The Importance of HLA-B27 in the Evolution of Reactive Arthritis.

Reactive arthritis is an inflammatory joint disease which develops after 1-4 weeks following an enteral, genital or ORL infection, with a higher frequency in HLA-B27 positive patients. AIMS: The objective of this paper is to study the importance of HLA-B27 antigen in the development of reactive arthritis. PATIENTS AND METHODS: The transversal, observational study was conducted in the Rheumatology Clinic of the University of Medicine and Pharmacy of Craiova during the period 2012-2015 and included 112 patients. They were divided into three groups, as follows: group I (52 reactive arthritis cases), group II (30 other spondyloarthritis cases), group III (40 osteoarthritis cases). ELISA and PCR techniques were used to determine the antigen. RESULTS: Those whom had this genetic marker present, the number of enthesitis almost doubled highlighting a possible correlation between the antigen and these imaging changes. We can confirm the same thing for the erosions as well. Unlike enthesitis, erosions occurred also in group III (37.5%), but if we refer to the first two groups, we will observe a significant relationship regarding HLA-B27. More specifically, in HLA-B27 positive patients (68.97%), erosions were found to be twice as numerous than in HLA-B27 negative patients (31.03%). In group I we identified stage 2 sacroiliitis in 68% of HLA-B27 positive patients and 32% in HLA-B27 negative, which shows another link to this antigen with both joint destruction and a possible unfavorable evolution of reactive arthritis. CONCLUSIONS: This antigen specific to the seronegative group of spondyloarthritis determines the acceleration of articular destruction, translated by erosion, and the evolution of sacroiliitis to a more advanced stage.

High Frequency Ultrasonography of the Hand in Rheumatoid Arthritis, Psoriatic Arthritis, Gout and Osteoarthritis Patients.

Over the past decades, management of rheumatic diseases improved both due to development of new drugs and to new imaging techniques. OBJECTIVE: The aim of this study was to evaluate the type and frequency of different structures involvement in the hand of patients with rheumatoid arthritis, psoriatic arthritis and gout compared to patients with osteoarthritis of the hand Methods: We designed an observational, transverse study, which included 110 consecutive patients evaluated in the Rheumatology Department, Emergency County Hospital Craiova, during one year 2014-2015, from which 50 were diagnosed with rheumatoid arthritis, 20 with psoriatic arthritis, 20 with gout and 20 with osteoarthritis. All patients uderwent clinical, biological and US examination. RESULTS: The global prevalence showed any US abnormalities at the hand level in 47 (94%) RA patients with respect to 17 (85%) patients in PsA group, 15 (75%) patients with gout and 12 (60%) patients in OA group (p=0.01) (Table 1). In all groups, except PsA patients, the tendon involvement (Figure 3a,b) was present in less than 30% of the patients, the high global prevalence being explained by the joint involvement (Figure 3c,d). In most of the patients with tendon involvement, we found joint involvement too. CONCLUSIONS: In conclusion, although further studies are needed, with more patients and more homogenous population, the study reveals some US involvement pattern depending on the patient's disease.

Osteoporosis in Systemic Lupus Erythematosus - Correlations with Disease Activity and Organ Damage.

PURPOSE: to assess the incidence of osteoporosis in a cohort of SLE patients and to determine the possible correlations with disease activity, organ damage and glucocorticoid therapy. MATERIAL AND METHODS: We analyzed a cohort that included 25 consecutive SLE patients, diagnosed according to ACR revised criteria, and 21 controls, with the same demographic characteristics. We assessed demographic, life style related, clinical, biologic and immunologic data; also, we registered information about the treatment and calculated disease activity and damage scores. Bone mineral density was measured both in lumbar spine and total hip, using dual-energy X-ray absorptiometry. RESULTS: Evaluation of T score profile, both in lumbar spine and total hip, established a percentage of 36 (9) patients with osteoporosis, 40 (10) patients with osteopenia and 24 (6) cases with normal values. Mean T score in lumbar spine was -1.28+1.31 SD and for the total hip -1.21+1.34 SD. Analysis of correlation between T score, both in lumbar spine and total hip, and SLEDAI, established a moderate, negative correlation; for SDI we obtained a moderate correlation, both for lumbar spine and total hip, statistically significant. CONCLUSIONS: our results show an increased percentage of osteoporosis among SLE patients and a relation to disease and treatment variables, imposing a periodic evaluation, in order to establish an early diagnosis, the proper therapeutic measures, and to prevent the major consequence, vertebral and non-vertebral fractures.

Musculoskeletal Ultrasound in Early Rheumatoid Arthritis - Correlations with Disease Activity Score.

PURPOSE: to assess synovial inflammation using musculoskeletal ultrasonography, in a cohort of patients with early rheumatoid arthritis, and establish the correlations with disease activity score. MATERIAL AND METHODS: We enrolled 29 patients diagnosed with early RA, according to ACR-EULAR 2010 classification criteria, in Rheumatology Clinic, Emergency County Hospital Craiova, between September 2013-August 2014. We performed clinical evaluation, assessed laboratory tests and performed US for all the patients. Musculoskeletal ultrasonography was performed using an ESAOTE MyLab 25 ultrasound, by the same examiner, with multi-frequency linear array transducers (7-12Mh). The presence of synovitis was assessed both in grey scale (GSUS) and power-Doppler (PDUS), according to OMERACT-EULAR consent. RESULTS: Assessment of synovial inflammatory activity by ultrasound examination, using both grey scale and PDUS, has shown active synovitis in all patients, with a mean number of joints with active synovitis of 5. Evaluating the grade, using PDUS, we found grade 1 in all patients, 2 in 14 and grade 3 in 3 patients. Inflammatory markers correlated significant with both GSUS and PDUS. Analysis of correlation between GSUS examination parameters and disease activity score, found a positive, moderate inter-relation, results found also for PD score. CONCLUSION: our results sustain the role of US for detecting inflammatory activity in early RA patients, and, in addition with clinical and biological assessment, represents a sensitive, reliable and reproducible method, easily approached, that should be included in our routine evaluation.

Contribution of Nail Fold Videocapillaroscopy in Patients with Early Inflammatory Arthritis.

BACKGROUND: Early inflammatory arthritis (EIA) a condition defined by joint swelling, with or without morning stiffness, and/or swelling of metacarpophalangeal and/or metatarsophalangeal joints. Nail fold video-capillaroscopy (NVC) is important for the evaluation of microcirculation in vivo. There are limited data about the role of NVC in EIA. OBJECTIVES: To study the capillaroscopic pattern in patients with EIA. PATIENTS AND METHODS: 27 patients with EIA - 21 women, 6 men, mean age of 41.6±4.2 yrs, mean disease duration of 6.9±3.1 months. Anamnesis and clinical examination were perform to identify clinical signs associated with connective tissue diseases. All the patients were nonsmokers and had no personal medical history of diabetes or non-immune mediated occlusive vascular disease. Blood and urine samples were collected for bio-chemical and immunological evaluation. All the patients were interrogated by NVC. RESULTS: Raynaud's phenomenon was found in 9 patients, puffy fingers in 2 pts, telangiectasia in 2 pts, Sicca symptoms in 6 pts, malar rash in 2 pts, photosensitivity and psoriasis plaque in one patient. Combined information from clinical exam, NVC and immunological assessment allowed a specific diagnosis in 5 patients. CONCLUSIONS: Nail fold capillaroscopy assessment can provide further information and has diagnostic value in some cases of early arthritis. Nail fold capillaroscopy assessment contribution to the differential diagnosis in patients with early arthritis is sometimes significant, especially in poorly clinical and immunological defined cases.

Spontaneous Cure of Acute Hepatitis C.

The statistics proved that approximately 25% of the patients with acute HCV present with jaundice, and only 10-20% develop gastrointestinal symptoms. We present the case of a 58 year-old woman, with prior antecedents of arterial hypertension and diabetes mellitus since 25 years old, hypercholesterolemia and hypertriglyceridemia, psoriasis, epilepsy and depressive syndrome. She clinically presents asthenia, anorexia, itching, jaundice and choluria. The objective examination showed an orientated patient, without flapping, hemorrhagic dyscrasia or signs of chronic hepatic disease, with icteric mucosa and skin, abdominal pain, with hepatomegaly and splenomegaly. The laboratory tests have been compatible with acute hepatitis with colestatic pattern: AST/ALT 969/798 UI/ml, FA 796 UI/ml, GGT 2476 UI/ml, BT/BD 7.39/6.10, INR 0.9. The abdominal echography showed: hepatomegaly, regular borders, hepatic steatosis, splenomegaly without ascitic fluid. The viral serological tests revealed protection for hepatitis A ( IgM neg/IgG pos), negative for HVB infection (AgHBs neg, anti-HBc neg), negative for HVE and other viruses (CMV Herpes virus, Epstein Barr, HIV), positive antibodies for HCV and positive RNA VHC (164200 UI/ml), HCV genotype 3a, IL-28B CT, negative autoimmunity. The previous HCV tests were negative, sustaining the recent infection. We assumed an acute hepatitis C. The patient was symptomatically treated with hydroxyzine for the skin itch, with vitamin K for INR correction and she was closely monitored. She had good clinical and laboratorial evolution and she was discharged after one week, maintaining hepatology consultation. She spontaneously cleared HCV infection after 3 months, maintaining negative RNA VHC 6 months after infection. The patient has cured the HCV infection with no need for antiviral treatment.

Screening of some Romanian plants for their activity against medically important insects.

The effects of the action of extracts from 82 plant species included in 39 families of indigenous flora against the larvae and adults of house fly (Musca domestica), the mosquitoes (Aedes aegypti and Anopheles atroparvus) and the German cockroach (Blattella germanica) are presented. Some of the extracts were prepared from air-dried and ground plant material which was exhaustively extracted with successive solvents of different polarity: ethyl ether, ethyl alcohol and water. Other extracts were prepared either by distillation of the whole water extracts of 24 hours macerated plants or by water extraction from residues of plants remained after distillation. These plant extracts act as toxicants, growth and development and reproduction inhibitors and repellents. The differential responses induced by these plant extracts on assessed insects were influenced by several factors such as the plant species, the solvents used for extractions, the species and the stages of insect life and also the methods employed for evaluation. Some of the tested plants appear to have a great potential for providing safer insect control agents.

Two French pioneer historians of Indian medicine.

This text constitutes a summary of the author's recent book on Gustave Lietard (1833 - 1904) and Palmyr Cordier (1871 - 1914), the first historians of Ayurveda in France. In this book, their writings are reprinted and analysed in a long introduction of Ayurvedic historiography.

Mantra and yantra in Indian medicine and alchemy.

This paper was presented at the International Workshop on mantras and ritual diagrams in Hinduism, held in Paris, 21-22 June1984. The complete text in French, which appeared in the Journal asiatique 1986, p.203, is based upon an analysis of Ayurvedc literature from ancient times down to the present and of numerous Sanskrit sources concerning he specialized sciences: alchemy and latrochemisry, veterinary medicine as well as agricultural and horticulture techniques.

Marcelin berthelot and Indian alchemy.

Based on unpublished manuscripts, the article reveals the keen interest shown by Marcelin Berthelot in Indian alchemy. The French Savant has actually inspired and encouraged the first historical research in this field, undertaken at the end of the last century, in Calcutta, by the Bengali scientist Prafulla Chandra Ray.