Revmatologiia (Bulgaria) <p>Revmatologiia/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>Revmatologiia/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> Bulgarian Rheumatology Society en-US Revmatologiia (Bulgaria) 1310-0505 Serum anti-CCP antibodies in periodontitis associated with rheumatoid arthritis - relative value for the severity of periodontitis <p>Antibodies against cyclic citrullinated peptides (ACPA) have significant prognostic value for the onset or progression of rheumatoid arthritis (RA). Extraarticular citrullination and the production of ACPA as an immune response have been well documented in a number of tissues, including inflamed gingiva associated with periodontal disease. The aim of this study was to analyze the relative value of serum ACPA, determined by anti-CCP test, in the periodontitis (P) associated with RA severity`s assessment. The study included 60 patients with a mean age of 58 ± 10 (34 to 74 years), of whom 44 were women and 16 were men with concomitant P and RA. All patients underwent clinical and laboratory tests for the diagnosis of RA and clinical periodontal examination for the diagnosis of P, after signed informed consent. In the studied cohort we found that the average number of lost teeth was 8 ± 5 (0-18), and the average depth of periodontal pockets in mm was 4.4 ± 1.1. In 50% of patients there was a loss of attachment&gt; 5 mm, and in 43% we found furcation lesions. Fifty-eight patients (96.7%) had a 100% prevalence of probing bleeding (BoP), and 47 patients (78.3%) had PISA ≥ 934.71mm². The mean value of PISA in the studied patients was 1727.04 ± 873.64 (214.37 - 4324.00). We did not find a statistically significant difference in serum ACPA levels depending on the severity of periodontal parameters PD (p = 0.357), CAL (p = 0.589) and PISA (p = 0.788). We found that the ROC-based cutoff values ​​for ACPA were high (123.85 IU / ml) and had low sensitivity and specificity in distinguishing between severe and moderate / mild forms of periodontal disease.</p> L Stefanov T. Bolyarova-Konova Zlatimir Kolarov Pavlinka Pavlova Mariana Ivanova ##submission.copyrightStatement## 2020-12-28 2020-12-28 28 4 3 18 10.35465/28.4.2020.pp3-18 Correlations between the severity of neurological deficit and anatomical localization in cerebral venous thrombosis patients – a retrospective study <p><strong>Abstract</strong>&nbsp;</p> <p>The aim&nbsp;of this study is to examine&nbsp;the relationship between anatomical localization of thrombosis and the severity of neurological deficits in patients with cerebral venous thrombosis (CVT). The diagnostic method is MR venography. The study is&nbsp;retrospective, with 49 patients included,&nbsp;diagnosed and followed in&nbsp;Military Medical Academy, Sofia, Clinic of Neurological Diseases for10 years period between 2005 and&nbsp;2015. Patients were divided into groups, according to the severity of the neurological deficit and the anatomical localization of thrombosis. We searched&nbsp;for a correlation between these two indicators. No statistically significant dependence was found in the analysis.</p> <p><strong>Keywords:</strong>&nbsp;anatomical localization, clinical manifestation,&nbsp;CVT</p> <p>&nbsp;</p> Stratina Stratieva Tatyana Valova K Prinova S Pashkunova ##submission.copyrightStatement## 2021-02-02 2021-02-02 28 4 19 30 10.35465/28.4.2020.pp19-30 Combination of platelet-rich plasma and hyaluronic acid in the treatment of moderate and severe osteoarthritis of the knee joint <p>The study aimed to determine the effectiveness of monthly intra-articular injection of combination of PRP and hyaluronic acid in improvement of outcome of knee OA. It was conducted as open clinical trial on a convenient sample of 17 patients with unilateral or bilateral symptomatic knee OA in rheumatology and orthopedic clinics at Al-Jumhoori Teaching Hospital in Mosul, Iraq during 1st of Jan to 30th Jun, 2018. The patients received intra-articular injection of combination of plate rich plasma (PRP) and hyaluronic acid (HA) monthly for three months. The outcome assessment was carried out 4&nbsp;weeks after the last injection using WOMAC index. The results revealed that WOMAC index subscales was reduced significantly (p &lt;0.001) after treatment by followings mean differences: 3.88 in pain (95% CI: 3.18-4.58); 1.29 in stiffness (95% CI: 0.85-1.73); 9.29 in physical function (95% CI: 6.70-11.88); and 14.47 in total score (95% CI: 11.20-17.73). The intervention effect size were as follows: 1.23 in pain; 1.49 in stiffness; 1.11 in physical function, and 1.20 in total WOMAC score. Overall, effect size of combination of PRP and HA intra-articular injection is classified as large effect size (&gt; 0.8) in improving outcome of knee OA. A combination of PRP and HA has large synergistic effect size in improving outcome of moderate and severe OA of knee.</p> Muthanna Abdul Razaq Anmar Ahmed Qasim Thamer Mohammed Assim Ramzi Ramzi ##submission.copyrightStatement## 2020-12-28 2020-12-28 28 4 31 35 10.35465/28.4.2020.pp31-35 RHEUMATOID ARTHRITIS AND THE COMPLEMENT SYSTEM <p>The complement system represents a major part of the immune response. Its normal functioning is mandatory for the organism’s defence against pathogens and for the clearance of immune complexes, apoptotic cells and cellular debris. Its over-activation however can lead to generation of many pro-inflammatory and cytotoxic mediators, causing inflammation and tissue damage. The participation of the complement system in rheumatoid arthritis’(RA) pathogenesis is indisputable but its intimate mechanisms and the opportunities for influencing them are still an object of investigation. The aim of this review is to outline and systematize all the relevant scientific evidence.</p> MARIYA BLAGOEVA KOSTURKOVA MARIA RADANOVA GALYA MIHAYLOVA VLADIMIR KADINOV ##submission.copyrightStatement## 2020-12-28 2020-12-28 28 4 45 58 10.35465/28.4.2020.pp45-58 Systemic sclerosis-associated interstitial lung disease: review of the literature <p class="western"><span style="font-family: 'Times New Roman', serif;">Systemic sclerosis (SSc) is a connective tissue disease characterized by progressive sclerosis, affecting the skin and the internal organs, vasculopathy, and immune dysregulation. Interstitial pneumonias are a group of diffuse parenchymal lung diseases (DPLDs), or also called interstitial lung diseases (ILDs). ILD is a leading complication of SSc and is a leading cause of mortality in patients with SSc. The pathogenesis of lung injury involves three major processes - persistent endothelial cell damage, immune system activation, and fibroblast activation leading to the accumulation of extracellular matrix and tissue damage. A comprehensive approach is required to properly diagnose and to select appropriate therapy. </span></p> Rositsa Svetoslavova Dacheva Simeon Valentinov Monov ##submission.copyrightStatement## 2020-12-28 2020-12-28 28 4 59 71 10.35465/28.4.2020.pp59-71 SARS-CoV-2 and autoimmune rheumatic diseases <p>Coronaviruses have been known to mankind for decades, accounting for about a third of flu-like illnesses each year in the early fall-winter period. At the end of 2019, a new coronavirus ( SARS – CoV-2) was found, which in March 2020 was declared pandemic by the World Health Organization (WHO). The structure of the new virus continues to be studied, but the S-protein has been shown to play a major role in the pathogenesis of the disease it causes. Using the&nbsp; S-protein a host is attached to the cell. The severity of COVID-19 varies from individual to individual, but the main risk factors are age, sex, comorbidities and etc.</p> <p>At present, the question of whether the patients with autoimmune disease are at greater risk of severe COVID-19, remains unclear. The development of an effective vaccine give hope to society, but also raises a number of questions about long-term safety.</p> Nikolay Stoilov Vladimira Boyadzhieva ##submission.copyrightStatement## 2021-02-02 2021-02-02 28 4 36 44 10.35465/28.4.2020.pp36-44 Clinical case of a patient with adult-onset Still’s disease – a diagnostic challenge or a late diagnosis? <p>Abstract. Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disease with poorly understood etiology, that features quotidian spiking fevers, polyarthritis and distinctive salmon-colored maculopapular rash. Extremely high levels of ferritin are present in most patients, making it an important laboratory test for diagnosis. AOSD is a crucial diagnostic and therapeutic problem, which in many cases remains unrecognized due to the rarity in the population and the diverse clinical features. We present the clinical case of a 34-yearold woman with a first manifestation – maculopapular rash on the dorsal surface of the wrist joints and on the knee joints. At this time the patient has first-time pregnancy in the 6th gestational week. During a gynecological examination, intrauterine fetal death was found, which necessitated premature termination of pregnancy in the 8th gestational week. At the same time the patient was subfebrile and a couple days later she reported fever, reaching up to 39°C. The patient was hospitalized in the Clinic of Rheumatology with a fever of unknown origin up to 39°C, polyarthralgia, polymyalgia, maculopapular rash on the chest, leukocytosis, thrombocytosis, increased LDH-, ferritin-, GGT-acute phase reactant levels, microcytic hypochromic anemia, negative immunological findings (anti-MCV, anti- CCP, ANA-screen, ANA-blot, anti-dsDNA, ANCA, anti-MPO, anti-PR3, aCL, anti-B2GPI, anti-prothrombin), negative Quantiferon test. The patient was diagnosed with AOSD and started therapy with Methylprednisolone 60mg/daily, when she got a persistent afebrile condition and significant improvement in the clinical status and laboratory parameters.</p> Soner Emin Vladimira Boyadzhieva Nikolay Stoilov Rumen Stoilov ##submission.copyrightStatement## 2021-02-02 2021-02-02 28 4 72 80 10.35465/28.4.2020.pp72-80