SummaryBackgroundThe aim of this study was to assess and compare patients’ access to biologic anti-RA drugs in selected Central and Eastern European (CEE) countries and to analyze the determinants of differences between countries.Material/MethodsThis is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using an affordability index, calculated comparing the index of health care expenditures to the price index, using Poland as an index of 1.ResultsThe percentage of patients on biologic treatment in 2009 was highest in Hungary (5% RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), Czech Republic (2.92%), Romania (2.2%), Estonia (1.8%), and Croatia, Serbia, Poland (below 1.5%). Infliximab, etanercept, adalimumab and rituximab were included in the reimbursement system in all countries, but abatacept and tocilizumab were included only in Slovakia. In Slovenia, public payer covered 75% of the price, and 25% is covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries, biologic drugs are reimbursed at 100%. Affordability index for biologic drugs was the lowest in Slovenia (0.4). In each country national guidelines define which patients are eligible for biologic treatment. Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.ConclusionsThe most important factors limiting access to biologic anti-RA treatment in the CEE region are macroeconomic conditions and restrictive treatment guidelines.

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Rheumatoid arthritis (RA) is an inflammatory joint disease, in which, unlike systemic lupus erythematosus (SLE), renal involvement is uncommon. The major causes of renal disease in RA are usually linked to amyloid or secondary effects of drugs. Nevertheless the relation between IgA, IgA-rheumatoid factor (RF) and renal disease in patients with RA is not clear, but the affinity of IgA for mesangium, skin and synovium might explain clinical presentation of RA with mesangial IgA glomerulonephritis. The case of a 42-year-old Caucasian man with RA and diffuse mesangial IgA glomerulonephritis proven by renal biopsy is presented. The patient was treated with boluses of methylprednisolone 1000 mg and cyclophosphamide 1000 mg monthly for 13 months. Between boluses there was a supported therapy with methylprednisolone 8 mg/day. After a year of treatment full clinical and laboratory remission of RA and IgA glomerulonephritis was achieved. Pathogenic therapy will be stopped and the patient followed-up.

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Reactive arthritis has been defined as an aseptic inflammatory arthritis associated with a concomitant infectious disease. Usually, the symptoms develop during or soon after a symptomatic infectious disease, however, in both sexes genitourinary infections might be asymptomatic.  Herein, we presented a case of a 68-year old woman with oligoarthritis associated with a “forgotten” intrauterine device (IUD). The IUD was successfully removed by laparoscopy leading to a full resolution of symptoms and improvement of inflammatory markers. The presented case shows that asymptomatic genital infection should be considered in case of suspected infection-related arthritis without clear etiological cause, especially in women with IUD. The in-depth training of patients regarding the proper use of contraception methods as well as the regular gynaecological examinations might help to prevent further similar cases.