Revmatologiia (Bulgaria) 2019-06-10T13:11:10+03:00 Rumen Stoilov Open Journal Systems <p>Revmatologiia/Rheumatology (Bulgaria) is the platinum open-access peer-reviewed journal owned by the Bulgarian Rheumatology Society and published by Central Medical Library of Medical University - Sofia. Its prime focus is on the evaluation and management of rheumatic diseases.</p> <p>Revmatologiia/Rheumatology features original research articles, reviews, clinical case reports,&nbsp;and editorial commentaries. Guidelines unique to Bulgarian Rheumatology will also be published.</p> <p>Please, follow the Instructions for Authors. The acceptance criteria for all papers are the quality and <strong>originality</strong> of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.</p> Treatment of rheumatoid arthritis: csDMARDS versus bDMARDS. Prospective study to evaluate disease activity 2019-06-10T13:06:35+03:00 Vladimira Boyadzhieva Nikolai Stoilov Mariana Ivanova Rumen Stoilov <p>The assessment of disease activity is an essential component in the selection of therapeutic approach for the prevention of disability of patients with RA. The current study was conducted to evaluate the disease activity in patients on csDMARDs and bDMARDs after 6 months to 1-year of treatment and to determine whether the benefits of different therapies were sustained over time. For the purpose of the study were selected 220 patients with a mean age 55.05 ± 10.63 SD years, meeting the 1987 ACR classification criteria for RA. Patients were stratified according to treatment regimens into 2 age-matched treatment groups: 96 on csDMARDs and 124 on bDMARD therapy. Patient‘s assessment of disease related pain, global health and physician assessment of global health was made by visual analogue scale (VAS) – 100 mm. Disease activity was the primary outcome domain. Independent joint assessor evaluated 28 joints on baseline, 6th and 12th month of the follow-up period. C-reactive protein (CRP) was used to measure the infl ammation process. DAS28-CRP, CDAI and SDAI were calculated according to the standard formulas. Comparison was performed by analysis variance ANOVA. On baseline, patients on bDMARDs had a significantly higher mean time-averaged 28-joint disease activity score (5.03 ± 0.84 SD vs. 4.35 ± 1.20 SD, p &lt; 0,001), CDAI (25.06 ± 7.32 SD vs. 20.83 ± 10.53 SD, p &lt; 0.001) and SDAI (28.27 ± 8.74 SD vs. 23.19 ± 11.89 SD, p &lt; 0.001) compared to those on csDMARDs. On the 6th month in both groups (bDMARDS and csDMARDs) we found significant decrease in mean DAS28 (p &lt; 0.001, p &lt; 0.001), although no significant difference in disease activity between the groups was measured by this indicator (3.75 ± 2.49 SD vs 3.90 ± 1.10 SD, p = 0.566). Patients on bDMARDs had significantly lower disease activity compared to those on csDMARDs after 6th and 12th month of treatment assessed by CDAI (13.43 ± 4.98 SD vs 16.81 ± 9.94 SD, p = 0.001; 8.65 ± 4.53 SD vs 15.86 ± 10.02 SD, p &lt; 0.001), and SDAI (14.63 ± 5.42 SD vs 18.38 ± 10.49 SD, p &lt; 0.001; 9.39 ± 4.92 SD vs 16.79 ± 10.5 SD, p &lt; 0.001). Unlike results reported by DAS28-CRP which showed no change between the 6th and 12th month in patients receiving csDMARDs (3.90 ± 1.10 SD, 3.82 ± 1.12 SD, p = 0.156), we observed a statistically significant difference in all three time intervals (0, the 6th, 10th month) of the follow up period regarding to CDAI and SDAI. After a year prospective follow-up, therapy with biologic DMARDs results in sustained suppression – minimal disease activity assessed by DAS28-CRP, CDAI and SDAI, compared to patients receiving DMARDs who had moderate disease activity according to these tools. The therapy with bDMARDs was superior to csDMARDs therapy for suppressing disease activity (assessed by DAS28-CRP, CDAI and SDAI) of rheumatoid arthritis (RA) on the 6th and 12th month of the follow-up period.</p> 2019-04-03T00:00:00+03:00 ##submission.copyrightStatement## Evaluation of the activity of RA and sustained remission in patients ongoing biological therapy 2019-06-10T13:08:56+03:00 Tanya Shivacheva <p>The aim of the study is to establish the frequency and sustained remission and low disease activity in patients with RA in the course of long-term treatment with synthetic and biological means (DMARDs) in real conditions. In the conditions of retrospective data analysis of real clinical practice, there were included 209 patients suffering from RA. Activity indexes of RA in all patients were analyzed in the last year of treatment with bDMARDs. The average age of the patients is 59,01 years old. The dominants sex is female (84.6%). The beginning of treatment with biological therapy is delayed with the average of 8.21 year. In all activity indexes of RA, which were monitored in the beginning of the 6th and the 12th months, there was established a significant difference in their variation for the periods surveyed. There is a general trend towards lowering the values of our indicators. In the beginning of the monitored period, the patients going into remission (DAS28 CRP) are approximately 3 times less – 11% (n = 23) in comparison with those in the end of the study – 32.99% (n = 64) (p &lt; 0.001). In 10% of the cases a sustained remission is observed by both combined indexes (DAS28 ESR and DAS28 CRP) (p &lt; 0.001). Today the accurate way is the “treat to target” strategy. The purpose is lowering the activity of the disease to very low levels (or remission) and achieving a long-term remission which is now real and achievable.</p> 2019-04-11T00:00:00+03:00 ##submission.copyrightStatement## Newly developed dynamic splint vs. dynamic outrigger splint for postoperative treatment of extensor tendon rupture in patients with rheumatoid wrists - a preliminary study 2019-06-10T12:57:49+03:00 Koichi Yano Takeshi Egi, MD, PhD Masahiro Yoneda, MD, PhD Akane Tokui, MS Mikinori Ikeda, MD, PhD Yasunori Kaneshiro, MD, PhD Kenichi Kazuki, MD, PhD <p style="margin: 0mm 0mm 0pt; line-height: 200%;"><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;"><strong>Aim and object of the study</strong>:&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;">Extensor tendon rupture in patients with rheumatoid wrists causes dysfunction of the hand and necessitates tendon reconstruction and surgical treatment of the wrist joint. Dynamic outrigger splints using rubber bands have been used for early postoperative mobilization of the fingers. However, these splints are bulky and cause discomfort. We developed a new dynamic splint, which is compact and uses torsion springs instead of the rubber bands used in conventional outrigger splints. The splint extends the metacarpophalangeal joints using a volar finger bar. The objective of this study was to compare the clinical outcomes and subjective assessments between patients treated with the two types of splint.&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;"><strong>Methodology</strong>:&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;">Fourteen wrists (14 patients) were included. Clinical outcomes (range of active motion of the metacarpophalangeal joint) and subjective assessments were investigated in patients treated with either an outrigger splint or our new dynamic splint.&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;"><strong>Results</strong>:&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;">There were no differences in clinical outcomes between patients treated with the two kinds of splint. The new splint performed better in terms of the subjective assessment of changing clothes and bulkiness.&nbsp;&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;"><strong>Conclusions</strong>:&nbsp;</span><span lang="EN-US" style="line-height: 200%; font-family: 'Times New Roman','serif'; font-size: 12pt;">The new splint yielded equivalent clinical outcomes and better subjective assessments compared to conventional outrigger splints due to its reduced size.</span></p> 2019-04-12T14:59:35+03:00 ##submission.copyrightStatement## Cardiovascular disease in patients with psoriatic arthritis: correlation or causation? 2019-06-10T12:52:15+03:00 Alexander Krasimirov Angelov Aleksandar Kopchev Tsvetoslav Georgiev Mariana Ivanova <p>Psoriatic arthritis (PsA) is a pleiotropic inflammatory disease from the spectrum of spondyloarthritides which can potentially affect many organ systems. The chronic nature of the inflammatory milieu presented in rheumatic diseases, is similar to that of atherosclerosis, suggesting a common pathogenic basis. Effector cells of innate and adaptive immunity along with pro-inflammatory cytokines and other immune mediators may work together to potentiate endothelial damage and accelerate cardiovascular diseases (CVD). Thus, the risk of CVD and associated complications in PsA might be elevated, especially in patients with severe psoriasis, long-standing disease, and multiple comorbidities. This narrative review focuses on the prevalence of CVD in PsA patients, the overlapping molecular features in the pathogenesis of both conditions, and summarizes the benefits of the current treatments on impairments resolution.</p> 2019-04-03T00:00:00+03:00 ##submission.copyrightStatement## A clinical case of a patient with scleroderma-like syndrome in chronic graft-versus host disease 2019-06-10T13:11:10+03:00 Iva Parvova V. Taneva E. Ivanova-Todorova D. Kyurkchiev Z. Kolarov E. Hristov <p>Chronic graft versus host disease is observed within the fi rst 100 days following allogeneic haematopoietic stem cell transplantation and can affect all tissues and organs (in 80% of the cases, it affects the skin). There are some clinical correspondences between chronic graft versus host disease and certain autoimmune diseases, such as systemic scleroderma, Sjogren‘s syndrome, autoimmune hepatitis. We present a case of a 54-year-old man with manifested diffuse, scleroderma-like skin changes, which occurred about a year and a half after allogenic bone marrow transplantation from an unrelated donor due to a blast transformation of chronic myelomonocytic leucosis type 2. The patient was treated in a haematology clinic with corticosteroids, 10 photophoresis sessions, Ciclosporin, Tacrolimus, Mycophenolate mofetil, Imatinib. It has been assumed that this is a case of chronic graft versus host disease resistant to corticosteroids, and Methotrexate 25 mg/weekly every other month was prescribed with no significant clinical improvement. In terms of the differential diagnosis, the question remains whether or not this is a case of paraneoplastic systemic scleroderma – autoimmune phenomena accompanying malignancy and often preceding it for months.</p> 2019-04-11T00:00:00+03:00 ##submission.copyrightStatement##