Rehabilitation in joint and connective tissue diseases. 1. Systemic diseases

1995 ◽  
Vol 76 (5) ◽  
pp. S32-S40 ◽  
Author(s):  
Neal Alpiner ◽  
Terry H. Oh ◽  
Steven R. Hinderer ◽  
Victoria A. Brander
Keyword(s):  
Connective Tissue ◽  
Connective Tissue Diseases ◽  
Systemic Diseases

scholarly journals COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series

2020 ◽  
Vol 39 (11) ◽  
pp. 3195-3204 ◽  
Author(s):  
Clodoveo Ferri ◽  
◽  
Dilia Giuggioli ◽  
Vincenzo Raimondo ◽  
Massimo L’Andolina ◽  
...  
Keyword(s):  
Immune System ◽  
General Population ◽  
Connective Tissue ◽  
Inflammatory Arthritis ◽  
Systemic Disease ◽  
Management Strategies ◽  
Connective Tissue Diseases ◽  
Systemic Diseases ◽  
High Exposure ◽  
Disease Modifying

Abstract Introduction Covid-19 infection poses a serious challenge for immune-compromised patients with inflammatory autoimmune systemic diseases. We investigated the clinical-epidemiological findings of 1641 autoimmune systemic disease Italian patients during the Covid-19 pandemic. Method This observational multicenter study included 1641 unselected patients with autoimmune systemic diseases from three Italian geographical areas with different prevalence of Covid-19 [high in north (Emilia Romagna), medium in central (Tuscany), and low in south (Calabria)] by means of telephone 6-week survey. Covid-19 was classified as (1) definite diagnosis of Covid-19 disease: presence of symptomatic Covid-19 infection, confirmed by positive oral/nasopharyngeal swabs; (2) highly suspected Covid-19 disease: presence of highly suggestive symptoms, in absence of a swab test. Results A significantly higher prevalence of patients with definite diagnosis of Covid-19 disease, or with highly suspected Covid-19 disease, or both the conditions together, was observed in the whole autoimmune systemic disease series, compared to “Italian general population” (p = .030, p = .001, p = .000, respectively); and for definite + highly suspected diagnosis of Covid-19 disease, in patients with autoimmune systemic diseases of the three regions (p = .000, for all comparisons with the respective regional general population). Moreover, significantly higher prevalence of definite + highly suspected diagnosis of Covid-19 disease was found either in patients with various “connective tissue diseases” compared to “inflammatory arthritis group” (p < .000), or in patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs treatments (p = .011). Conclusions The finding of a higher prevalence of Covid-19 in patients with autoimmune systemic diseases is particularly important, suggesting the need to develop valuable prevention/management strategies, and stimulates in-depth investigations to verify the possible interactions between Covid-19 infection and impaired immune-system of autoimmune systemic diseases. Key Points• Significantly higher prevalence of Covid-19 is observed in a large series of patients with autoimmune systemic diseases compared to the Italian general population, mainly due to patients’ increased susceptibility to infections and favored by the high exposure to the virus at medical facilities before the restriction measures on individual movement.• The actual prevalence of Covid-19 in autoimmune systemic diseases may be underestimated, possibly due to the wide clinical overlapping between the two conditions, the generally mild Covid-19 disease manifestations, and the limited availability of virological testing.• Patients with “connective tissue diseases” show a significantly higher prevalence of Covid-19, possibly due to deeper immune-system impairment, with respect to “inflammatory arthritis group”.• Covid-19 is more frequent in the subgroup of autoimmune systemic diseases patients without ongoing conventional synthetic disease-modifying anti-rheumatic drugs, mainly hydroxyl-chloroquine and methotrexate, which might play some protective role against the most harmful manifestations of Covid-19.

Neuropathy of Connective Tissue Diseases and Other Systemic Diseases

2019 ◽  
Vol 39 (05) ◽  
pp. 651-668
Author(s):  
Peter H. Jin ◽  
Susan C. Shin
Keyword(s):  
Peripheral Neuropathy ◽  
Connective Tissue ◽  
Clinical Features ◽  
Connective Tissue Diseases ◽  
Chemotherapeutic Agents ◽  
Nutritional Deficiencies ◽  
Systemic Diseases ◽  
Monoclonal Gammopathies ◽  
Diagnosis And Management

AbstractPeripheral neuropathy is associated with numerous systemic diseases. It is often the heralding finding, which can lead to earlier diagnoses and better outcomes. An understanding of the epidemiology and clinical features of these diseases is paramount to their diagnosis and management. This article will focus on neuropathy associated with connective tissue diseases, monoclonal gammopathies, paraneoplastic disorders, medications including chemotherapeutic agents, nutritional deficiencies, alcohol, and toxins.

scholarly journals POS1246 COVID-19 IN ITALIAN PATIENTS WITH RHEUMATIC AUTOIMMUNE SYSTEMIC DISEASES: RESULTS OF A NATIONWIDE SURVEY STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 906-907
Author(s):  
C. Ferri ◽  
D. Giuggioli ◽  
V. Raimondo ◽  
L. Dagna ◽  
V. Riccieri ◽  
...  
Keyword(s):  
General Population ◽  
Connective Tissue ◽  
Surveillance System ◽  
Systemic Vasculitis ◽  
Connective Tissue Diseases ◽  
Survey Study ◽  
Systemic Diseases ◽  
Lung Involvement ◽  
National Surveillance ◽  
National Surveillance System

Background:SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement.Objectives:To evaluate the impact of Covid-19 pandemic in a large series of Italian patients with ASD.Methods:Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, Covid-19 was classified as definite Covid-19 (signs or symptoms of Covid-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected Covid-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis.Results:The main findings of the survey study revealed a significantly increased prevalence of Covid-19 in:a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%; p=0.0007;definite Covid-19 plus highly suspected Covid-19: 74/2,994, 2.47%; p<0.0001) when compared to Italian general population of Covid-19 infected individuals (349/100000 = 0.34%; data from Italian Superior Institute of Health;https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-national-surveillance-system).b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%; p=0.036; definite Covid-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%; p<0.0001)c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%; p=0.0015; definite Covid-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%; p<0.0001).Of interest, the prevalence of Covid-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs; while patients treated with conventional DMARDs showed a significantly lower prevalence of Covid-19 compared to those without. Covid-19 was more frequently observed in the patients’ populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate; 4/9 individuals requiring hospital admission died for severe pneumonia.Conclusion:The prevalence of Covid-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population; moreover, the actual prevalence of Covid-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as ‘frail patients’ during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection.The statistically significant association of Covid-19 with connective tissue diseases/systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients’ vulnerability to SARS-CoV-2 infection.Disclosure of Interests:None declared

scholarly journals CONDITION OF HUMORAL IMMUNITY IN PATIENTS WITH SYSTEMIC DISEASES OF CONNECTIVE TISSUE WITH ACTIVATED CHRONIC SIMPLE HERPETIC INFECTION

2020 ◽  
pp. 64-71
Author(s):  
Igor Gaiduchok ◽  
Yuriy Fedorov ◽  
Khrystyna Lishchuk-Yakymovych ◽  
Roman Pukalyak
Keyword(s):  
Connective Tissue ◽  
Humoral Immunity ◽  
Genetic Diagnosis ◽  
Connective Tissue Diseases ◽  
Active Phase ◽  
Control Group ◽  
Systemic Diseases ◽  
Autoimmune Pathology ◽  
Latent Phase ◽  
Hsv 1

The aim - to study and to analyze the indicators of the humoral link of the immune system in patients with systemic connective tissue diseases with chronic activated HSV 1/2 infection and to assess the effect of the revealed disorders on the development of autoimmune pathology. Materials and methods. We examined 380 patients with systemic diseases of the connective tissue (systemic lupus erythematosus, systemic vasculitis, rheumatoid arthritis, psoriasis) with chronic HSV 1/2 infection at the age of 21-67 years. In 45 of them, using the modern molecular genetic diagnosis of herpes simplex, the active phase of chronic HSV 1/2 infection was verified based on the results of the polymerase chain reaction, and in the other 335, the latent phase was verified. The control group consisted of 20 healthy individuals of the appropriate age and gender. In patients with systemic connective tissue diseases with chronic HSV 1/2 infection, the humoral immunity indices were studied: levels of complement component C3 and IFN-a in saliva and blood and acquired: concentration of common major immunoglobulinins: IgG, IgM IgA, IgE; specific IgM and IgG to HSV 1/2; levels of cryoglobulins, cryofibrinogen, CІC in serum. Statistical processing of the results of the study was carried out using generally accepted methods of variation statistics. Results. In patients with systemic diseases of connective tissue with chronic HSV 1/2 infection, activation of the humoral immunity was detected, it was especially evident in the active phase of the infection and was characterized by an increase in the antibody production of specific IgM HSV 1/2 and IgG HSV 1/2, аn increase in the levels of CIC, IgM, IgA and IgE, cryoprecipitation proteins, IFN-a in the blood. In the latent phase of HSV 1/2 infection the levels of IgG production of HSV 1/2, IgE, CEC, cryofibrinogen and cryoglobulins in the blood serum of these patients increased. Conclusions. The presence of chronic activated HSV 1/2 infection in patients with systemic diseases of the connective tissue causes activation of the humoral immunity, creates the conditions for the development of autoimmune processes.

Clinical symptoms in rheumatology

2020 ◽  
pp. 4-11
Author(s):  
Marina Kochiyeva
Keyword(s):  
Internal Medicine ◽  
Connective Tissue ◽  
Rheumatic Diseases ◽  
Clinical Symptoms ◽  
Connective Tissue Diseases ◽  
Diagnosis And Treatment ◽  
Systemic Diseases ◽  
Connective Tissues ◽  
The Subject ◽  
Timely Treatment

Rheumatology is one of the areas of internal medicine that deals with the diagnosis and treatment of rheumatic diseases. The term rheumatology is based on the merger of the words «rheuma», which means «flowing current», and «logos», which means «studies». Thus, the subject of the rheumatology study is inflammatory and degenerative-dystrophic diseases affecting the joints, as well as systemic diseases of the connective tissues (the outdated name is collagenosis). Diversity and polymorphism of the clinical symptoms of connective tissue diseases often leads to the difficulties in diagnosis and timely treatment.

scholarly journals P170 The validity and utility of the SLE-key® rule-out serological test when applied in a selected cohort of patients with SLE and other connective tissue diseases

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Sheilla Achieng ◽  
John A Reynolds ◽  
Ian N Bruce ◽  
Marwan Bukhari
Keyword(s):  
Linear Regression ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Negative Correlation ◽  
Connective Tissue Diseases ◽  
Inflammatory Myositis ◽  
The Mean ◽  
Negative Rule ◽  
Spearman’S Correlation ◽  
Rule Out

Abstract Background/Aims  We aimed to establish the validity of the SLE-key® rule-out test and analyse its utility in distinguishing systemic lupus erythematosus (SLE) from other autoimmune rheumatic connective tissue diseases. Methods  We used data from the Lupus Extended Autoimmune Phenotype (LEAP) study, which included a representative cross-sectional sample of patients with a variety of rheumatic connective tissue diseases, including SLE, mixed connective tissue disease (MCTD), inflammatory myositis, systemic sclerosis, primary Sjögren’s syndrome and undifferentiated connective tissue disease (UCTD). The modified 1997 ACR criteria were used to classify patients with SLE. Banked serum samples were sent to Immune-Array’s CLIA- certified laboratory Veracis (Richmond, VA) for testing. Patients were assigned test scores between 0 and 1 where a score of 0 was considered a negative rule-out test (i.e. SLE cannot be excluded) whilst a score of 1 was assigned for a positive rule-out test (i.e. SLE excluded). Performance measures were used to assess the test’s validity and measures of association determined using linear regression and Spearman’s correlation. Results  Our study included a total of 155 patients of whom 66 had SLE. The mean age in the SLE group was 44.2 years (SD 13.04). 146 patients (94.1%) were female. 84 (54.2%) patients from the entire cohort had ACR SLE scores of ≤ 3 whilst 71 (45.8%) had ACR SLE scores ≥ 4. The mean ACR SLE total score for the SLE patients was 4.85 (SD 1.67), ranging from 2 to 8, with mean disease duration of 12.9 years. The Sensitivity of the SLE-Key® Rule-Out test in diagnosing SLE from other connective tissue diseases was 54.5%, specificity was 44.9%, PPV 42.4% and NPV 57.1 %. 45% of the SLE patients had a positive rule-out test. SLE could not be ruled out in 73% of the MCTD patients whilst 51% of the UCTD patients had a positive Rule-Out test and &gt;85% of the inflammatory myositis patients had a negative rule-out test. ROC analysis generated an AUC of 0.525 illustrating weak class separation capacity. Linear regression established a negative correlation between the SLE-key Rule-Out score and ACR SLE total scores. Spearman’s correlation was run to determine the relationship between ACR SLE total scores and SLE-key rule-out score and showed very weak negative correlation (rs = -0.0815, n = 155, p = 0.313). Conclusion  Our findings demonstrate that when applied in clinical practice in a rheumatology CTD clinic setting, the SLE-key® rule-out test does not accurately distinguish SLE from other CTDs. The development of a robust test that could achieve this would be pivotal. It is however important to highlight that the test was designed to distinguish healthy subjects from SLE patients and not for the purpose of differentiating SLE from other connective tissue diseases. Disclosure  S. Achieng: None. J.A. Reynolds: None. I.N. Bruce: Other; I.N.B is a National Institute for Health Research (NIHR) Senior Investigator and is funded by the NIHR Manchester Biomedical Research Centre. M. Bukhari: None.

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