Browsing by Author "Ostojic, P. (8503557700)"

Alopecia universalis is an advanced form of alopecia areata, characterized by complete loss of hair on all hair-bearing areas. It is currently believed to be an autoimmune disorder. The development of alopecia during treatment with tumor necrosis factor alpha (TNF-α) inhibitors is a rarely observed adverse event. This case describes a 56-year-old female patient with rheumatoid arthritis (RA), who developed alopecia universalis during treatment with adalimumab. There was no improvement in alopecia despite withdrawal of adalimumab. It is believed that interferon-α is the main cytokine involved in promoting inflammation in hair loss after blocking TNF-α by TNF inhibitors. Risk/benefit ratio of maintenance and discontinuation of the drug should be weighed up when alopecia appears during treatment with TNF inhibitors. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Objectives: This study aims to estimate the impact of disease activity, obesity, functional disability, and depression on lipid status, glycoregulation, and risk for coronary heart disease (CHD) in patients with rheumatoid arthritis (RA). Patients and methods: A total of 36 patients with RA (30 women and 6 men, mean age 54.9 years, mean disease duration 7.9 years) were included in this study. We estimated the impact of age, body mass index, disease activity [assessed by DAS28 index and C-reactive protein (CRP) value], functional ability (estimated using the HAQ disability index), and depression [assessed using the Beck Depression Inventory (BDI)] on glycoregulation, lipid status, and risk for CHD in our patients. Glycoregulation was assessed by measuring insulin resistance, insulin, and glucose in blood. Lipids tested in blood included total cholesterol, HDL and LDL cholesterol, and triglycerides (TG). The 10-year risk for CHD was estimated using the Framingham risk score. Results: Of 36 patients, 11 (30.6 %) fulfilled the criteria for metabolic syndrome (MS). Ten of 11 patients (90.1 %) with MS have a 10-year risk for CHD greater than 10 % compared to only 3 of 25 patients (12 %) without MS (p = 0.0001). Patients with high disease activity had lower HDL values than patients with mild or moderate disease activity (1.4 vs. 1.7 mmol/l, p = 0.04). Significant correlations were observed between CRP level and insulinemia (ρ = 0.57, p = 0.003), as well as CRP level and the HOMA index (ρ = 0.59, p = 0.002). The body mass index (BMI) correlated significantly with total cholesterol (r = 0.46, p = 0.02), LDL (ρ = 0.41, p = 0.04), and TG (ρ = 0.65, p < 0.001) in blood. The HAQ-DI did not correlate either with parameters of glycoregulation or lipid status. There was a significant positive correlation between BDI and BMI (ρ = 0.60, p < 0.001). Conculsion: Active RA is independently associated with decreased HDL cholesterol and increased insulin resistance. Obesity was found to be an independent risk factor for increased total cholesterol, LDL cholesterol, and TG. Depressed patients with RA tend to be overweight or obese and, therefore, have an unfavorable lipid profile. © 2015, Springer-Verlag Berlin Heidelberg.

Objective: To estimate whether combination of ibuprofen and paracetamol is more effective than ibuprofen in monotherapy, in the treatment of acute low back pain. Methods: 80 adult patients with acute low back pain were randomized into two subgroups. In the first subgroup, 40 patients were treated with ibuprofen 400mg three times a day (TID), whilst patients in the second subgroup (n=40) were treated with a fixed-dose combination tablet of ibuprofen 200mg plus paracetamol 325mg TID, for three consecutive days. Patients were followed for another 7 days. Efficacy and tolerability of both treatment options was assessed. Results: A statistically significant decrease in pain inten sity, assessed using a visual analogue scale (p<0.001), as well as the 5-point Likert scale, was noticed in both subgroups of patients. However, intensity of pain on Day 4 was significantly lower in patients treated with combined therapy (t=2.05, p=0.045). Considerable improvement in mobility of the lumbar spine was noticed in both subgroups of patients (p<0.001), but at the end of the follow up period, finger- to-floor distance was lower in patients on combined therapy (4.7cm vs. 8.3cm, t=2.27, p=0.03). Improvement of functional ability on Day 4 and Day 10 was significant, regardless of treatment (p<0.001). One patient on combined therapy and two patients on ibuprofen monotherapy reported minor gastric intolerability. Conclusion: Compared to ibuprofen monotherapy, combination of ibuprofen and paracetamol may provide faster and longer analgesia in patients with acute low back pain, with equally favorable effect on mobili - ty and functional ability and similar tolerability.

This study aims to assess the prevalence and possible causes of restless legs syndrome (RLS) in patients with systemic sclerosis (SSc). The prevalence of RLS was assessed in 27 patients with SSc and 60 healthy controls. We evaluated the impact of age, disease duration, disease form, antibodies, and metoclopramide on the development of RLS in SSc patients. In order to reveal peripheral neuropathy or iron deficiency as possible causes of the syndrome, patients with RLS underwent electromyoneurography (EMNG) and ferritin level testing. RLS was diagnosed in 40.7% of SSc patients (11 out of 27), compared to 4.9% of healthy controls (p< 0.001). Eight out of 18 patients (44.4%) with diffuse SSc and 3 out of 9 patients (33.3%) with limited SSc exhibited RLS (p = 0.28). Mean age and mean disease duration did not differ significantly between patients with or without RLS. RLS was observed in 47.1% of patients with anticentromere antibodies and 30% of patients with anti-topoisomerase I antibodies (p = 0.22). RLS was diagnosed more frequently (p = 0.02) in patients taking metoclopramide (75%) than in patients who were not being treated with this drug (26.3%). EMNG revealed sensitive polyneuropathy in four, and lumbosacral radiculopathy in two out of 11 patients with RLS. Two patients with SSc and RLS had low levels of ferritin. Three patients had normal EMNG findings and ferritin levels. In conclusion, RLS is a common disorder in patients with SSc. Possible causes include sensitive polyneuropathy, lumbosacral radiculopathy, and iron deficiency. A strong relationship was observed between RLS and metoclopramide, which is sometimes used to treat SSc-related gastrointestinal motility disturbances. © 2013 Springer-Verlag Berlin Heidelberg.