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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: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

(1) Background: Although the association between psoriasis and atopic dermatitis (AD) is reported in the literature, scarce data are known about the efficacy of biologic therapy (including TNF and IL-17 inhibitors) in patients with psoriatic arthritis (PsA) and concomitant AD. (2) Objective: We aimed to explore AD in patients with PsA undergoing biologics for their active disease, focusing on prevalence and clinical and potential therapeutic implications. (3) Material and methods: We performed a retrospective analysis of 64 patients with PsA receiving various biological agents, followed-up in an academic outpatient rheumatology department up to 10 years. (4) Results: Atopic diseases were reported in about one third of cases, with a higher incidence of AD (10 cases; 52.6%) vs. atopic rhinitis (6 cases; 31.6%) and allergic asthma (3 cases; 15.8%). Three morphological patterns of AD were recognized including chronic prurigo (3 cases), a chronic lichen simplex (1 case), and eczemas (6 cases). All PsA with concomitant AD displayed a late onset of skin atopy (in their adult life) and demonstrated a specific profile (younger), from urban settings, equally distributed among genders, and requiring switching to a higher number of biologics to achieve disease control. (5) Conclusion: PsA and AD may coexist, requiring special attention when selecting the optimal biologic agent. [ABSTRACT FROM AUTHOR]

(1) Objective: The main aims of our study were to explore the drug survival and effectiveness of secukinumab in patients with axial spondyloarthritis (axSpA). (2) Methods: We underwent a retrospective analysis of consecutive axSpA treated with secukinumab as a first line of biologics or at switch in a biologic-experienced population. Efficacy data, indicating improvement in inflammation parameters (such as C-reactive protein and erythrocyte sedimentation rate) and disease activity scores (such as Ankylosing Spondylitis Disease Activity Score [ASDAS-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and patient-reported outcomes (pain), were assessed at 6, 12, 24, 36 and 48 months. The drug survival rate, dropout rate and discontinuation reasons (efficacy versus safety) of secukinumab were assessed in subgroup analysis (axSpA with and without exposure to biologics). (3) Results: In total, 46 patients were exposed to the IL-17A inhibitor secukinumab. The drug survival for axSpA patients 59.7% at 12 months and 31.3% at 24 months. There were no statistically significant differences in the median drug survival between biologic-naïve versus biologic-experienced subgroups. (4) Conclusions: Secukinumab has demonstrated effectiveness and safety in treating a cohort of axSpA patients in real-world settings, with a notable retention rate of the drug. [ABSTRACT FROM AUTHOR]

(1) Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease of autoimmune etiology. Increased scientific evidence suggests that immune-mediated inflammatory dis-eases are associated with autonomic nervous system (ANS) dysfunction. Studies proved that autonomic imbalance is correlated with RA evolution and may explain augmented cardiovascular pathology and mortality not attributable to classical risk factors. (2) Methods: 75 patients (25 males, 50 females) with RA were submitted to standard ECG recording and 24 h Holter monitoring. Twenty-five healthy patients were used as controls. Both time (SDNN, SDANN, SDANN Index, RRmed, rMSSD, and pNN50) and frequency domain (TP, VLF, HF, LF and LF/HF) heart rate variability (HRV) parameters were obtained. Parameters were compared to controls, and correlations with the QTc-interval and inflammatory status expressed through the C-reactive protein (CRP) were evaluated. (3) Results: In patients with a CRP > 5 mg/L, HRV parameters were lower compared to controls and to patients with a CRP ≤ 5 mg/L. All HRV parameters generated by Holter monitoring are negatively correlated with CRP levels and QTc values. The number of premature ventricular contractions (PVC) recorded is correlated with SDNN, SDANN, and LF/HF values. (4) Conclusions: Our study supports recent data suggesting that in RA there is an autonomic system dysfunction strongly connected with the inflammatory status of the patient. The autonomic dysfunction can contribute to the increased risk of cardiovascular death observed in patients with RA. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

(1) Background: Recent data shed light on the association between atopic disorders (ADs) (atopic dermatitis, allergic asthma, allergic rhinitis) and spondyloarthropathies (SpAs), underpinning the critical role of T helper (Th)1-Th17/Th2-T regulatory cells disbalance. We evaluated the prevalence of AD in axial SpAs (axSpAs) and psoriatic arthritis (PsA) and explored the potential association between atopic status, disease-related parameters, and biological therapy. (2) Methods: A monocentric, retrospective study was conducted that enrolled 200 patients taking biologics. Demographics, disease, and drug-related variables, along with a screening questionnaire focused on Ads, were systematically collected. (3) Results: Overall, 51 patients (25.5%) had atopy—namely, 24.4% of axSpA and 28% of PsA, with a higher frequency of rhinitis (43%) vs. atopic dermatitis (37.2%) or asthma (21.5%). We failed to demonstrate any statistically significant difference in demographics, SpA-related parameters excepting concomitant inflammatory bowel disease, and biologic drug exposure in patients with and without atopy (p > 0.05). However, significantly more non-atopic patients need only one TNF inhibitor (54%) vs. atopic patients (28%) (p < 0.05) to control active SpA. (4) Conclusions: We successfully demonstrated that AD is associated with one out of four SpA. Irrespective of the SpA subtype, atopic patients require more frequent switching among biologics, as significantly more non-atopic patients remain on their first anti-TNF. [ABSTRACT FROM AUTHOR]

Successful pregnancy requires an immunological shift with T helper CD4+ bias based on disbalance Th1/Th17 versus Th2/T regulatory (Tregs) required to induce tolerance against the semi-allogeneic fetus and placenta and to support fetal growth. Considered a pregnancy-specific hypertensive disorder, pre-eclampsia is characterized by multifaceted organ involvement related to impaired maternal immune tolerance to paternal antigens triggered by hypoxic placental injury as well as excessive local and systemic anti-angiogenic and inflammatory factor synthesis. Both systemic and local Th1/Th2 shift further expands to Th17 cells and their cytokines (IL-17) complemented by suppressive Treg and Th2 cytokines (IL-10, IL-4); alterations in Th17 and Tregs cause hypertension during pregnancy throughout vasoactive factors and endothelial dysfunction, providing an explanatory link between immunological and vascular events in the pathobiology of pre-eclamptic pregnancy. Apart from immunological changes representative of normotensive pregnancy, lupus pregnancy is generally defined by higher serum pro-inflammatory cytokines, lower Th2 polarization, defective and lower number of Tregs, potential blockade of complement inhibitors by anti-phospholipid antibodies, and similar immune alterations to those seen in pre-eclampsia. The current review underpins the immune mechanisms of pre-eclampsia focusing on local (placental) and systemic (maternal) aberrant adaptive and innate immune response versus normotensive pregnancy and pregnancy in systemic autoimmune conditions, particularly lupus. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to explore the influence of weekly subcutaneous administration of interleukin-6 (IL-6) receptor inhibitor tocilizumab (TCZ) on periodontal status in a local longitudinal study of patients with rheumatoid arthritis (RA) and periodontal disease (PD). Methods: We performed a 6-month prospective study in 51 patients with chronic periodontitis and moderate-to-severe RA starting TCZ in accordance with local recommendations. Extensive rheumatologic (clinical activity, inflammatory, serological biomarkers) and periodontal (visible plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment loss) assessments were done. Changes in RA activity and periodontal status were reassessed after 3 and 6 months. Results: We demonstrated significant correlations between periodontal status, disease activity, and serologic biomarkers (p < 0.05). Tocilizumab significantly improved the gingival index scores and decreased the number of sites with bleeding on probing after only 3 months (p < 0.05), while the probing pocket depth significantly decreased after 6 months; overall, clinical attachment loss presented only slight changes without any statistical significance as well as teeth count and plaque levels (p > 0.05). Conclusion: IL-6 inhibition is able to improve periodontal outcomes in patients with RA and concomitant PD, which is essentially related to a dramatic decrease in serum inflammatory mediators. [ABSTRACT FROM AUTHOR]

Background: Oral health issues are commonly reported in systemic sclerosis (SSc), comprising a broad spectrum of manifestations, e.g., reduced mouth opening, periodontal disease, increased periodontal ligament (PDL) space width, and mandibular resorption. We aimed to assess oral radiographic abnormalities, particularly PDL space widening and erosions, and to identify potential relations with disease measures. Methods: cross-sectional study in 43 SSc and matching controls receiving systematic oral assessments (full mouth dental/periodontal) and imaging (radiographs and cone beam computed tomography (CBCT)). Associations between disease variables and radiologic findings were investigated by univariate and multivariate analysis (SPSS-v.20, p < 0.05). Results: CBCT demonstrated generalized PDL space widening in up to half SSc, with at least one tooth involved, essentially in the posterior region (p < 0.05). Significant correlations between number of teeth with PDL space widening and disease severity, skin score, disease subset, topoisomerase I specificity, age, and disease duration were reported (p < 0.05). Additionally, mandibular erosions were described in one out of four patients, commonly condylar erosions. Conclusions: Tridimensional CBCT approach confirmed widening of PDL and mandibular erosions as common dental findings in scleroderma. Furthermore, widened PDL spaces correlated with several disease characteristics including severity, skin extent, and antibody profile. [ABSTRACT FROM AUTHOR]