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Krajewska-Włodarczyk M, Szeląg M, Batko B, Żuber Z, Orleański M, Podwójcic K, Sowiński J, Jopek J, Świderek M, Maluchnik M, Brzosko M, Śmiglewska A, Kwiatkowska B. Rheumatoid arthritis epidemiology: a nationwide study in Poland. Rheumatol Int 2024:10.1007/s00296-024-05591-8. [PMID: 38678142 DOI: 10.1007/s00296-024-05591-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/06/2024] [Indexed: 04/29/2024]
Abstract
To assess the incidence and prevalence of rheumatoid arthritis (RA) in Poland for the period 2013-2021, total and dependent on gender, age, region and serological status. Information on reported National Health Fund (NHF) health services and reimbursed prescriptions were used, defining an RA patient as a person who had at least two visits in different quarters with ICD-10 code M05 or M06 and at the same time filled at least one reimbursed prescription for a drug whose active substance is methotrexate, sulfasalazine, leflunomide or was treated with biologic disease-modifying anti-rheumatic drugs (bDMRDs) or targeted synthetic DMARDs (tsDMARDs) as part of a drug program financed by the National Health Fund. The nationwide standardised incidence rate of RA in 2021 was 29 persons per 100,000 population (18 per 100,000 population of seropositive vs. 11 per 100,000 population of seronegative RA). The prevalence of RA in Poland in 2021 was 689.0 people per 100,000 population, a total of 0.7% (1.1% in women and 0.3% in men). The incidence of seronegative RA was approximately 38%. The majority of new RA diagnoses were in the sixth and seventh decades of life, irrespective of patients' gender. The results allow RA to be classified as a disease with a significant social impact. A trend of later onset of RA has been observed, which requires special consideration of the needs of patients over 55 years of age.
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Affiliation(s)
| | - Mateusz Szeląg
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland.
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Kraków, Poland
| | - Zbigniew Żuber
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Kraków, Poland
| | - Michał Orleański
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
| | - Krzysztof Podwójcic
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
- Institute of Labour and Social Studies, Warsaw, Poland
| | - Jakub Sowiński
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
| | - Jakub Jopek
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
| | - Maria Świderek
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
| | - Michał Maluchnik
- Department of Adult Neurology, Medical University of Gdansk, Gdańsk, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases, Geriatrics and Clinical Immunology, Faculty of Medicine and Dentistry, Pomeranian Medical University, Szczecin, Poland
| | - Agata Śmiglewska
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
| | - Brygida Kwiatkowska
- Clinic of Early Arthritis, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Drynda A, Padjas A, Wójcik K, Dziedzic R, Biedroń G, Wawrzycka-Adamczyk K, Włudarczyk A, Wilańska J, Musiał J, Zdrojewski Z, Czuszyńska Z, Masiak A, Majdan M, Jeleniewicz R, Augustyniak-Bartosik H, Jakuszko K, Krajewska M, Dębska-Ślizień A, Storoniak H, Bułło-Piontecka B, Tłustochowicz W, Kur-Zalewska J, Wisłowska M, Głuszko P, Madej M, Jassem E, Damps-Konstańska I, Kucharz E, Brzosko M, Milchert M, Hawrot-Kawecka A, Miłkowska-Dymanowska J, Górski P, Lewandowska-Polak A, Makowska J, Zalewska J, Zaręba L, Bazan-Socha S. Clinical Characteristics of EGPA Patients in Comparison to GPA Subgroup with Increased Blood Eosinophilia from POLVAS Registry. J Immunol Res 2024; 2024:4283928. [PMID: 38699219 PMCID: PMC11065486 DOI: 10.1155/2024/4283928] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/26/2024] [Accepted: 04/06/2024] [Indexed: 05/05/2024] Open
Abstract
Objective To characterize the eosinophilic granulomatosis with polyangiitis (EGPA) population from the POLVAS registry depending on ANCA status and diagnosis onset, including their comparison with the granulomatosis with polyangiitis (GPA) subset with elevated blood eosinophilia (min. 400/μl) (GPA HE) to develop a differentiating strategy. Methods A retrospective analysis of the POLVAS registry. Results The EGPA group comprised 111 patients. The ANCA-positive subset (n = 45 [40.54%]) did not differ from the ANCA-negative one in clinics. Nevertheless, cardiovascular manifestations were more common in ANCA-negative patients than in those with anti-myeloperoxidase (MPO) antibodies (46.97% vs. 26.92%, p = 0.045). Patients diagnosed before 2012 (n = 70 [63.06%]) were younger (median 41 vs. 49 years, p < 0.01), had higher blood eosinophilia at diagnosis (median 4,946 vs. 3,200/μl, p < 0.01), and more often ear/nose/throat (ENT) and cardiovascular involvement. GPA HE comprised 42 (13.00%) out of 323 GPA cases with reported blood eosinophil count. Both GPA subsets had a lower prevalence of respiratory, cardiovascular, and neurologic manifestations but more often renal and ocular involvement than EGPA. EGPA also had cutaneous and gastrointestinal signs more often than GPA with normal blood eosinophilia (GPA NE) but not GPA HE. The model differentiating EGPA from GPA HE, using ANCA status and clinical manifestations, had an AUC of 0.92, sensitivity of 96%, and specificity of 95%. Conclusion Cardiovascular symptoms were more prevalent in the ANCA-negative subset than in the MPO-ANCA-positive one. Since EGPA and GPE HE share similarities in clinics, diagnostic misleading may result in an inappropriate therapeutic approach. Further studies are needed to optimize their differentiation and tailored therapy, including biologics.
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Affiliation(s)
- Anna Drynda
- Students' Scientific Group of Immune Diseases and Hypercoagulation, Jagiellonian University Medical College, Cracow, Poland
| | - Agnieszka Padjas
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Radosław Dziedzic
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Grzegorz Biedroń
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Anna Włudarczyk
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Wilańska
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Zbigniew Zdrojewski
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, Gdansk, Poland
| | - Zenobia Czuszyńska
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, Gdansk, Poland
| | - Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, Gdansk, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland
| | - Radosław Jeleniewicz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland
| | | | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Hanna Storoniak
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Barbara Bułło-Piontecka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
| | - Witold Tłustochowicz
- Department of Internal Medicine and Rheumatology, Military Medical Institute, Warsaw, Poland
| | - Joanna Kur-Zalewska
- Department of Internal Medicine and Rheumatology, Military Medical Institute, Warsaw, Poland
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Głuszko
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Jassem
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - Eugeniusz Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Diabetology, Geriatrics and Clinical Immunology with the Gastroenterology Unit, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Diabetology, Geriatrics and Clinical Immunology with the Gastroenterology Unit, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anna Hawrot-Kawecka
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Paweł Górski
- Department of Pneumology, Chair of Internal Medicine, Medical University of Lodz, Lodz, Poland
| | | | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Joanna Zalewska
- Department of Rheumatology and Connective Tissue Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz of the Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Lech Zaręba
- Institute of Computer Science, College of Natural Sciences, University of Rzeszow, Rzeszow, Poland
| | - Stanisława Bazan-Socha
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
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Dima A, Vonk MC, Garaiman A, Kersten BE, Becvar R, Tomcik M, Hoffmann-Vold AM, Castellvi I, Jaime JT, Brzosko M, Milchert M, Krasowska D, Michalska-Jakubus M, Airo P, Matucci-Cerinic M, Bruni C, Iudici M, Distler J, Gheorghiu AM, Poormoghim H, Motta F, De Santis M, Parvu M, Distler O, Mihai C. Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis: Analysis of the European Scleroderma Trials and Research (EUSTAR) cohort and a systematic literature review. Eur J Intern Med 2024:S0953-6205(24)00143-2. [PMID: 38599922 DOI: 10.1016/j.ejim.2024.03.035] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The anti-Nucleolar Organizer Region 90 antibodies (NOR90) are rare antinuclear antibodies (ANA) reported in systemic sclerosis (SSc). Especially due to low prevalence, the clinical relevance of NOR90 in SSc remains uncertain. OBJECTIVES To analyze the clinical associations of NOR90 in patients with SSc in a multicentric cohort. METHODS Post-hoc, cross-sectional study of prospectively collected data from the European Scleroderma Trials and Research (EUSTAR) database, with additional information on NOR90. Further, we performed a systematic literature search, using the terms "systemic sclerosis" and "NOR90" across three databases: Medline via PubMed, Scopus, and Thomson Reuters' Web of Science Core Collection, from inception to November 1st, 2023. RESULTS Overall, 1318 patients with SSc were included (mean age 58.3 ± 13.7 years, 81.3 % female), of whom 44 (3.3 %) were positive for NOR90. Of these, 32 were also positive for one of the SSc-criteria antibodies: 9/44 (20.5 %) for anti-topoisomerase I, 18/42 (42.9 %) for anti-centromere, and 5/40 (12.5 %) for anti-RNA polymerase III. NOR90-positive patients were more frequently female, had lower modified Rodnan skin score (mRSS), and lower prevalence of upper and lower gastrointestinal (GI) symptoms compared to NOR90-negative patients. In multivariable analysis, NOR90 remained significantly associated with lower mRSS and less frequent GI symptoms. The literature search identified 17 articles, including a total number of 87 NOR90-positive out of 3357 SSc patients, corresponding to an overall prevalence of 2.6 %. CONCLUSION To our best knowledge, this is the largest SSc cohort tested for NOR90 to date, confirming the NOR90 prevalence in SSc patients is around 3 %.
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Affiliation(s)
- A Dima
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland; Department of Rheumatology, Colentina Clinical Hospital, 19-21 Stefan cel Mare, 020125 Bucharest, Romania.
| | - M C Vonk
- Department of the Rheumatology, Radboud University Nijmegen Medical Centre Huispost 667, 6500HB Nijmegen, the Netherlands
| | - A Garaiman
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - B E Kersten
- Department of the Rheumatology, Radboud University Nijmegen Medical Centre Huispost 667, 6500HB Nijmegen, the Netherlands
| | - R Becvar
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University - Na Slupi 4, 12800 Praha 2, Czechia
| | - M Tomcik
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University - Na Slupi 4, 12800 Praha 2, Czechia
| | - A-M Hoffmann-Vold
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland; Department of Rheumatology, Rikshospitalet University Hospital - Sognsvannveien 20, 0027 Oslo, Norway
| | - I Castellvi
- Department of Rheumatology, Hospital Universitari de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167 Barcelona, Spain
| | - Jl Tandaipan Jaime
- Department of Rheumatology, Hospital Universitari de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167 Barcelona, Spain
| | - M Brzosko
- Department of Internal Medicine Rheumatology Diabetology Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - M Milchert
- Department of Internal Medicine Rheumatology Diabetology Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - D Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Staszica 11L, 20-081 Lublin, Poland
| | - M Michalska-Jakubus
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Staszica 11L, 20-081 Lublin, Poland
| | - P Airo
- 9 Spedali Civili di Brescia, Scleroderma UNIT, UOC Reumatologia ed Immunologia Clinica, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - M Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence & Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - C Bruni
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland; Department of Experimental and Clinical Medicine, University of Florence & Division of Rheumatology AOUC, Florence, Italy
| | - M Iudici
- Rheumatology Unit, Geneva University Hospitals, 1211 Geneva 14, Switzerland
| | - Jhw Distler
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - A M Gheorghiu
- Department of Internal Medicine and Rheumatology Clinic, Ion Cantacuzino Hospital - Ion Movila Street 5-7, 020475 Bucharest, Romania
| | - H Poormoghim
- Department of Rheumatology, Firoozgar Hospital - Beh Afarin street, Tehran, Iran
| | - F Motta
- Department of Biomedical Sciences, Humanitas University, via R Levi Montalcini, 20090, Pieve Emanuele, Italy; Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, via A Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M De Santis
- Department of Biomedical Sciences, Humanitas University, via R Levi Montalcini, 20090, Pieve Emanuele, Italy; Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, via A Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M Parvu
- Department of Rheumatology, Colentina Clinical Hospital, 19-21 Stefan cel Mare, 020125 Bucharest, Romania
| | - O Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - C Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
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Winikajtis-Burzyńska A, Brzosko M, Przepiera-Będzak H. Elevated Serum Levels of Soluble Transferrin Receptor Are Associated with an Increased Risk of Cardiovascular, Pulmonary, and Hematological Manifestations and a Decreased Risk of Neuropsychiatric Manifestations in Systemic Lupus Erythematosus Patients. Int J Mol Sci 2023; 24:17340. [PMID: 38139169 PMCID: PMC10743550 DOI: 10.3390/ijms242417340] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
The aim of this study was to analyze the relationship between the serum levels of soluble transferrin receptor (sTfR) and interleukin 4 (IL-4), and the disease activity and organ manifestations in SLE patients. We studied 200 SLE patients and 50 controls. We analyzed disease activity, organ involvement, serum sTfR, IL-4 and interleukin-6 (IL-6) levels, and antinuclear and antiphospholipid antibody profiles. The median serum levels of sTfR (p > 0.000001) and IL-4 (p < 0.00001) were higher in the study group than in the controls. SLE patients, compared to the controls, had significantly lower HGB levels (p < 0.0001), a lower iron concentration (p = 0.008), a lower value of total iron-binding capacity (TIBC) (p = 0.03), and lower counts of RBC (p = 0.004), HCT (p = 0.0004), PLT (p = 0.04), neutrophil (p = 0.04), and lymphocyte (p < 0.0001). Serum sTfR levels were negatively correlated with lymphocyte (p = 0.0005), HGB (p = 0.0001) and HCT (p = 0.008), and positively correlated with IL-4 (p = 0.01). Elevated serum sTfR > 2.14 mg/dL was associated with an increased risk of myocardial infarction (OR: 10.6 95 CI 2.71-464.78; p = 0.001), ischemic heart disease (OR: 3.25 95 CI 1.02-10.40; p = 0.04), lung manifestations (OR: 4.48 95 CI 1.44-13.94; p = 0.01), and hematological manifestations (OR: 2.07 95 CI 1.13-3.79; p = 0.01), and with a reduced risk of neuropsychiatric manifestations (OR: 0.42 95 CI 0.22-0.80; p = 0.008). Serum IL-4 was negatively correlated with CRP (p = 0.003), and elevated serum IL-4 levels > 0.17 mg/L were associated with a reduced risk of mucocutaneous manifestations (OR: 0.48 95 CI 0.26-0.90; p = 0.02). In SLE patients, elevated serum levels of sTfR were associated with an increased risk of cardiovascular, pulmonary, and hematological manifestations, and with a decreased risk of neuropsychiatric manifestations. In contrast, elevated serum IL-4 levels were associated with a decreased risk of mucocutaneous manifestations.
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Affiliation(s)
- Agnieszka Winikajtis-Burzyńska
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
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Winikajtis-Burzyńska A, Brzosko M, Przepiera-Będzak H. Increased Serum Interleukin 10 Levels Are Associated with Increased Disease Activity and Increased Risk of Anti-SS-A/Ro Antibody Positivity in Patients with Systemic Lupus Erythematosus. Biomolecules 2023; 13:974. [PMID: 37371554 DOI: 10.3390/biom13060974] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Interleukin 10 (IL-10) plays a role in inflammation and cell-type responses. The anti-SS-A/Ro antibody contributes to leucopenia, and cutaneous and neonatal lupus. OBJECTIVES To evaluate the association between serum IL-10 levels and autoantibodies, disease activity and organ involvement in systemic lupus erythematosus (SLE) patients. PATIENTS AND METHODS We studied 200 SLE patients and 50 controls. We analyzed organ involvement, disease activity, serum IL-10 and interleukin-6 (IL-6) levels, and antinuclear and antiphospholipid antibody profiles. RESULTS Serum IL-10 and IL-6 levels were higher in SLE patients than in controls (all p < 0.00001). Serum IL-10 levels were positively correlated with IL-6 (p < 0.00001), CRP (p < 0.00001), fibrinogen (p = 0.003), and ESR (p < 0.00001), and negatively correlated with hemoglobin (p = 0.0004) and lymphocytes (p = 0.01). Serum IL-6 levels were positively correlated with CRP (p < 0.00001), fibrinogen (p = 0.001), and ESR (p < 0.00001); and negatively correlated with hemoglobin (p = 0.008) and lymphocytes (p = 0.03). Elevated serum IL-10 levels were associated with an increased risk of anti-SS-A/Ro antibody positivity (p = 0.03). Elevated serum IL-6 levels were associated with an increased risk of heart (p = 0.007) and lung (p = 0.04) involvement. CONCLUSIONS In SLE patients, increased serum IL-10 levels were associated with increased disease activity and risk of anti-SS-A/Ro antibody positivity.
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Affiliation(s)
- Agnieszka Winikajtis-Burzyńska
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
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Milchert M, Fliciński J, Brzosko M. Intima-media thickness cut-off values depicting "halo sign" and potential confounder analysis for the best diagnosis of large vessel giant cell arteritis by ultrasonography. Front Med (Lausanne) 2022; 9:1055524. [PMID: 36582293 PMCID: PMC9792608 DOI: 10.3389/fmed.2022.1055524] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
Background Vascular ultrasound enables fast-track diagnosis of giant cell arteritis (GCA), but this method remains subjective. We aimed to determine intima-media thickness (IMT) cut-off values for large vessel GCA (LV-GCA) and identify the clinically relevant factors influencing it. Methods We included 214 patients referred for ultrasound evaluation within a fast-track clinic due to suspected GCA. IMT was measured in axillary, brachial, subclavian, superficial femoral, and common carotid arteries (CCA), in a place without identifiable atherosclerotic plaques. IMT cut-off values for vasculitis were determined by comparing measurements in arteries classified as vasculitis vs. controls without GCA/polymyalgia rheumatica (PMR). Results Giant cell arteritis was diagnosed in 81 individuals, including extracranial LV-GCA in 43 individuals. Isolated PMR was diagnosed in 50 subjects. In 83 remaining patients, another diagnosis was confirmed, and they served as controls. The rounded optimal IMT cut-off values for the diagnosis of axillary vasculitis were 0.8 mm, subclavian-0.7 mm, superficial femoral-0.9 mm, CCA-0.7 mm, and brachial-0.5 mm. The IMT cut-off values providing 100% specificity for vasculitis (although with reduced sensitivity) were obtained with axillary IMT 1.06 mm, subclavian-1.35 mm, superficial femoral-1.55 mm, CCA-1.27 mm, and brachial-0.96 mm. Axillary and subclavian arteritis provided the best AUC for the diagnosis of GCA, while carotid and axillary were most commonly involved (24 and 23 patients, respectively). The presence of calcified atherosclerotic plaques was related to an increase of IMT in both patients and controls, while male sex, age ≥ 68, hypertension, and smoking increased IMT in controls but not in patients with GCA. Conclusion Cut-off values for LV-GCA performed best in axillary and subclavian arteritis but expanding examination to the other arteries may add to the sensitivity of GCA diagnosis (another location, e.g., brachial arteritis) and its specificity (identification of calcified atherosclerotic plaques in other arteries such as CCA, which may suggest applying higher IMT cut-off values). We proposed a more linear approach to cut-off values with two values: one for the most accurate and the other for a highly specific diagnosis and also considering some cardiovascular risk factors.
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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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Fischer K, Przepiera-Będzak H, Brzosko I, Sawicki M, Walecka A, Brzosko M. Anti-Phosphatidylethanolamine and Anti-Phosphatidylserine Antibodies—Association with Renal Involvement, Atherosclerosis, Cardiovascular Manifestations, Raynaud Phenomenon and Disease Activity in Polish Patients with Systemic Lupus Erythematosus. Biomolecules 2022; 12:biom12101328. [PMID: 36291537 PMCID: PMC9599205 DOI: 10.3390/biom12101328] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Objective. To evaluate the association between anti-phosphatidylethanolamine (aPE) and anti-phosphatidylserine (aPS) antibodies and cardiovascular risk, organ involvement and disease activity in systemic lupus erythematosus (SLE) patients. Methods. We studied 93 SLE patients and 30 controls. We analyzed levels of anti-phospholipid antibodies, including aPS and aPE, the profiles of antinuclear, anti-neutrophil cytoplasmic (ANCA) and anti-endothelial antibodies, carotid intima-media thickness (cITM) and atherosclerotic plaque presence, ankle-brachial and high resistance indices, atherosclerotic risk factors, organ manifestations and treatment. Results. Levels of aPS and aPE were significantly higher in SLE patients in comparison with the controls (p = 0.038 and p = 0.044, respectively). aPS was associated with the risk of Raynaud’s phenomenon (p = 0.021) development. aPE increased the risk of renal involvement (p = 0.049), cerebral stroke (p = 0.050), high vlues of cIMT (p = 0.041) development as well as occurrence of selected serological markers associated with activity of the disease such as anti-double stranded DNA (p = 0.021). The long duration of regular smoking (p = 0.021) and the high number of cigarettes/day (p = 0.015) were significantly associated with the risk of aPE occurrence. Conclusions. Patients with aPS and aPE are at risk of vascular involvement. Especially the presence of aPE may significantly increase the risk of thrombotic complications development in SLE patients without classical serological markers of APS. Finally, aPE might be used as a marker of disease activity and risk of renal injury development in this patient group. The classical atherosclerotic markers including lipid indices play an important role in complex analysis of cardiovascular risk in lupus patients and enable to identify patients at the highest risk and implement effective preventive, diagnostic and therapeutic procedures.
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Affiliation(s)
- Katarzyna Fischer
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
- Correspondence: ; Tel.: +48-914-250-552; Fax: +48-914-253-344
| | - Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Iwona Brzosko
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Marcin Sawicki
- Department of Imaging Diagnostics and Interventional Radiology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Anna Walecka
- Department of Imaging Diagnostics and Interventional Radiology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
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Manzo C, Milchert M, Venditti C, Castagna A, Nune A, Natale M, Brzosko M. Fever Correlation with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentrations in Patients with Isolated Polymyalgia Rheumatica (PMR): A Retrospective Comparison Study between Hospital and Out-of-Hospital Local Registries. Life (Basel) 2022; 12:life12070985. [PMID: 35888074 PMCID: PMC9317449 DOI: 10.3390/life12070985] [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: 06/05/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Polymyalgia rheumatica (PMR) is the most common systemic inflammatory rheumatic disease affecting the elderly. Giant cell arteritis (GCA) is a granulomatous vasculitis affecting the aorta and its branches associated with PMR in up to 20% of cases. In recent studies based on university hospital registries, fever correlated with the erythrocyte sedimentation rate (ESR) but not with C-reactive protein (CRP) concentrations at the time of diagnosis in patients with isolated PMR. A long delay to a PMR diagnosis was suggested to explain this discrepancy, possibly caused by laboratory alterations (for instance, anemia of chronic disease type) that can influence only ESR. We performed a retrospective comparison study between the university hospital and two out-of-hospital public ambulatory databases, searching for any differences in fever/low-grade fever correlation with ESR and CRP. Methods: We identified all patients with newly diagnosed PMR between 2013 and 2020, only including patients who had a body temperature (BT) measurement at the time of diagnosis and a follow-up of at least two years. We considered BT as normal at <37.2 °C. Routine diagnostic tests for differential diagnostics were performed at the time of diagnosis and during follow-ups, indicating the need for more in-depth investigations if required. The GCA was excluded based on the presence of suggestive signs or symptoms and routine ultrasound examination of temporal, axillary, subclavian, and carotid arteries by experienced ultrasonographers. Patients with malignancies, chronic renal disease, bacterial infections, and body mass index (BMI) > 30 kg/m2 were excluded, as these conditions can increase CRP and/or ESR. Finally, we used the Cumulative Illness Rating Scale (CIRS) for quantifying the burden of comorbidities and excluded patients with a CIRS index > 4 as an additional interfering factor. Results: We evaluated data from 169 (73 from hospital and 96 from territorial registries) patients with newly diagnosed isolated PMR. Among these, 77.7% were female, and 61.5% of patients had normal BT at the time of diagnosis. We divided the 169 patients into two cohorts (hospital and territorial) according to the first diagnostic referral. Age at diagnosis, ESR, CRP, median hemoglobin (HB), and diagnostic delay (days from first manifestations to final diagnosis) were statistically significantly different between the two cohorts. However, when we assessed these data according to BT in the territorial cohort, we found a statistical difference only between ESR and BT (46.39 ± 19.31 vs. 57.50 ± 28.16; p = 0.026). Conclusions: ESR but not CRP correlates with fever/low-grade fever at the time of diagnosis in PMR patients with a short diagnosis delay regardless of HB levels. ESR was the only variable having a statistically significant correlation with BT in a multilevel regression analysis adjusted for cohorts (β = 0.312; p = 0.014).
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Affiliation(s)
- Ciro Manzo
- Rheumatologic Outpatient Ambulatory, Health District No. 59, Azienda Sanitaria Locale Napoli 3 Sud, 80065 Naples, Italy;
- Correspondence:
| | - Marcin Milchert
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, 71-457 Szczecin, Poland; (M.M.); (M.B.)
| | - Carlo Venditti
- Rheumatologic Outpatient Clinic Health District Campobasso, Via Ugo Petrella 1, 86100 Campobasso, Italy;
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, 88068 Soverato, Italy;
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK;
| | - Maria Natale
- Rheumatologic Outpatient Ambulatory, Health District No. 59, Azienda Sanitaria Locale Napoli 3 Sud, 80065 Naples, Italy;
| | - Marek Brzosko
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, 71-457 Szczecin, Poland; (M.M.); (M.B.)
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Wójcik K, Ćmiel A, Satława T, Lichołai S, Wawrzycka-Adamczyk K, Biedroń G, Masiak A, Zdrojewski Z, Storoniak H, Bułło-Piontecka B, Dębska-Ślizień A, Jeleniewicz R, Majdan M, Jakuszko K, Augustyniak-Bartosik H, Krajewska M, Brzosko I, Brzosko M, Kur-Zalewska J, Tłustochowicz W, Madej M, Hawrot-Kawecka A, Kucharz E, Głuszko P, Wisłowska M, Miłkowska-Dymanowska J, Lewandowska-Polak A, Makowska J, Zalewska J, Gubała T, Malawski M, Musiał J. POS0253 PERSONALIZED RISK EVALUATION FOR OUTCOME PREDICTION IN ANCA ASSOCIATED VASCULITIS (AAV) USING LATENT CLASS ANALYSIS AND MACHINE LEARNING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1089] [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: 11/03/2022]
Abstract
BackgroundANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology. In the most severe cases AAV can lead to end stage kidney disease or death. Since etiology and detailed pathogenesis of AAV is not known, the prediction of disease outcome at the time of diagnosis is challenging. Thus, there is an unmet need for tools to identify patients with the highest risk of organ dysfunction and death and apply effective personalized therapy.ObjectivesThe aim of this work was to search for tools allowing outcome prediction at the time of AAV diagnosis. Early identification of patients, who are likely to develop severe organ dysfunction and death is crucial for appropriate disease management. Induction therapy in AAV relays on immunosuppressive drugs characterized by a high risk of severe side effects. Thus, their administration in high doses should be limited only to individual patients with an especially high risk of poor outcome.MethodsWe applied here two methods of identification of AAV patients at risk to develop severe organ dysfunction and death. First method (latent class analysis [LCA] followed by logistic regression) was meant to subcategorize patients and identify a subgroup at subjects at risk to develop chronic renal replacement therapy (CRRT) and death [1]. Second, served to assess individual poor outcome risk and was based on two machine learning (ML) classifiers, which by analyzing clinical information allow assigning computed risk for CRRT and death in an individual patient allowing to identify subjects with high risk of chronic replacement therapy (CRRT) and death. We have evaluated a number of different approaches to build the ML models (including logistic regression, support vector machines, random forests), and obtained the best results for the gradient boosting algorithm implementation called LightGBM [2]. It works as a sequential ensemble of so-called weak learners (decision trees) finally combined in a one prediction model. Both analyses were based on retrospective data from Polish national AAV registry (POLVAS) [3] including presently 565 GPA and 135 MPA patients. The parameters used were: demographic data and laboratory parameters, specific organ involvement, ANCA specificity and time between selected stages of the disease.ResultsLCA used on our AAV cohort identified four subphenotypes – three already previously proposed - and revealing a fourth clinically relevant subphenotype. This new subphenotype includes only GPA patients, usually diagnosed at a younger age as compared to other groups, and characterized by multiorgan involvement, high relapse rate, relatively high risk of death, but no end-stage kidney disease. Logistic regression analysis revealed significant differences in the risk of CRRT and death between those subphenotypes – the worst prognosis was found for severe MPO AAV. On the other hand, using ML approach we obtained an individual prediction model with potentially relevant clinical performance (ROC AUC of 0.85 for CRRT and 0.82 for death).ConclusionWe consider results obtained encouraging. They may offer a new insight into AAV course based on data available at diagnosis, and create a solid foundation for potential clinical decision support system.References[1]Wójcik K et al. Subphenotypes of ANCA-associated vasculitis identified by latent class analysis. Clin Exp Rheumatol. 2021 Mar-Apr;39 Suppl 129(2):62-68.[2]Ke G, at al. Light GBM: A Highly Efficient Gradient Boosting Decision Tree. Advances in Neural Information Processing Systems 30 (NIPS 2017), pp. 3149-3157.[3]Wójcik K et al. Clinical characteristics of Polish patients with ANCA-associated vasculitides-retrospective analysis of POLVAS registry. Clin Rheumatol. 2019 Sep;38(9):2553-2563.AcknowledgementsThis work was supported by a grant from Polish National Science Center UMO-2018/31/B/NZ6/03898Disclosure of InterestsNone declared
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Milchert M, Castagna A, Manzo C, Brzosko M. Implications of fever on erythrocyte sedimentation rate but not on C-reactive protein concentrations at the time of diagnosis of polymyalgia rheumatica. Comments on Betrains et al. Clin Exp Rheumatol 2022; 40:667. [PMID: 34796849 DOI: 10.55563/clinexprheumatol/8u94jp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marcin Milchert
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, Szczecin, Poland
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, Italy
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, Health District no. 59, Rheumatologic Outpatient Clinic, Sant'Agnello, Napoli, Italy.
| | - Marek Brzosko
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, Szczecin, Poland
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12
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Wiącek MP, Bobrowska-Snarska D, Brzosko M, Lubiński W, Modrzejewska M. Impact of systemic steroids combined with immunosuppressive treatment on glaucomatous features in patients with systemic lupus erythematosus. Int J Ophthalmol 2022; 15:71-76. [PMID: 35047359 DOI: 10.18240/ijo.2022.01.11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the incidence of increased intraocular pressure (IOP) and glaucomatous changes in systemic lupus erythematosus (SLE) patients in comparison with systemic steroids and immunosuppressive treatment. METHODS Sixty-two women with SLE were divided into two groups: treated (n=47, 94 eyes) and not treated (n=15, 30 eyes) with systemic glucocorticosteroids (GC; GC-free). Twenty-one individuals in GC group were treated with immunosuppressive agents (immunomodulating and biologic). The visual acuity and IOP with ocular pulsatile amplitude (OPA) measurements, as well as scanning laser polarimetry (GDx) with nerve fiber index (NFI) measurement, spectral domain optical coherence tomography (SD-OCT) of the optic disk with retinal nerve fiber layer (RNFL) analysis and the macular region with ganglion cell analysis (GCA) were performed. RESULTS Mean IOP values in group with combined GC and immunosuppressive therapy was 15.8±2.56 mm Hg and was significantly lower than in individuals with exclusive GC treatment (17.63±4.38 mm Hg, P=0.043). Contrary, no differences in mean IOP values between GC-free group and individuals treated with combined GC and immunosuppressive therapy were detected (P=0.563). Similarly, mean IOP in GC was 17.14±3.94 mm Hg and in GC-free patients was equal to 16.67±3.45 mm Hg (P=0.671). According to treatment regimen no statistical differences in optic disk SD-OCT for RNFL thickness, RNFL symmetry, cupping volume and the C/D ratio were observed. Similarly, no statistical differences for the mean and minimal ganglion cell layer (GCL) thickness measured in macular SD-OCT or NFI in GDx were detected. CONCLUSION Combined immunosuppressive and systemic GC therapy in SLE patients may lower the risk of iatrogenic ocular hypertension. No relationship between treatment regimen and glaucomatous damage of optic nerve fibers in analyzed groups with SLE is detected.
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Affiliation(s)
- Marta P Wiącek
- First Department of Ophthalmology, Pomeranian Medical University, Szczecin 70-111, Poland.,Institute of Physics, University of Szczecin, Szczecin 70-451, Poland
| | - Danuta Bobrowska-Snarska
- Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University, Szczecin 71-252, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University, Szczecin 71-252, Poland
| | - Wojciech Lubiński
- Second Department of Ophthalmology, Pomeranian Medical University, Szczecin 70-111, Poland
| | - Monika Modrzejewska
- Second Department of Ophthalmology, Pomeranian Medical University, Szczecin 70-111, Poland
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Snarska W, Jurkowska Z, Bobrowska-Snarska D, Brzosko M, Przepiera-Będzak H. Risk factors for SARS‑CoV-2 infection in patients with rheumatic diseases. Pol Arch Intern Med 2021; 131. [PMID: 34845898 DOI: 10.20452/pamw.16147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Weronika Snarska
- Student Scientific Society, Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Zuzanna Jurkowska
- Student Scientific Society, Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Danuta Bobrowska-Snarska
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, 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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Milchert M, Manzo C, Castagna A, Brzosko M. Calcium pyrophosphate disease and polymyalgia reumatica: association or coincidence? Comment on "Ultrasound shoulder assessment of calcium pyrophosphate disease with suspected polymyalgia rheumatica" Ottaviani et al. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/kcan9r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Health District no. 59, Sant’Agnello, Naples, Italy.
| | - Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Department, Fragility Outpatient Clinic, Casa della salute "Chiaravalle Centrale", Chiaravalle, Catanzaro, Italy
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
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Mularek-Kubzdela T, Ciurzyński M, Kowal Bielecka O, Kasprzak JD, Kopeć G, Mizia-Stec K, Mroczek E, Lewicka E, Skoczylas I, Grabka M, Furdal M, Florczyk M, Brzosko M, Batko B, Przepiera-Będzak H, Samborski W, Kucharz EJ. An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation and the Polish Society for Rheumatology on the diagnosis and treatment of pulmonary hypertension in patients with connective tissue disease. Kardiol Pol 2021; 79:917-929. [PMID: 34227677 DOI: 10.33963/kp.a2021.0055] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
Systemic connective tissue diseases (CTDs) comprise a large group of diseases that are auto-immune in nature and characterized by the involvement of multiple systems and organs. Pul-monary hypertension (PH) of various etiologies may develop in the course of CTD, including pulmonary arterial hypertension (PAH), PH secondary to the lung disease, postcapillary PH in the course of left heart disease, and chronic thromboembolic pulmonary hypertension (CTEPH). In addition, the different forms of PH may coexist with each other. Among patients with CTD, PAH occurs most commonly in those with systemic sclerosis, where it affects ap-proximately 8%-12% of patients. The prognosis in patients with untreated PAH is very poor. It is particularly important to identify the high-risk CTD-PAH population and to perform effi-cient and accurate diagnostics so that targeted therapy of the pulmonary arteries can be intro-duced. Echocardiography is used to screen for PH, but clinical and echocardiographic suspicion of PH always requires confirmation by right heart catheterization. Confirmation of PAH ena-bles the initiation of life-prolonging pharmacological treatment in this group of patients, which should be administered in referral centers. Drugs available for pharmacological management include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclins.
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Affiliation(s)
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Otylia Kowal Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Poland
| | - Jarosław D Kasprzak
- Department of Cardiology, Medical University of Lodz, Bieganski Regional Specialist Hospital, Łódź, Poland
| | - Grzegorz Kopeć
- Pulmonary Circulation Center, Department of Cardiovascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital in Krakow, Poland
| | - Katarzyna Mizia-Stec
- Department of Cardiology, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Mroczek
- Cardiology Department, Regional Hospital in Wroclaw, Research and Development Center, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Ilona Skoczylas
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marek Grabka
- 1st Department of Cardiology Silesian University of Medicine, Katowice, Poland
| | - Michał Furdal
- Cardiology Department, Centre for Heart Diseases, 4thMilitary Hospital, Wrocław, Poland
| | - Michał Florczyk
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Center in Otwock, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geristrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Andrzej Frycz Modrzewski University, Kraków, Poland
| | - Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine, Geristrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Włodzimierz Samborski
- Department of Rheumatology, Rehabilitation and Internal Medicine, Karol Marcinkowski Medical University, Poznań, Poland
| | - Eugeniusz J Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
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Wójcik K, Masiak A, Zdrojewski Z, Jeleniewicz R, Majdan M, Brzosko I, Brzosko M, Madej M, Jakuszko K, Kur-Zalewska J, Tłustochowicz W, Storoniak H, Bułło-Piontecka B, Dębska-Ślizień A, Hawrot-Kawecka A, Głuszko P, Stasiek M, Wisłowska M, Kucharz E, Musiał J. AB0820 INFLUENCE OF ANCA ANTIBODIES ON DEMOGRAPHIC AND CLINICAL CHARACTERISTIC OF AAV. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology and the broad clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Unfortunately the clinical classification, ANCA specificity or genetic characteristics alone is not able to categorize AAV patients in a satisfactory manner. As a consequence advanced statistical techniques were used to identify and stratify AAV subphenotypes [1, 2]. Here we have analyzed influence of the ANCA type on clinical manifestations and demographic characteristics in various types of AAV, based on data from the POLVAS registryObjectives:We decided to retrospectively analyze a large cohort of Polish AAV patients deriving from several referral centers – members of the Scientific Consortium of the Polish Vasculitis Registry (POLVAS) – and concentrate on demographic and clinical characteristics of anti-PR3 and anti-MPO positive patients regardless of their clinical diagnosis.Methods:We conducted a systematic multicenter retrospective study of adult patients diagnosed with AAV between Jan 1990 and Dec 2016. Patients were enrolled by 9 referral centers. We analyzed dichotomous variables: gender; ANCA status – anti-PR3+ or anti-MPO+, ANCA negative; organ involvement - skin, eye, ENT, respiratory, heart, GI, renal, urinary, CNS, peripheral nerves and polytomous variable (number of relapses), supported by quantitative covariates (e.g., age at diagnosis, CRP at diagnosis, maximal serum creatinine concentration ever)[3].Results:MPO-positive patients (both GPA and EGPA phenotype) were older at the time of diagnosis with a substantial percentage diagnosed > 65 years of age, and with high rate of renal involvement. Interestingly, while in the whole group of patients diagnosed with EGPA male to female ratio was 1:2, the MPO+ EGPA patients showed M:F ratio of 1:1.The analysis of ANCA negative AAV reveled significant differences in GPA, ANCA negative group is characterized with significantly lower frequency of renal involvement compared to rest GPA (11,5% vs 63,7%) p<0,05 what should be emphasized ANCA negative AAV never lead to ESRD (end stage renal disease) or even transient dialysis.Conclusion:ANCA specificity is indispensable as a separate variable in any clinically relevant analysis of AAV subcategories. MPO+ group is characterized by older age at time of diagnosis, male to female ration 1:1, kidney involvement, and shows more homogenous clinical phenotype than PR3+ AAV patients. In our group ANCA negative AAV never lead to ESRD (end stage renal disease) or even transient dialysis.References:[1]Mahr A, Specks U, Jayne D. Subclassifying ANCA-associated vasculitis: a unifying view of disease spectrum. Rheumatol Oxf Engl 2019;58:1707–9. https://doi.org/10.1093/rheumatology/kez148.[2]Wójcik K, Biedroń G, Wawrzycka-Adamczyk K, Bazan-Socha S, Ćmiel A, Zdrojewski Z et al. Subphenotypes of ANCA-associated vasculitis identified by latent class analysis. Clin Exp Rheumatol. 2020 Sep 1. Epub PMID: 32896241.[3]Wójcik K, Wawrzycka-Adamczyk K, Włudarczyk A, Sznajd J, Zdrojewski Z, Masiak A, et al. Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clinical Rheumatology. 1 wrzesień 2019;38(9):2553–63.Disclosure of Interests:None declared
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Affiliation(s)
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology of Pomeranian Medical University in Szczecin, Poland
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Wójcik K, Biedroń G, Wawrzycka-Adamczyk K, Bazan-Socha S, Ćmiel A, Zdrojewski Z, Masiak A, Czuszyńska Z, Majdan M, Jeleniewicz R, Klinger M, Krajewska M, Kusztal M, Brzosko M, Iwona B, Dębska-Ślizień A, Storoniak H, Bułło-Piontecka B, Tłustochowicz W, Kur-Zalewska J, Wisłowska M, Madej M, Hawrot-Kawecka A, Głuszko P, Stasiek M, Kucharz E, Musiał J. Subphenotypes of ANCA-associated vasculitis identified by latent class analysis. Clin Exp Rheumatol 2021; 39 Suppl 129:62-68. [DOI: 10.55563/clinexprheumatol/d01o72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Biedroń
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Stanisława Bazan-Socha
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Ćmiel
- Department of Applied Mathematics, AGH University of Science and Technology, Kraków, Poland
| | - Zbigniew Zdrojewski
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
| | - Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
| | - Zenobia Czuszyńska
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland
| | - Radosław Jeleniewicz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Marek Brzosko
- Department of Rheumatology and Internal Diseases, Pomeranian Medical University in Szczecin, Poland
| | - Brzosko Iwona
- Department of Rheumatology and Internal Diseases, Pomeranian Medical University in Szczecin, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Poland
| | - Hanna Storoniak
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Poland
| | - Barbara Bułło-Piontecka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Poland
| | - Witold Tłustochowicz
- Department of Internal Medicine and Rheumatology, Military Medicine Institute, Warsaw, Poland
| | - Joanna Kur-Zalewska
- Department of Internal Medicine and Rheumatology, Military Medicine Institute, Warsaw, Poland
| | - Małgorzata Wisłowska
- Department of Internal Diseases and Rheumatology, Central Clinical Hospital of the Ministry of the Interior and
Administration, Warsaw, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Anna Hawrot-Kawecka
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Głuszko
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Małgorzata Stasiek
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Eugeniusz Kucharz
- Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland.
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Manzo C, Milchert M, Natale M, Brzosko M. Polymyalgia rheumatica without elevated baseline acute phase reactants. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/s4c5k3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic Outpatient Clinic, Health District no.59, Sant’Agnello, Naples, Italy.
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
| | - Maria Natale
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic Outpatient Clinic, Health District no.59, Sant’Agnello, Naples, Italy
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
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Biedroń G, Włudarczyk A, Wawrzycka-Adamczyk K, Wójcik K, Musiał J, Bazan-Socha S, Zdrojewski Z, Masiak A, Czuszyńska Z, Majdan M, Jeleniewicz R, Klinger M, Krajewska M, Augustyniak-Bartosik H, Jakuszko K, Brzosko M, Brzosko I, Dębska-Ślizień A, Storoniak H, Bułło-Piontecka B, Tłustochowicz W, Kur-Zalewska J, Wisłowska M, Madej M, Hawrot-Kawecka A, Głuszko P, Kucharz EJ, Szczeklik W. Respiratory involvement in antineutrophil cytoplasmic antibody-associated vasculitides: a retrospective study based on POLVAS registry. Clin Exp Rheumatol 2021; 40:720-726. [DOI: 10.55563/clinexprheumatol/tvtyen] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Grzegorz Biedroń
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Włudarczyk
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof Wójcik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisława Bazan-Socha
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Zdrojewski
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
| | - Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
| | - Zenobia Czuszyńska
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland
| | - Radosław Jeleniewicz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, and Department of Nephrology and Internal Medicine, University of Opole, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | | | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Marek Brzosko
- Department of Rheumatology and Internal Diseases, Pomeranian Medical University in Szczecin, Poland
| | - Iwona Brzosko
- Department of Rheumatology and Internal Diseases, Pomeranian Medical University in Szczecin, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Poland
| | - Hanna Storoniak
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Poland
| | - Barbara Bułło-Piontecka
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdańsk, Poland
| | - Witold Tłustochowicz
- Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warszawa, Poland
| | - Joanna Kur-Zalewska
- Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Warszawa, and Clinical Research Support Centre, Military Institute of Medicine, Warszawa, Poland
| | - Małgorzata Wisłowska
- Department of Internal Diseases and Rheumatology, Central Clinical Hospital of the Ministry of the Interior and Administration, Warszawa, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Anna Hawrot-Kawecka
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Głuszko
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warszawa, Poland
| | - Eugeniusz J. Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
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Przepiera-Będzak H, Fischer K, Brzosko M. Serum interleukin-23 protects, whereas methotrexate treatment stimulates selected components of the metabolic syndrome in patients with SAPHO syndrome. Arch Med Sci 2021; 17:120-126. [PMID: 33488864 PMCID: PMC7811326 DOI: 10.5114/aoms.2018.76953] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/04/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the impact of disease activity, selected serum cytokines, and therapy on metabolic syndrome (MetS) components in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. MATERIAL AND METHODS We studied 46 SAPHO patients (40 women, 6 men). We recorded age, sex, disease duration, arthritis localization, type of skin changes, bone scintigraphy results, comorbidities, BASDAI, VAS, and treatment. We measured erythrocyte sedimentation rate, C-reactive protein, lipid profile, serum IL-6, IL-18, IL-23, endothelin-1, vascular endothelial growth factor, and epidermal growth factor (EGF). RESULTS 97.8% of patients had sternoclavicular joint arthritis, 91.3% of patients palmoplantar pustulosis. In 65.2% of SAPHO patients skin changes and arthritis started simultaneously. Apart from non-steroidal anti-inflammatory drugs, patients were treated with methotrexate (41.3%), sulfasalazine (41.3%), and antibiotics (39.1%). 19.5% of patients met MetS criteria. Serum IL-23 correlated positively with total cholesterol (TC; p = 0.02) and high-density lipoprotein cholesterol (HDL-C) (p = 0.01) in the SAPHO group. There was a negative correlation between HDL-C and BASDAI (p = 0.02). Patients treated with methotrexate had higher triglyceride (p = 0.01) and low-density lipoprotein cholesterol (LDL-C) (p = 0.01) levels. There was a negative correlation between TC and EGF (p = 0.03). Increased prevalence of autoimmune diseases and depression was observed in SAPHO patients. CONCLUSIONS Serum IL-23 protects, whereas methotrexate treatment stimulates selected components of the MetS in patients with SAPHO syndrome.
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Affiliation(s)
- Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Fischer
- Independent Laboratory of Rheumatic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University, Szczecin, Poland
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Milchert M, Brzosko M. Familial aggregation of longevity in giant cell arteritis and polymyalgia rheumatica. Rheumatol Int 2020; 40:2071-2075. [PMID: 32683496 PMCID: PMC7591435 DOI: 10.1007/s00296-020-04649-7] [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: 04/03/2020] [Accepted: 07/11/2020] [Indexed: 11/25/2022]
Abstract
The long-term mortality in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) is unexpectedly decreased or at least not increased regardless of several mortality risk factors that these diseases share with other chronic immune-mediated rheumatic diseases. The genetic and immunological profile of PMR/GCA patients is unique, therefore, the hypothesis that this profile provides some survival advantage to PMR/GCA patients should be considered. The longevity is a phenomenon that was demonstrated to be familial. The familial aggregation of longevity can be studied by analysis of life expectancy in family members. Here we test the hypothesis of the aggregation of an increased longevity in the families of PMR/GCA patients. We compared the age of death of 358 parents of 179 PMR and GCA patients with corresponding data retrieved from 506 parents of 253 randomly collected age and sex-matched controls. The number of nonagenarian (≥ 90-year -old) mothers of PMR/GCA patients was significantly higher (OR = 2.34, 95%CI 1.11–11.95, p < 0.0005) vs controls. Both nonagenarian parents were found in 6 patients (3.35%) and none in the control cohort (OR = 8.77, 95%CI 2.26–405.10, p = 0.003). Our data suggest the familial aggregation of nonagenarians in PMR/GCA patients.
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Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland.
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, ul Unii Lubelskiej 1, 71-252, Szczecin, Poland
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Masiak A, Ziętkiewicz M, Wójcik K, Wawrzycka-Adamczyk K, Madej M, Kur-Zalewska J, Wisłowska M, Storoniak H, Komorniczak M, Brzosko I, Brzosko M, Dębska-Ślizień A, Musiał J, Zdrojewski Z. SAT0265 RISK FACTORS FOR INFECTIOUS COMPLICATIONS FOLLOWING RITUXIMAB TREATMENT – MULTICENTER POLISH EXPERIENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2930] [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: 11/03/2022]
Abstract
Background:Rituximab (RTX) is a B cell depleting monoclonal antibody with proven efficacy in the treatment of ANCA-associated vasculitis (AAV). The infectious complications occur in 15-25%.Objectives:We aimed to assess the frequency and risk factors of infections in patients with AAV receiving RTX among Polish patients.Methods:7 tertiary referral centers experienced in the treatment of vasculitis completed a questionnaire regarding AAV patients treated with RTX.Results:Among 49 patients included in the analysis (47 with GPA, 2 with MPA; 36/73% men; mean age at diagnosis 42,45±14,9 yrs., mean age on RTX initiation 46,14±14,72 yrs.,) at least one infection occurred in 20 patients (40.82%) after mean time of 16,65±16,01 weeks since the administration of RTX. Patients were followed for a mean time of 26,88±21,94 months. There were no differences in the incidence of infectious complications by gender, age, BMI, smoking status, severity of the disease, activity of the disease (BVAS), time from diagnosis to RTX initiation, carriage of staphylococcus aureus in the upper respiratory tract, total dose of CYC before RTX treatment. We didn’t observe severe hypogammaglobulinemia or neutropenia after RTX treatment. 40% of the observed infections occurred during the first month, 35% between second and sixth month of follow-up, while 25% were observed between 6 and 12 months after the RTX initiation. Of the 20 patients who developed infection, 12 (24.5%) had further infections. Antibiotic prophylaxis with trimethoprim–sulfamethoxazole was administered in 40 out of 49 (81.63%). Upper respiratory tract infection was the most common infectious complication (n=11), followed by lower respiratory tract (n=4), soft tissues (n=4) and urinary tract infections (n=4), lacrimal gland abscess (n=2) and abdomen (n=1). In cases with a positive microbial result Staphylococcus aureus (n=4), Klebsiella pneumoniae (n=2), Pseudomonas aeruginosa (n=1), Candida (n=1) and others (n=6) were identified. No fatalities were recorded and only 3 patients had severe infection with the necessity of prolonged treatment.Conclusion:Despite the high number of infections in our group treated with RTX, most of them were not severe. Upper respiratory tract was the most common site of infection.Disclosure of Interests:None declared
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Milchert M, Brzosko M. SAT0266 FAMILIAR AGGREGATION OF LONGEVITY IN GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4266] [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: 11/04/2022]
Abstract
Background:The long-term mortality in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) is unexpectedly decreased (1,2,3,4) or at least not increased regardless increased mortality risk factors that these diseases share with other systemic inflammatory disorders.Objectives:We aimed to test the hypothesis on aggregation of increased longevity in families of PMR/GCA patients because the family members of long-lived subjects have a survival advantage.Methods:After questioning our patients we compared age of death of 358 parents of 179 PMR and GCA patients with corresponding data retrieved from 506 parents of 235 randomly collected age and sex matched controls.Results:We found the number of nonagenarian (≥90 year old) mothers of PMR/GCA patients significantly higher vs controls. Both nonagenarian parents were found in 6 patients (3.35%) and in none of the controls. Decreased number of nonagenarian fathers of our patients remains unexplained.Table 1.Number of nonagenarians (.90 years olds) in parents of PMR/GCA patientsParents agePMR/GCA (N=179)Controls (N=253)OR95%CIpMothers<90148 (82.68%)243 (96.05%)≥9031 (17.32%)10 (3.95%)2.341.11-11.95<0.0005Fathers<90≥90161 (89.94%)18 (10.06%)203 (80.24%)50 (19.76%)0.450.24-0.830.0064One of parents<90≥90136 (75.98%)43 (24.02%)193 (76.28%)60 (23.72%)1.020.63-1.630.9412Both parents<90≥90173 (96.65%)6 (3.35%)253 (100.00%)0 (0%)8.772.26-405.100.003Mothers of female patients<90≥90105 (84%)20 (16%)149 (97%)4 (3%)7.12.27-29.190.0001Mothers of male patients<90≥9043 (80)11 (20%)94 (94%)6 (6%)4.011.25-13.970.0066N - number of all parentsConclusion:Confirming our findings in a wider studies would imply a need of including some genetic or behavioural factors to explain PMR/GCA survival advantage.References:[1]Garen T, Lerang K, Hoffmann-Vold AM, et al. Mortality and causes of death across the systemic connective tissue diseases and the primary systemic vasculitides. Rheumatology (Oxford) 2019;58:313-20.[2]Bengtsson BA, Malmvall BE. Prognosis of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. A follow-up study on ninety patients treated with corticosteroids. Acta Med Scand 1981;209:337-45.[3]Andersson R, Malmvall BE, Bengtsson BA. Long-term survival in giant cell arteritis including temporal arteritis and polymyalgia rheumatica. A follow-up study of 90 patients treated with corticosteroids. Acta Med Scand 1986;220:361-4.[4]Gonzalez-Gay MA, Blanco R, Abraira V et al Giant cell arteritis in Lugo, Spain, is associated with low longterm mortality. J Rheumatol 1997;24:21716.Acknowledgments:o professor Maciej Markiewski for revision of the manuscriptDisclosure of Interests:Marcin Milchert Consultant of: Sanofi, Roche, Marek Brzosko: None declared
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Wójcik K, Ćmiel A, Masiak A, Zdrojewski Z, Jeleniewicz R, Majdan M, Brzosko I, Brzosko M, Głuszko P, Stasiek M, Wisłowska M, Kur-Zalewska J, Madej M, Hawrot-Kawecka A, Storoniak H, Bułło-Piontecka B, Dębska-Ślizień A, Kucharz E, Jakuszko K, Musiał J. FRI0223 SUBPHENOTYPES OF ANCA ASSOCIATED VASCULITIS IDENTIFIED BY LATENT CLASS ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:ANCA associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown etiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus there is an unmet need for phenotype identification especially among patients with granulomatosis with polyangiitis GPA, patients with microscopic polyangiitis MPA group seems to be more uniform. Recently, based on previous clustering analysis and clinical, histopathological, serological and prognostic aspects three subcategories of AAV have been proposed and named as: non-severe AAV, severe PR3-AAV and severe MPO-AAV [1].Objectives:In line with these attempts to subcategorize AAV we decided to use latent class analysis (LCA) on a large multicenter cohort of polish AAV patients from POLVAS [2] registry to identify potential new subphenotypes or confirm already proposed ones.Methods:Latent Class Analysis (LCA) approach was used as a model based clustering method of objects described by dichotomous (e.g., gender; ANCA status – cANCA, pANCA; organ involvement - skin, eye, ENT, respiratory, heart, GI, renal, urinary, CNS, peripheral nerves) and polytomous (number of relapses) variables supported by quantitative covariates (e.g., age at diagnosis, CRP at diagnosis, maximal serum creatinine concentration ever).Results:Results of LCA on our AAV group returned four class model of AAV subphenotypes, confirming existence of the previously proposed by Mahr at al. [1] and revealed fourth – previously not described clinically relevant subphenotype. To this fourth class - belong patients only with GPA, diagnosed at young age, with multiorgan involvement, high relapse rate and relatively high risk of death.Table 1.AAV subcategorization – summary of clinical characteristics and ANCA specificityLCA Class 1LCA Class 2LCA Class 3LCA Class 4No of patients13019410297AAV typeMainly GPAMainly GPAmainly MPAOnly GPAAge at diagnosisMiddle ageMiddle ageOldYoungMale/female ratio1:22:11:11:1Main organ involvementENT, respiratory, eyeRenal, respiratory, ENTRenal, respiratory, skinMultiorgan involvementRelapse rateintermediateintermediatelowhighModified class description (based on ref. [1])Non severe AAVSevere PR3 AAVSevere MPO AAVSevere non-renalPR3 AAVConclusion:Based on multiple clinical and serological variables LCA methodology identified 4-class subphenotypes model of AAV. Fourth-class is a new clinically important subphenotype including exclusively PR3-positive young AAV patients with multiorgan involvement, high risk of relapse and distinct mortality.References:[1]Mahr A, Specks U, Jayne D. Subclassifying ANCA-associated vasculitis: a unifying view of disease spectrum. Rheumatol Oxf Engl 2019;58:1707–9.https://doi.org/10.1093/rheumatology/kez148.[2]Wójcik K, Wawrzycka-Adamczyk K, Włudarczyk A, Sznajd J, Zdrojewski Z, Masiak A, i in. Clinical characteristics of Polish patients with ANCA-associated vasculitides—retrospective analysis of POLVAS registry. Clinical Rheumatology. 1 wrzesień 2019;38(9):2553–63.Disclosure of Interests:Krzysztof Wójcik: None declared, Adam Ćmiel: None declared, Anna Masiak: None declared, Zbigniew Zdrojewski: None declared, Radoslaw Jeleniewicz: None declared, Maria Majdan Consultant of: Roche, Amgen, Speakers bureau: Roche, Amgen, Iwona Brzosko: None declared, Marek Brzosko: None declared, Piotr Głuszko: None declared, Małgorzata Stasiek: None declared, Małgorzata Wisłowska: None declared, Joanna Kur-Zalewska: None declared, Marta Madej: None declared, Anna Hawrot-Kawecka: None declared, Hanna Storoniak: None declared, Barbara Bułło-Piontecka: None declared, Alicja Dębska-Ślizień: None declared, Eugeniusz Kucharz: None declared, Katarzyna Jakuszko: None declared, Jacek Musiał: None declared
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Sierakowska M, Doroszkiewicz H, Sierakowska J, Olesińska M, Grabowska-Jodkowska A, Brzosko M, Leszczyński P, Pawlak-Buś K, Batko B, Wiland P, Majdan M, Bykowska-Sochacka M, Romanowski W, Zon-Giebel A, Jeka S, Ndosi M. Factors associated with quality of life in systemic sclerosis: a cross-sectional study. Qual Life Res 2019; 28:3347-3354. [PMID: 31482431 PMCID: PMC6863937 DOI: 10.1007/s11136-019-02284-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a connective tissue disease characterized by progressive fibrosis of the skin and internal organs, leading to their failure and disturbances in the morphology and function of blood vessels. The disease affects people in different ways, and identifying how the difficulties and limitations are related to quality of life may contribute to designing helpful interventions. The aim of this study was to identify factors associated with quality of life in people with SSc. METHODS This was a cross-sectional study conducted in 11 rheumatic centres in Poland. Patients diagnosed with SSc were included. Quality of life was measured using the SSc Quality of Life Questionnaire (SScQoL). The following candidate factors were entered in preliminary multivariable analysis: age, place of residence, marital status, occupational status, disease type, disease duration, pain, fatigue, intestinal problems, breathing problems, Raynaud's symptoms, finger ulcerations, disease severity, functional disability, anxiety and depression. Factors that achieved statistical significance at the 10% level were then entered into a final multivariable model. Factors achieving statistical significance at the 5% level in the final model were considered to be associated with quality of life in SSc. RESULTS In total, 231 participants were included. Mean age (SD) was 55.82 (12.55) years, disease duration 8.39 (8.18) years and 198 (85.7%) were women. Factors associated with quality of life in SSc were functional disability (β = 2.854, p < 0.001) and anxiety (β = 0.404, p < 0.001). This model with two factors (functional disability and anxiety) explained 56.7% of the variance in patients with diffuse SSc and 73.2% in those with localized SSc. CONCLUSIONS Functional disability and anxiety are significantly associated with quality of life in SSc. Interventions aimed at improving either of these factors may contribute towards improving the quality of life of people with SSc.
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Affiliation(s)
- Matylda Sierakowska
- Department of Integrated Medical Care, Medical University of Bialystok, 7a Maria Sklodowska-Curie Street, 15-096, Bialystok, Poland.
| | | | - Justyna Sierakowska
- Department of Foreign Languages, Medical University of Bialystok, Bialystok, Poland
| | - Marzena Olesińska
- Department of Connective Tissue Disease, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Agnieszka Grabowska-Jodkowska
- Department of Connective Tissue Disease, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases and Geriatrics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Piotr Leszczyński
- Department of Rheumatology and Rehabilitation, Medical University in Poznań, Poznań, Poland
| | - Katarzyna Pawlak-Buś
- Department of Rheumatology and Rehabilitation, Medical University in Poznań, Poznań, Poland
| | - Bogdan Batko
- Center of Rheumatology, J. Dietl Hospital in Krakow, Krakow, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Diseases and Geriatrics, Medical University in Wroclaw, Wroclaw, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University in Lublin, Lublin, Poland
| | | | | | - Aleksandra Zon-Giebel
- Silesian Center of Rheumatology, Rehabilitation and Prevention of Disability, Ustroń, Poland
| | - Sławomir Jeka
- Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital in Bydgoszcz, Bydgoszcz, Poland
| | - Mwidimi Ndosi
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
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Milchert M, Brzosko M, Bull Haaversen A, Diamantopoulos AP. Correspondence to ‘Slope sign’: a feature of large vessel vasculitis? Ann Rheum Dis 2019; 80:e198. [DOI: 10.1136/annrheumdis-2019-216601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/04/2022]
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Wańkowicz P, Bobrowska-Snarska D, Nowacki P, Brzosko M. Clinical manifestations of neuropsychiatric systemic lupus erythematosus: a single-center study from West Pomerania Province in Poland. Pol Arch Intern Med 2019; 130:82-84. [PMID: 31596274 DOI: 10.20452/pamw.15015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paweł Wańkowicz
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland.
| | - Danuta Bobrowska-Snarska
- Department of Rheumatology, Internal Diseases and Geriatrics, Pomeranian Medical University, Szczecin, Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases and Geriatrics, Pomeranian Medical University, Szczecin, Poland
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Wiacek MP, Bobrowska-Snarska D, Lubiński W, Brzosko M, Modrzejewska M. What is new in recommendations on ophthalmological screening in patients treated with chloroquine and hydroxychloroquine? Update and literature review. Niger J Clin Pract 2019; 20:919-923. [PMID: 28891533 DOI: 10.4103/njcp.njcp_380_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.
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Affiliation(s)
- M P Wiacek
- Department of Ophthalmology, Geriatrics and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - D Bobrowska-Snarska
- Department of Rheumatology, Geriatrics and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - W Lubiński
- Department of Ophthalmology, Geriatrics and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - M Brzosko
- Department of Rheumatology, Geriatrics and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - M Modrzejewska
- Department of Ophthalmology, Geriatrics and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
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Suh CH, Yoo DH, Berrocal Kasay A, Chalouhi El-Khouri E, Cons Molina FF, Shesternya P, Miranda P, Medina-Rodriguez FG, Wiland P, Jeka S, Chavez-Corrales J, Linde T, Hrycaj P, Abello-Banfi M, Hospodarskyy I, Jaworski J, Piotrowski M, Brzosko M, Krogulec M, Shevchuk S, Calvo A, Andersone D, Park W, Shim SC, Lee SJ, Lee SY. Long-Term Efficacy and Safety of Biosimilar CT-P10 Versus Innovator Rituximab in Rheumatoid Arthritis: 48-Week Results from a Randomized Phase III Trial. BioDrugs 2019; 33:79-91. [PMID: 30719632 PMCID: PMC6373391 DOI: 10.1007/s40259-018-00331-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate long-term clinical outcomes of extended treatment with CT-P10, a rituximab biosimilar, compared with rituximab reference products sourced from the USA and the EU (US-RTX and EU-RTX) in rheumatoid arthritis (RA) for up to 48 weeks. METHODS In this multinational, randomized, double-blind trial, adults with active RA received up to two courses of CT-P10, US-RTX, or EU-RTX alongside methotrexate. Efficacy endpoints included Disease Activity Score 28-joint count (DAS28) and American College of Rheumatology (ACR) response rates. Pharmacokinetics, pharmacodynamics, immunogenicity, and safety were also assessed. RESULTS Of 372 patients randomized to the study drug, 330 (88.7%) completed the second treatment course. Mean change from baseline to week 48 in DAS28-C-reactive protein was comparable in the CT-P10 and combined rituximab (US-RTX and EU-RTX) groups (- 2.7 and - 2.6, respectively). ACR20, ACR50, and ACR70 response rates at week 48 indicated no differences between groups (80.6%, 55.4%, and 31.7% vs. 79.8%, 53.9%, and 33.7% in the CT-P10 and combined rituximab groups, respectively). Similar improvements in the Health Assessment Questionnaire Disability Index and all medical outcomes in the Short Form 36-Item Health Survey, including physical and mental health, were seen in all groups. At week 48, antidrug antibodies were detected in 4.9%, 9.4%, and 8.6% of patients in the CT-P10, US-RTX, and EU-RTX groups, respectively. CT-P10 and rituximab displayed similar pharmacokinetic, pharmacodynamic, and safety profiles. CONCLUSION CT-P10 was similar to EU-RTX and US-RTX in terms of efficacy, pharmacokinetics, pharmacodynamics, immunogenicity, and safety up to week 48. CLINICALTRIALS. GOV IDENTIFIER NCT02149121.
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Affiliation(s)
- Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dae Hyun Yoo
- Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea.
| | | | | | | | | | | | | | | | - Slawomir Jeka
- Department of Rheumatology and Connective Tissue Diseases, University Hospital No. 2, Collegium Medicum UMK, Bydgoszcz, Poland
| | | | - Thomas Linde
- MVZ für Rheumatologie und Autoimmundiagnostik, Halle (Salle), Germany
| | - Pawel Hrycaj
- Department of Rheumatology, Koscian Municipal Hospital, Koscian, Poland
| | | | | | | | - Mariusz Piotrowski
- Department of Rheumatology, Medical University of Lublin, Lublin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Diseases and Geriatrics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Sergii Shevchuk
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Armando Calvo
- Centro de Investigación Clínica Inunoreumatología, Clínica San Felipe, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Won Park
- School of Medicine, Medicine/Rheumatology, IN-HA University, Incheon, Republic of Korea
| | - Seung Cheol Shim
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Wańkowicz P, Nowacki P, Brzosko M, Bobrowska-Snarska D. An overlapping case of Bickerstaff brainstem encephalitis and acute motor axonal neuropathy variant of Guillain-Barré syndrome associated with systemic lupus erythematosus. Pol Arch Intern Med 2019; 129:50-51. [PMID: 30444497 DOI: 10.20452/pamw.4371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Manzo C, Milchert M, Natale M, Brzosko M. Polymyalgia rheumatica with normal values of both erythrocyte sedimentation rate and C-reactive protein concentration at the time of diagnosis. Rheumatology (Oxford) 2019; 58:921-923. [DOI: 10.1093/rheumatology/key431] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Mariano Lauro Hospital, Sant’Agnello, Italy
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
| | - Maria Natale
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Mariano Lauro Hospital, Sant’Agnello, Italy
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
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Deodhar A, Gensler LS, Sieper J, Clark M, Calderon C, Wang Y, Zhou Y, Leu JH, Campbell K, Sweet K, Harrison DD, Hsia EC, Heijde D, Ariel F, Asnal CA, Berman A, Citera G, Rodriguez G, Savio VG, Bird P, Griffiths H, Nicholls D, Rischmueller M, Zochling J, De Vlam K, Malaise M, Toukap AN, Van den Bosch F, Vanhoof J, Bonfiglioli R, Keiserman M, Scotton AS, Xavier R, Ximenes AC, Atanasov A, Goranov I, Kazmin I, Licheva RN, Nikolov N, Oparanov B, Stoilov R, Bessette L, Rodrigues J, Bortilik L, Dokoupilova E, Dvoarak Z, Galatikova D, Nemec P, Podrazilova L, Simkova G, Stejfova Z, Moravcova R, Vitek P, Cantagrel A, Baillet A, Banneville B, Combe B, Breban M, Nguyen M, Goupille P, Braun J, Everding A, Kekow J, Koenig R, Rubbert‐Roth A, Witte T, Bartha A, Drescher E, Kerekes K, Kovacs A, Pulai J, Rojkovich B, Szanto S, Toth E, Avila H, Torre IG, Irazoque F, Maradiaga M, Pacheco C, Brzosko M, Dudek A, Jeka S, Krogulec M, Kwiatkowska B, Wiland P, Wojciechowski R, Zielinska A, Santos H, Bugrova O, Christyakov V, Gorbunov V, Ilivanova E, Zemerova E, Kamalova R, Kameneva T, Macievskaya G, Marusenko I, Maslyansky A, Myasoedova S, Myasoutova L, Nemtsov B, Nesmeyanova O, Plaksina T, Pokrovskaya T, Polyakova S, Rebrov A, Savina L, Smakotina S, Stanislav M, Ukhanova O, Vinogradova I, Zonova E, Baek HJ, Kim T, Lee C, Lee S, Lee S, Lee S, Park S, Song Y, Suh C, Ramos JA, Blanco FJ, Collantes E, Diaz MC, Vivar MLG, Gratacos J, Juanola X, Chen D, Chen H, Chen K, Chen Y, Chiu Y, Luo S, Tsai S, Tseng J, Wei C, Weng M, Abrahamovych O, Reshotko D, Golovchenko O, Hospodarsky I, Iaremenko O, Levchenko O, Dudnyk O, Garmish O, Grishyna O, Protsenko G, Rekalov D, Smiyan S, Stanislavchuk M, Trypilka S, Tseluyko V, Turianytsia S, Vasylets V, Virstyuk N, Kleban Y, Ciurtin C, Gaffney K, Gunasekera W, Mackay K, Packham J, Sengupta R, Tahir H, Aelion J, Bennett R, Deodhar A, Gonzalez‐Paoli J, Griffin RM, Grisanti M, Mallepalli J, Peters E, Schechtman J, Singhal A. Three Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Studies Evaluating the Efficacy and Safety of Ustekinumab in Axial Spondyloarthritis. Arthritis Rheumatol 2018; 71:258-270. [DOI: 10.1002/art.40728] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Michael Clark
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Cesar Calderon
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Yuhua Wang
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Yiying Zhou
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Jocelyn H. Leu
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Kim Campbell
- Janssen Research & Development, LLC Spring House Pennsylvania
| | - Kristen Sweet
- Janssen Research & Development, LLC Spring House Pennsylvania
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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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Przepiera-Będzak H, Brzosko M. Clinical symptoms, imaging, and treatment of SAPHO syndrome: a single‑center study of 52 cases. Pol Arch Intern Med 2018; 128:396-399. [PMID: 29726848 DOI: 10.20452/pamw.4261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Polymyalgia rheumatica (PMR) is a unique disease of elderly people, traditionally diagnosed based on a clinical picture. A typical case is a combination of severe musculoskeletal symptoms and systemic inflammatory response with spectacular response to corticosteroids treatment. The severity of symptoms may be surprising in older patients where immunosenescence is normally expected. However, PMR may be diagnosed in haste if there is a temptation to use this diagnosis as a shortcut to achieve rapid therapeutic success. Overdiagnosis of PMR may cause more problems compared to underdiagnosis. The 2012 PMR criteria proposed by European League against Rheumatism/American College of Rheumatology aim to minimize the role of clinical intuition and build on more objective features. However, questions arise if this is possible in PMR. This has been discussed in this review.
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Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
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Żołnierczyk-Zreda D, Jędryka-Góral A, Bugajska J, Bedyńska S, Brzosko M, Pazdur J. The relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis: A cross-sectional study. J Health Psychol 2017. [PMID: 28866909 DOI: 10.1177/1359105317727842.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To evaluate the relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis, the data of 282 participants were drawn from baseline. The results of structural equation modeling showed that among rheumatoid arthritis patients, those who were engaged in occupational activity had lower levels of fatigue compared to those who did not work and that this relationship was mediated by better mental health, not by physical health.
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Affiliation(s)
| | | | - Joanna Bugajska
- Central Institute for Labour Protection-National Research Institute, Poland
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Żołnierczyk-Zreda D, Jędryka-Góral A, Bugajska J, Bedyńska S, Brzosko M, Pazdur J. The relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis: A cross-sectional study. J Health Psychol 2017; 25:665-673. [PMID: 28866909 DOI: 10.1177/1359105317727842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To evaluate the relationship between work, mental health, physical health, and fatigue in patients with rheumatoid arthritis, the data of 282 participants were drawn from baseline. The results of structural equation modeling showed that among rheumatoid arthritis patients, those who were engaged in occupational activity had lower levels of fatigue compared to those who did not work and that this relationship was mediated by better mental health, not by physical health.
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Affiliation(s)
| | | | - Joanna Bugajska
- Central Institute for Labour Protection—National Research Institute, Poland
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Peregud-Pogorzelska M, Trzcińska-Budkiewicz B, Kaźmierczak J, Wielusiński M, Zieliński M, Brzosko M. Śluzak prawego przedsionka u pacjenta z twardziną układową. Folia Cardiologica 2017. [DOI: 10.5603/fc.2016.0116] [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: 11/25/2022] Open
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Przepiera-Będzak H, Brzosko M. Antiphospholipid Syndrome with Antiβ2glicoprotein-1 Antibodies as the Cause of Recurrent Tibial Vein Thrombosis in SAPHO syndrome. Acta Dermatovenerol Croat 2016; 24:305-306. [PMID: 28128085] [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: 06/06/2023]
Abstract
The antiphospholipid antibody syndrome is defined by the presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism (1). SAPHO syndrome is a rare disease, characterized by specific clinical manifestations of synovitis, acne pustulosis, hyperostosis, and osteitis. It is a disease that manifests with a combination of osseous and articular manifestations associated with skin lesions (2). Venous thrombosis complicating SAPHO syndrome seems to be uncommon with an unclear pathogenesis (3-9). Coexistence of antiphospholipid syndrome and SAPHO syndrome was not previously mentioned in literature. A 33-year-old white woman was diagnosed with SAPHO syndrome at the age of 31. The patient was previously diagnosed with polycystic ovary syndrome and depressive syndrome. She was treated with sulfasalazin (2 g daily) and methotrexate (20 mg weekly). Seven months before admission to our department she experienced an episode of deep vein thrombosis of the left leg, successfully treated with subcutaneous enoxaparin sodium (40 mg daily) that was continued for the following 6 months as secondary prophylaxis. Pustular skin changes on palmar surface of the hands and plantar surface of the feet (characteristic for palmo-plantar pustulosis), tenderness of sterno-clavicular joints, swelling and restricted motion of both wrists, and pain on motion in both elbows, shoulders, knees, and ankles were found on physical examination. There was also a moderate amount of effusion in her left knee. There was a 3-centimeter difference between the circumferences of the shins. The level of C reactive protein was increased (6.21 mg/L). The patient was positive for antiβ2glicoprotein-1 (anti-β2G-1) antibodies. Tests for anticardiolipin antibodies (aCL), antiannexin V antibodies, antiphosphatidylserine antibodies (aPS), and antiprothrombin antibodies (aPT) were negative. Prothrombin time, activated partial thromboplastin time, and D-dimer level were normal, and lupus anticoagulant was not present. Serum concentrations of protein C, protein S, factor V Leiden, and antiprothrombin III levels were normal. Tests for antinuclear antibodies, rheumatoid factor, and HLA-27 antigen were negative. Serum vascular endothelial growth factor (VEGF) level was 360 pg/mL, serum epidermal growth factor (EGF) level was 566 pg/mL. Bacteria culture of discharge from pustules was negative. Doppler ultrasound examination of the left leg confirmed thrombosis of one the posterior tibial veins at its lower third. Subcutaneous enoxaparin sodium was started and later replaced with acenocumarol. The dose of sulfasalazin was increased to 3.0 g daily, and azithromycin 1.0 g daily once a week (for 8 weeks) was added. After 3 months, the patient reported reduction of joint pain. The follow-up Doppler ultrasound examination of the left leg revealed resolution of thrombosis. Three months later, the anti-β2G-1 antibodies were positive, so the patient met the criteria of antiphospholipid syndrome (1). The treatment with acenocumarol was continued and hydroxychlorochine was started. Venous thrombosis complicating SAPHO syndrome seems to be uncommon with an unclear pathogenesis. There were reports of thrombosis of the following veins: subclavian, mediastinan, iliac, and the superior vena cava (3-8). We have diagnosed recurrent tibial vein thrombosis in a patient with SAPHO syndrome in the course of antiphospholipid syndrome. There were suggestions that the reason for some cases of vein thrombosis in SAPHO syndrome is a pressure of the hyperostotic skeleton or inflamed soft tissue on the vein walls (3,4,6,10), which was not the case in our patient. Legoupil et al. (6) suggested that the reason for iliac vein thrombosis in SAPHO syndrome was an impressive extension of the inflammatory process to the soft tissues within the lumbar spine. That patient was negative for aCL antibodies (6). Kawabata et al. (7) suspected that aCL antibodies could be the reason for thrombosis in this syndrome, but the patient with multiple venous thrombosis presented in his case report was negative for aCL antibodies; however, he was not tested for anti-β2G-1 antibodies. There was a paper demonstrating increased level of aCL antibodies in 5 of 12 patients with SAPHO syndrome (11). In our observations of 17 patients with SAPHO syndrome, only 1 had increased level of aCL antibodies without symptoms of thrombosis (12). That patient was negative for aCL antibodies, aPT antibodies, aPS antibodies, and antiphosphatidylserine antibodies, but she was positive twice for anti-β2G-1 antibodies. The presence of anti-β2G-1antibodies may be caused by an infectious agent, but in our case bacteria culture of the discharge from pustules was negative. One year after the first episode of deep vein thrombosis, our patient met the criteria of antiphospholipid syndrome. We conclude that antiphospholipid syndrome, especially the presence of anti-β2G-1 antibodies, could be the cause of increased risk of vein thrombosis in SAPHO syndrome.
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Affiliation(s)
- Hanna Przepiera-Będzak
- Hanna Przepiera-Będzak, MD, Department of Rheumatology and Internal Diseases, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
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Milchert M, Brzosko M. Does Viking ancestry influence the distribution of polymyalgia rheumatica and giant cell arteritis in Poland? Scand J Rheumatol 2016; 45:536-537. [PMID: 27088874 DOI: 10.3109/03009742.2016.1141980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Milchert
- a Department of Rheumatology, Internal Medicine and Geriatrics , Pomeranian Medical University , Szczecin , Poland
| | - M Brzosko
- a Department of Rheumatology, Internal Medicine and Geriatrics , Pomeranian Medical University , Szczecin , Poland
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Abstract
The presented case report describes a female patient suffering from polymyositis, in whom atrial tachycardia and depressed left ventricular function were diagnosed. Atrial tachycardia was confirmed by electrophysiological study, and the radiofrequency ablation failed to restore sinus rhythm. This case is an example of the tachy phase in brady-tachy syndrome. The patient is evaluated cardiologically on a regular basis with emphasis on bradycardia and asystole episodes because she was symptomatic for many years.
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Przepiera-Będzak H, Fischer K, Brzosko M. Serum Interleukin-18, Fetuin-A, Soluble Intercellular Adhesion Molecule-1, and Endothelin-1 in Ankylosing Spondylitis, Psoriatic Arthritis, and SAPHO Syndrome. Int J Mol Sci 2016; 17:ijms17081255. [PMID: 27527149 PMCID: PMC5000653 DOI: 10.3390/ijms17081255] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 01/05/2023] Open
Abstract
To examine serum interleukin 18 (IL-18), fetuin-A, soluble intercellular adhesion molecule-1 (sICAM-1), and endothelin-1 (ET-1) levels in ankylosing spondylitis (AS), psoriatic arthritis (PsA), and Synovitis Acne Pustulosis Hyperostosis Osteitis syndrome (SAPHO). We studied 81 AS, 76 PsA, and 34 SAPHO patients. We measured serum IL-18, fetuin-A, sICAM-1, ET-1, IL-6, IL-23, vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). IL-18 levels were higher in AS (p = 0.001), PsA (p = 0.0003), and SAPHO (p = 0.01) than in controls, and were positively correlated with CRP (p = 0.03), VEGF (p = 0.03), and total cholesterol (TC, p = 0.006) in AS and with IL-6 (p = 0.03) in PsA. Serum fetuin-A levels were lower in AS (p = 0.001) and PsA (p = 0.001) than in controls, and negatively correlated with C-reactive protein (CRP) in AS (p = 0.04) and SAPHO (p = 0.03). sICAM-1 positively correlated with CRP (p = 0.01), erythrocyte sedimentation rate (ESR, p = 0.01), and IL-6 (p = 0.008) in AS, and with IL-6 (p = 0.001) in SAPHO. Serum ET-1 levels were lower in AS (p = 0.0005) than in controls. ET-1 positively correlated with ESR (p = 0.04) and Disease Activity Score 28 (DAS28, p = 0.003) in PsA. In spondyloarthritis, markers of endothelial function correlated with disease activity and TC.
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Affiliation(s)
- Hanna Przepiera-Będzak
- Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, Szczecin 71-252, Poland.
| | - Katarzyna Fischer
- Independent Laboratory of Rheumatic Diagnostics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, Szczecin 71-252, Poland.
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine and Geriatrics, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, Szczecin 71-252, Poland.
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Lewandowski M, Peregud-Pogorzelska M, Stachowiak P, Brzosko M, Kornacewicz-Jach Z. Optical coherence tomography imaging during endovascular treatment of a patient with Takayasu arteritis. Kardiol Pol 2016; 74:697. [PMID: 27401294 DOI: 10.5603/kp.2016.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Paweł Stachowiak
- Department of Cardiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland.
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Kremer JM, Blanco R, Halland AM, Brzosko M, Burgos-Vargas R, Mela CM, Rowell L, Fleischmann RM. Clinical efficacy and safety maintained up to 5 years in patients with rheumatoid arthritis treated with tocilizumab in a randomised trial. Clin Exp Rheumatol 2016; 34:625-633. [PMID: 27087059] [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] [Received: 09/17/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To report 5-year efficacy and safety in rheumatoid arthritis (RA) patients with active disease treated with tocilizumab. METHODS LITHE was a 2-year, randomised, placebo-controlled study of tocilizumab in RA patients (ClinicalTrials.gov, NCT00106535), with an additional 3-year, open-label extension. Patients were randomly assigned to tocilizumab (4 or 8 mg/kg IV) or placebo every 4 weeks + methotrexate. They could receive rescue with tocilizumab from week 16; after week 52, patients could switch to open-label tocilizumab 8 mg/kg. Radiographs were analysed by randomized treatment using the Genant-modified Total Sharp Score (GmTSS). Patients with at least baseline, week 104 and post-week 104 radiographs were included. Clinical and safety data were pooled for all patients who received ≥1 dose of tocilizumab; results are presented from the first tocilizumab dose. RESULTS 1,149 patients were included with 4,380 patient-years of exposure; 34% received 5 years of treatment. Mean 5-year change in GmTSS revealed greater inhibition of radiographic progression in tocilizumab patients than placebo patients (1.34 vs. 3.02), with the greatest annualised progression rate in year 1. Overall, 53% of tocilizumab and 35% of placebo patients experienced no progression (GmTSS ≤0). Clinical benefit was maintained - determined by ACR response, DAS28-ESR <2.6, EULAR good/moderate response and Boolean remission - as was physical function. The safety profile over 5 years was similar to that over 2 years. CONCLUSIONS Over 5 years, tocilizumab + MTX inhibited radiographic progression and maintained improvements in signs and symptoms and physical function in MTX-inadequate responders with active disease; no new safety signals occurred.
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Affiliation(s)
| | - Ricardo Blanco
- Hospital Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Marek Brzosko
- Rheumatology and Internal Diseases Clinic, Pomeranian Medical University, Szczecin, Poland
| | - Ruben Burgos-Vargas
- Hospital General de México and Universidad Nacional Autónoma de México, Mexico City, Mexico
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Milchert M, Brzosko M. SAT0534 How To Define Sonographic Signs of Axillary Vasculitis in Giant Cell Arteritis? Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5069] [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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Park W, Yoo DH, Miranda P, Brzosko M, Wiland P, Gutierrez-Ureña S, Mikazane H, Lee YA, Smiyan S, Lim MJ, Kadinov V, Abud-Mendoza C, Kim H, Lee SJ, Bae Y, Kim S, Braun J. Efficacy and safety of switching from reference infliximab to CT-P13 compared with maintenance of CT-P13 in ankylosing spondylitis: 102-week data from the PLANETAS extension study. Ann Rheum Dis 2016; 76:346-354. [PMID: 27117698 PMCID: PMC5284340 DOI: 10.1136/annrheumdis-2015-208783] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the efficacy and safety of switching from infliximab reference product (RP) to its biosimilar or maintaining biosimilar treatment in patients with ankylosing spondylitis (AS). METHODS This open-label extension study recruited patients with AS who completed a 54-week, randomised controlled study comparing CT-P13 with RP (PLANETAS). CT-P13 (5 mg/kg) was administered intravenously every 8 weeks from week 62 to week 102. Efficacy end points included the proportion of patients achieving Assessment of SpondyloArthritis international Society (ASAS)20. Antidrug antibodies (ADAs) were measured using an electrochemiluminescent method. Data were analysed for patients treated with CT-P13 in the main PLANETAS study and the extension (maintenance group) and those who were switched to CT-P13 during the extension study (switch group). RESULTS Overall, 174 (82.9%) of 210 patients who completed the first 54 weeks of PLANETAS and agreed to participate in the extension were enrolled. Among these, 88 were maintained on CT-P13 and 86 were switched to CT-P13 from RP. In these maintenance and switch groups, respectively, ASAS20 response rates at week 102 were 80.7% and 76.9%. ASAS40 and ASAS partial remission were also similar between groups. ADA positivity rates were comparable (week 102: 23.3% vs 27.4%). Adverse events led to treatment discontinuation during the extension study in 3 (3.3%) and 4 (4.8%) patients, respectively. CONCLUSIONS This is the first study to show that switching from RP to its biosimilar CT-P13 is possible without negative effects on safety or efficacy in patients with AS. In the maintenance group, CT-P13 was effective and well tolerated over 2 years of treatment. TRIAL REGISTRATION NUMBER NCT01571206; Results.
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Affiliation(s)
- Won Park
- IN-HA University, School of Medicine, Medicine/Rheumatology, Incheon, Republic of Korea
| | - Dae Hyun Yoo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Pedro Miranda
- Universidad de Chile and Centro de Estudios Reumatologicos, Santiago de Chile, Chile
| | - Marek Brzosko
- Department of Rheumatology and Internal Diseases, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Sergio Gutierrez-Ureña
- Department of Rheumatology, Hospital Civil de Guadalajara "Fray Antonio Alcalde" CUCS, Universidad de Guadalajara, Guadalajara Jalisco, Mexico
| | | | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Svitlana Smiyan
- I.Ya. Horbachevsky Ternopil State Medical University, Municipal Institution of Ternopil Regional Council "Ternopil University Hospital", Ternopil, Ukraine
| | - Mie-Jin Lim
- IN-HA University, School of Medicine, Medicine/Rheumatology, Incheon, Republic of Korea
| | - Vladimir Kadinov
- Multiprofile Hospital for Active Treatment 'Sv. Marina', Varna, Bulgaria
| | - Carlos Abud-Mendoza
- Hospital Central and Faculty of Medicine, Universidad Autónoma de San Luis Potosi, San Luis Potosi, Mexico
| | - HoUng Kim
- CELLTRION, Incheon, Republic of Korea
| | | | - YunJu Bae
- CELLTRION, Incheon, Republic of Korea
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Przepiera-Będzak H, Fischer K, Brzosko M. Serum VEGF, EGF, basic FGF, and acidic FGF levels and their association with disease activity and extra‑articular symptoms in ankylosing spondylitis. ACTA ACUST UNITED AC 2016; 126:290-2. [PMID: 27025929 DOI: 10.20452/pamw.3341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fischer K, Sawicki M, Chamiak-Ciemińska K, Stolarczyk J, Winikajtis-Burzyńska A, Milchert M, Ostanek L, Bobrowska-Snarska D, Kapłon Ł, Przepiera-Będzak H, Walecka A, Brzosko I, Brzosko M. A5.07 The role of immunologic and inflammatory factors in the risk of microvascular and macrovascular impairment development in systemic lupus erythematosus – preliminary data. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-209124.105] [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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