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1
Content available remote The role of Th17 lymphocytes in pathogenesis of autoimmune arthritides
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EN
Th17 cells are newly described population of lymphoctyes, that recruits neutrophils to the site of inflammation and activate inflammatory phenotype of various tissues. They also play a pivotal role in autoimmune diseases and cancers. These cells secrete mainly different isoforms of IL-17, but also IL-21 and IL-22. Rheumatoid arthritis and juvenile idiopathic arthritis are the most common autoimmune joints’ inflammatory disease, affecting respectively adults and children. For a long time the immunopathogenesis of autoimmune diseases has been associated with Th1 lymphocytes. This hypothesis has changed after the discovery of Th17 cells, which are thought to be key mediators of autoimmune arthritides
PL
Reumatoidalne Zapalenie Stawów (RZS) jest przewlekłą, zapalną chorobą układową tkanki łącznej. Celem niniejszej pracy była ocena wpływu czasu trwania choroby, od momentu postawienia diagnozy RZS, na temperaturę stawów objętych procesem zapalnym. Za pomocą kamery termowizyjnej przebadano następujące stawy: stawy nadgarstka, stawy śródręczno-paliczkowe, stawy międzypaliczkowe bliższe, stawy międzypaliczkowe dalsze dłoni prawej i lewej oraz stawy: skokowo goleniowy i śródstopno-paliczkowy stopy prawej i lewej. Zaobserwowano istotnie niższą temperaturę stawu skokowo-goleniowego stopy prawej u pacjentów chorujących dłużej niż 10 lat w porównaniu z osobami zdrowymi.
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Rheumatoid Arthritis (RA) is a chronic inflammatory disease of human connective tissue. The aim of the study was to assess the impact of RA duration on the temperature of inflamed joints. Temperatures of the following joints were measured: wrist joints, metacarophalangeal joints, proximal interphalangeal joints, distal interphalangeal joints of left and right hand as well as ankle joints and metatarsophalangeal joints of right and left foot. Significantly lower right ankle joint temperature was observed for patients of more than 10 years’ disease duration compared to healthy subjects
EN
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease which affects approximately 1% of the population worldwide. Recent research on the role of heat shock proteins (Hsps) in RA development indicates that they may have pro- or anti-inflammatory effect, most probably via modulating cytokine secretion. We investigated type Th1 (INFγ, TNFα, IL-2) and type Th2 (IL-10, IL-6, IL-4) cytokine levels in sera of RA patients and healthy controls, using flow cytometric bead array assay, and searched for correlations between the cytokine levels and serum antibodies against bacterial (DnaJ) and human (Hdj1, Hdj2 and Hdj3) Hsp40 proteins, as well as clinical and laboratory parameters. The levels of all cytokines studied were significantly increased in RA patients; the highest increase relative to healthy controls (7-fold) was observed for IL-6 and its levels correlated positively with the antibodies directed to DnaJ and to the C-terminal domain of Hdj2, and with diagnostic parameters (DAS 28, Steinbrocker RTG criteria, ARA/7, ESR, TEN, SW and GH). INFγ levels correlated negatively with DAS 28, ESR, TEN and SW. No correlations were found for TNFα, IL-2 or IL-4. Our results support the hypothesis of Hsp40 involvement in RA as well as indicate that IL-6 serum level is a good marker of the RA activity.
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Purpose: The aim of the study is comparative analyze the Health Related Quality of Life (HRQOL); effect of social-demographic factors on quality of life also taking into account four domains and effect of the duration of disease on quality of life. Material and Methods: The evaluation of the quality of life in patients with rheumatoid arthritis (RA)(n=64), ankylosing spondylitis (AS) (n=60) and systemic sclerosis (SSc) (n=63) was conducted with the use of a standardized research tool - WHOQOL Bref. Results: The conducted general analysis of particular life quality domains showed that for RA patients the weakest domain was the one related the environment (11.3) and physical health (11.6), with the strongest social domain (14.7). The respondents with AS had the lowest score for physical health (12.2), also with the strongest social domain (14.2). The results obtained from SSc patients are slightly better than for RA and AS patients as regards physical health (12.6) and the environment (13.9). Conclusions: It seems that, taking into account the patient’s own opinion about the treatment and its consequences by means of QOL evaluation, makes the patient a partner in the process of treatment and nursing, which leads to a greater humanization of medicine.
EN
Objectives. Recent epidemiological studies suggested an association between a poor vitamin D [25(OH)D] status, inflammatory mediators, and rheumatoid arthritis (RA). We have recently proposed that pro-inflammatory interleukin 6 (IL-6) may represent a good marker for disease activity of RA. The aim of this study was to investigate the relationship between serum 25(OH)D levels and disease activity, joint damage, as well as serum IL-6 levels in a Polish RA population. Materials and Methods. Serum 25(OH)D levels were measured in 35 female RA patients and 38 age- and gender-matched healthy controls. Statistical correlations between 25(OH)D levels and the disease activity score 28 (DAS 28), joint damage based on the Steinbrocker criteria, as well as serum IL-6 levels were performed. Results. There was no statistically significant difference between levels of 25(OH)D in RA (16.89±8.57 ng/ml) and healthy controls (14.12±7.51 ng/ml), and the vitamin D deficiency (<20 ng/ml) was found in 71.43% of RA patients and 73.68 % of healthy controls. While vitamin D status did not correlate with DAS 28 (r=0.265, p=0.149) and joint damage based on the Steinbrocker criteria (r=0.367, p=0.065), a positive correlation between 25(OH)D and IL-6 (r=0.537, p=0.002) was observed in RA. Conclusion. Although further studies on a larger group of patients will be needed to confirm the data presented here, it seems that hypovitaminosis D is common in the RA patients and middle-aged non-RA healthy women in the Polish population. 25(OH)D levels were similar in the RA patients and age- and gender-matched healthy controls, and were not associated with joint damage and disease activity in patients.
EN
Introduction. Rheumatoid arthritis (RA) is a progressive joint condition that leads to joints destruction and complications in the internal organs and significantly affects the a patient’s functional, physical, psychological and social condition. Over the last few years, research into the quality of life (QoL) in people with chronic disease has been conducted to assess the results of treatment. Aim. The aim of the study was to assess QoL in various areas of life in regards to physical and mental functioning, social relations, and environmental influences in people with RA. Material and methods. The study group (subjects with RA) and the control group (subjects without RA) consisted of 48 people each. Subject age ranged from 19 to 68. In order to assess QoL, the WHOQOL-BREF questionnaire was used, while socio-demographic data were assessed with a questionnaire developed by the authors. Results. QoL in people with RA was lower than that of healthy individuals. The worst QoL was observed in the physical domain. No statistically significant association was found between BMI and QoL. It was found, however, that subjects with RA and a higher level of physical activity had a better QoL than those with a lower level of physical activity. Conclusion. There was no association between the body mass of RA patients and QoL assessment. However, an association was found between the level of physical activity in people with RA and QoL in the physical and environmental domain.
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Content available remote Fizjoterapia w reumatoidalnym zapaleniu stawów
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PL
Reumatoidalne zapalenie stawów (RZS) jest postępującym wielostawowym procesem zapalnym prowadzącym do destrukcji i deformacji stawów, a w konsekwencji do niepełnosprawności. Bardzo ważnym elementem w terapii jest stałe monitorowanie leczenia, a kompleksowa opieka powinna obejmować farmakoterapię, fizykoterapię, kinezyterapię, a także terapię zajęciową i psychoterapię.
EN
Rheumatoid arthritis is a progressive inflammatory process with a variety of states leading to destruction and deformation of joints and consequently to disability. A very important element of therapy is permanent monitoring of treatment. The complex care should comprise drug therapy, physiotherapy, kinesytherapy as well as psychotherapy.
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Content available remote Revmatoidní artritida jako psychický problém
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The article deals with the issue of psychic problems of rheumatoid arthritis patients. Rheumatoid arthritis is a chronic, inflammatory motor system disease with comprehensive impact on the patient's life. The disease is often considered an exclusively physical disease. But such approach is insufficient because the disease is accompanied by motor limitations of different intensities, by pain and by fatigue that cause considerable exhaustion to the patient. The patients often must give up their hobbies and in some cases even their jobs. In most serious cases, even common daily activities including self-servicing actions become an obstacle to the patient. It is therefore logical that the psyche of a patient with such disease is considerably strained. One of the partial goals of the study consisted in mapping the subjectively perceived quality of life of rheumatoid arthritis patients in facet 8, "negative feelings", and in ascertaining whether there is statistically significant relation to facets 1, "pain and discomfort", and 2, "energy and fatigue". Another goal consisted in comparing the subjectively perceived quality of life between men and women with rheumatoid arthritis, as well as between population of rheumatoid arthritis patients and control healthy population. The study was implemented within the research project of the Grant Agency of the University of South Bohemia in České Budějovice number 120/2012/S, "Reflection of quality of life in nursing", under use of two standardized questionnaires, WHOQOL-100 and HAQ. This article presents exclusively the data acquired based on the WHOQOL-100 questionnaire. The research set consisted of patients suffering from rheumatoid arthritis from all over the Czech Republic. The size of the set was determined by a statistician at 200 individuals suffering from the disease, in a ratio of 150 women and 50 men. The selection set was derived from the basic set of rheumatoid arthritis patients and can therefore be considered representative with regard to the whole Czech population of rheumatoid arthritis patients. The actual selection of respondents was carried out based on quota selection, at specifying two quotas: presence of the diagnosis of rheumatoid arthritis" and "gender". The data collection took place from January to May 2013. 214 questionnaires were distributed in total, to achieve the required return amount of 200. The return rate was 93,5 %. The statistical data analysis was performed in two stages. The first degree of data sorting was implemented in the SASD program (Statistic Analysis of Social Data); the second degree was implemented in the SPSS program (Statistical Package for the Social Science), version 15.0. It was ascertained based on the study that up to 90 % of respondents feel problems of different intensity in psychic area. 73,5 % of respondents perceive the problems as obstacle of different intensity to daily life. 66 % respondents reported actual feelings of depression. A very surprising finding consisted in the result of comparison of facet 8, "negative feelings", between the population suffering from rheumatoid arthritis and the control healthy population. Based on the comparison, it was found out that the control healthy respondents reported psychic problems in almost the same frequency and intensity as the rheumatoid arthritis patients. Such a high frequency and sameness to rheumatoid patients occurred probably due to wrong interpretation of the question from the respondents' perspective, particularly in healthy population that uses the term of "depression" relatively often for different common feelings of sadness and mood changes every person faces repeatedly in common life. It is not possible to admit that such a high percentage of healthy population suffers from actual depression. No statistically significant difference was found from the perspective of genders, based on comparison of results of facet 8, "negative feelings". Based on evaluation of relations between facet 8 (negative feelings) and facet 1 (pain and discomfort) and 2 (energy and fatigue), it was found out that there is statistically significant relation between the facets. It can be therefore accepted that patients feeling more intensive fatigue and pain experience more psychic problems and vice versa. The results evidence that therapy of rheumatoid arthritis as somatic disease is not sufficient and that comprehensive approach considering all patient's aspects should be applied in this area.
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Content available remote Collagen type II modification by hypochlorite.
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Oxidation of proteins is a common phenomenon in the inflammatory process mediated by highly reactive agents such as hypochlorite (HOCl/OCl-) produced by activated neutrophils. For instance, in rheumatoid arthritis hypochlorite plays an important role in joint destruction. One of the major targets for HOCl/OCl- is collagen type II (CII) - the primary cartilage protein. In our study, HOCl/OCl- mediated collagen II modifications were tested using various methods: circular dichroism (CD), HPLC, ELISA, dynamic light scattering (DLS), fluorimetry and spectrophotometry. It was shown that hypochlorite action causes deamination with consecutive carbonyl group formation and transformation of tyrosine residues to dichlorotyrosine. Moreover, it was shown that ammonium chloramine (NH2Cl) formed in the reaction mixture reacts with CII. However, in this case the yield of carbonyl groups and dichlorotyrosine is lower than that observed for HOCl/OCl- by 50%. CD data revealed that collagen II exists as a random coil in the samples and that chlorination is followed by CII fragmentation. In the range of low HOCl/OCl- concentrations (up to 1 mM) 10-90 kDa peptides are predominant whereas massive production of shorter peptides was observed for high (5 mM) hypochlorite concentration. DLS measurements showed that chlorination with HOCl/OCl- decreases the radius of collagen II aggregates from 30 to 6.8 nm. Taking into account the fact that chlorinated collagen is partially degraded, the DLS results suggest that smaller micelles are formed of the 10-90 kDa peptide fraction. Moreover, collagen chlorination results in epitope modification which affects CII recognition by anti-CII antibodies. Finally, since in the synovial fluid the plausible hypochlorite concentration is smaller than that used in the model the change of size of molecular aggregates seems to be the best marker of hypochlorite-mediated collagen oxidation.
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Rheumatoid arthritis is the most common inflammatory arthritis, affecting approximately 1% of the world’s population. Its pathogenesis has not been completely understood. However, there is evidence that the disease may involve synovial joints, subchondral bone marrow as well as intra- and extraarticular fat tissue, and may lead to progressive joint destruction and disability. Over the last two decades, significant improvement in its prognosis has been achieved owing to new strategies for disease management, the emergence of new biologic therapies and better utilization of conventional disease-modifying antirheumatic drugs. Prompt diagnosis and appropriate therapy have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. Despite the potential of ultrasonography and magnetic resonance imaging to visualize all tissues typically involved in the pathogenesis of rheumatoid arthritis, the diagnosis of early disease remains difficult due to limited specificity of findings. This paper summarizes the pathogenesis phenomena of rheumatoid arthritis and describes rheumatoid arthritis-related features of the disease within the synovium, subchondral bone marrow and articular fat tissue on MRI and ultrasound. Moreover, the paper aims to illustrate the significance of MRI and ultrasound findings in rheumatoid arthritis in the diagnosis of subclinical and early inflammation, and the importance of MRI and US in the follow-up and establishing remission. Finally, we also discuss MRI of the spine in rheumatoid arthritis, which may help assess the presence of active inflammation and complications.
PL
Reumatoidalne zapalenie stawów (RZS) jest najczęstszą chorobą zapalną stawów, występującą u ok. 1% populacji światowej(1). Charakteryzuje się zapaleniem błony maziowej oraz zapaleniem kości, które prowadzą do powstania nadżerek kostnych, niszczenia chrząstki stawowej, destrukcji stawu, a co za tym idzie – trwałej niepełnosprawności(2). W ciągu ostatnich 20 lat znacznie poprawiło się rokowanie u chorych na reumatoidalne zapalenie stawów dzięki wprowadzeniu nowych strategii leczenia, zastosowaniu terapii biologicznej i lepszemu wykorzystaniu konwencjonalnych leków modyfikujących przebieg choroby(1). Szybka diagnoza i wdrożenie odpowiedniego leczenia stały się kluczowe dla uzyskania dobrego wyniku leczenia u chorych z wczesnym RZS(1). Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/wydawnictwa/volume-17-no-68
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Introduction and aim. The association between periodontitis (PD) and rheumatoid arthritis (RA) has been analyzed and described in literature. Periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans are pointed as the common factors for both diseases. In this work we demonstrate that treatment of dental and oral diseases is an unconditional requirement for patients with RA. Material and methods. PubMed was searched with the keyword “rheumatoid arthritis” and “periodontitis” from May 1999 to January 2022, showed 181 articles. Ultimately 72 articles were included in the review. Analysis of the literature. The above mentioned pathogens exhibit multiple mechanisms that disturb immune and inflammatory responses of the human organism. Those mechanisms lead to the periodontal disease (PD) that may activate the systematic reactions which in turn lead to intensification of systematic diseases such as rheumatoid arthritis (RA). P. gingivalis has the ability to expresses PAD enzyme (peptidylarginine deiminase) and activates the citrullization process. Moreover, the bacterium produces gingipain cysteine proteinases, which degrade the mechanisms of immunological system. The latter pathogen, A. actinomycetemcomitans, expresses hypercitrullization in neutrophils. Conclusion. Both pathogens influence inflammatory response of the organism, through the common pro-inflammatory mediators for periodontitis and rheumatoid arthritis, intensify the clinical manifestations of both diseases.
PL
Celem niniejszej pracy było zastosowanie wybranych technik obróbki obrazów i ocena ich wpływu na analizę zdjęć rentgenowskich. Przedmiotem analizy były stawy między-paliczkowe bliższe palców II, III, IV obu rąk osób zdrowych i chorujących na reumatoidalne zapalenie stawów. Porównywano wyniki pomiarów szpar stawowych uzyskane przed i po filtracji komputerowej. Do obróbki wybrano trzy filtry oferowane przez program Optimas: Horizontal, Mediana i Sharpen Hi. Zwrócono uwagę, że na dokładność pomiaru szerokości szpary stawowej wpływa sposób obróbki obrazu. Udowodniono również, że u osób chorych szpary stawowe są węższe niż u osób zdrowych.
EN
The goal of the research was the evaluation of image processing methods applied for analysis of radiographic pictures. The proximal interphalangeal joints of II, III and IV finger of healthy subjects and patients suffering from rheumatoid arthritis were examined. The width of joint gap was measured. The image transforms offered by Optimas image processing program: Horizontal, Mediana i Sharpen Hi, were tested. The accuracy of the measurement is influenced by the applied image processing method. It was stated that healthy individuals have wider joint gaps than the ill persons.
PL
Cel badań: Celem pracy było zbadanie wpływu krioterapii ogólnoustrojowej na właściwości reologiczne krwi u kobiet z reumatoidalnym zapaleniem stawów. Materiał: Grupę badaną stanowiło 10 kobiet z reumatoidalnym zapaleniem stawów w wieku 57,2 ± 9,4 lat, które korzystały z zabiegów krioterapii ogólnoustrojowej (czas zabiegu 3 min, temperatura komory -120 °C, 10 zabiegów – 5 razy w tygodniu). Średnia wysokość ciała wynosiła 165,5 ± 4,6 cm, waga 68,5 ± 4,9 kg i BMI 24,8 ± 2,2 kg/m2. W celu analizy parametrów reologicznych krwi uczestniczącym w badaniu pobrano dwukrotnie krew żylną. Pierwsze badanie odbyło się w dniu rozpoczęcia zabiegów, a drugie po serii 10 zabiegów. Metodyka: Pomiary wykonano przy użyciu analizatora hematologicznego ABX MICROS 60 (USA). Do badania agregacji i odkształcalności erytrocytów wykorzystano analizator LORRCA (Laser-assisted Optical Rotational Cell Analyser RR Mechatronics, Holandia). Wyniki otrzymano jako indeks elongacji i agregacji, według metody Hardeman (2001). Wyniki: Analizując średnie wartości wskaźników morfologicznych i reologicznych krwi u kobiet z reumatoidalnym zapaleniem stawów w grupie badanej średnie wartości RBC i Hct i AI po serii 10 zabiegów były znacząco wyższe w porównaniu do pomiarów wykonanych przed zabiegami. Analizując średnie wartości T½ zaobserwowano statystycznie istotne zmniejszenie wartości po serii 10 zabiegów. Wnioski: Regularne korzystanie z zabiegów krioterapii ogólnoustrojowej może wpływać na wskaźniki morfologiczne i reologiczne krwi u kobiet z reumatoidalnym zapaleniem stawów – RBC, Hct i AI (zwiększenie) oraz T½ (zmniejszenie).
EN
Study aim: The aim of this study was to assess the effects of systemic cryotherapy on the rheological properties of the blood in women with rheumatoid arthritis. Study group: The study group consisted of 10 women with rheumatoid arthritis, aged 57.2 ± 9.4, who underwent systemic cryotherapy treatments (3 min treatment time, -120 °C chamber temperature, 10 treatment sessions - 5 times a week). Their average body height was 165.5 ± 4.6 cm, weight 68.5 ± 4.9 kg and BMI 24.8 ± 2.2 kg/m2. In order to analyze morphological and rheological parameters of the blood, venous blood samples were drawn from the participants of the study twice. The first study was held on the day of beginning treatments and the second test was conducted after a series of 10 treatments. Methodology: The morphological blood test - measurements were taken using the ABX MICROS 60 (USA) hematology analyser. Erythrocyte deformability and aggregation were tested using the LORCA analyser (Laser-assisted Optical Rotational Cell Analyser RR Mechatronics, The Netherlands). The results were obtained as the index of elongation and aggregation according to the Hardeman method (2001). Results: Analysing the average values of morphological and rheological parameters of the blood in women with rheumatoid arthritis in the study group, the mean values of RBC, Hct and AI following the series of 10 treatments were significantly higher after cryotherapy in comparison to the measurements taken before treatments. Analysing the mean concentrations of T½, there was statistically significant reduction after the series of 10 treatments. Conclusions: Regular usage of cryotherapy treatments may affect the levels of morphological and rheological parameters of the blood in women with rheumatoid arthritis - RBC, Hct and AI (increase) and T½ (reduction) in the blood. null
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