Dorota Sikorska

The most serious complications of systemic sclerosis (SSc) and mixed connective tissue disease (MCTD) include lung fibrosis (LF) and pulmonary hypertension (PH). The aim of this study was to find any association between the serological profile and the incidence of these complications. The tested group included 121 persons (87 SSc, 34 MCTD); mean age 55.6 ± 13.4 years. Patients were qualified for the LF presence group based on HRCT. Likelihood of PH was determined using echocardiography. The presence of antinuclear antibodies (ANA) was assessed using indirect immunofluorescence, ANA-profile, sclerosis-profile (using EUROIMMUN kits), and antiphospholipid antibodies (aPL) (using the ELISA method). Distribution of individual antibody types was at a level similar to the previously described groups in the Polish population and differed from the American and African population. A positive correlation was found between LF and the presence of anti-Scl-70 (p = 0.024) antibodies, negative correlation was found between LF and the presence of anti-histone (p = 0.03), anti-centromere A (p = 0.009), anti-centromere B (p = 0.014), and anti-nucleosomes (p = 0.03) antibodies. No correlation between the presence of aPL and the above complications was found. The prevalence of individual antibody types in SSc and MCTD may have ethnic and geographical grounds. Scl-70 antibodies correlate positively with LF. Anti-centromere, anti-histone, and anti-nucleosome antibodies reduce its risk. No correlation between aPL and the occurrence of LF and elevated PH risk was found.

Axial spondyloarthritis affects 0.1% to 1% of the general population, depending on the source. Unfortunately, despite new diagnostic criteria, also adapted to non-radiographic axial spondyloarthritis, and advances in imaging modalities (widespread use of magnetic resonance imaging), the late diagnosis of the disease and, therefore, a delay in starting therapy still pose a serious problem. On average, the time between the first symptoms of the disease and its diagnosis is several years. Patients' access to modern treatment methods is also still delayed. This paper presents a practical guide to both the diagnosis and treatment of axial spondyloarthritis in Poland. Keywords: ankylosing spondylitis axial spondyloarthritis biological treatment

Introduction: Periodontitis, characterized by inflammation affecting the tooth-supporting tissues, may increase the risk of rheumatoid arthritis (RA) or cardiovascular diseases. The aim of the study was to evaluate the periodontal status in RA patients and its impact on the inflammatory markers and red cell parameters obtained from complete blood laboratory tests to study the risk of cardiovascular disease development.Material and methods: The cross-sectional study included 50 patients with RA treated with biologi­cal therapies: tumor necrosis factor inhibitors, interleukin-6 blockers. Rheumatoid arthritis disease activity was assessed with Disease Activity Score with 28-joint count (DAS28). The periodontal indices modified Approximal Periodontal Index, modified Papillary Bleeding Index, and Periodontal Screening Index (PSI) were used to assess patients’ periodontal status. Serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used as inflammatory markers and a potential cardiovascular risk factor.Results: No statistically significant correlation was found between the periodontal status and RA activity. However, a statistically significant correlation was found between the CRP results and the PSI scores (R = –0.264510, p = 0.048837). Evaluation of the red cell parameters showed statistically significant differences in the markers of inflammation ESR (R = 0.369398, p = 0.008289) and CRP (R = 0.367405, p = 0.008672). Red cell distribution width values were also correlated with RA activity (R = 0.286387, p = 0.043769) and duration of the disease (R = 0.339425, p = 0.015889).Conclusions: A satisfactory periodontal status was found in most of the study group. Increased CRP levels in patients with periodontitis may indicate the negative impact of periodontal status on the general clinical condition of the patient.

Cerebral palsy is a group of nonprogressive conditions that affect movement and posture caused by damage to the central nervous system at an early stage of a child's development. Among this group of patients, there is a higher risk of the appearance and progression of neurogenic scoliosis, which unlike idiopathic scoliosis, progresses after skeletal maturity. The aim of the study was to analyze the association of comorbid factors with the risk of development and progression of neurogenic scoliosis. The study included 133 patients with cerebral palsy. The relationship between comorbidities in children with cerebral palsy and the risk of developing neurogenic scoliosis was demonstrated and proven.

Objectives: The importance of the kynurenine pathway in normal immune system function has led to an appreciation of its possible contribution to autoimmune disorders such as rheumatoid arthritis (RA). The aim of the study was to evaluate the effect of treatment with tumor necrosis factor α (TNF-α) inhibitors on the activity of the kynurenine pathway in patients with RA.Material and methods: This was an investigator-initiated, prospective, observational study. The study was performed on 30 RA patients (Caucasian, 11 male, 19 female; mean age 45 ±16 years) treated with TNF-α inhibitors. All patients were assessed before and after 6 months of therapy. As a control group, age- and sex-matched, 20 healthy volunteers were recruited. Disease activity was evaluated by the Modified Disease Activity Score with 28-joint count (DAS28). Inflammatory markers were assessed routinely by the hospital central laboratory. Serum concentrations of kynu­renine, serotonin and tryptophan were measured with specific immunoassays. To estimate indoleamine 2,3-dioxygenase (IDO) activity, kynurenine-to-tryptophan ratio was calculated.Results: The results of our study showed changes in tryptophan metabolism in RA patients, compared with healthy controls. Surprisingly, RA patients had statistically significant decreased kynu­renine-to-tryptophan ratio (p = 0.003), which could indicate diminished IDO activation in RA. Moreover, we found no significant changes in kynurenine-to-tryptophan ratio after treated with TNF-α inhibitors (p = 0.490), despite disease remission. Additionally, tryptophan metabolism activity did not correlate with objective markers of inflammation.Conclusions: The RA patients had altered tryptophan metabolism, compared with healthy controls. The mechanisms affecting tryptophan metabolism in RA may be complex. We believe that continuing elucidation of pathophysiological pathways relevant in RA offer substantial hope for the development of specific pharmacotherapy for treatment of RA – especially for comorbidity of RA and depression.

Despite the passage of time and the emergence of more drugs on the pharmaceutical market, methotrexate (MTX) is still considered the primary drug for the treatment of rheumatoid arthritis and other inflammatory rheumatic disorders. However, the best forms of MTX therapy are still being sought. Based on the available literature, subcutaneous MTX is preferred, especially when using higher doses, due to its better bioavailability and lower incidence of side effects. Nevertheless, some patients still prefer oral therapy. Therefore, it is important to make patients as comfortable as possible with injectable MTX, which can contribute to better cooperation. This paper presents the results from a comparative analysis of selected 15 mg pre-filled syringes (PFS) containing MTX available on the Polish market in terms of technological differences and product administration. Keywords: methotrexate rheumatic diseases subcutaneous injections

Nonsteroidal anti-inflammatory drugs (NSAIDs) show high efficacy in anti-inflammatory and analgesic therapy and are the most widely used drugs worldwide. In addition to their efficacy, the widespread use of NSAIDs has been fostered by their wide availability, especially as some are available without a prescription. Unfortunately, this group of drugs is also fraught with adverse effects, including serious ones. Due to the widespread use of NSAIDs, updated data on this group of drugs is critical for practitioners to make the right therapeutic decisions. Each patient requires individualised therapy because, in the case of NSAIDs, the choice of a specific drug, in relation to the type and nature of pain and potential adverse effects, is very important. Over the years, attempts have been made to develop an algorithm for the selection of NSAIDs according to the risk of developing complications associated with drugs of this group in individual cases, taking into account the so-called 'golden mean' of NSAIDs and the knowledge of interactions between some NSAIDs and cardioprotective acetylsalicylic acid. This study is another attempt to summarise this issue. With the current state of knowledge, resulting primarily from the publication of the large PRECISION study, which is limited to only three molecules, there remains the fundamental question of expanding the knowledge to include such commonly used drugs as diclofenac, ketoprofen, meloxicam and etoricoxib. In addition to the results of the PRECISION study, this version includes a study by an expert group on other NSAIDs on the Polish market and presents an algorithm for selecting NSAIDs according to individual gastroenterological and cardiovascular risk. Keywords: nonsteroidal anti-inflammatory drugs gastroenterological complications cardiovascular complications nephrological complications

Rapid advances in pharmacotherapy have resulted in significant changes in recommendations for the treatment of psoriatic arthritis (PsA) in recent years. The most recent guidelines for the treatment of PsA are the 2019 recommendations of the European League Against Rheumatism (EULAR) and the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The wide range of currently available modern drugs provides ample opportunity to select an effective therapy individually for each patient. Psoriatic arthritis (PsA) is a very heterogeneous disease, so the choice of a particular drug should be tailored to the needs of the individual patient. When making therapeutic decisions, it is crucial to identify the predominant musculoskeletal symptoms; however, the coexistence of extra-articular symptoms, such as skin lesions and nail involvement, and other concomitant conditions must also be taken into account. This paper presents current recommendations for the treatment of PsA in Poland, with a particular focus on biologic treatment. Rapid advances in pharmacotherapy have resulted in significant changes in recommendations for the treatment of psoriatic arthritis (PsA) in recent years. The most recent guidelines for the treatment of PsA are the 2019 recommendations of the European League Against Rheumatism (EULAR) and the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The wide range of currently available modern drugs provides ample opportunity to select an effective therapy individually for each patient. Psoriatic arthritis (PsA) is a very heterogeneous disease, so the choice of a particular drug should be tailored to the needs of the individual patient. When making therapeutic decisions, it is crucial to identify the predominant musculoskeletal symptoms; however, the coexistence of extra-articular symptoms, such as skin lesions and nail involvement, and other concomitant conditions must also be taken into account. This paper presents current recommendations for the treatment of PsA in Poland, with a particular focus on biologic treatment.

The imbalance between the kynurenine and serotonin pathways can have serious consequences, e.g., depression. One of the factors leading to the imbalance between the pathways of tryptophan metabolism is inflammation. The aim of our study was to assess the impact of treatment with tumor necrosis factor-alpha (TNFα)-inhibitors on tryptophan metabolism in patients with ankylosing spondylitis (AS). Forty patients with AS (twenty-eight males, twelve females; mean age 40 ± 11 years), qualified to receive anti-TNF-α treatment, were prospectively assessed. As a control group, 20 healthy volunteers (7 males and 13 females, mean age 38 ± 5 years) were recruited from the general population. Patients underwent full clinical and biochemical assessment before and after 6 months of therapy. Disease activity was assessed by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The presence of depressive disorders was assessed with Beck's Depression Inventory (BDI) scale. Serum concentrations of tryptophan, serotonin, kynurenine, and quinolinic acid were measured. The predominance of the kynurenine pathway in AS patients (compared to the control group) was demonstrated (p < 0.001). Surprisingly, no significant changes in serum levels of tryptophan and its metabolites in AS patients after treatment were found, despite clinical improvement. Moreover, the components of tryptophan metabolism did not correlate significantly with the clinical activity of AS, depression nor laboratory inflammatory markers. Probably some other factors influence the pathways of tryptophan metabolism in patients with ankylosing spondylitis.

(1) Background: Muscle tension around the head and neck influences orofacial functions. The data exist concerning head posture during increased salivation; however, little is known about muscle tightness during this process. This study aims to investigate whether or not any muscles are related to problems with eating, such as drooling in individuals with cerebral palsy; (2) Methods: Nineteen patients between the ages of 1 and 14 were examined prior to the physiotherapy intervention. This intervention lasted three months and consisted of: relaxing muscles via the strain-counterstrain technique, functional exercises based on the NeuroDevelopmental Treatment-Bobath method, and functional exercises for eating; (3) Results: the tone of rectus capitis posterior minor muscle on the left side (p = 0.027) and temporalis muscle on the right side (p = 0.048) before the therapy, and scalene muscle on the right side after the therapy (p = 0.024) were correlated with drooling behavior and were considered statistically significant. Gross motor function was not considered statistically significant with the occurrence of drooling behavior (p ≤ 0.05). Following the therapeutic intervention, the frequency of drooling during feeding decreased from 63.16% to 38.89% of the total sample of examined patients; (4) Conclusions: The tightness of the muscles in the head area can cause drooling during feeding.