IntroductionThe aim of the study was to investigate the presence of subclinical atherosclerosis and predictors of change in carotid intima-media measures in early rheumatoid arthritis patients (eRA) as compared to chronic RA patients and patients without arthritis.Material and methodsFifty-five consecutive eRA patients were assessed at the time of diagnosis and after 1 year of therapy. Fifty-five sex- and age-matched chronic RA patients and 29 patients without inflammatory disease were used as controls. Carotid artery intima-media thickness (CIMT) and carotid plaques were measured at baseline and after follow-up. In eRA patients ultrasound assessment of hand joints was performed before and after treatment. Carotid artery intima-media thickness was assessed again after 2 years in 44 eRA patients.ResultsCarotid artery intima-media thickness progression after 1 year of therapy was higher in eRA patients compared to both control groups (p = 0.017) and correlated with symptoms duration (p = 0.017) and DMARD monotherapy (p = 0.015). Ultrasound progression of hand joint erosions was associated with longer symptoms duration (p = 0.006). After 2 years of observation CIMT progression was similar in all examined groups.ConclusionsWe observed rapid CIMT progression during the first year of RA therapy. Longer symptoms duration and less aggressive therapy were associated with CIMT increase.

BackgroundDelay of disease modifying anti-rheumatic drugs (DMARDs) therapy is an important factor for poor outcome in rheumatoid arthritis (RA).ObjectivesTo study the lag time between the onset of arthritis symptoms and the beginning of DMARD's therapy, and to determine factors associated with therapy delay.MethodsWe studied 70 consecutive patients with new RA onset (70% female, median age 60±14 years) admitted to the Department of Internal Medicine and Rheumatology, Military Institute of Medicine in Warsaw. Demographic, clinical, laboratory, and treatment variables were collected. Disease activity was assessed every month during the first year of therapy using DAS28, CDAI, SDAI indices. Health assessment questionnaire (HAQ) and Beck depression inventory were assessed at baseline, after 6 and 12 months. Factors associated with delay of DMARD's therapy were analyzed.ResultsThe median time from the onset of symptoms to DMARD administration was 3 months (0.5-36 months).The median time before the patient was assessed in primary care was 3 weeks (7 days-35 months),the median time to referral from primary to secondary care was 1 month (0 days-30 months)and the median delay from that referral to the assessment by rheumatologist was 10 days (0 days-3 months). 33 (47.14%) patients were diagnosed within 3 months, 15 (21.4%) within 6 months, 22 (31.4%) waited for diagnosis >6 months. These 22 patients were significantly older than others. ESR, global visual analogue scale (VAS) by patient and physician, CDAI, SDAI, DAS28, HAQ at baseline correlated inversely with the treatment delay. The treatment delay was significantly longer in patients living alone. This delay was determined by the period from symptoms onset to primary care visit and the time from secondary care referral to rheumatologist's consultation (p=0.006). The treatment delay was associated with shorter period of remission (DAS28≤2.6) during the first year of therapy. We have found no significant association between age, sex, socioeconomic status, years of education, depression symptoms, comorbidities and presence of rheumatoid factor or anticitrulinated antibodies and delay of the treatment.ConclusionsThe patients living alone and with low disease activity at baseline are less likely to receive immediate DMARD's treatment. Delay of the treatment is associated with shorter time of remission during the first year of therapy. Awareness of factors associated with a delay in access to rheumatology care and DMARD therapy may help to reduce barriers that prevent early access and improve outcome in RA patients.ReferencesV.P.K. Nell, K.P. Machold, G. Eberl, T.A. Stamm, M. Uffmann, J.S. Smolen. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 2004;43:906–914D.E. Feldman, S. Bernatsky, J. Haggerty, K. Leffondre, P. Tousignant, Y. Roy, Y. Xiao, M. Zummer, M. Abrahamowicz. Delay in Consultation With Specialists for Persons With Suspected New-Onset Rheumatoid Arthritis: ...

Reumatologia 2013; 51/3 S t r e s z c z e n i e Plamica Schönleina-Henocha to zapalenie małych naczyń, które wystę-puje głównie u dzieci i zwykle wiąże się u nich z dobrym rokowaniem. Znacznie rzadziej choroba występuje u dorosłych, u których często ma cięższy przebieg. W pracy przedstawiono przypadek 65-letniej pacjentki z plamicą Schönleina-Henocha o burzliwym przebiegu, z zaję-ciem przewodu pokarmowego oraz nerek, a także typowymi objawami skórnymi i stawowymi. U chorej stosowano leczenie glikokortykosteroidami, cyklofosfamidem, leczenie nerkozastępcze; konieczna okazała się również interwencja chirurgiczna. Pomimo zastosowanego złożonego leczenia stan chorej się pogarszał. Choroba zakończyła się zgonem pacjentki. Przedstawiony przypadek zwraca uwagę na moż-liwość wystąpienia i ciężkiego przebiegu zapalenia naczyń tego typu u pacjentów dorosłych. S u m m a r yHenoch-Schönlein purpura is a small-vessel vasculitis mostly affecting children and usually has a good prognosis. Adults, though affected rarely, may experience a more severe course of the disease. We present a case of a 65-year-old woman with Schönlein-Henoch purpura with dramatic course due to kidney and gastrointestinal involvement, with typical purpura and arthritis. Treatment with corticosteroids and cyclophosphamide was administered. Dialysis and surgical intervention were also required. Despite the treatment the patient's condition continued to deteriorate and finally she died of the disease. This case report shows that Schönlein-Henoch purpura may occur and have a severe clinical course in adults.A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i: : lek. Olga Bujakowska, Klinika Chorób Wewnętrznych i Reumatologii, Wojskowy Instytut Medyczny, ul. Szaserów 128, 04-141 Warszawa, tel. +48 22 681 74 80, faks +48 22 681 69 20, e-mail: obujakowska@wim.mil.pl P Pr ra ac ca a w wp pł ły yn nę ęł ła a: : 30.08.2012 r.

BackgroundVitamin D deficiency is common in rheumatoid arthritis (RA) and may be related to disease activity.Objectives1. To study the relationship between vitamin D deficiency and disease activity at RA onset. 2. To investigate possible influence of vitamin D supplementation on disease activity in early RA patients.MethodsWe studied 81 consecutive patients with new RA onset (71,6% women, mean age 60±14 years) admitted to the Department of Internal Medicine and Rheumatology, Military Institute of Medicine in Warsaw. Demographic, clinical, laboratory, and treatment variables were collected. The patients were treated with methotrexate, low dose of glucocorticoids and supplemented with vitamin D. Disease activity was assessed every month during the first year of therapy using DAS28-ESR, DAS28-CRP, CDAI, SDAI indices. Serum 25-hydroxy- vitamin D (25(OH)D3) was measured at baseline, after 6 and 12 months. Ultrasound assessment of hand joints was performed by the same assesssor at baseline and after 12 months. We defined vitamin D serum concentration <20ng/mL as vitamin D insufficiency and serum concentration <10ng/mL as vitamin D deficiency. New erosions found at ultrasound examination after 12 months were considered disease progression.ResultsAt baseline mean 25(OH)D3 serum concentration was 14,6±7,7ng/mL. Sufficient vitamin D serum concentration was found in 22% patients, 49% of patients had vitamin D insufficiency and 29% were vitamin D deficient. The patients with vitamin D deficiency at baseline had significantly higher number of tender and swollen joints, higher physician global assessment and higher number of joint effusion detected by ultrasound examination than other patients. There were no significant differences in ESR and CRP values according to vitamin D concentration. After 12 months (the data available for 65 patients) 20,3% of the patients had still insufficient vitamin D concentration and 4,7% were vitamin D deficient. Taking into account the mean vitamin D concentration during observation period only 52,4% of patients were vitamin D sufficient. New erosions in ultrasound examination were found in 14 (21,5%) patients. We have found no significant difference between vitamin D sufficient and insufficient patients according to the average indices of disease activity, disease activity improvement, time to achieve remission, duration of the remission and disease progression during the first year of therapy.ConclusionsHigher disease activity at RA onset is associated with lower serum vitamin D concentration. Vitamin D supplementation does not improve disease outcome during the first year of therapy.ReferencesM. Salesi, Z. Farajzadegan. Efficacy of vitamin D in patients with active rheumatoid arthritis receiving methotrexate therapy. Rheumatol Int 2012; 32: 2129–2133K. Gopinath, D. Donda. Supplementation of 1,25 dihydroxy vitamin D3 in patients with treatment naïve early rheumatoid arthritis: a randomized controlled trial. International Journal of Rheumatic Diseases 2011;4: 332–339Disclosure of InterestNone d...

Background Interstitial lung disease (ILD) in rheumatoid arthritis (RA) is frequent. Joint disease precedes the interstitial lung involvement by several years in most cases, although ILD may be the first RA manifestation. Objectives The aim of this study was to evaluate the prevalence and clinical presentation of ILD in patients with early RA, and to identify factors associated with its occurrence. Methods 48 patients (34 women and 14 men) with early RA, fulfilling 2010 ACR-EULAR classification criteria were enrolled to the study. The mean age was 59.6 years (±15.7). The mean disease duration was 4.7 months. Detailed medical and smoking history was taken. A physical examination, laboratory analysis, PFT and HRCT of the lung were performed in all patients. Pulmonary manifestations were defined as the presence of respiratory symptoms and abnormalities revealed on physical examination of the lung. The diagnosis of ILD was based on high resolution computed tomography (HRCT) of the lung and defined as the presence of diffuse or patchy reticular or reticulo-nodular lesions, honeycombing and/or ground-glass opacities, localized mainly in the peripheral or subpleural parts of the lower lobes. Non-specific interstitial lung lesions were defined as the presence of parenchymal or subpleural bands, or pleural thickening. Results Based on the definitions above, ILD was diagnosed in 11 patients (23%) and non-specific interstitial lung lesions in 20 patients (41.6%). Among patients with ILD, 6 had reticular lesions, 3 had ground-glass opacities and remaining 2 had ground-glass opacities associated with reticular lesions. Respiratory symptoms were reported in 25 patients (52%) and included: cough (11), dyspnea (4), decreased physical endurance (3), fatigue (9) and fever (14). The physical examination revealed abnormalities in 3 patients (6.3%) and included: bilateral basal crackles (1) and wheezes and/or rhonchi (2). Pulmonary manifestations occurred in 27 patients (56.3%). 6 of them (22%) had ILD and 11 (40.7%) non-specific interstitial lung lesions. Among patients with ILD, 6 (54.5%) had the following pulmonary manifestations: cough (3), fatigue (2), fever (3) and bilateral basal crackles (1). 11 patients with non-specific interstitial lung lesions (55%) reported the following respiratory symptoms: cough (6), dyspnea (11), decreased physical endurance (3), fatigue (8) and fever (7). PFT showed restrictive process in 1 patient (2.1%) with non-specific interstitial lung lesions on HRCT of the lung. The obstructive lung disease occurred in 1 patient (1.8%) with normal chest HRCT. There were significant differences in time from the first RA symptoms to the first rheumatological assessment (9 vs 3.6 months, p- 0.008), time from the first symptoms to RA diagnosis (9.1 vs 4.6 months, p- 0.02) and time from the first symptoms to treatment (8.9 vs 4.3, p- 0.02) between patients with and without ILD. There were no significant differences between these two groups in terms of age, gender, RA activity (ESR, CRP, SJC, TJC, DAS28, SDA...