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Spondyloarthritis refers to a broad group of conditions that include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and enteropathic arthritis associated with Crohn’s disease or ulcerative colitis. They have been classified by the ASAS group (ASsessment in Ankylosing Spondylitis) into axial spondyloarthritis and peripheral spondyloarthritis. Common features include the absence of autoantibodies, genetic predisposition, and clinical aspects such as axial joint involvement, peripheral manifestations, and extra-articular involvement. However, the pathogenic mechanisms remain complex and incompletely elucidated, despite the fact that the specialized literature has described several pathways that act in synergy: genetic predisposition, environmental factors (infections and mechanical stress), or innate and acquired immune mechanisms. Finally, an inflammatory response is triggered by the recruitment of a large number of inflammatory cells and the release of innate cytokines in the affected areas: joints or periarticular or extraarticular tissues. The current article aims to update and systematize the knowledge accumulated so far on this topic, focusing on the mechanisms that have been involved in the onset, progression, and severity of ankylosing spondylitis.

Background/Objectives: Psoriasis is a chronic inflammatory condition mediated by the immune system with various manifestations. The increased prevalence of subclinical joint involvement has led to the development of early diagnostic methods for psoriatic arthritis, including several instruments that have been validated and used in clinical practice. The aim of this study was to perform the Romanian translation, cultural adaptation, and validation of three assessment tools: the Early Arthritis for Psoriatic Patients (EARP) Questionnaire, Psoriasis Epidemiology Screening Tool (PEST), and Toronto Psoriatic Arthritis Screen 2 (TOPAS 2), which are designed to evaluate early-stage arthritis in patients with psoriasis. Methods: All the activities were carried out in accordance with the internationally recognized methodology recommended by the International Society for Pharmacoeconomics and Outcome Research (ISPOR), the recommendations of the World Health Organization (WHO) regarding the translation process and the validation of instruments, and data from the international literature. These three questionnaires were administered to 29 patients with psoriasis diagnosed by biopsy. A descriptive study was conducted and the data were analyzed with appropriate statistical tests using the PSPP program. A reliability test was assessed using Cronbach’s alpha coefficient. Results: The obtained values were significant for the first two questionnaires, with a value of 0.89 for the EARP and 0.63 for the PEST, but the value was not as significant for ToPAS2, at 0.40. Conclusions: This pilot study revealed that the Romanian and original versions of the three questionnaires are similar.

Abstract Background Certifying long-term sick leave and coordinating complex rehabilitation programs are essential activities of social insurance doctors. These doctors have a role in preventing the decreased work capacity of employees that may lead to leaving the labour market and the transition of these employees to other social insurance benefits, such as a work disability pension. Objectives Analysis of long-term sick leaves (over 183 days) to identify risk factors and population groups with low potential for work capacity rehabilitation. Method We conducted a cross-sectional study between September 2019 and September 2020. The information was collected from the National Institute of Medical Assessment and Work Capacity Rehabilitation Bucharest registers and the EXPMED application. The data were statistically analysed using PSPP software. Results The highest rehabilitation percentage was achieved in cases of traumatic injuries (73.17%), followed by musculoskeletal diseases (70.06%). We noticed lower recovery in cases of nervous system diseases (50.56%) and cardiovascular diseases (44.23%). In the group that summed up the other pathologies, the recovery percentage was 58.37%. People who regained their work capacity were significantly younger (mean age 47.87 y ± 8.93) than those who turned to other forms of social benefits, such as a disability pension or an old-age pension (mean age 53.16 y ± 8.43). Conclusion Most of the subjects (72%) regained their work capacity and did not need a disability pension. We identified the sociodemographic and morbidity characteristics of people on long-term sick leave along with target groups requiring intensive intervention measures.

Club cells have a distinct role in the epithelial repair and defense mechanisms of the lung. After exposure to environmental pollutants, during chronic exposure, the secretion of club cells secretory protein (CCSP) decreases. Exposure to occupational hazards certainly has a role in a large number of interstitial lung diseases. According to the American Thoracic Society and the European Respiratory Society, around 40% of the all interstitial lung disease is attributed to occupational hazards. Some of them are very well characterized (pneumoconiosis, hypersensitivity pneumonitis), whereas others are consequences of acute exposure (e.g., paraquat) or persistent exposure (e.g., isocyanate). The category of vapors, gases, dusts, and fumes (VGDF) has been proven to produce subclinical modifications. The inflammation and altered repair process resulting from the exposure to occupational respiratory hazards create vicious loops of cooperation between epithelial cells, mesenchymal cells, innate defense mechanisms, and immune cells. The secretions of club cells modulate the communication between macrophages, epithelial cells, and fibroblasts mitigating the inflammation and/or reducing the fibrotic process. In this review, we describe the mechanisms by which club cells contribute to the development of interstitial lung diseases and the potential role for club cells as biomarkers for occupational-related fibrosis.

Background and Objective Burnout syndrome is well-documented and highly prevalent among healthcare professionals. The literature search found studies mainly aimed at front-line medical specialties, cardiologists, or physicians working in intensive care units. Workload and work conditions favor the occurrence of burnout syndrome among social insurance physicians, with many consequences on health status and a decrease in the quality of their work. We aimed to assess the degree of vulnerability to developing burnout syndrome, factors associated with stress, and coping strategies at social insurance physicians. Materials and Methods: Social insurance physicians working in territorial services for medical assessment of work capacity from Romania participated in the study. An observational study was performed to describe the extent of the exhaustion syndrome among social insurance physicians (SIPhs). Three questionnaires were filled out by the participants: a short version of MBI-HSS to analyze the degree of burnout, an interview with specific questions for the source of stress and Brief-COPE for stress control. Brief demographic data were also collected. Data were statistically analyzed with appropriate tests using PSPP software. Results: Seventy-four physicians were included in the study. Fifty-six were females (75.7%) and twenty-eight (38%) had moderate or high burnout and cognitive distortions with depression resulting as a major side-effect (p < 0.001). Professional factors, mainly deadline pressure (p < 0.001) and high workload (p = 0.012), have emerged as contributing factors to burnout syndrome. Mental disengagement (p = 0.001), active coping (p = 0.006), and acceptance (p = 0.014) would improve stress control. Conclusion: More than two-thirds of social insurance physicians had moderate and high burnout syndrome. The development of strategies to standardize workload was identified as an important action area, along with the long-term preservation of health status and professional performance.