric arthralgias in proximal interphalangeal, metacarpophalangeal joints of the hands and in knees), systemic symptoms like fever, fatigue, malaise and a six months previous history of a transient ischemic attack. The presence of antibodies to double-stranded deoxyribonucleic-acid (DNA) and antiphospholipid antibodies led to the diagnosis of systemic lupus erythematosus with secondary antiphospholipid syndrome. Cerebral infarction develops significantly more often in patients with lupus and antiphospholipid antibodies, but other clinical syndromes are associated with lupus anticoagulant: cognitive dysfunction, seizures, polyneuropathy, aseptic meningitis, myelopathy.

ANOVA is the abbreviation of the ANalysis Of Variance. It was developed for inferences concerning more than two populations. The tested hypothesis is the equality of the means of several normal populations. Some mathematical aspects are presented and also advantages and drawbacks of the method are marked out. Finally a practical example (implementing the ANOVA test) using the SPSS statistical software and also Microsoft Excel are shown.

Alcoholic cardiomyopathy (ACM), a principal form of secondary dilated cardiomyopathy, can ensue from heavy consumption of alcohol over a long period of time. In harmful consumption, alcohol and its metabolites has a toxic effect on heart muscle cells. The clinical features include dilatation of the left ventricle, poor myocardial contractility and symptoms of heart failure. The heart and lung X-ray examination is required in all disease stages. The information gathered from this cheap and noninvasive investigation method, are very important in the diagnosis algorithm. In the ACM stages beginning, before the installation of the heart failure symptoms, it is possible to found normal dimensions of the heart, which is compatible with the alcoholic cardiomyopathy diagnosis. Specific for dilated alcoholic cardiomyopathy is the reversible character of cardiomegaly, objectified through the reduction of the cardio-thoracic index in conditions of alcohol abstinence and adequate treatment of the heart failure.