Rheumatology (Bulgaria) http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia <p>Rheumatology (Bulgaria) is the platinum open-access peer-reviewed journal owned by the Bulgarian Rheumatology Society and published by the Central Medical Library - Bulgaria.</p> <p>Rheumatology (Bulgaria) focuses on all aspects of rheumatic diseases. Revmatologiia features Original Articles, Society Recommendations, Editorials, Invited Reviews, Clinical Rheumatology Cases or Case-Based Reviews, Letters to the Editor. Guidelines unique to Bulgarian and Balkan Rheumatology will also be published.</p> <p>Indexing and abstracting: <strong>Scopus</strong>, EMBASE, Excerpta Medica, <strong>Google Scholar</strong>,<strong> CrossRef</strong>, Central Medical Library - Bulgaria, Bulgarian Medical Literature Database, OUCI.</p> <p>Online ISSN&nbsp;2738-831X; Print ISSN&nbsp;1310-0505.</p> Bulgarian Rheumatology Society en-US Rheumatology (Bulgaria) 1310-0505 Musculoskeletal pain in patients with COVID-19 http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=168 <p>Introduction: The end of 2019 marked the beginning of a new disease for the mankind, which changed the lives of people all over the world. Almost 3 years have passed from the declaration of a global pandemic till today, but despite this, our knowledge of the disease COVID-19 caused by SARS CoV-2 is still the object of many researches. This is because the heterogeneous manifestation of the disease and the involvement of many organs and systems in the clinical presentation. The spectrum of rheumatological manifestations that directly concern the rheumatologist is also very miscellaneus. Most common are musculoskeletal pain phenomena as a rheumatic manifestation of the disease. Objectives: The purpose of the study is to assess the frequency and intensity of pain of musculoskeletal origin - joint (arthralgia) and muscle (myalgia) and its relationship with anxiety and depressive attitudes in hospitalized patients with COVID-19 in the Rheumatology Clinic - Varna. Material and methods: In a single-center, observational study, were included patients with diagnosed COVID-19, hospitalized in the Rheumatology Clinic, UMBAL "St. Marina" - Varna. The etiological diagnosis was accepted with a positive result of polymerase chain reaction (PCR) test or rapid antigen test for SARS-CoV-2. An inclusion criterion was new-onset musculoskeletal pain during the acute phase of COVID-19. Visual analogue scales (VAS) were used to assess pain intensity (muscular and joint) and Tsung self-report scales for depression (SDS) and anxiety (SAS). Laboratory acute inflammatory indicators and thrombotic biomarkers were investigated, chest imaging was performed in all patients. Descriptive statistics, Spearman Rho correlation analysis and SPSS linear regression analysis were used. A significance level of p&lt;0.05 was accepted. Results: 226 patients (aged 26-91 years) with musculoskeletal pain were included. 46.5% (n=105) were women and 53.5% (n=121) were men. The mean age of the study population was 65.5 years (65.57 ± SD). A significant correlation (p=0.001) and predictive value was found between the score for depression and anxiety and the intensity of pain (for the two studied pain phenomena - arthralgias and myalgias). No correlation was found between pain intensity and inflammatory markers, nor with thrombogenic markers in patients with SARS-CoV-2. Of all examined patients with musculoskeletal pain, 46.5% (n=105) were women and 53.5% (n=121) were men. The average age of the study population was 65.5 years (65.57). After the correlation and regression analysis, a significant correlation (0.001) and predictive value was found between the score for depression and anxiety and the strength of pain (for the two studied pain phenomena - arthralgias and myalgias). On the other hand, in the studied patients, we found no correlation with either inflammation indicators or thrombogenic markers in the SARS-CoV-2 patients.mong all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n =121), were men. Mean age was 65 and a half years (65.57). After correlation and regression (ANOVA) analysis made we found strongly significant correlation (correlation is significant et the 0.001 level) and predictive value between depression and anxiety scales score from one side and pain intensity from other (both arthralgia and myalgia). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients. mong all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n =121), were men. Mean age was 65 and a half years (65.57). After correlation and regression (ANOVA) analysis made we found strongly significant correlation (correlation is significant et the 0.001 level) and predictive value between depression and anxiety scales score from one side and pain intensity from other (both arthralgia and myalgia). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients. Conclusion: Musculoskeletal pain is one of the most common clinical presentations of COVID-19. The intensity of the pain correlates with anxiety and depressive symptoms in these patients and does not correlate with the levels of inflammation and thrombotic biomarkers.</p> Simona Bogdanova ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 3 17 10.35465/30.2.2022.pp3-17 SCREENING OF OSTEOPOROSIS IN MEN http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=158 <p>Underestimation of the disease osteoporosis in men is a serious problem, as osteoporotic fractures among men are frequent and they are accompanied by serious complications. Conducting DXA scans in men in Bulgaria is important to determine the state of their bone health.</p> <p>The aim of the study was to assess the bone mineral density (BMD) and T-score of the lumbar spine and of the hip through dual-energy X-ray absorptiometry (DXA) in men and to compare their values ​​in different age groups.</p> <p>Object of the study. Height, weight, body mass index (BMI) were assessed in 359 men with a mean age of 56 years (yrs.) ± 14 yrs., BMD and T-score of the lumbar spine and femoral neck were also examined.</p> <p>Methodology. Men are divided into the following age decades: 20-29 yrs., 30-39 yrs., 40-49 yrs., 50-59 yrs., 60-69 yrs., 70-79 yrs. and ≥80 yrs. Statistical program SPSS version 19.0 was used to access the data. The ANOVA test analyzes was applied to investigate if there are any statistically significant differences in BMD and T-score of the lumbar spine and femoral neck between the different age decades.</p> <p>Results and conclusions. 264 men were evaluated for total BMD of the lumbar spine and 95 men had results for BMD of the femoral neck. The mean total BMD of the lumbar spine differed significantly between the individual age decades in men (p = 0.000). The mean BMD values ​​of the femoral neck did not differ significantly in the different age decades in men (p = 0.07). 34 of 264 men (12.9%) were diagnosed with lumbar spine osteoporosis and 13 out of 93 men (14%) were diagnosed with femoral neck osteoporosis. The data obtained show a widespread prevalence of osteoporosis among men with a predominance of low values ​​of BMD on the axial skeleton in the age range between 60 and 79 years.</p> E. Kirilova Nikolay Georgiev Nikolov N. Kirilov M. Nikolov S. Vladeva ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 18 27 10.35465/30.2.2022.pp18-27 Evaluation of Metabolic Syndrome in Egyptian Patients with Radiographic and Non-Radiographic Axial Spondyloarthritis (Cross Sectional Study) http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=161 <p><strong>Background</strong>: Axial spondyloarthritis is a chronic inflammatory rheumatic disease that has a great risk for metabolic syndrome. Our aim was to study metabolic syndrome (MetS) in radiographic and non- radiographic axial spondyloarthritis patients in Egyptian population. <strong>Methods</strong>: The cross-sectional study included 60 consecutive Ax-SpA patients aged 25-55 years fulfilling the Assessment of Spondyloarthritis International Society criteria; they were divided into 40 patients with radiographic and 20 patients with non- radiographic axial spodyloarthritis. MetS was assessed using new international diabetes federation definition. <strong>Results</strong>: The prevalence of MetS was higher in radiographic patients (37.50%) than non-radiographic axial spondyloarthritis (20%) (X2 = 0.170, P = 0.242) with significant differences between the two groups as regard triglycerides (p = 0.012*) and HDL cholesterol (p &lt; 0.001*). Decreased HDL-cholesterol was the most frequent metabolic syndrome component with a prevalence of 66.66% (40 patients) in both groups. <strong>Conclusion</strong>: Metabolic syndrome was more prevalent in radiographic axial spodyloarthritis. Therefore, follow up of these patients is important for early detection of any cardiovascular events.</p> Souzan Ezzat Gado S. A. Elwan A. M. El Sharkawy H. S. El-Banna ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 28 34 10.35465/30.2.2022.pp53-59 STRATIFICATION OF KNEE OSTEOARTHRITIS: TO THE PROBLEM OF PHENOTYPES http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=153 <p>The presented review is devoted to the actual problem of knee osteoarthritis (OA) stratification and consists of descriptive and systemic analysis parts. In the first part, the evolution of OA concepts and the development of phenotypic approach is reflected. It is noted that OA followed long path from age-related “wear and tear” to inflammatory disease with high heterogeneity, which triggered enormous number of attempts to group this disease in the last decade. As no unified approach has been proposed in its classifying, rheumatology has collected an abundance of ambiguous data obtained in studies on knee OA. Recent advances in phenotyping made obvious the need to systematize proposed earlier classifications and to evaluate their compliance with the modern concept, which was done in the second part of review. Systematic search strategy was used in the referenced databases MEDLINE/PubMed and Google Scholar without a time frame with the following keywords "osteoarthritis", "phenotypes", "classification", "subtypes", "subsets", "subgroups", "endotypes", and 58 different classifications were extracted, analyzed and stratified into the following boxes: phenotypes, endotypes, and other classifications. Among the proposed OA classifications, clinical groups were the most common, followed by structural, laboratory, molecular, genetic, and progression trajectories. Only few of proposed OA kinds can rightly be called phenotypes whereas most of classifications aimed to distinguish predictors or risk factors for this disease. It can be assured that the variety of accumulated information will soon lead us to novel approaches of phenotype-associated management strategy for OA patients.</p> Kristina Valerjevna Korochina Tatyana Viktorovna Chernysheva Irina Eduardovna Korochina Irina Alekseevna Krivotulova Andrey Aleksandrovich Averyanov Marina Vladimirovna Stolbova ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 35 50 10.35465/30.2.2022.pp28-43 POTENTIAL OF UMBILICAL CORD MESENCHYMAL STEM CELL (UC-MSC) IN THERAPY OF RHEUMATOID ARTHRITIS (RA) http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=151 <p>Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation of the joints. Even RA usually found in elderly patients, however, it is possible to occur at a young age, such as juvenile rheumatoid arthritis (JRA), the most common type of arthritis in children and adolescents. Unfortunately, common conventional therapies given to patients with RA to modulate the immune response, including disease-modifying anti-rheumatic drugs (DMARDS) and nonsteroidal anti-inflammatory drugs (NSAIDs), found have limitation therapeutic effects in RA patients. Long-term use of these drugs will cause side effects and resistance to therapy. In recent years mesenchymal stem cells (MSCs) are highly recommended therapy. The therapy considered promising for curative action in RA patient due to potential as immunomodulators that MSCs can differentiate into various cell types and stimulate tissue repair. These cells also have strong chemotactic abilities because they can migrate to damaged tissues and act as an anti-inflammatory. Therefore, MSC potentially suitable for autoimmune therapy. In addition, many research evidences in clinical trials stating that there are no toxicity and side effects in the long term. One type of MSC based on its tissue source is umbilical cord mesenchymal stem cell which is believed to be the best among other types. This review discusses a UC-MSC-based therapeutic approach in children, adults, and the elderly focusing based on published clinical data and clinical trials for the treatment of RA that are currently ongoing.</p> Ferdiana Laura Margareta Yudhi Nugraha Boenga Nurcita Cut Fauziah ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 44 52 10.35465/30.2.2022.pp44-52 BONE BIOLOGY, OSTEOIMMUNOLOGY AND RHEUMATIC DISEASES http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=152 <p>Osteoimmunology (OI) is a relatively new field in medicine, improving our understanding of the pathogenesis of the rheumatic diseases. OI focuses on the relationship and interaction between the immune and the musculoskeletal systems, observing these processes in three main aspects: regulating the bone resorption by the immune system, the impact of inflammation on the bone formation, the role of&nbsp; bone and bone marrow as a depot for immune cells. Changes in the bone architecture may be due to the activation of the immune system. Proinflammatory cytokines leading in the pathogenesis ofthe inflammatory joint disease are potent activators of nuclear factor-kB receptor activator (RANKL) expression and thus promote the osteoclast differentiation. This link explains why therapy whose target are the cytokines , especially TNF inhibition, is very effective in delaying structural damage in rheumatic diseases. Knowledge of these mechanisms would allow better use of medical therapies to reduce skeletal damage.</p> Irina Ivanova Momcheva D. Staykov S. Dimitrov ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 64 67 10.35465/30.2.2022.pp64-67 Relatives of patients with systemic lupus erythematosus - antinuclear antibodies, immunological profile and risk of developing the disease http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=145 <p><strong>Резюме. </strong>Системният лупус еритематозус е системно автоимунно заболяване, което в действителност започва години преди клиничното начало с поява на антинуклеарни антитела и имунологични признаци на дисрегулация в серума. Същевременно, поради тенденцията към фамилна агрегация, рискът за развитието на болест у роднините на болните и няколко десетки пъти по-голям. При изследвания, у роднините на болните се намират антинуклеарни антитела значително по-често отколкото в общата популация, а комбинация от повишени проинфламаторни и намалени регулаторни цитокини може да бъде предиктивна по отношение на рисковите индивиди, които следва да се предпазват от въздействието на рискови фактори или дори да предприемат профилактично медикаменти. Настоящият литературен обзор предлага обобщение на съвременните литературни данни по темата.</p> Bogdan Frediev Penev Georgi Vasilev Dobroslav Kyurkchiev Simeon Monov ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 68 84 10.35465/30.2.2022.pp68-84 New therapeutic options for the treatment of ankylosing spondylitis. http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=173 <p>The pathogenesis of spondyloarthritis (SpA) is multifactorial and involves multiple immune cells and cytokines that are signaled by Janus kinase (JAK). Inhibition of JAK signaling pathways has emerged as a new therapeutic option for patients with inflammatory joint diseases. Despite the proven effect of treatment with anti-IL-17, as well as TNFα inhibitors, some patients with ankylosing spondylitis cannot reach minimal disease activity or remission. This necessitated the development of a new class of molecules, and in recent years more and more clinical studies have proven their role in the treatment of both rheumatoid arthritis and ankylosing spondylitis. JAK inhibition is a promising therapeutic strategy for the treatment of SpA and its application has potential in patients with axial, polyarticular, or extraarticular manifestations of the disease in psoriatic arthritis and ankylosing spondylitis.</p> <p>The present literature review aims to highlight the new therapeutic options offered by this class of target synthetic disease-modifying antirheumatic drugs and to summarize the clinical trial data for tofacitinib, upadacitinib and filgotinib reported to date.&nbsp;</p> Vladimira Boyadzhieva Nikolay Stoilov Mariela Geneva-Popova Mariana Ivanova Rumen Stoilov ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-25 2022-08-25 30 2 85 101 10.35465/30.2.2022.pp85-101 A clinical case of a patient with mucocutaneous and musculoskeletal manifestations after COVID-19 vaccination http://www.rheumatologybg.org/journal/index.php?journal=revmatologiia&page=article&op=view&path%5B%5D=163 <p>With the onset of the global pandemic due to the new virus SARS-CoV-2 and the development of vaccines against it, various adverse events have been reported to them. We present a clinical case of a 53-year-old Caucasian woman who presented one week after Pfizer vaccination against SARS-CoV-2 with severe muscle weakness, myalgia in upper and lower extremities, alopecia 2 cm in diameter, and two mucosal ulcerations on lower lip. No deviations from the hematological, biochemical and immunological indicators were found from the laboratory tests carried out. Two weeks later, the patient developed total alopecia on the scalp. Due to the causal relationship with the administered vaccine, the patient was not given a second dose and a diagnosis of Systemic Connective Tissue Disease was not accepted. Six months later, recovery and partial hair growth was observed in the affected areas of the capillitium.</p> <p>Alopecia areata is autoimmune in nature, with literature reporting initial or recurrent alopecia after vaccination. It is important that adverse events after vaccination are properly evaluated in order to choose a proper therapeutic approach.</p> Zhaklin Rumenova Dimova Vladimira Boyadzhieva Nikolay Stoilov Soner Emin Nikolay Nikolov Rumen Stoilov ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc-sa/4.0 2022-08-24 2022-08-24 30 2 102 107 10.35465/30.2.2022.pp102-107