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Background: Timely detection and aggressive management of interstitial lung disease (ILD) in systemic sclerosis (SSc) are essential to improving outcomes and reducing risks of irreversible lung injury. Objective: to explore the usefulness of an ultraportable ultrasound device for the management of SSc-related ILD and to compare it with clinical and instrumental data. Methods: A total of 19 consecutive SSc patients underwent a comprehensive pulmonary evaluation: clinical, pulmonary function tests (PFTs) (spirometry, DLCO), lung CT (1.5 mm slice thickness reconstruction; HRCT), and lung ultrasound (LUS). A total score was calculated based on the number of color-coded B-lines recorded for each lung sliding. B-lines were analyzed against dyspnea, cough, Velcro, CT imaging (Warrick’s score), and PFTs. Global and subgroup analysis were performed (diffuse versus limited cutaneous SSc, Warrick’s < 7 versus >7). Results: Symptomatic lung involvement with varying degrees of dyspnea was reported in about 74% of cases (functional NYHA > 2 in more than half), chronic dry cough in one-third, Velcro rales in 42%. A total of 84.24% were classified as SSc with ILD on CT imaging. Statistically significant mild-to-moderate correlations between B-lines and clinical manifestations were demonstrated, as well as PFTs and Warrick’s scores (more B-lines, lower pulmonary function, but higher extent and severity on CT) (p < 0.05); there were differences between SSc patients without and with ILD in terms of the number and distribution of B-lines (p < 0.05), as well as different B-lines patterns and numbers in diffuse versus limited SSc (p < 0.05). Conclusions: Ultraportable handheld LUS is a promising method suitable for the management (screening, early detection, and evaluation) of SSc patients.

The aim of this study is to carry out an epidemiological retrospective of COVID-19 with individualization of the peculiarities of manifestation on the territory of Moldova, the evolutionary peculiarities being in full agreement with the general status of the patient up to that moment. 779 patients with COVID-19, hospitalized between September 2020 and April 2021, 386 men (49.6%) and 393 women (50.4%), aged between 7 and 93 years, were investigated; the mean age of the patients was 52.26 ± 15.844 years, with no significant differences between men (52.26 ± 15.830 years) and women (52.26 ± 15.878 years). More than half of the patients (59.6%) are aged between 30-59 years; 8.3% are young people under 30 years old, and about a third (32.1%) are elderly, over 60 years old (table 1) – without statistically significant differences between the sexes ( Pearson Chi – squared = 3.102, p = 0.875 ). There are certain correlations between the symptoms noticed in patients, their comorbidities and the appearance of lung changes on CT, respectively febrile or afebrile evolution. Among the characteristic symptoms of COVID-19, patients with comorbidities present more frequently cough, physical asthenia, inappetence and other than chest pain compared to those without comorbidities.

The therapeutic solutions chosen were ceramics on a zirconium support or ceramics on a metal infrastructure made by laser technique, which is a therapeutic alternative beneficial for the relationship with the affected tissues, a situation that is found in patients with cardiovascular or other types of general diseases. In addition to the technological line chosen, the biomaterials chosen are also extremely important, with Co-Cr alloys remaining a biocompatible option that satisfies the optimal parameters of the final prosthetic construction. From the study group we selected a representative clinical case for cardiovascular pathology in conjunction with partial edentulousness.The aim of this study is to identify how modern fixed prosthodontic technologies optimize the integration of fixed prostheses in the context of the current oral manifestations which occur as a consequence of different types of systemic damage.The study group consisted of 200 patients diagnosed with different forms of partial edentulousness and at the same time presenting different general status disorders. Non-invasiveness in conjunction with precise modern technologies with a different degree of biocompatibility creates the prerequisites for a good integration of oral rehabilitation against the background of different types of complications in the territory of oral manifestations in patients with different types of systemic diseases.

Hepatitis C virus (HCV) infection is a major global health concern, with a significant risk of developing hepatocellular carcinoma (HCC) in infected individuals. The advent of oral antiviral therapy has revolutionized the management of HCV, achieving sustained virologic response (SVR) rates and reducing the risk of HCC. However, some patients still remain at risk for HCC even after successful antiviral treatment. Scoring systems have emerged as valuable tools to predict HCC risk and assist in post-treatment surveillance. This review aims to summarize and evaluate the existing scoring systems developed to assess HCC risk in HCV patients after oral antiviral therapy. We systematically searched relevant databases for published articles. We included studies that focused on the development, validation, and clinical application of scoring models for HCC risk prediction. We identified scoring systems, utilizing different variables such as demographic data, liver function tests, imaging findings, and genetic markers. We discuss the strengths and limitations of each scoring system and compare their predictive accuracy. Furthermore, we explore the potential for combining multiple scoring models to enhance risk stratification. The findings of this review highlight the utility of scoring systems in identifying patients at higher risk of developing HCC despite achieving SVR with oral antiviral therapy. Additionally, we discuss the implications of these scoring systems for clinical practice, risk stratification, and long-term surveillance of HCV patients. In conclusion, scoring systems offer a valuable approach to estimate the risk of HCC in HCV patients post oral antiviral treatment. A better understanding of these scoring models will help clinicians in tailored follow-up strategies and early detection of HCC, ultimately improving patient outcomes. Further research is needed to refine and validate these scoring systems in different populations and to explore their potential inclusion into clinical guidelines.

Temporomandibular joint (TMJ) involvement with bone resorption of the mandible is a rare complication in systemic sclerosis (SSc), leading to restrictive mandibular movements, malocclusion, difficult swallowing and mastication, and subsequently altered nutrition. We report a case of SSc-related TMJ pathology in a 23-year woman, emphasizing the relevance of advanced imaging. Extensive bone resorption of mandibular condyle reveled on dental panoramic image explains the malocclusion and impaired interincisal opening, while CBCT demonstrates reshaping of the mandibular condyle with cortical lysis, osteophytes, decreased height and flattening. Furthermore, electromyography confirms masticatory muscles involvement.

Professional activity of a dental practitioner is widely recognized not only for the excessive biomechanical stress of the spine and the peripheral joints, but also for the high percentage of axial and peripheral musculoskeletal disorders. The aim of this study was to identify the risk factors and their consequences on the cervical spine in a cohort of dental practitioners who are currently involved in endodontic therapy. We included 30 dentists who worked daily in private offices in Iasi and in the Iasi county area. They were classified as belong to group A or B based on specific ergonomic criteria. We performed a complex analysis of all the participants in the current study based on a standard questionnaire aiming to identify if specific ergonomic measures may positively influence the musculoskeletal morbidity in dental practitioners. the endodontic field of the professional activity also generates different pathological conditions at this level. As a consequence, chronic pain, paresthesias, decreased muscle strength developed on a background of X-ray modifications including the malalignment of the cervical spine and degenerative disco-vertebral processes are commonly reported among dental practitioners, especially in those performing their daily activities in a non-ergonomic environment.

The term “diabetes mellitus” includes a varied number of chronic diseases characterized by hyperglycemia and relative or absolute insulin deficiency. Hyperglycemia is the most obvious biochemical marker in the complex of metabolic changes that affect carbohydrate, lipid, protid and electrolyte metabolism and can alter many organs and functions of the whole organism.The diagnosis of diabetes is based on clinical signs and laboratory explorations. The clinical picture is typical in about half of the cases and the main signs are polyuria, polydpsia, weight loss. In addition to these, others may be present in the clinical picture: asthenia, fatigue, decreased physical and intellectual strength, polyphagia. Sometimes, the diagnosis of diabetes can be revealed by the presence of signs of infectious complications, of the symptoms and signs of acute metabolic complications of diabetes or of the symptoms and signs of chronic degenerative complications. The terms of insulin-dependent and non-insulin-dependent have been eliminated, in favor of type 1 diabetes and type 2 diabetes. Type 1 is caused by autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency. Type 1 includes idiopathic and immune-mediated forms of β-pancreatic cell dysfunction that result in total insulin deficiency. Diabetes LADA (latent autoimmune diabetes in adults) is a recently recognized category of diabetes mellitus, which falls within the complex of type 1 diabetes. The study group consisted of 96 patients, 38 women (39.58%). and 58 men (60.42%) with oral manifestations in patients with diabetes and obesity.

Women with rheumatoid arthritis (RA) may carry an increased risk of adverse pregnancy outcomes (APO). The aims of this study were to compare pregnancy outcomes in RA patients as compared to the general obstetric population (GOP) and to identify a risk profile in RA. A case-control study was conducted on 82 prospectively followed pregnancies in RA and 299 pregnancies from the GOP. The mean age at conception was 31.50 ± 4.5 years, with a mean disease duration of 8.96 ± 6.3 years. The frequency of APO in RA patients was 41.5%, 18.3% experienced spontaneous abortions, 11.0% underwent preterm deliveries, 7.3% had small for gestational age infants, 4.9% experienced intrauterine growth restriction, 1.2% experienced stillbirth, and 1.2% suffered from eclampsia. The risk of APO was correlated with a maternal age higher than 35 years (p = 0.028, OR = 5.59). The rate of planned pregnancies was 76.8%, and the subfertility rate was 4.9%. Disease activity improved every trimester, and approximately 20% experienced an improvement in the second trimester. Planned pregnancies and corticosteroids use (≤10 mg daily) were protective factors for APO in RA pregnancies (p < 0.001, OR = 0.12, p = 0.016, OR = 0.19, respectively). There was no significant association between APO and disease activity or DMARDs used before and during pregnancy. Regarding the comparison between the RA group and the controls, RA mothers were significantly older (p = 0.001), had shorter pregnancies (p < 0.001), and had neonates with a lower birth weight (p < 0.001).

Temporomandibular joint (TMJ) is widely involved in rheumatic disorders, especially in inflammatory but also in degenerative conditions. The burden of TMJ osteoarthritis is related to both soft and hard tissue damage meaning cartilage, subchondral bone and, to a lesser extent, synovial membrane involvement resulting in a wide range of clinical signs and symptoms and significant disability. The diagnosis of degenerative TMJ disease is challenging comprising a comprehensive algorithm based on both clinical as well as imaging techniques from simple radiology to newer ones such as cone beam computer tomography.

Background. Systemic sclerosis (SSc) is a chronic multisystem autoimmune condition defined by a complex pathobiology, comprising excessive fibrosis of skin and internal organs, peripheral vasculopathy with endothelial cell dysfunction, inadequate vascular repair and neovascularization, and aberrant immunity. Vitamin D is a steroid hormone with pleiotropic effects beyond its traditional role in calcium and bone homeostasis. Since vitamin D has immunomodulatory, cardioprotective, and antifibrotic properties, it could potentially interfere with SSc pathogenesis. Suboptimal vitamin D levels are classically recognized in scleroderma, irrespective of clinical and serological phenotype. Aim. This systematic review is aimed at investigating and clarifying the role of vitamin D in SSc and emphasizing the association of vitamin D status with different clinical settings. Methods and Results. A systematic online search was performed, using PubMed databases to collect articles on the topic of vitamin D in SSc. The final analysis included 40 eligible articles. Conclusions. Hypovitaminosis D is common in SSc patients and could be associated with clinical and serologic patterns of the disease. Intervention for low serum vitamin D levels in SSc pathogenesis remains controversial, as well as the significance of vitamin D supplementation in such patients.

The aim of this study was to determine if cervical-facial radiotherapy can influence the carious disease indices in relation to duration, total dose and session’s number. Materials and method The study group included 18 patients following cervical-facial radiotherapy for oro-maxillo-facial cancers (6 females, 12 males, age 45-70). The radiotherapy was performed with a dose 200cGy per session, 50Gy total dose, 30 number sessions, sessions duration 7 minutes. The clinical examen and paraclinical tests were performed on all patients included in study. DMFS, RFR, RFS, pH were determined. The results show a positive correlation between DMFS, RFS, radiation dose and number of radiotherapy sessions. Negative correlation was observed between RFR, salivary pH and the radiotherapy sessions duration. Conclusions The patients following cervical-facial radiotherapy present xerostomia and constitute a high cariogenic risk group.

The main aim of this study was to evaluate the frequency of temporomandibular joint (TMJ) disorders in patients with various rheumatic conditions and to define the accurate assessment protocol. We performed a prospective observational study in 1052 consecutive patients with various inflammatory (433 rheumatoid arthritis, RA; 258 ankylosing spondylitis, AS; 103 psoriatic arthritis, PsA; 32 juvenile idiopathic arthritis, JIA) and degenerative (226 osteoarthritis, OA) rheumatic disorders attending at least once the rheumatology department. Patients were classified in six study groups, as follows: group A comprising 152 RA; group B: 55 AS; group C: 44 PsA; group D: 22 JIA; group E: 42 patients with osteoarthritis (OA); and group F or the control group. All patients were evaluated according to the same standardized protocol including several variables e.g. demographics, epidemiologic, clinical, biological and imaging parameters according to the underlying rheumatic condition. TMJ and dental-periodontal system were also examined. Statistical analysis was done in SAS 4.3 program, p

Temporomandibular joint (TMJ) may be involved in different JIA subtypes, with a prevalence ranging between 40 to 70%, leading to various degrees of disability, mainly related to pain, inflammation, reduced mandibular mobility, damage of the condyle and secondary masticatory muscle impairment. The aim of the present work was to describe TMJ involvement in different subtypes of JIA, based on a complex epidemiological, clinical and imaging approach. We performed a prospective observational study on 22 consecutive JIA attending an academic rheumatology department. Imagistic assessments comprised: (i) an X-ray of vertebral (lumbar and cervical spine) as well as peripheral joints in order to support the diagnosis and to evaluate the stage of the disease; (ii) a TMJ ultrasonography; (iii) a TMJ CT scan; and (iv) a CBCT. The following parameters were evaluated in our patients: demographics and general characteristics (sex, age, duration of disease, JIA onset); TMJ-related data e.g. spontaneous or provoked unilateral or bilateral TMJ pain measured on a visual analog scale (VAS), accompanied by morning stiffness or stiffness after rest; clicking and crepitation were noted in the context mandible mobilization; muscle contracture (masseter, temporal, internal pterygoid); parafunctions; TMJ imaging; dental, gingival and occlusal status. TMJ involvement is classically described among JIA patients, presenting with various clinical signs and symptoms and different degrees of inflammation and condylar damage.

It is widely recognized that anatomic and functional integrity of the shoulder is critical for a highest performance during routine practice in different health-care professionals, particularly in dentistry. The main aim of this survey was to highlight the morbidity of musculoskeletal shoulder pathology and to demonstrate the role of physical therapy in the prevention and treatment of shoulder disorders among dentists. 30 dentists aged between 35 and 60, with a minimum of 10 years of experience in the medical field and at least 6 working hours per day, were selected for the study and classified in two groups: group A, consisting of 15 dentists performing a complex (general, specific) physical therapy program for the upper limb, and group B, 10 women and 5 men, who were not allowed to participate in the specific kinetic program. All the subjects were evaluated based on a protocol comprising the following variables: pain in the shoulder (character, location, intensity, radiation), joint mobility on flexion/extension/abduction/ adduction/rotation (internal, external), working position (standing, sitting), X-rays of the shoulder, physical therapy exercises on a daily basis (yes/no). The final follow-up was done at 12 months, when the same protocol was applied. Both the upper limb and the spine are the most affected regions among dentists due vicious positions, repetitive movements, prolonged isometric muscle contraction and vibrations, typically related to routine professional activities. After the first 6 months, but also at the end of our survey, we demonstrated significant improvement of pain in subjects who were enrolled in the kinetic program; moreover, joint mobility was also better (maintained throughout the maximal range of motion) in dentists performing physical therapy daily. An individualized kinetic program, typically designed for the shoulder, but including the upper arm joints, revealed the importance of physical therapy in the management of work-related musculoskeletal shoulder pathology

Dentistry is acknowledged as an outstandingly practical domain of medicine, with an excessive and extensive role of the hand acting in a professional dental environment, with specific working postures, repetitive movements and using different dental instruments. The main objective of our study was to evaluate occupational-hand pathology in dentists and potential trigger factors and to highlight the role of physical therapy in preventing and management of different musculoskeletal issues in dentistry settings. We performed a prospective 12-months study on 30 dentists (20 women), aged between 30 and 60 years, working in private practice aiming to assess professional hand involvement. Enrolled dentists were classified in two equal groups, according to their participation in a kinetic program: group A, dentists performing an individual kinetic program on a daily basis, and group B, dentists without being involved in a physical therapy program. All subjects were followed-up for 12 months. A specific questionnaire derived from the Cornell Musculoskeletal Discomfort Questionnaire was applied in all cases, evaluating different musculoskeletal items such as pain, paresthesias, muscle spasm and amyotrophy, but also joint mobility (wrist, metacarpophalangeal joints).Work-related hand pathology is widely confirmed among dentists, specifically connected to different professional factors such as working postures and movements, number of working hours, cumulative time and experience, as well as type of devices and tools handled. Moreover, dentistry performed according to ergonomic settings is essential in order to reduce the burden of musculoskeletal features and to improve related disability and working performance. Work-related hand pathology accounts for significant morbidity and physical discomfort among dental professionals. With a multifaceted pathobiology ranging from inflammatory to degenerative damage of both soft tissue, nerve and joints (wrist and fingers), musculoskeletal issues are typically linked to professional triggers during routine practice in dentistry.

The burden of work-related musculoskeletal pathology among dental professionals is widely recognized, particularly associated with specific risk factors in routine practice. Aim of the study: The main objective of our study was to evaluate musculoskeletal issues in students in dentistry based on their participation in different levels of professional activities, and to identify potential risk factors. Material and methods: We performed a cross-sectional study in 100 consecutive students attending the School of Dentistry, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, classified in two main groups: 50 students in their first and second year of study, not engaged in specific dental work (group A) and 50 students in their third to sixth year, already performing professional activities in patient (group B). A predefined questionnaire survey was applied in all students, including general data, risk factors for musculoskeletal problems, and information on pain (vertebral, hand) and muscle spasm as main musculoskeletal complains potentially related to their professional doings. Conclusions: Ergonomic postures adopted by the student / dentist in routine practice as well as ergonomic dental instruments are usually associated with less vertebral (lumbar spine) and hand pathology. Ergonomic principles must be applied in routine dental practice and the student educated about prevention of musculoskeletal pathology.

Background: This study investigates the clinical characteristics and differences between primary Sjögren’s Syndrome (pSS) and secondary Sjögren’s Syndrome (sSS) in a cohort of 50 patients. Methods: Conducted across two academic facilities in North-East Romania, the study emphasizes the importance of glandular and extraglandular manifestations, focusing on salivary flow rates, pH levels, and buffer capacity. Patients were diagnosed using the 2016 ACR-EULAR classification criteria, with a detailed examination including salivary tests, biopsies, and antibody presence. Results: The findings highlight significant differences between pSS and sSS, particularly in salivary function, with pSS patients exhibiting more severe glandular dysfunction. The study also notes a higher prevalence of inflammatory joint involvement in sSS patients, often associated with rheumatoid arthritis. Statistical analysis revealed correlations between salivary parameters and disease progression, underscoring the necessity of tailored treatment strategies. The research suggests that lower salivary flow rates and altered pH levels in pSS patients contribute to compromised oral health, including increased dental cavities and periodontal disease. Conclusions: The study’s results contribute to a deeper understanding of Sjögren’s Syndrome and reinforce the need for multidisciplinary management to address both systemic and oral health complications in these patients.

The aim of present work is a double one. On the first hand we tried to collect together the newest data concerning the enteroneurons’ morphology, their association in the parietal plexuses and their synaptic interconnections. All classes of enteroneurons were discussed in detail, but, despite their diversity, we have concluded that, essentially, they can be classified as motor, sensitive and interneurons, are disposed in layers and have the same functionality as the cerebral cortex neurons. According to their neurochemistry, we have imagined reflex circuits subserving motor and secretory functions, illustrated with original diagrams. Enteroglia and interstitial cells of Cajal are also assessed in interrelation with neurilema and myolema of gut muscles fibers. The second goal of our study was focussed on serotoninergic enteroneurons, their contribution to both motor and secretory gut functions and also on synuclein production in the enteroneurons, named by us extraparietointestinal. Their contribution to trigger the initial stages of Parkinson disease is proposed.

Objective. Understanding comorbidities of rheumatoid arthritis (RA) and their burden definitely redefines the holistic approach of RA in daily practice. This study aimed to explore a range of comorbidities in patients with RA and to analyze their involvement in the choice of individualized treatment in real-life to achieve better disease outcomes. Material and method. A retrospective cross-sectional observational study in a cohort of 201 consecutive adult RA (diagnosed by either ACR 1987 or EULAR/ACR 2010 criteria) examining the association between comorbidities and different drug prescriptions for RA. Results. Comorbidities were recognized in 90% of patients; top five associated disorders were hypertension (n=106; 52.72%), osteoporosis (n=73; 36.32%), dyslipidemia (n=58; 28.86%), interstitial lung disease (n=43; 21.39%), chronic kidney disease (n=35; 17.41%). Antimalarials were the most commonly prescribed drugs (n=84; 41.79%) followed by methotrexate (n=76; 36.81%) and biologics (n=63; 31.34%) with a comparable distribution between TNF inhibitors (n=27; 13.43%) and anti-IL-6 drugs (n=28; 13.93); only 13 cases (6.47%) received tsDMARDs. 16% patients with concomitant hypertension, 11% with diabetes, 15% with osteoporosis and 15.52% with dyslipidemia received intermittent low doses of glucocorticoids. Reported in 24 cases (11.94%), hepatitis B and C significantly affect the use of medication, including bDMARDs (only 4 cases on etanercept given together with antivirals), while RA with interstitial lung disease received biologics in one third of cases. Conclusion. Exploring RA journey from the perspective of comorbidities in real-life underpins management challenges related to associated conditions as comorbidities of RA patients may impact treatment regimens of RA and/or the prescribed drugs may worsen associated disorders.

Introduction. Spondyloarthritis (SpA) represent a heterogeneous group of chronic inflammatory conditions sharing clinical, genetic, imaging and therapeutic features. Objectives. To analyze the clinical and biological characteristics, disease activity and functional impact in non-radiographic axial SpA (nr-axSpA) versus ankylosing spondylitis (AS). Material and method. Cross-sectional observational 12 months study on 46 patients with axial SpA; disease related parameters (clinical, biological, activity and functionality indices) and treatment options were compared in disease categories (nr-axSpA and AS). Outcomes. AS was diagnosed in 73.9%, and nr-axSpA in 26.1% cases. The majority of patients with nr-axSpA were women (72% vs 28%), with a younger age at onset (35.2±9.5 years vs 41±0.6 years) and a shorter time to diagnosis (3±0.5 vs 5.5±3.2 years). C-reactive protein levels were significantly higher in AS compared to nr-axSpA (2.2±0.5 vs 1.28±0.7) (p0.05) in AS vs nr-axSpA. Conclusions. Although nr-axSpA occurs frequently in women and may present with lower CRP levels, there are similar trends in disease activity and functional outcomes in both disease categories of the ax-SpA spectrum. Both nr-axSpA and AS patients experience high disease burden.

Objective: we aimed to estimate the long-term global cardiovascular risk (GCVR) in patients with psoriatic arthritis (PsA) and to identify factors correlated with this risk among traditional and non-traditional risk factors. Material and method: cross-sectional observational study enrolling 45 consecutive patients with PsA without known atherosclerotic disease or heart failure, attending an outpatient rheumatology department over 12 months. Disease-related parameters (clinical phenotype, inflammation tests, type of medication), traditional cardiovascular risk factors (smoking, obesity, dyslipidemia, hypertension, diabetes) and 10-year GCVR (Framingham Heart Study online platform) were collected in all patients according to a predefined protocol. Results: 57.77% of patients were female, with a mean age of 52.1 years; hypertension (46.66%), dyslipidemia and current smoking (20% each) were reported as main traditional cardiovascular risk factors in our cohort. 46.67% patients presented with high cardiovascular risk, 37.78% with intermediate risk, while only 15.55% with low risk. Framingham risk score correlated with coronary atherosclerosis, its sensitivity for the detection of CV risk factors being high (p0.05). Conclusion: Traditional cardiovascular risk factors were reported in a significant proportion of PsA patients, but cannot entirely explain the global cardiovascular risk; additionally, more than half of patients were stratified as having high or intermediate cardiovascular risk. Different factors could interfere with 10-year cardiovascular risk.

Objectives Tocilizumab showed trends for improving skin fibrosis and prevented progression of lung fibrosis in systemic sclerosis (SSc) in randomised controlled clinical trials. We aimed to assess safety and effectiveness of tocilizumab in a real-life setting using the European Scleroderma Trial and Research (EUSTAR) database.Methods Patients with SSc fulfilling the American College of Rheumatology (ACR)/EULAR 2013 classification criteria, with baseline and follow-up visits at 12±3 months, receiving tocilizumab or standard of care as the control group, were selected. Propensity score matching was applied. Primary endpoints were the modified Rodnan skin score (mRSS) and FVC at 12±3 months compared between the groups. Secondary endpoints were the percentage of progressive/regressive patients for skin and lung at 12±3 months.Results Ninety-three patients with SSc treated with tocilizumab and 3180 patients with SSc with standard of care fulfilled the inclusion criteria. Comparison between groups did not show significant differences, but favoured tocilizumab across all predefined primary and secondary endpoints: mRSS was lower in the tocilizumab group (difference −1.0, 95% CI −3.7 to 1.8, p=0.48). Similarly, FVC % predicted was higher in the tocilizumab group (difference 1.5 (−6.1 to 9.1), p=0.70). The percentage of progressive/regressive patients favoured tocilizumab over controls. These results were robust regarding the sensitivity analyses. Safety analysis confirmed previously reported adverse event profiles.Conclusion Although this large, observational, controlled, real-life EUSTAR study did not show significant effectiveness of tocilizumab on skin and lung fibrosis, the consistency of direction of all predefined endpoints generates hypothesis for potential effectiveness in a broader SSc population.

Background. Systemic sclerosis (SSc) is a rare chronic disease, with unknown aetiology and complex pathogenesis. The hand is often implied in the main clinical findings, being affected primarily by the vascular component (Raynaud phenomenon, digital ulcers). One of the possible complications of the hand vasculopathy is osteonecrosis (ON) of the carpal bones. In these cases, the lunate is the most frequently affected, followed by the scaphoid. In the ON process, not only the vascular supply is important, but the nearby mechanical factors and anatomic variants of the wrist. Our objective was to reveal the most important aspects regarding the ON of the carpal bones in patients with SSc. Methods. A systematic literature review was performed through July 31, 2021 on Pubmed and Cochrane databases. The eligible articles were read in full text and were included in this paper, in the absence of exclusion criteria and after consensus between two reviewers. Results. Ten articles met the inclusion criteria, their main results being described in this review. In all studies, ON of the lunate and the scaphoid is associated with advanced SSc and severe Raynaud phenomenon. Conclusions. In conclusion, carpal ON is a rare complication of SSc, especially of the diffuse type. There is limited data on this condition, its prevalence being difficult to estimate due to the lack of symptoms.

Availability of biosimilar medicines is rapidly increasing, potentially leading to a wider prescription and a support for healthcare system costs. Despite efforts of patient and physician educational initiatives there still remains a reluctance in prescribing or administering this type of products. A multi-centric survey was conducted on 336 patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) or lupus (SLE) on biologic treatment. Half of the patients stated never hearing of biosimilars and one third feared adverse events (infections, cancer). Another 20% felt insecure on drug tolerability or efficacy. However, the majority declared relying on their rheumatologist if prescribing a biosimilar. Lack of patient information should be accurately addressed by health organizations so that the choice of treatment is done knowingly.

Objective. Cardiovascular disease (CVD) is considered to be the main cause of morbidity and mortality in rheumatoid arthritis (RA) patients. Tumor necrosis factor alpha (TNF), an important pro-inflammatory cytokine, has a multivalent role in the pathogenesis of RA. It is also responsible for the glucose metabolism related alterations and for the increased levels of serum lipids found in these patients. We aimed to evaluate the effects of TNF inhibitors on lipid and glucose metabolism in patients with active RA. Methods. We performed a prospective study in 117 consecutive patients with active RA undergoing periodic treatment with TNF inhibitors – Adalimumab (ADA), Etanercept (ETA), Infliximab (IFX) –, combined with conventional synthetic disease modifying antirheumatic drugs (csDMARDs), according to the national recommendations for the treatment of RA. At the time of the enrollment, all patients were assessed according to a predefined protocol including demographics and RA-related parameters (inflammatory syndrome, disease activity, medication) as well as metabolic biomarkers such as total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TG) and serum glucose level. Statistical analysis was performed in STATA 12/SE software, p

We aimed to analyse parameters defining carious disease in patients with rheumatoid arthritis (RA) and to evaluate potential correlations with inflammatory systemic parameters related to RA. Materials and method. We performed a complex clinical oral exam (DMFT, PI, RFR, RFS, CT) and inflammatory tests (ESR, C-reactive protein) and ASLO in seven patients known with RA. The results were statistically analyzed by SPSS 16 programs and Spearman`s correlation. The results showed a positive correlation between ASLO and DMFT, PI, CT, ESR and DMFT, PI, CT, C-reactive protein and variable: CT, PI; negative correlations were reported between ASLO and RFR, RFS, while C-reactive protein also associated with DMFT, RFR, RFS. Conclusions RA can influence the patient's cariogenic risk.

Background: Patients with rheumatoid arthritis (RA) have increased systemic inflammatory burden associated with elevated cardiovascular mortality. Prolonged ventricular repolarisation evaluated by QT interval duration is a risk factor for cardiovascular and total mortality. In RA, mortality risk is correlated with dynamics and cumulative incidence of QTc prolongation rather than QTc value. The aim is to evaluate if QT parameters evaluated with 24 h Holter ECG are a better option to complete the cardiovascular profile of RA patients than parameters from short ECG recordings. Materials and methods: A total of 58 patients (22 males, 36 females) with RA were submitted to short ECG recordings at admission and to 24 h Holter ECG. QT interval parameters and ventricular ectopy generated from both types of recordings were analyzed. Results: QTc interval values obtained from Holter ECG were significantly higher than the values from short term ECG and were correlated with severity of inflammatory process. The number of QRS complexes with QTc > 450 ms recorded during 24 h Holter was strongly correlated with the number of ventricular events and severity of the inflammatory process. Conclusions: In patients with RA, the Holter ECG recordings could realize a more precise evaluation of the extent and dynamics of QTc interval duration and of ventricular ectopic events with potential risk of sudden death.

The aim of our study was to identify potential relations between temporomandibular joint (TMJ) pathology (signs and symptoms) and disease activity, disability and impairment of quality of life in patients with inflammatory rheumatic conditions. We performed a cross-sectional observational study in a cohort of consecutive patients with inflammatory rheumatic disorders (IRD) and TMJ-related arthritis, attending at least once the outpatient rheumatology department between 2005 and 2007. 152 patients with rheumatoid arthritis (RA) and 55 with ankylosing spondylitis (AS) met the eligibility criteria (IRD with TMJ involvement at the time of examination) and were recruited for this study; supplementary, 33 healthy controls also featured signs and symptoms related to TMJ involvement and qualified to be included in the study. TMJ complaints were recorded by a regular questionnaire examining the following items: spontaneous muscle pain, muscle pain during use of the jaw, articular pain, difficulty in opening the mouth. In all cases we evaluated disease activity and disability according to internationally validated instruments specifically designed for each disorder or with a common destination. TMJ involvement is commonly reported in patients with RA and AS account for high levels of disability and impaired health-related quality of life. TMJ arthritis significantly correlates with disease activity and disability, not only in RA but also in AS, requiring a complex management.

Considered as one of the most common traumatic injuries of the maxillofacial region, mandibular fractures remain among the complex causes of temporomandibular joint disorders (TMDs). Due to the complexity of the temporomandibular joint, the management of TMDs represents a challenge in real-life practice; although many treatment modalities have already been proposed, ranging from conservative options to open surgical procedures, a consensus is still lacking in many aspects. Furthermore, despite continuous improvement of the management of mandible fractures, the duration of immobilization and temporary disability is not reduced, and the incidence of complications remains high. The aim of the present study is to (i) review anatomophysiological components of temporomandibular joint; (ii) review concepts of temporomandibular joint fractures; and (iii) describe methods of the recovery of the temporomandibular joint after mandibular fracture immobilization.

Although antibodies targeting Ro52 protein/TRIM21 are commonly detected in systemic autoimmune rheumatic disorders (SARDs), their clinical significance and pathobiologic role remains incompletely understood. Objectives. We aimed to define clinical relevance and immunological associations of anti-Ro52/TRIM21 positivity in a cohort of patients with SARDs. Methods. We retrospectively reviewed medical records of 97 consecutive SARDs who attended at least once our Rheumatology Department between March 2016 and June 2017. Clinical manifestations, rheumatoid factor (RF) (Latex and Waalter-Rose tests), antinuclear antibodies (ANA>1:100, immunofluorescence assays) as well as detailed ANA profile (nRNP/Sm, Sm, SS-A/Ro, Ro52/TRIM21, SS-B/La, Scl-70, PM/Scl, Jo-1, CENP-B, PCNA, dsDNA, nucleosome, histone, P-ribosomal protein, AMA-M2, DFS70) (line immunoblot assay) were systematically evaluated. Statistical analysis was performed in SPSS19.0, assuming significance for p

Classified as a distinct subset of idiopathic inflammatory myopathies, anti-synthetase syndrome is an orphan autoimmune disease characterized by the presence of anti-aminoacyl-tRNA synthetase antibodies associated with a spectrum of clinical features including interstitial lung disease, myositis or dermatomyositis, chronic polyarthritis, fever, mechanic‘s hands and Raynaud‘s phenomenon. The main objective of our study was to evaluate nailfold capillary abnormalities in a series of cases diagnosed with anti-synthetase syndrome, aiming to describe capillaroscopy findings and to identify potential relation with clinical and functional outcomes. Irrespective of clinical and serological disease subtype, significant capillaroscopic changes may help diagnosis and identify negative prognostic factors, advancing the role of routine capillaroscopy in the decisional algorithm of anti-synthetase syndrome. Nailfold videocapillaroscopy is able to provide valuable information in patients with anti-tRNA synthetase myositis, suggesting that diffuse microangiopathy represents an early pathobiologic event.

We report the clinical case of an emergent Crohn’s disease (CD) as a paradoxical effect after 24 months of successfully treatment with etanercept for active ankylosing spondylitis in a young women. Despite rapid and sustained response of articular disease (remission achieved as soon as three months and maintained through the entire period of administration), new onset intestinal manifestations developed during biological therapy. A complex assessment comprising clinical, endoscopic and histopathologic evaluation, associated with high levels of fecal calprotectin confirmed drug-induced inflammatory bowel disease (IBD) compatible with CD. Although optimal treatment strategy is not yet validated, discontinuation of putative etanercept and cycling to a monoclonal anti-TNF antibody (adalimumab) demonstrated positive outcomes for both articular and IBD. New onset CD may be considered as an immune-mediated injury induced etanercept and should be considered in any patient with spondylarthritis in whom IBD develops with a clear temporal relationship with TNF inhibitors, especially etanercept.

Musculoskeletal pathology in dentistry settings has multifaceted triggers, including prolonged, either standing or sitting static postures, repetitive movements, vicious positions with excessive bending and rotation with subsequent overloading and overstress of the head, spine, scapula-humeral joint, hand, but also weight bearing joints such as hips and knees. The main objective of our study was to investigate the prevalence of musculoskeletal complains, especially cervical spine involvement, among dentists. We performed a cross-sectional study on 40 gender, age, and years of practice-matched subjects stratified in two groups according to their background profession – dentists in group I, general practitioners (GP) in group II, aiming to identify work-related musculoskeletal issues. A specific questionnaire derived from the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was applied in all cases, evaluating the sitting discomfort and working performance; we focused on two main items that reflect the level of comfort or discomfort (item 1) and cervical pain on a visual analogue scale of 0-10 cm (item 2). Working in specific dental environment must complain with ergonomic recommendations, particularly focused on working posture aiming to limit as a feasible extent the overload on lumbar spine and excessive negative influence on cervical segment. Sitting on an ergonomic chair or alternating sitting with standing posture during working day should be promoted in routine dentistry practice. Work-related musculoskeletal complains, with special emphasis on cervical spine pathology, is commonly reported among dentists; both static and dynamic overstress of the vertebral structure are responsible for abnormal biomechanics and subsequent pathology in routine dental professional practice.

Paget’s disease of the bone (PDB) or osteitis deformans is a chronic metabolic bone disorder, characterized by focal increase in bone resorption, followed by a rapid and abnormal bone repair with a disorganized and excessive bone formation, leading to pain, bone deformities and, eventually, fractures. Although the exact etiology of the disease remains controversial, genetic background and environmental factors (viral infections) are typically involved in the complex pathobiology pathways of PDB. The diagnosis of PDB, subsequent classification in disease subtype (monostotic or polyostotic), activity and severity, and complications (fracture, deformities, osteoarthritis, secondary development of tumors, hearing loss, neural compression, high output congestive cardiac failure) are usually made using a sequence of a blood tests (biochemical markers of bone turnover, especially elevated serum alkaline phosphatase) and imaging (x-ray or bone scan). Bisphosphonates are widely used for the management aiming to reduce bone turnover, promote healing of osteolytic lesions and improve bone pain. We report the case of a polyostotic Paget’s disease of bone as an unusual case of low back pain.

Critical digital ischemia (CDI) remains a distinct, serious complication of peripheral vasculopathy in systemic sclerosis, macrovascular as well as microvascular disease, abnormal vascular remodeling, vasoconstriction-vasodilation imbalance and fibrosis being key underlying factors. Successful short- as well as long-term outcomes may arise from early diagnosis, broad assessment and prompt therapeutic intervention. However, current treatment options are far from ideal, indicating the need for a complex approach focused on pathobiologic issues. We report the case of a middle age postmenopausal woman with a recent onset of CDI and subsequent gangrene, evolving in a very early PM-Scl positive systemic sclerosis. Dramatic improvement with complete resolution of CDI as well as healing of digital gangrene with minimal tissue loss was rapidly achieved under vasodilating therapy, after two cycles of intravenous prostanoids.

Background and Objectives: Cardiac involvement in systemic sclerosis has important consequences on patient survival. Myocardial fibrosis and microcirculation involvement can generate arrhythmic complications, which can be associated with a higher death risk. QT interval prolongation is considered as a risk factor for ectopic ventricular events and can be evaluated using standard short ECG recordings or 24-h Holter ECG recordings. Materials and Methods: 39 patients with systemic sclerosis were submitted to a standard ECG recording at admission and 24-h Holter ECG monitoring. Results: QT interval values resulted from Holter ECG monitoring are higher than the values generated by the short-term ECG recordings. Holter ECG monitoring permits the detection of ventricular ectopy in patients with no events on standard ECG. Conclusions: In patients with systemic sclerosis, 24-h Holter ECG recordings can realize a more precise evaluation of the extent of QTc interval prolongation and ventricular ectopic events associated with myocardial involvement.

Posture influences at work on the entire musculoskeletal apparatus, but with great consequences for the spine. Postural dentists use two totally different ways of working: seated working position and postural working position. The seating position is currently considered the ergonomic and postural is considered all unergonomic. This study aims to analyze the disco-vertebral and muscle pain, the conditions for carrying out or postural seating. The study was conducted on two groups A and B consisting of 43 random and that 47 dentists (49 women, 41 men), aged 30-55 years (maximum age of assets). The primary composition of the lots was the position taken during medical activity. Group A was selected for orthostatic position and group B seated on a wheelchair. In conclusion, there is an ideal working posture for the dentist, such as orthostatic position and sitting with the three types of support may be required for the backbone. Must always wanted workstations that causes less fatigue as being major change position after a period of time (maximum one hour).

Both posture and professional movement in a dental office are shaping the behaviour of the musculoskeletal system, particularly the spine. Two different postural methods are commonly used by dental practitioners, including sitting and standing postures. While sitting is considered as ergonomic, the standing position is considered non-ergonomic, with significant consequences on vertebral structures. Objectives: to realize a complex analysis of the disco-vertebral and muscular pathology in relation with either orthostatic or sitting posture in the real life dental practice. Materials and methods: prospective observational trial on 142 dentists classified into groups based on the predominant position during medical activity, either orthostatic or sitting on ergonomic chair. Results: there is no ideal working posture for the dentist; both orthostatic and sitting position with three subtypes (ischiatic, ischio-femoral, ischio-sacral support) result in significant spine morbidity, meaning an increased number of degenerative disco-vertebral pathology identified clinically (local or irradiated pain, restriction of mobility, impaired tolerance for standing position) and imagistic (X-rays, computed tomography, magnetic resonance imaging). Conclusion: It is widely promoted the recurrent alternation of posture in dental practice and an ergonomic attitude at the workplace. An individualized, strictly monitored kinetic activity is mandatory for both prevention and management of static and dynamic spine abnormalities due to repetitive postural stress in dental practice.