Pulmonary hypertension (PH) has gained more and more attention in the last years given the increased mortality and morbidity rate and in particular pulmonary arterial hypertension associated with autoimmune diseases (a specific subgroup of PH), entities with an increasing incidence and prevalence globally. Among these, systemic sclerosis is of particular interest, being the most common among connective tissue diseases (CTDs) with PH as a major complication. Other CTDs such as mixed connective tissue disease (MCTD), systemic lupus erythematosus (SLE), primary Sjogren's syndrome, and dermatomyositis may also develop PH as a complication of these severe and complex conditions, which can have a major impact on prognosis and quality of life. PH has also been reported in rheumatoid arthritis and ankylosing spondylitis but further studies are necessary. Several studies have shown that the 3-year survival rate for patients with systemic sclerosis-associated with pulmonary hypertension (SSc-PH) is between 31% and 52%, while the 5-year survival rate is below <50%. Therefore, an early and accurate diagnosis as well as subsequent management of PH in these conditions is mandatory, since survival remains suboptimal despite treatment advances. The aim of this article is to provide an overview of different autoimmune diseases associated with PH and to provide an easy reference source on current best practices.
Retinal migraine (ophthalmic migraine, ocular migraine, anterior visual pathway migraine) is a rarely encountered medical condition, but with an interesting and complex clinical presentation. The goal of this article is to compile the literature on retinal migraine, detailing nomenclature, pathophysiology, differential diagnosis, and medical investigations including newer imaging modalities, like optical coherence tomography (OCT). We will approach topics of great concern such as risk factors, complications, treatment, and management of this condition. Retinal migraine is mainly a diagnosis of exclusion and it must be isolated from transient monocular vision loss (TMVL) developed from other causes, for instance, papilledema, giant cell arteritis, carotid artery disease (amaurosis fugax), intermittent angle closure glaucoma, and others. Its treatment is similar to migraine treatment; topiramate, amitriptyline, and nortriptyline are some of the pharmacological drugs successfully used.
Auto-immune rheumatic diseases are characterised by high levels of inflammation that accelerate the development of atherosclerosis, increasing the cardiovascular risk. Direct evaluation of arteries such as of intima media thickness measurement is a simple test that asesses the cerebral and cardiovascular risk. In the initial stages, an increase of the intimal media thickness can be observed. Later on, atherosclerosis (plaques), stenosis and occlusion of the arteries can be identified. Indirect evaluation of the cardiovascular risk can be performed using serological markers - fibrinogen, C reactive protein, estimated sedimentation rate, total cholesterol, low density lipoproteins and high density lipoproteins, homocysteine levels etc. The presence of certain lifestyle factors that increase the risk, such as smoking, sedentarism and associated pathologies such as obesity, diabetes, hypertension were assesed in patients with rheumatoid arthritis. The aim of the study is to prove the relationship between anti-tumor necrosis factor alpha therapy effect on the cardiovascular risk in rheumatoid arthritis patients.
A symbiotic association between humans and microbes has been established over time. Disruptions in gut homeostasis have been linked to immune-mediated inflammatory diseases. Factors such as genetics, environment, diet, age, and medication play a major role in shaping the intestinal microbiome. An altered gut microbiome seems to modulate the progression and severity of inflammatory rheumatic diseases. Disruptions in the eubiotic state of the intestinal microbiome might promote intestinal and extraintestinal autoimmune and inflammatory disorders, although the mechanisms involved are not well understood. In this review, we provide a general overview of several studies concerning intestinal microbiome perturbations and their implications in rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Furthermore, we discuss the relationship between diet, intestinal microbiota, and inflammation.
Introduction: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints associated with HLA B27 antigen and with the predominance of the male gender (with an average between 20 and 30 years old). Case presentation A 48 years old male patient was admitted to our clinic, having a long history regarding this disease since he was 16. This patient has switched 3 therapies with anti TNF alpha agents until now, and we hope to obtain a good response for a long time. During the treatment with Etanercept he presented an acute anterior uveitis which had a good response to therapy. Conclusion: The ankylosing spondylitis management is complicated when we have the possibility to choose only three anti TNF alpha agents. If a patient does not respond to the first or second agent we are constrained to follow the last one. Therefore the principal problem regarding this special case is that the patient is non responder at the last agent. So the question that arises is witch will be the next therapy for this patient? INTRODUCTION Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints – asymmetric. Its major characteristic is the early damage of the sacroiliac joint, ascending to ankylosis. The incidence is increased for males between 20 and 30 years old, thus most of the patients are associating a HLA B27 antigen. The existence of cardiovascular risk due to inflammatory rheumatic diseases for decades but the real significance and therapy designed to control this risk has been recently evaluated. is known Systemic inflammatory rheumatic diseases accelerates atherosclerosis and inflammation because of destabilizes plaque of atheroma, contributing to an increased frequency of fatal cardiovascular events such as myocardial heart attacks and strokes. The ankylosing spondylitis cardiovascular events include: aortic damage (dilatation/hypertrophy), nerve impulse conduction disorders, accelerated atherosclerosis. heart muscle insufficiency, pericarditis, and Anti TNF-alpha therapy leads to a decrease of the disease activity score the nonspecific inflammatory syndrome. (BASDAI) and also The anti TNF approved drugs which are currently in clinical practice are: 1 Carol Davila Central University Emergency Military Hospital, Bucharest 39
Background and objective: Contrast-enhanced ultrasound, used to assess atherosclerotic carotid plaques, improves visualization of vessel wall irregularities and depicts intraplaque neovascularization. This article illustrates the use of contrast-enhanced ultrasound in the risk assessment of carotid atherosclerotic lesions, especially in challenging plaques evaluation. Materials and methods: For 23 patients with difficult duplex ultrasound examination due to carotid tortuosity or calcifications we assessed plaque morphology (contour, echogenicity and stenosis degree) using contrast substance (Sonovue, Braco) with dedicated vascular low mechanical index CPC software. Conclusion: Contrast-enhanced ultrasound is a new, noninvasive, and safe procedure for imaging carotid atherosclerotic lesions. It is a valuable tool for evaluating the vulnerable plaque at risk for rupture and for the diagnostic of the development and severity of systemic atherosclerotic disease
