LAM KID

[Recognition of the characteristics of rare types of arthritis]

ROJKOVICH Bernadette, MÉSZÁROS Györgyi

MAY 30, 2014

LAM KID - 2014;4(02)

[Recognition of the characteristics of arthritis is crucial for making a correct diagnosis. Several aspects of the history and physical examination could help the diagnosis, such as the mode of onset (acute, insidious), duration of symptoms (self-limiting, chronic), number of affected joints (mono-, oligo-, polyarthritis), distribution of joint involvement (symmetrical, asymmetrical), localisation of affected joints (axial, peripherial) and sequence of involvement (additive, migratory, intermittent). Other important aspects for the correct diagnosis are the characteristics of the patient (gender, age, family history) and the presence or absence of extra-articular features of disease. The articular pattern may change with time in the course of a disease, and the single clinical pattern of joint disease may correspond to more than one diagnosis. Evidence of some distinct articular patterns may limit the spectrum of diagnostic options and reduces unnecessary diagnostic testing. The diagnostic process may require the addition of laboratory examination, imaging techniques, and other tests to refine the analysis. In this article, we report a case where joint punction and histological elucidation was necessary to make the correct diagnosis, because a syndrome of acute, destructive sterile arthritis mimicking articular infection might be present in a variety of joint disorders. In this paper, we highlight those characteristics that are distinctive for particular rheumatological disorders, in order to help starting treatment early.. In a substantial number of patients the cause of the diseases remains undetermined. However, a detailed anamnesis and physical examination remain the cornerstone of a diagnostic evaluation.]

COMMENTS

0 comments

Further articles in this publication

LAM KID

[Effects of up to 5 years of denosumab treatment on bone histology and histomorphometry: The FREEDOM study extension]

BALLA Bernadett

LAM KID

[Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures]

HORVÁTH Péter

LAM KID

[Diclofenac/orphenadrin as a combined analgetics in relief of pain. Systemic literature review]

ROJKOVICH Bernadette

[The objectives of this paper are to discuss the safety and tolerability of combined infusion -Neodolpasse(®) - containing nonsteroidal antiinflammarory drug, diclofenac and central muscle relaxant orphenadrin on the basis of recent data. The author reviewed phase IV randomised, controlled studies published on Medline and in the Hungarian literature. On the basis of the available data, diclofenac/orphenadrin infusion is an effective and safe analgesic, which is easy to administer and to combine with other painkillers in acute low back pain and other painful rheumatic conditions, as well as postoperative pain.]

LAM KID

[A clinical trial gone awry: the Chocolate Happiness Undergoing More Pleasantness (CHUMP)]

BALLA Bernadett

LAM KID

[Determining sclerostin level in healthy men]

MOLNÁR Zsuzsanna, WAMWAKI John, PETHŐ Zsófia, KALINA Edit, FÖLDESI Róza, BALOGH Ádám, ANTAL-SZALMÁS Péter, BHATTOA Harjit Pál

[The aim of this study is to evaluate the relationship of serum sclerostin levels with age, cystatin C, bone mineral density (BMD) and biochemical markers of bone turnover in healthy Hungarian men over 50 years of age. We determined serum levels of sclerostin and examined its relationship with age, cystatin C, osteocalcin, C-terminal telopeptides of type-I collagen, procollagen type 1 amino-terminal propeptide, 25- hydroxyvitamin D, parathyroid hormone, and L1-L4 (LS) and femur neck (FN) BMD data available from 194 randomly selected ambulatory men belonging to the HunMen cohort. In the study population as a whole (n=194; age (median, range): 59 (51-81) years), statistically significant correlation was found between sclerostin and age (r=0.211; p=0.003), cystatin C (r=0.246; p=0.001), FN-BMD (r=0.147; p=0.041) and LS BMD (r=0.169; p=0.019). Compared with middle-aged men (age: ≤ 59 years, n=98), elderly men (age > 59 years, n=96) had significantly higher serum sclerostin levels (67.8±15.9 pmol/l vs. 63.5±14; p=0.047). Among men with normal (T score >-1,0) FN-BMD, the elderly had significantly higher serum sclerostin levels as compared with the middle-aged (70.4±17 pmol/l vs. 63.9±11.5 pmol/l; p=0.019). Furthermore, among the elderly men cystatin C was the only significant predictor of serum sclerostin levels (standardized regression coefficient (béta) = 0,487; p<0,001). Our results show that in the studied healthy elderly cohort sclerostin levels significantly increase with age, along with the deterioration of kidney function as determined by plasma cystatin C levels. ]

All articles in the issue

Related contents

Hungarian Immunology

[Molecular mechanisms and clinical importance of the RANK - RANK ligand - osteoprotegerin system]

SZENTPÉTERY Ágnes, BALOGH Ádám, VARJÚ Tibor, SZEKANECZ Zoltán

[The receptor activator of nuclear factor κB ligand (RANKL) is an essential cytokine for the formation and activation of osteoclasts. RANK, expressed on osteoclasts, interacts with RANKL, produced by osteoblasts and stromal cells. RANK-RANKL interaction is involved in osteoclastogenesis and bone resorption underlying metabolic bone diseases, arthritis, malignant bone disorders and some vascular diseases. Osteoprotegerin (OPG) physiologically counterbalance the action of RANKL. Several factors including estrogens, citokines and others regulate the RANKL-OPG ratio and thus bone resorption. RANKL blockade using recombinant OPG or anti-RANKL antibody may prevent bone loss in osteoporosis, chronic inflammatory and vascular disorders, as well as tumors. Active vaccination and gene therapy are further future perspectives in therapy. All these treatment modalities may be included in the future management of bone and vascular diseases.]

Hungarian Immunology

[The role of endothelium, cell migration, chemokines and angiogenesis in inflammatory rheumatic diseases]

BESENYEI Tímea, PÁKOZDI Angéla, VÉGVÁRI Anikó, SZABÓ Zoltán, SZEKANECZ Zoltán

[Endothelial cells, leukocyte-endothelial interactions and angiogenesis are highly involved in the pathogenesis of inflammation and thus in that of inflammatory rheumatic diseases. As this research area is very progressive, one needs to review novel molecular mechanisms and new therapeutic approaches in this respect. Authors review the most important functions of endothelial cells, the process of leukocyte extravasation, tissue infiltration and their cellular and molecular basis. Endothelial cells themselves produce a number of inflammatory mediators including interleukin-1 (IL-1), IL-6, IL-8, chemokines and others. Among cell adhesion molecules, β1 and β3 integrins, as well as E-, L- and P-selectins and their respective ligands have been implicated in leukocyte-endothelial adhesion. In recent years, numerous inflammatory mediators, cytokines, chemokines and proteases have been implicated in angiogenesis and angiostasis. Hypoxia, the vascular endothelial growth factor (VEGF)-angiopoietin system and mechanisms driven by β3 integrins are of major importance during angiogenesis. Significant amount of data have become available of the regulation of cell adhesion, migration and neovascularisation. Adhesion, chemokine and angiogenesis research has important clinical, practical aspects for antirheumatic and anti-cancer therapy. VEGF antagonists, anti-integrin antibodies, chemokine and chemokine receptor inhibitors, as well as thalidomide are currently in the first line of development.]

LAM Extra for General Practicioners

[Recognition of the characteristics of rare types of arthritis]

ROJKOVICH Bernadette, MÉSZÁROS Györgyi

[Recognition of the characteristics of arthritis is crucial for making a correct diagnosis. Several aspects of the history and physical examination could help the diagnosis, such as the mode of onset (acute, insidious), duration of symptoms (self-limiting, chronic), number of affected joints (mono-, oligo-, polyarthritis), distribution of joint involvement (symmetrical, asymmetrical), localisation of affected joints (axial, peripherial) and sequence of involvement (additive, migratory, intermittent). Other important aspects for the correct diagnosis are the characteristics of the patient (gender, age, family history) and the presence or absence of extra-articular features of disease. The articular pattern may change with time in the course of a disease, and the single clinical pattern of joint disease may correspond to more than one diagnosis. Evidence of some distinct articular patterns may limit the spectrum of diagnostic options and reduces unnecessary diagnostic testing. The diagnostic process may require the addition of laboratory examination, imaging techniques, and other tests to refine the analysis. In this article, we report a case where joint punction and histological elucidation was necessary to make the correct diagnosis, because a syndrome of acute, destructive sterile arthritis mimicking articular infection might be present in a variety of joint disorders. In this paper, we highlight those characteristics that are distinctive for particular rheumatological disorders, in order to help starting treatment early.. In a substantial number of patients the cause of the diseases remains undetermined. However, a detailed anamnesis and physical examination remain the cornerstone of a diagnostic evaluation. ]

Hungarian Immunology

[Biological therapy of arthritis and systemic autoimmune diseases - 2007]

SZEKANECZ Zoltán, TAMÁSI László

[Biological therapy acts at a specific point of inflammation. Today, rheumatoid arthritis is the prototype disease in this context due to the relatively high number of accessible patients and wellstandardized follow-up tools. However, apart from this disease, biological therapy has been introduced to the treatment of other diseases including various forms of arthritis, such as ankylosing spondylitis and psoriatic arthritis, as well as systemic autoimmune disorders, such as lupus, scleroderma, inflammatory myopathies and Sjogren’s syndrome. Anti-tumor necrosis factor-α (TNF-α) agents play a central role in biological therapy as these agents have been successfully tried in most of these diseases. However, when seeking for specific targets for biologicals, specific pathogenic factors of the given disease should be determined. For example, while anti-TNF agents seem to be most effective in various types of arthritis, anti-B cell therapy may be the first choice in other autoimmune conditions, such as lupus, Sjogren’s syndrome or dermatomyositis. It is important to consider the specific characteristics of the administered agents as there may be differences regarding side-effects.]