Revmatologiia (Bulgaria) <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> en-US (Rumen Stoilov) (Tsvetoslav Georgiev) Wed, 20 Nov 2019 15:22:33 +0200 OJS 60 Predictive ability of the osteoporosis self-assessment tool for assessing the risk of osteoporosis Osteoporosis (OP) is a progressive metabolic bone disease caused by disturbed balance between bone formation and bone resorption. Osteoporotic fractures lead to a deterioration in the quality of patients’ life due to high morbidity and mortality, and the economic burden of osteoporotic fractures is expected to increase. Various tools have been developed to assess the risk of osteoporosis in the clinical practice. The Osteoporosis Self-Assessment Tool (OST) is used to predict osteoporosis and is suitable for self-assessment. The purpose of this study is to assess the ability of the OST score to predict the risk of OP. 180 postmenopausal women with a mean age of 61 ± 13 years (38-86 years) were included in the study. The OST score was evaluated using the formula: (body weight  age) × 0.2. Patients were divided into three groups according to the risk of OP: low risk (> -1), moderate risk (-1 to -4) and high risk (<-4). Based on the total lumbar spine T-score, measured by dual-energy X-ray absorptiometry (DEXA), the actual number of the women with OP was established. According to the OST score, 22 women were in the high risk group, 41 women in the moderate risk group, and 117 women in the low risk group. There was a correlation between the risk of OP calculated with OST and the number of patients with OP, established by DEXA measurement - with increased risk of OP, the number of the women with OP also increased (p = 0.000). The percentage of the women with osteoporosis is highest in the high risk group and lowest in the low risk group. In the high risk group, 95.5% of the women had a diagnosis of osteoporosis. These results demonstrate the good ability of OST score to predict the risk of OP in the Bulgarian population. Elena Kirilova, N. Kirilov, F. Bischoff ##submission.copyrightStatement## Mon, 30 Sep 2019 00:00:00 +0300 Real-life data – a characteristic of RA in patients with cardiovascular diseases on the background of treatment with biological agents <p>Purpose: The purpose of this study is to analyze real-life data in order to characterize patients with RA and cardiovascular diseases that are treated with biological agents. Material and Methods: &nbsp;In a retrospective study, data from real clinical practice were analyzed in 195 patients with seropositive RA, which are being treated with biological agents.&nbsp;Results:&nbsp;In patients with existing CVD, significantly higher mean ESR values ​​(23.95 vs. 19.31, p = 0.031) and CRP (6.41 vs. 3.36, p = 0.004) were detected over the period of the study period &nbsp;of treatment. In contrast to the laboratory parameters, mean values of clinical parameters of RA - TJC, SJC and VAS clinical sings did not show a significant difference in patients with and without CVD. The time average value of DAS28 (ESR) during the study period was significantly higher in patients with CVD (3.7 vs. 3.39, p = 0.002) compared to those without CVD. DAS28 (CRP) shows the same trend. In patients with CVD, the time average value of the follow-up indicator was 3.21, and in patients without CVD, 2.88 (p &lt;0.001). Conclusion: The results of this study, in PA patients conducting treatment with biological agents in the real life, outside of the clinical study conditions, demonstrate that independently of treatment, patients with CVD continue to maintain higher background inflammation. An optimization of therapeutic behavior in real life is necessary to improve the long-term prognosis of these patients.</p> Tanya Shivacheva ##submission.copyrightStatement## Sat, 19 Oct 2019 09:13:29 +0300 Vitamin D status, bone mineral density and body mass index in patients with newly diagnosed postmenopausal osteoporosis and healthy menopausal women. <p>This study aims to assess vitamin D levels in women with postmenopausal osteoporosis and healthy women going through menopause. Two groups of menopausal women took part in the study – 41 women with osteoporosis and 22 without osteoporosis. The levels of vitamin D, parathormone, alkaline phosphatase, calcium and phosphorus were examined during the autumn-winter period. Calcium, phosphorus and alkaline phosphatase were established within the reference range in both groups. A negative correlation with increase of parathormone levels among the patients with osteoporosis and vitamin D deficiency was found (r = -0.46, p&lt;0.01).</p> <p>16 women with osteoporosis (39%) were with normal levels of vitamin D, 14 (34,1%) were with insufficiency and 11 (26,9%) with deficiency. Within the control group, 8 women (36,4%) were with normal levels of vitamin D, 12 (54,5%) were with &nbsp;insufficiency and 2 (9,1%) with deficiency.</p> <p>There is no statistically significant difference in the mean age of patients with normal levels and vitamin D insufficiency in the two groups. There are statistically significant differences in the age of women with vitamin D deficiency. Patients with deficiency were significantly older, both in the osteoporosis group and in the control group (r = -0.32, p &lt;0.05). There are no statistically significant differences in BMD of lumbar spine associated with vitamin D levels in the two groups. There is a significant statistical difference in the average values of BMI in both groups. The average value of BMI in the patients with osteoporosis is 24.2 kg/m<sup>2</sup> while in the patients of the control group it’s 29.5 kg/m<sup>2</sup> (p&lt;0.0001). The results show an overall bad status of vitamin D. 61% of the patients with osteoporosis and 63,6 % of the healthy controls have levels of vitamin D showing either insufficiency or deficiency.</p> <p>&nbsp;</p> <p>Key words: postmenopausal osteoporosis, insufficiency and deficiency of vitamin D, BMD, BMI</p> Tatyana Nedkova Simeonova, K. Stefanova, I. Himcheva, P. Yordanova-Laleva, A. Dimitrova ##submission.copyrightStatement## Fri, 18 Oct 2019 14:39:52 +0300 Assessment of health-related quality of life in patients with rheumatoid arthritis and analysis of its change during csDMARDS and bDMARDS therapy after one year of follow-up Rheumatoid arthritis is a chronic disabling systemic autoimmune disease of the musculoskeletal system, which significantly impairs the quality of life of patients. The aim of this study is to evaluate the quality of life of patients with RA using standardized HAQ-DI, SF-36, EQ-5D, RAQoL questionnaires and analyze its change after one year of treatment with conventional synthetic and biological medical products. For the purpose of the study, 220 patients were selected and monitored. Of these, 96 patients were treated with csDMARDS divided into 5 groups and 124 patients treated with biological medicinal products divided into 6 groups. All patients completed the standardized questionnaires at the initial visit, at 6 and 12 months. The results are calculated using licensed calculators. A significant improvement in quality of life was observed in all groups of patients up to the 6th month of the follow-up period, after which, until the 12th month of follow-up, a significant improvement was observed only in those receiving biological treatment evaluated by HAQ-DI, SF-36 and EQ-5D. In contrast to the results obtained with the other three indicators (HAQ, SF-36, EQ-5D) for patients treated with csDMARDS, the RAQоL score in the disease-specific questionnaire showed a significant improvement in their quality of life from 6 months to 12 months (p = 0.009). Vladimira Boyadzhieva, Nikolay Stoilov, Rumen Stoilov ##submission.copyrightStatement## Mon, 30 Sep 2019 00:00:00 +0300 Effects exerted by mesenchymal stem cells on monocytes obtained from patients with rheumatoid arthritis and progressive systemic sclerosis <p>In the context of autoimmune inflammatory diseases, the therapeutic benefits of mesenchymal stem cells (MSCs) could be found in their potential to exert immunosuppressive effects and to regulate the immune response. In pursuit of having a more complete look a the regulatory mechanisms&nbsp; performed by AT-MSC, we examined the influence of adipose stem cells (AT-MSC) on blood monocytes from patients with rheumatoid arthritis (RA). Comparison of the effect exerted by the soluble factors produced by AT-MSC <em>vs.</em> cell culture control media, on peripheral blood mononuclear cells (PBMC), showed a significant decrease in the percentage of HLA-DR expressing monocytes, 55.3% (IQR 30-65%) <em>vs.</em> 72% (IQR 62-81%), <em>p</em> = 0.001, as well as a significant decrease in mean fluorescence intensity MFI of HLA-DR was observed, 265 MFI (IQR 102-896 MFI) <em>vs.</em> 473 MFI IQR 160-2201 MFI), <em>p </em>= 0.001. The percentage of CD14 expressing monocytes and CD14 MFI, was increased in PBMC cultured with AT-MSC conditioned media as opposed to control media: 11.7% (IQR 7.6-16.5%) <em>vs.</em> 6.6% (IQR 4.6-11.8%), <em>p</em> = 0.013 and the surface expression density of CD14, 2702 (IQR 1548-3418) <em>vs.</em> 1540 (IQR 1146-2140), <em>p</em> = 0.05. sVEGF-A levels in PBMC cultures from PA patients cultured with conditioned media from AT-MSC were significantly higher than PBMC cultured with control media suppressing secretion of sVEGF-A, 5012 (IQR 2516-5054 pg/ml) <em>vs.</em> 561 pg/ml (IQR 288-699 pg/ml), <em>p</em> = 0.001.</p> <p>&nbsp;</p> Georgi Hristov Vasilev, Ekaterina Krasimirova, Mariana Ivanova, Ekaterina Ivanova-Todorova, Kalina Tumangelova-Yuzeir, Rada Gancheva, Rumen Stoilov, Dobroslav Kyurkchiev ##submission.copyrightStatement## Sat, 19 Oct 2019 09:16:29 +0300 Osteoporotic fracture risk prediction tools <p>The therapeutic approach of the osteoporosis aims an impact not only on the bone mineral density (BMD), but also on the fracture risk. Fracture risk is defined as a 10-year absolute risk in %. The principles for fracture risk assessment are defined. Age and BMD are initial points of its calculation. A 10-year absolute risk of fractures is assessed on the basis of a table or nomogram. Each serious risk factor such as pre-existing fracture (vertebral or hip), low body mass index (below 20 kg/m2), heredity for hip fractures, high doses of corticosteroid therapy, etc. is accompanied by a doubling of the absolute fracture risk. The process of osteoporotic fracture risk assessment involves several stages: depth anamnesis, physical examination, BMD test, X-ray analysis of vertebral fractures and laboratory tests to exclude secondary cause of osteoporosis. The obtained data can be input into each of the methods for assessing the risk of fractures. Simple screening tools for fracture prediction are OST, ORAI, OSIRIS, SCORE and age alone. Other widely used methods are FRAX®, a Garvan risk calculator and QFracture®. Diff erences in the introduced variables create significant variations in calculated risks from each calculator. The decision on the type of the risk calculator can be made on the basis of country-specific features, although it is necessary for the physician to be aware of the limitations of the chosen method. The complex infl uence on the fracture risk can be achieved through an integrated multidisciplinary approach. The aim is achievement of real outcomes in the prevention of osteoporosis before the occurrence of the first osteoporotic fracture to reduce the expansion of the disease and its negative effects.</p> Elena Kirilova, N. Kirilov ##submission.copyrightStatement## Mon, 30 Sep 2019 00:00:00 +0300 Opportunities and place of physical therapy in the complex treatment of osteoarthritis <p>A significant place in the treatment of osteoarthritis (OA) is taken by physical therapy. Its modalities may be grouped into the following three categories, which could be used alone or in combination: 1) physiotherapeutic (preformed); 2) kinesitherapeutic; 3) resort-climatic (natural) means. The purpose of this review is to outline the place of physical therapy in the treatment of OA. The choice of one or another preformed physical factor depends on the severity of the disease process, the sensitivity of the patient and the physiotherapist's experience. Among the most commonly used physiotherapeutic agents for pain and stiffness and joint function improvement are ultrasound, laser, magnetic therapy, and transcutaneous electrical nerve stimulation. Kinesitherapy aims to soothe pain, strengthen, relax and stretch the muscles, increase the volume of movements, improve gait, joints with aids, and more. Balneotherapy has an important place in the complex therapeutic program for diseases of the musculoskeletal system.</p> Georgi Georgiev, Tsvetoslav Georgiev, Rumen Stoilov, Mariana Ivanova ##submission.copyrightStatement## Mon, 30 Sep 2019 00:00:00 +0300 The value of contrast-enhanced musculoskeletal ultrasound for early diagnosis, monitoring of disease activity and assessment of treatment efficacy in patients with rheumatoid arthritis and psoriatic arthritis Rheumatoid arthritis (RA) and Psoriatic arthritis (PsA) are the most common autoimmune infl ammatory joint diseases. The prevalence of RA is at 0,5-1%. The main clinical manifestation of RA is symmetric progressive erosive polyarthtitis. PsA is infl ammatory arthritis associated with skin psoriasis. The prevalence of PsA in general population vary from 0,3% to 1%. The disease has heterogeneous clinical features – joint involvement, tenosynovitis, enthesitis, dactylitis, nail changes, eyes disorders, skin lesions. Most patients, at 70-80% of cases, present with asymmetric mono- or oligoarthritis. Both RA and PsA are chronic infl ammatory joint disorders which may cause severe structural joint changes and functional defi ciency of patients. They have a signifi cant medical and social importance. Within the past two decades musculoskeletal ultrasound (MUS) has become an essential diagnostic method for evaluation of musculoskeletal diseases with ultrasound imaging. MUS is accessible, non-invasive technique which can provide precise information about pathological changes occurring in all articular and periarticular structures in patients with RA and PsA. Advances in technology together with the usage of higher frequency transducers, the possibilities of color/ power Doppler imaging, the implementation of ultrasound contrast agent, have contributed to the progressive development of the methodology. The purpose of this review is to perform the value of contrast-enhanced musculoskeletal ultrasound (CEUS) for early diagnosis, monitoring of disease activity and assessment of treatment effi cacy in patients with rheumatoid arthritis and psoriatic arthritis. Plamena Ermencheva, Tsvetanka Petranova ##submission.copyrightStatement## Mon, 30 Sep 2019 00:00:00 +0300