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Kwiatkowska B, Krajewska-Włodarczyk M, Batko B, Maślińska M, Stajszczyk M, Świerkot J, Wiland P, Żuber Z, Tomasiewicz K. COVID-19 prophylaxis, diagnostics, and treatment in patients with rheumatic diseases. The Polish experts panel opinion. Reumatologia 2024; 62:4-17. [PMID: 38558893 PMCID: PMC10979375 DOI: 10.5114/reum/183469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolves, infection management in vulnerable populations requires formalized guidance. Although low-virulence variants of SARS-CoV-2 remain predominant, they pose an increased risk of severe illness in adults with rheumatic and musculoskeletal diseases (RMDs). Several disease-specific (chronic long-grade inflammation, concomitant immunosuppression) and individual (advanced age, multimorbidity, pregnancy, vaccination status) factors contribute to excess risk in RMD populations. Various post-COVID-19 manifestations are also increasingly reported and appear more commonly than in the general population. At a pathogenetic level, complex interplay involving innate and acquired immune dysregulation, viral persistence, and genetic predisposition shapes a unique susceptibility profile. Moreover, incident cases of SARS-CoV-2 infection as a trigger factor for the development of autoimmune conditions have been reported. Vaccination remains a key preventive strategy, and encouraging active education and awareness will be crucial for rheumatologists in the upcoming years. In patients with RMDs, COVID-19 vaccines' benefits outweigh the risks. Derivation of specialized diagnostic and therapeutic protocols within a comprehensive COVID-19 care plan represents an ideal scenario for healthcare system organization. Vigilance for symptoms of infection and rapid diagnosis are key for introducing antiviral treatment in patients with RMDs in a timely manner. This review provides updated guidance on optimal immunization, diagnosis, and antiviral treatment strategies.
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Affiliation(s)
- Brygida Kwiatkowska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Maria Maślińska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustron, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Zbigniew Żuber
- Department of Rheumatology, St. Louis Voivodeship Specialist Children’s Hospital, Krakow, Poland
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Felis-Giemza A, Moskal M, Proc K, Guzera Z, Stajszczyk M, Palej K, Chmurzyńska K, Wiland P, Batko K, Batko B. Multicenter evaluation of tofacitinib retention and safety in rheumatoid arthritis - why cardiovascular risk factors do not equate to overt risk. Reumatologia 2024; 61:414-423. [PMID: 38322101 PMCID: PMC10839916 DOI: 10.5114/reum/175626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction This multicenter, real-world, retrospective cohort study aimed to assess the effectiveness and safety of tofacitinib (TOFA) in rheumatoid arthritis (RA). Material and methods Two hundred nine patients with active RA treated with TOFA, unresponsive to at least 2 conventional synthetic disease-modifying drugs, were recruited. Clinical characteristics were extracted from an electronic registry and supplemented with manual chart review and data linkage with ambulatory care. Drug retention and reasons for discontinuation were evaluated. Results Median (interquartile range) follow-up in the whole sample was 16.9 (5.93-31.7) months. Mean (standard deviation) age was 51.44 (±11.84) years, with female predominance (n = 168, 80.4%). Only 30 patients (14.4%) had no pre-existing traditional cardiovascular (CV) risk factor at TOFA initiation. Tofacitinib retention rates were high, with median survival estimated at 89.3% at 6 months, 82.4% at 12 months, and 60.4% at 24 months. Ineffectiveness was the primary cause of discontinuation (n = 50). The rate of adverse events (AEs) was relatively low, with lipid abnormalities, blood count alterations, and infectious events among the most common. No major adverse CV event was reported. The incidence rate of AEs necessitating treatment switch was 60.34 (95% CI: 37-92) per 1,000 person-years of follow-up. Presence of multiple (> 3) CV risk factors was associated with lower odds of TOFA retention and treatment effectiveness. Conclusions Tofacitinib demonstrated high retention rates and a favorable safety profile in RA patients, including those with traditional CV risk factors. Tofacitinib may be a valuable treatment option for RA patients when combined with individualized CV risk management. Further studies are warranted to explore the long-term effects of TOFA and its CV impact in larger populations.
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Affiliation(s)
- Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Mateusz Moskal
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Krzysztof Proc
- Clinical Department of Rheumatology and Internal Medicine, University Clinical Hospital in Wroclaw, Poland
| | - Zbigniew Guzera
- Świętokrzyskie Centrum Reumatologii, St. Luke Hospital, Konskie, Poland
| | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustron, Poland
| | - Karolina Palej
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Kornelia Chmurzyńska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Batko
- Department of Research and Development, Medicine Economy Law Society (MELS) Foundation, Krakow, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
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Stajszczyk M, Kwiatkowska B, Żuber ZM, Batko B. Access to biologics and JAK inhibitors for the treatment of rheumatic diseases in the biosimilars era in Poland: nation-level study. Pol Arch Intern Med 2024:16655. [PMID: 38165391 DOI: 10.20452/pamw.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION By reducing treatment costs, biosimilars represents an opportunity for improved accessibility to highly effective drugs. OBJECTIVES This study aimed to assess access to the biologic antirheumatic drugs (bDMARDs) and janus kinase inhibitors (JAKis) among patients with rheumatic musculoskeletal diseases within a ten year timeframe in Poland. PATIENTS AND METHODS A retrospective analysis using a nationwide public payer database was done. RESULTS By 2022, 11,102, 6,602 and 4,400 patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) were treated with bDMARDs/JAKis, respectively. Peak drug utilization was observed for adalimumab followed by etanercept and tocilizumab. Within the study timeframe, the estimated access to innovative drugs increased to 3.2%, 8.7% and 3.5% from the previous 0.8%, 1.4% and 0.8%, among RA, PsA and axSpA patients, respectively. Affordable TNF inhibitors (TNFis) are still predominant among innovative therapeutics, but a market share decline from 87% to 46% was observed. Respective to less costly TNFis, the increase in the number of patients treated with other bDMARDs/JAKis, was almost doubled within the prespecified timeframe. Overall, the average annual treatment cost per patient decreased by 60%, from the €7,315 to €2,886. Despite the recent safety warnings, JAKis appear to be increasingly utilized. Additional analyses regarding COVID-19 pandemic showed impaired access to intravenous therapies, but not subcutaneous or oral formulations. CONCLUSIONS In Poland, biosimilars-related savings contributed more so to improvement of higher priced innovative drugs availability, rather than less costly TNFis. Data-driven resource allocation and dedicated policy solutions facilitating access to affordable biologics are recommended.
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Stajszczyk M, Świerkowska G, Smolik K, Domysławska I, Charkiewicz K, Samborski W. The perspective of Polish patients with rheumatoid arthritis - treatment expectations, patient-reported outcomes, and digital literacy (the SENSE study). Reumatologia 2023; 61:331-338. [PMID: 37970121 PMCID: PMC10634413 DOI: 10.5114/reum/171625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/28/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction A widely accepted treat-to-target strategy for rheumatoid arthritis (RA) requires the patient's perspective in making treatment decisions. However, data on treatment preferences and expectations of Polish patients with RA are scarce. The aim of the study was to determine the satisfaction with treatment and the nature of therapeutic preferences and expectations of Polish patients with moderate to severe RA. Material and methods Fifty-two adult Polish patients with moderately to highly active RA were asked to complete patient-reported outcomes and patient-provided information questionnaires. Additionally, patient sociodemographic and clinical data and information on patient current and planned treatment strategies were collected. Results The mean global assessment of patient satisfaction with treatment was 64.1 ±24.6, below the level of indicating satisfaction. Rheumatoid arthritis negatively impacted patients' lives, resulting in a 37.8% impairment of work efficiency and 45% impairment of total activity. Primary treatment expectations for patients were lasting relief of RA symptoms, reduced pain and swelling in joints, increased flexibility of joints, and general improvement of arthritis. The most acceptable potential side effect was weight gain and the least acceptable were increases in the risk of cardiovascular disease, infection, and malignancies. The rapid onset of the drug effect (up to 1 week) was a preference of 48.1% of patients. Access to internet health resources was important for 44.2% of patients, but the median total eHealth literacy score in the study population was 24.0 (interquartile range: 20.5-28.0, range 8-37), which means low digital health literacy (DHL). Conclusions Understanding these treatment preferences and expectations of patients with RA is essential for clinical practitioners to facilitate shared treatment decision-making. Digital health literacy data suggest the need of further improvement.
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Affiliation(s)
- Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustron, Poland
| | - Grażyna Świerkowska
- Division of Rheumatology, Provincial Multispecialist Center of Oncology and Traumatology – N. Copernicus Memorial Hospital in Lodz, Poland
| | | | - Izabela Domysławska
- Formerly: Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Poland
| | | | - Włodzimierz Samborski
- Department of Rheumatology, Rehabilitation and Internal Medicine, University of Medical Sciences, Poznan, Poland
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Stajszczyk M, Obarska I, Jeka S, Batko B. Budget impact analysis and treatment availability with biosimilar TNF inhibitors in rheumatic diseases in Poland: real-world evidence using a nationwide database. Ann Rheum Dis 2023; 82:1171-1180. [PMID: 37328194 PMCID: PMC10423465 DOI: 10.1136/ard-2022-223696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Although several years have passed since biologic disease modifying antirheumatic drugs were introduced to the market, considerable disparities in access still remain. Tumour necrosis factor inhibitors (TNFi) have proven to be highly effective and safe for treating patients with rheumatic musculoskeletal diseases (RMDs). The emergence of biosimilars is promising for cost reduction and more equitable, widespread access. METHODS A retrospective budget impact analysis based on final drug prices was conducted using 12 687 treatment courses for infliximab, etanercept and adalimumab. Estimated and real-life savings for public payer were calculated from an 8-year perspective of TNFi use. Data on the treatment cost and on the evolution in the number of patients treated was provided. RESULTS From a public payer perspective, the estimated total savings amount to over €243 million for TNFi, with over €166 million attributed to treatment cost reduction in RMDs. Real-life savings were calculated as €133 million and €107 million, respectively. The rheumatology sector generated between 68% and 92% of total savings across models, depending on the adopted scenario. The overall decrease in mean annual cost of treatment ranged between 75% and 89% in the study frame. If all budget savings were spent on reimbursement of additional TNFi, a hypothetical total of almost 45 000 patients with RMDs could be treated in 2021. CONCLUSIONS This is the first nation-level analysis that shows estimated and real-life direct cost-savings for TNFi biosimilars. Transparent criteria for reinvesting savings should be developed on both a local and an international levels.
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Affiliation(s)
- Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustroń, Poland
| | | | - Slawomir Jeka
- Clinical Department of Rheumatology and Connective Tissue Disease, Collegium Medicum UMK, University Hospital No. 2, Bydgoszcz, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Kraków, Poland
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Batko B, Jeka S, Wiland P, Brzosko M, Samborski W, Stajszczyk M, Chudek J, Żuber Z. Deep dive into achieving the therapeutic target: results from a prospective, 6‑month, observational study nested in routine rheumatoid arthritis care. Pol Arch Intern Med 2022; 132. [PMID: 35420283 DOI: 10.20452/pamw.16244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Achieving remission or lowdisease activity (LDA) is an integral principle of treat‑to‑target (T2T) strategy in rheumatoid arthritis (RA). Prior studies have reported that achieving T2T therapeutic goals may be realistic only for a fraction of patients. Prospective, real‑world data on achieving target disease control in ambulatory care populations are limited for Central and Eastern European countries. OBJECTIVES The aim of the study was to analyze the efficacy of treatment and determine simple predictors of achieving T2T therapy goals in daily RA practice. PATIENTS AND METHODS This multicenter, 6‑month study evaluated therapy outcomes and clinical characteristics of 791 consecutive RA outpatients, meeting the preset criteria of inadequate disease control. RESULTS Only 9% of RA patients achieved remission or LAD after 3 months and 35% after 6 months. Achieving treatment targets after 6 months was associated with lower rates of pain, disability, presenteeism and absenteeism, which reflected improved quality of life. Provider views on adherence appeared discordant with patient claims, and did not predict target achievement. Never smoking, lower body mass index, and lower prednisone dose (<7.5 mg daily) were independently associated with a higher likelihood of achieving T2T therapeutic goals after 6 months. CONCLUSIONS A combination of clinical characteristics and provider treatment decisions shapes the "profile" of a patient failing to achieve T2T goals. Low‑dose steroid equivalent, never smoking, and lower body mass index appear as individual characteristics independently associated with achieving LDA / remission at 3 and 6 months.
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Affiliation(s)
- Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Kraków, Poland.
| | - Sławomir Jeka
- Clinic and Department of Rheumatology and Connective Tissue Diseases, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Stajszczyk
- Silesian Rheumatology Center, Rheumatology and Autoimmune Diseases Department, Ustroń, Poland
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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Batko B, Kucharz E, Stajszczyk M, Brzosko M, Samborski W, Żuber Z. Real-World Data from a Multi-Center Study: Insights to Psoriatic Arthritis Care. J Clin Med 2021; 10:jcm10184106. [PMID: 34575217 PMCID: PMC8465653 DOI: 10.3390/jcm10184106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Real-world data indicate disparities in biologic access across Europe. Objectives: To describe the national structure of PsA care in Poland, with a particular focus on the population of inadequate responders (IRs) and difficulties associated with biologic therapy access. Methods: A pool of rheumatologic and dermatologic care centers was created based on National Health Fund contract lists (n = 841), from which 29 rheumatologic and 10 dermatologic centers were sampled randomly and successfully met the inclusion criterium. Additionally, 33 tertiary care centers were recruited. For successful center recruitment, one provider had to recruit at least one patient that met the criteria for one of the four pre-defined clinical subgroups, in which all patients had to have active PsA and IR status to at least 2 conventional synthetic disease-modifying drugs (csDMARDs). Self-assessment questionnaires were distributed among physicians and their patients. Results: Barriers to biologic DMARD (bDMARD) treatment are complex and include stringency of reimbursement criteria, health care system, logistic/organizational, and personal choice factors. For patients who are currently bDMARD users, the median waiting time from the visit, at which the reimbursement procedure was initiated, to the first day of bDMARD admission was 9 weeks (range 2–212; 32% < 4 weeks, 29% 5–12 weeks, 26% 13–28 weeks, 13% with >28 weeks delay). Out of all inadequate responder groups, bDMARD users are the only group with “good” therapeutic situation and satisfaction with therapy. Patient satisfaction with therapy is not always concordant with physician assessment of therapeutic status. Conclusions: Despite the fact that over a decade has passed since the introduction of biologic agents, in medium welfare countries such as Poland, considerable healthcare system barriers to biologic access are present. Out of different IR populations, patient satisfaction with treatment is often discordant with physician assessment of disease status.
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Affiliation(s)
- Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland
- Correspondence:
| | - Eugeniusz Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Marcin Stajszczyk
- Silesian Rheumatology Center, Rheumatology and Autoimmune Diseases Department, 43-450 Ustron, Poland;
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, 70-204 Szczecin, Poland;
| | - Włodzimierz Samborski
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland;
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
- Ward for Older Children with Neurology and Rheumatology Subdivision, St. Louis Regional Specialised Children’s Hospital, 31-503 Krakow, Poland;
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Batko B, Urbański K, Świerkot J, Wiland P, Raciborski F, Jędrzejewski M, Koziej M, Cześnikiewicz-Guzik M, Guzik TJ, Stajszczyk M. Comorbidity burden and clinical characteristics of patients with difficult-to-control rheumatoid arthritis. Clin Rheumatol 2019; 38:2473-2481. [PMID: 31076943 DOI: 10.1007/s10067-019-04579-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Difficult-to-treat rheumatoid arthritis (RA) is a significant clinical problem despite no clear definition. We aimed to provide clinical characteristics and associated comorbidities of RA patients in relation to disease control. METHODS RA characteristics and physician-recorded comorbidities were analyzed in a sample of 1937 RA patients. Patients treated for RA for 5.2 y (IQR, 2.1-11.3) were classified as difficult-to-control when presenting with DAS28-ESR > 3.2 despite previous use of at least 2 csDMARDs. A comparison of demographic and RA-related characteristics between difficult-to-treat and low disease activity patients (DAS28-ESR ≤ 3.2) was performed. Comorbidity burden was assessed by calculating Rheumatic Diseases Comorbidity Index (RDCI). Logistic regression model was constructed for difficult-to-control disease. RESULTS Hypertension (46.9% (95%CI, 44.7-49.2)), coronary artery disease (CAD) (18.5% (95%CI, 16.8-20.3)), and diabetes (14.4% (95%CI, 12.9-16.0)) were the most prevalent conditions in RA patients. When compared with the adequate control group, difficult-to-control patients were increasingly burdened with hypertension (52.7% (95%CI, 47.5-57.8) vs. 42.0% (95%CI, 36.6-47.6); p = 0.006), cardiovascular diseases (24.2% (95%CI, 20.1-28.9) vs. 11.1% (95%CI, 8.0-15.1); p < 0.001), respiratory system diseases (7.0% (95%CI, 4.8-10.2) vs. 3.3% (95%CI, 1.8-5.9); p = 0.03) and gastroduodenal ulcers (2.3% (95%CI, 1.2-4.4) vs. 0.3% (95%CI, 0.1-1.8); p = 0.04). Patients with higher RDCI had lower chance to obtain low disease activity (OR 0.69 (95%CI, 0.61-0.79); p < 0.001). In multivariate analysis, RDCI was independently associated with difficult-to-control disease (OR 1.46 (95%CI, 1.21-1.76); p < 0.001). CONCLUSIONS RA patients suffer from a variety of comorbidities. Cardiovascular and respiratory system diseases occur twice as often in difficult-to-control patients. RDCI may provide a valuable tool in evaluating a risk for difficult-to-control RA. Key Points • Hypertension, coronary artery disease and diabetes are the most prevalent comorbidities in rheumatoid arthritis. • Cardiovascular and respiratory tract diseases as well as gastroduodenal ulcers are more common among difficult-to-control patients, when compared with subjects with adequately controlled RA. • Rheumatic Diseases Comorbidity Index is an independent predictor for difficult-to-control RA.
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Affiliation(s)
- Bogdan Batko
- Department of Rheumatology, J. Dietl Specialist Hospital, 1 Skarbowa St, 31-121, Krakow, Poland.
| | - Karol Urbański
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University School of Medicine, Krakow, Poland
| | - Marta Cześnikiewicz-Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland.,Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Tomasz J Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland.,BHF Centre of Research Excellence, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marcin Stajszczyk
- Rheumatology and Autoimmune Diseases Department, Silesian Rheumatology Center, Ustron, Poland
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Batko B, Stajszczyk M, Świerkot J, Urbański K, Raciborski F, Jędrzejewski M, Wiland P. Prevalence and clinical characteristics of rheumatoid arthritis in Poland: a nationwide study. Arch Med Sci 2019; 15:134-140. [PMID: 30697263 PMCID: PMC6348369 DOI: 10.5114/aoms.2017.71371] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/13/2017] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION There are no reliable data regarding the prevalence of rheumatoid arthritis (RA) in Poland. MATERIAL AND METHODS The first stage was a face-to-face survey on a nationwide representative sample of 3000 people, which identified respondents with a physician-confirmed diagnosis of RA. The second stage was a survey of RA patients, which characterized the disease course and treatment. It was evaluated by analysis of a representative group of 1957 RA patients in routine clinical practice. RESULTS The overall RA prevalence in Poland was 0.9% (95% CI: 0.6-1.2%), 1.06% for women, 0.74% for men. Seventy-eight percent were female, mean age was 56 and mean disease duration 7 years. Younger patients (< 50) remained professionally active in 90% of cases. Thirty percent of patients were diagnosed within 3 months of the first RA symptoms, while for 17% it took more than 1 year. Fifty-six percent of newly diagnosed patients were characterized by high disease activity (DAS-28 > 5.1). Presently, low disease activity (DAS-28 < 3.2) was found in 38.5% of patients. In Poland, 94% of patients have been treated with non-steroid anti-inflammatory drugs, almost 80% with glucocorticoids. Meanwhile, methotrexate, as an anchor drug in Poland, has been used by 80% of patients, biological agents by 2.94% of patients. CONCLUSIONS This is the first cross-sectional population-based epidemiological study regarding prevalence of RA in the adult Polish population. The results demonstrate a high prevalence, falling within the upper boundary estimates for Europe. Despite ongoing treatment, the majority still have moderate to high disease activity, and the use of biological therapies is low.
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Affiliation(s)
- Bogdan Batko
- Department of Rheumatology, J. Dietl Specialist Hospital, Krakow, Poland
| | - Marcin Stajszczyk
- Rheumatology and Autoimmune Diseases Department, Silesian Rheumatology Center, Ustron, Poland
| | - Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karol Urbański
- Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Poland
| | | | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
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Kucharz EJ, Stajszczyk M, Kotulska-Kucharz A, Batko B, Brzosko M, Jeka S, Leszczyński P, Majdan M, Olesińska M, Samborski W, Wiland P. Tofacitinib in the treatment of patients with rheumatoid arthritis: position statement of experts of the Polish Society for Rheumatology. Reumatologia 2018; 56:203-211. [PMID: 30237624 PMCID: PMC6142023 DOI: 10.5114/reum.2018.77971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022] Open
Abstract
Tofacitinib is a newly approved small-molecule targeted synthetic disease-modifying antirheumatic drug. The drug was designed as a selective and specific inhibitor of pro-inflammatory receptor signalling. Tofacitinib inhibits the process of intracellular signalling from the receptor to the cellular nucleus and inhibits the inflammation process via a new pathway (inhibition of the Janus kinases), which is unavailable to biological medicines. Tofacitinib has been approved for use in the treatment of patients with moderate to severe active RA. The drug may be used in combination with methotrexate or another conventional synthetic disease-modifying antirheumatic drug or in monotherapy. The efficacy of tofacitinib has been confirmed in several clinical trials. The drug inhibits radiographic progression of the disease. The innovative mechanism of action of tofacitinib is a noteworthy feature because it offers hope of effective treatment for patients who fail to respond to other drugs. The presented article discusses the mechanism of action and the clinical application of tofacitinib. Tofacitinib represents a new group of disease-modifying antirheumatic drugs that can be placed on an equal footing with biological drugs already available.
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Affiliation(s)
- Eugeniusz J. Kucharz
- Department of Internal Medicine, Rheumatology, and Clinical Immunology, Medical University of Silesia in Katowice, Poland
| | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Centre for Rheumatology, Rehabilitation, and Disability Prevention in Ustroń, Poland
| | - Anna Kotulska-Kucharz
- Department of Internal Medicine, Rheumatology, and Clinical Immunology, Medical University of Silesia in Katowice, Poland
| | - Bogdan Batko
- Department of Rheumatology, J. Dietl Memorial Specialist Hospital in Kraków, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, and Geriatrics, Pomeranian Medical University in Szczecin, Poland
| | - Sławomir Jeka
- Department of Rheumatology and Systemic Connective Tissue Disorders, Jan Biziel University Hospital No. 2 in Bydgoszcz, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland
| | - Piotr Leszczyński
- Department of Rheumatology and Rehabilitation, Poznań University of Medical Sciences, Poland
- Department of Rheumatology and Osteoporosis, J. Struś Memorial Multidisciplinary Municipal Hospital in Poznań, Poland
| | - Maria Majdan
- Department of Rheumatology and Systemic Connective Tissue Disorders, Medical University of Lublin, Poland
| | - Marzena Olesińska
- Clinic of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology and Rehabilitation, Poznań University of Medical Sciences, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wrocław Medical University, Poland
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11
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Świerkot J, Batko B, Wiland P, Jędrzejewski M, Stajszczyk M. Methotrexate treatment for rheumatoid arthritis in Poland: Retrospective analysis of patients in routine clinical practice. Reumatologia 2018; 56:3-9. [PMID: 29686436 PMCID: PMC5911651 DOI: 10.5114/reum.2018.74741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/21/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate methotrexate (MTX) treatment administered by Polish rheumatologists in everyday practice. MATERIAL AND METHODS The study was based on a retrospective analysis of a cohort of 1957 patients with rheumatoid arthritis (RA). It was conducted among 100 rheumatologists, each of whom received 20 questionnaires and completed them based on the data from their rheumatoid arthritis patients. RESULTS Methotrexate was taken by 91% of patients, and 80% of them continued the treatment either as a monotherapy (65%) or concomitantly with other disease-modifying anti-rheumatic drugs. In 60% of the cases, therapy was initiated within six months of diagnosis. Dose modifications were observed in 76% of cases and were contingent on different factors, e.g. lack of efficacy, presence of adverse events. The most prevalent adverse events were nausea and vomiting, weakness, and elevated liver enzyme activity. The most common initial dose of MTX was 10 or 15 mg/week. An increase in dose to the maximum of 25 mg/week was observed in 36% of cases, with continuation for 27% of patients. Treatment interruption was noted in 21% of patients, predominantly due to MTX intolerance; however, in 13% of cases, it was due to patient choice. CONCLUSIONS Methotrexate is the most common agent used to treat rheumatoid arthritis. Dose modifications are often applied to maximise efficacy and reduce adverse reactions, which could lead to withdrawal. Methotrexate is an effective drug for treatment of RA when used according to current recommendations. To optimise MTX therapy, regular medical visits are required.
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Affiliation(s)
- Jerzy Świerkot
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | - Bogdan Batko
- Department of Rheumatology, J. Dietl Specialist Hospital, Krakow, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Poland
| | | | - Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Rheumatology Centre, Ustron, Poland
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12
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Świerkot J, Batko B, Stajszczyk M, Jedrzejewski M, Wiland P. AB0389 Methotrexate Treatment for Rheumatoid Arthritis in Poland: Retrospective Analysis of Patients in Routine Clinical Practice. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Stajszczyk M. [Bisphosphonates in the treatment of multiple myeloma]. Przegl Lek 2002; 59:37-42. [PMID: 12108045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Bisphosphonates are the most potent class of antiresorpitve drugs used in the treatment of bone diseases with enhanced resorption, like malignant osteolysis, osteoporosis and Paget's disease. Multiple myeloma is commonly associated with skeletal morbidity, including osteolysis, bone fractures, pain and hypercalcemia. These clinical complications result from increased osteoclast number and function which is due to release of osteoclast-stimulating factors by myeloma cells and the tumoral environment. By inhibition of osteoclast activity and inducing cell apoptosis, bisphosphonates can prevent development of bone destruction in myeloma patients. This article reviews efficacy of bisphosphonates in reducing skeletal events in patients with multiple myeloma and several in vitro studies which have shown that aminobisphosphonates may act as antimyeloma agents.
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Affiliation(s)
- Marcin Stajszczyk
- Klinika Chorób Wewnetrznych i Chemioterapii Onkologicznej SAM 40-029 Katowice
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14
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Stajszczyk M. [Role of receptor activator of nuclear factor kappa B (RANK), its ligand (RANK-L) and osteoprotegerin (OPG) in bone metabolism]. Pol Arch Med Wewn 2002; 108:915-24. [PMID: 12600190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Marcin Stajszczyk
- Klinika Chorób Wewnetrznych i Chemioterapii Onkologicznej Sl. AM w Katowicach
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15
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Stajszczyk M, Mykała-Cieśla J. [Inhibitors of HMG-CoA reductase in prevention of osteoporosis and bone fractures. Similar mechanism of action of statins and bisphosphonates]. Pol Arch Med Wewn 2002; 107:85-91. [PMID: 12046350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Marcin Stajszczyk
- Klinika Chorób Wewnetrznych i Chemioterapii Onkologicznej Sl. AM Katowice. marcins(at)mp.pl
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16
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Stajszczyk M, Mykała-Cieśla J. [Bisphosphonates in the treatment of breast carcinoma]. Pol Arch Med Wewn 2001; 106:729-38. [PMID: 11926150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- M Stajszczyk
- Klinika Chorób Wewnetrznych i Chemioterapii Onkologicznej Sl. AM w Katowice. marcins(at)mp.pl
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17
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Stajszczyk M. [Inhibition of bone resorption by bisphosphonates, heterogeneous group of drugs with different intracellular model of action]. Pol Arch Med Wewn 2001; 106:617-29. [PMID: 11928574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- M Stajszczyk
- Klinika Chorób Wewnetrznych i Chemioterapii Onkologicznej Sl. AM w Katowicach. marcins(at)mp.pl
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18
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Stajszczyk M, Mykała-Cieśla J, Machalski M, Pajak J. [Ormond's fibrosis, bone osteolysis and stomach intramural metastases in the course f low-differentiated prostatic cancer]. Pol Arch Med Wewn 2001; 106:593-600. [PMID: 11928571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Retroperitoneal fibrosis (Ormond's disease) is rare chronic inflammatory process, that can occur at any age. It is characterised by development of periaortic fibrous mass leading to progressive obstruction of vessels around the abdominal aorta and ureters. In the one third of cases we can find the causes of disease. There are ergotamine abuse, radiation, retroperitoneal surgery or hemorrhage, urine extravasation and response to different cancers. The other cases are idiopathic disease. We report a case of prostate cancer with unique course. The first manifestations of disease were diffuse peritoneal fibrosis and ureteral obstruction leading to bilateral hydronephrosis. Clinical course and histopathology showed idiopathic Ormond's fibrosis. Patient received oral immunosuppressive treatment (prednisolone 1 mg/kg/day + azathioprine 1 mg/kg/day), followed by intravenous methylprednisolone puls (2 g). Treatment also consisted of DJ-stent placement on the left side. On the right side we were unable to overcome the obstruction of ureter. Because of persistent renal failure, thrombocytopenia, DIC and progressive lower back pain we did control MR and CT scan. The CT scans showed multiple osteolytic bone metastases in vertebral column (the sizes of them were between a few millimetres and 1.5 centimetre). Patient died due to renal failure and haemorrhagic diathesis in the course of disseminated cancer of unknown origin. The postmortem examination revealed diffuse peritoneal infiltration surrounding the ureters, intramural ventricular metastases, pulmonary metastases and vertebral metastases. The prostate was only slightly enlarged. Histological and immunohistochemical examinations of prostate showed primary low-differentiated prostate carcinoma (CK/+/, PAP/+/, PSA/+/). Peritoneal, ventricular and bone infiltrations also were metastases from low-differentiated carcinoma of prostate origin (CK/+/, PAP/+/, PSA/-/).
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Affiliation(s)
- M Stajszczyk
- Klinika Chorób Wewnetrznych i Chemioterapii Onkologicznej Sl. AM w Katowicach. marcins(at)mp.pl
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19
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Stajszczyk M, Gmiński J. [Genetic predisposition to cardiovascular diseases]. Przegl Lek 2000; 57:48-51. [PMID: 10907371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The development of cardiovascular system disorders depends on both environmental and genetic factors. Precise mechanism by which genetic factors may promote atherosclerotic lesion formation is still under investigation. From multiple candidate genes for cardiovascular disorders the special attention should be paid to that which control synthesis of molecules involved in atherosclerosis process. For now lots of experiments have been done to test specific genes speculated to be crucial for the onset and progression of atherosclerosis, including genes of lipoprotein metabolism, coagulation and fibrinolysis system, renin-angiotensin system and substances influencing the metabolism of arterial wall. Many of them showed the association between tested polymorphisms and pathogenesis of cardiovascular diseases.
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Affiliation(s)
- M Stajszczyk
- Zakładu Biochemii Doświadczalnej, i Klinicznej, Slaskiej Akademii Medycznej w Katowicach
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20
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Siemianowicz K, Gminski J, Stajszczyk M, Wojakowski W, Goss M, Machalski M, Telega A, Brulinski K, Magiera-Molendowska H. Serum HDL cholesterol concentration in patients with squamous cell and small cell lung cancer. Int J Mol Med 2000; 6:307-11. [PMID: 10934294 DOI: 10.3892/ijmm.6.3.307] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cancer patients often present altered serum lipid profile including changes of HDL cholesterol level. The aim of our work was to evaluate serum level of HDL cholesterol in patients with squamous cell and small cell lung cancer and its dependence on histological type and clinical stage of lung cancer. Fasting serum level of HDL cholesterol was analysed in 135 patients with newly diagnosed lung cancer and compared to a control group of healthy men. All lung cancer patients, as well as subgroups of squamous cell and small cell lung cancer had statistically significantly lower HDL cholesterol concentration than controls. There were no statistically significant differences of HDL cholesterol level between the histological types or between clinical stages of each histological type of lung cancer.
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Affiliation(s)
- K Siemianowicz
- Department of Experimental and Clinical Biochemistry, Silesian Medical Academy, 40-752 Katowice, Poland.
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21
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Wojakowski W, Gmiński J, Stajszczyk M, Goss M, Siemianowicz K, Machalski M. [The influence of angiotensin-converting enzyme inhibitors on collagen content of the aorta wall in experimental hypercholesterolemia]. Przegl Lek 2000; 56:716-9. [PMID: 10800584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In atherosclerosis numerous qualitative and quantitative changes in connective tissue metabolism parameters in serum and aorta occur. In atherosclerosis there is an enhanced activity of local renin-angiotensin systems. It leads to overexpression of ANG II, both in serum and arterial wall. ANG II stimulates SMC to over-synthesize the collagens type I and III. Hyper-cholesterolemia is a form of metabolic injury which can both induce phenotypic change of SMC and activate RA system in arterial wall. ACEI lower the accumulation of collagens type I and III, and enhance elastin content in arterial wall in experimental hypertension. The aim of this study was to assess the influence of captopril, enalapril and quinapril on connective tissue metabolism of the aorta in experimental hyper-cholesterolemia. 64 male New Zealand rabbits were used. Animals were fed with standard fodder, special diet (1% cholesterol content) or special diet + tested ACEI. Two doses of ACE inhibitors were used: 1st--equivalent to doses applied to human subjects (in mg/kg of body weight), 2nd--dose 10 times higher. The animals were divided into 8 equal groups: K--standard fodder, B--special diet, C1, C2--special diet + captopril in doses 2.5 and 25 mg/kg/24 hours, respectively, E1, E2--special diet + enalapril in doses 0.75 and 7.5 mg/kg/24 hours, respectively, Q1 i Q2--special diet + quinapril in doses 0.75 and 7.5 mg/kg per day, respectively. The experiment lasted for 6 months. After 24 weeks the animals were sacrificed and aortae were excised for collagens assay. The statistical analysis was performed using ANOVA, followed by LSD test; p < 0.05 was considered statistically significant. The aorta collagens content of cholesterol-fed rabbits significantly increased. The tested ACEI (captopril, enalapril in both doses and quinapril in lower dose) had a preventive effect against the increase of aorta collagen content.
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Affiliation(s)
- W Wojakowski
- Zakładu Biochemii Doświadczalnej i Klinicznej, Slaskiej Akademii Medycznej w Katowicach
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22
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Siemianowicz K, Gminski J, Stajszczyk M, Wojakowski W, Goss M, Machalski M, Telega A, Brulinski K, Magiera-Molendowska H. Serum total cholesterol and triglycerides levels in patients with lung cancer. Int J Mol Med 2000; 5:201-5. [PMID: 10639602 DOI: 10.3892/ijmm.5.2.201] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Epidemiological studies indicate that low serum total cholesterol level may increase the risk of death due to cancer, mainly lung cancer. The aim of our study was to evaluate serum levels of total cholesterol (TC) and triglycerides (TG) in patients with squamous cell and small cell lung cancer and their dependence on the histological type and the clinical stage of the neoplasm. Lung cancer patients (n=135) and healthy controls (n=39) entered the study. All lung cancer patients had higher rate of hypocholesterolemia and lower TC and TG levels than the control group. TC concentration was lower in lung cancer patients and in both histological types in comparison with the control group, TG level was lower only in patients with squamous cell lung cancer. There were no statistically significant differences of TC and TG levels between the histological types, or between the clinical stages of each histological type.
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Affiliation(s)
- K Siemianowicz
- Department of Experimental and Clinical Biochemistry, Silesian Medical Academy, 40-752 Katowice, Poland
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23
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Siemianowicz K, Gminski J, Stajszczyk M, Wojakowski W, Goss M, Machalski M, Telega A, Brulinski K, Magiera-Molendowska H. Serum LDL cholesterol concentration and lipoprotein electrophoresis pattern in patients with small cell lung cancer. Int J Mol Med 2000; 5:55-7. [PMID: 10601574 DOI: 10.3892/ijmm.5.1.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Epidemiological studies show that people with low level of total cholesterol have a greater risk of death due to cancer, predominantly lung cancer. The aim of our study was to evaluate serum level of LDL cholesterol and lipoprotein electrophoresis pattern in patients with small cell lung cancer and their dependence on clinical stage of the neoplasm. The studied group consisted of 34 patients with newly diagnosed small cell lung cancer and 39 healthy controls. Fasting level of LDL cholesterol was analyzed and lipoprotein electrophoresis was performed. There were no statistically significant differences of evaluated serum lipid parameters between lung cancer patients and controls, and between the clinical stages of small cell lung cancer.
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Affiliation(s)
- K Siemianowicz
- Department of Experimental and Clinical Biochemistry, Silesian Medical Academy, 40-752 Katowice, Poland
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24
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Wojakowski W, Gmiñski J, Stajszczyk M, Goss M, Siemianowicz K, Machalski M. The influence of angiotensin-converting enzyme inhibitors on the aorta elastin metabolism in diet-induced hypercholesterolemia in rabbits. Atherosclerosis 1999. [DOI: 10.1016/s0021-9150(99)80217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Stajszczyk M, Gmiński J. [Treatment of hypertension in postmenopausal women]. Przegl Lek 1998; 54:789-92. [PMID: 9501690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Epidemiological and clinical studies have defined the lower incidence of atherosclerotic vascular disease in women than in age-matched men. After menopause the difference becomes less significant, what is due to estrogen deficiency. The mechanism of vascular protective effect of estrogen involves inhibition of smooth muscle cell proliferation, protection of endothelium function and improvement of lipid metabolism. One of the most important risk factor of atherosclerosis is hypertension. The prevalence of hypertension in elderly women is extremely high-up to 80%. Because of absence of the hormonal replacement therapy effect on blood pressure, there is an indication for antihypertensive therapy in postmenopausal women. Angiotensin-converting enzyme inhibitors are the class of drugs which can lower cardiovascular mortality due to hypertension and atherosclerosis in elderly women. They improve impaired insulin sensitivity and inhibit activation of renin-angiotensin system, both processes leading to the development of hypertension in postmenopausal women. Angiotensin-converting enzyme inhibitors also possess a direct anti-atherosclerotic properties, like inhibition of smooth muscle cell proliferation and migration, protection of endothelium function, reduced macrophages activation and foam cell accumulation, protection of LDL particles and improvement of fibrinolysis.
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Affiliation(s)
- M Stajszczyk
- I Katedry i Kliniki Chorób Wewnetrznych Slaskiej Akademii Medycznej w Katowicach
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26
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Siemianowicz K, Gmiński J, Telega A, Stajszczyk M, Wojakowski W, Machalski M, Goss M. 1.P.160 Serum lipid profile in patients with different clinical stages of squamous cell and small cell lung cancer. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)88339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Stajszczyk M, Gmiński J. [The role of DNA polymorphism in the renin-angiotensin system and the pathogenesis of cardiovascular diseases]. POSTEP HIG MED DOSW 1997; 51:171-83. [PMID: 9235564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Myocardial infarction and stroke are the major cause of death in developed countries and are the clinical manifestation of atherosclerosis and hypertension. Both the environmental factors and genetic predisposition have an influence on the pathogenesis of these diseases. Despite we know lots of environmental risk factors and we made important advances in the prevention and treatment of mentioned diseases, our knowledge about the pathogenic linkage between genetic predisposition and cardiovascular diseases is still very little. Activation of the renin-angiotensin system has been proposed as a very important step in the pathogenesis of hypertension and atherosclerosis. In spite of vasoconstrictor activity, angiotensin II can stimulate migration and proliferation of vascular smooth muscle cells, macrophage-foam cells formation, adhesion and aggregation of platelets and fibrinolytic system inhibition. Angiotensin convertin enzyme inhibitors reduce the development of the atherosclerotic process after vascular injury and in hyperlipidemic animals. Blockade of renin-angiotensin system seems to be also effective in secondary prevention of myocardial infarction in men. In sum, the genetic variations inside the renin-angiotensin system which may affect the function of its components might have an influence on genetic predisposition to cardiovascular diseases. The paper deals with the current state of knowledge on association between polymorphic variations in renin gene, angiotensinogen gene, angiotensin converting enzyme gene and AT1 receptor gene and primary hypertension, ischaemic heart disease and myocardial infarction.
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Affiliation(s)
- M Stajszczyk
- I Klinika Chorób Wewnetrznych Slaskiej Akademii Medycznej w Katowicach
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28
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Stajszczyk M, Gmiński J. [Angiotensin converting enzyme inhibitors in secondary prevention of myocardial infarction]. Pol Arch Med Wewn 1996; 96:199-207. [PMID: 9122010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M Stajszczyk
- I Katedra i Klinika Chorób Wewnetrznych, Slaskiej Akademii Medycznej, Katowice
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29
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Gmiński J, Stajszczyk M. [Anti-atherosclerotic action of hypotensive drugs]. Wiad Lek 1996; 49:182-98. [PMID: 9245114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hypertension is an important risk factor for the development of atherosclerosis. Traditional antihypertensive therapy is not fully effective in prevention of cardiovascular abnormalities of hypertension. Two classes of hypotensive drugs, calcium antagonists and angiotensin-converting enzyme (ACE) inhibitors, reduce atherosclerosis in several experimental models in animals. Anti-atherosclerotic effects of calcium antagonists include attenuation of endothelial dysfunction, prevention of LDL modification, stimulation of LDL receptor activity, inhibition of superoxide radical generation and inhibition of vascular smooth muscle cells proliferation and migration. In large angiographic trials calcium antagonists reduced the development of new atherosclerotic plaques. ACE inhibitors also lead to the lower incidence of atherosclerosis in experimental animals. They inhibit migration and proliferation of vascular smooth muscle cells, reduce macrophage-derived foam cell accumulation, preserve protective endothelium function, reduce LDL modification and increase fibrinolytic activity. It depends on reduced angiotensin II synthesis, increased concentration of kinins, substance P and angiotensin-(1-7), inhibition of leukotriene B4 formation and improvement of insulin action. In some studies they also reduce plasma lipids concentration, including lipoprotein (a). ACE inhibitors were found to be ineffective in prevention of restenosis after PTCA in human but data derived from large, multicenter trials indicate that they are effective in the secondary prevention of myocardial infarction.
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Affiliation(s)
- J Gmiński
- I Katedry i Kliniki Chorób Wewnetrznych Slaskiej Akademii Medycznej w Katowicach
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30
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Stajszczyk M, Gmiński J. [Anti-atherosclerotic action of angiotensin converting enzyme II. Effect on metabolism of kinin, free radical reaction, sensitivity to insulin and lipid metabolism]. POSTEP HIG MED DOSW 1996; 50:635-47. [PMID: 9064683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Blockade of the renin-angiotensin system reduces the development of the atherosclerotic process after vascular injury and in hyperlipidemic animals. ACE-inhibitors inhibit vascular smooth muscle cells migration and proliferation, macrophage-foam cell accumulation and preserve the antiaggregatory and antithrombotic function of the endothelium in atherosclerotic vessels. In addition to the inhibition of angiotensin II synthesis, reduced degradation of kinins and improvement of insulin action after ACE-inhibition may be responsible for observed actions. ACE-inhibitors may have also influence on lipids metabolism, including low density lipoprotein oxidation. Despite this, ACE-inhibitors failed to prevent restenosis after coronary angioplasty in humans. One reason for the lack of ACE-inhibitors effect in human restenosis might depend on the activation of the alternative angiotensin II-generating system in human arteries after vascular injury.
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Affiliation(s)
- M Stajszczyk
- Katedra i Zakład Biochemii i Chemii Slaskiej Akademii Medycznej w Katowicach
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Maślanka R, Siemianowicz K, Stajszczyk M, Wojakowski W. [Effect of feeding methods in infants on serum lipid profile]. Pediatr Pol 1995; 70:579-83. [PMID: 8649957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Mothers very often do not start to breast feed their children, or stop very quickly and introduce various formulas based either on modified or unmodified cow's milk. These infant formulas differ from human milk in their chemical composition. Breast milk is the most suitable source of all nutrients required for the development of a newborn or infant. The serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and phospholipids were determined. The influence of the type of feeding on the levels of the above-mentioned lipids was analyzed. Higher serum levels of triglycerides in babies fed formulas based on modified cow's milk than in those fed formulas based on unmodified milk were found. Higher serum levels of phospholipids were found in breast-fed babies than in those fed formulas based on unmodified cow's milk.
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Affiliation(s)
- R Maślanka
- IV Katedra i Klinika Pediatrii Slaskiej Akademii Medycznej, Katowicach
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Stajszczyk M, Gmiński J. [Cyclosporin and atherosclerosis]. Pol Arch Med Wewn 1994; 92:76-80. [PMID: 7971481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Stajszczyk
- Katedry i Zakładu Biochemii i Chemii Slaskiej Akademii Medycznej
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