Anja Ljilja Posavec

We present a case report of a new-onset seropositive rheumatoid arthritis in a 60-year-old patient, occurring six weeks after SARS-CoV-2 infection. The patient had pain and swelling of several joints with positive rheumatoid factor and anti-citrullinated protein antibodies.

. Background: Some of the hospitalized patients after severe COVID-19 pneumonia experience persistent radiological pulmonary sequelae, respiratory symptoms, and decreased lung function despite optimal treatment according to the guidelines. Because of immune dysregulation in COVID-19 there are indications that prolonged corticosteroids could be considered in treating patients for persistent radiological sequelae and respiratory symptoms. Objectives: to investigate lung function and lung sequelae on high-resolution CT (HRCT) in COVID-19 patients who were treated with glucocorticoid therapy in two dose regimens with a control group of patients who did not receive additional glucocorticoid therapy. Methods: In this prospective cohort research patients discharged from the hospital after being hospitalized because of severe COVID-19 pneumonia received corticosteroid therapy in two dose regimens: for 14 days and for 3 months. The control group of patients did not receive additional corticosteroid therapy. Lung function, post-COVID-19 symptoms, and lung abnormalities on HRCT scans were analyzed in three months follow-up. Results: Patients who received prolonged corticosteroid therapy for three months did not have better HRCT findings of lung abnormalities, lung function, or symptoms recovery in comparison to the patients with 14 days of therapy and the control group of patients. Onwards, the control group had significantly fewer dyspnea symptoms (Chi-square test, p=0,04) and higher DLCO (Kruskal Wallis test, p=0,03). Conclusions: Supplementary corticosteroid therapy for patients after severe COVID-19 pneumonia with lung abnormalities did not improve lung function, symptoms or lung lesions on CT.

Objectives: The primary aim of this study was to improve the diagnosis of lymphocytic pleural effusions (LPEs) by combining their ultrasound characteristics with their macroscopic and biochemical features. Methods: This prospective, single-center, clinical observational study was conducted over a period of three years. The possible malignant etiology of LPEs was assessed using several diagnostic criteria: 1. ultrasound characteristics of the LPEs; 2. typical combinations of macroscopic and ultrasound features; and 3. the logistic regression method with three parameters—pleural nodularity, absence of fibrin, and serum protein concentration. Results: Eighty-four patients with LPEs were included in this study. Pleural nodularity (first criterion) was an ultrasound characteristic that yielded the best individual results (p < 0.001) in the differentiation of malignant and nonmalignant etiologies of LPEs (accuracy 73.81%). The combination of the second and third criteria yielded the best results in the prediction of a malignant etiology of LPEs (sensitivity 90.48%, specificity 83.33%, PPV 84.44%, NPV 89.74%, accuracy 86.90%). Based on the results of this prospective study, a protocol for the diagnostic procedure of lymphocytic pleural effusions without a definitive fluid diagnosis has been proposed. Conclusions: A combination of the ultrasound characteristics of LPEs and their macroscopic and biochemical features has improved the predictive accuracy for the malignant etiology of LPEs.

The diaphragm is the most important muscle in respiration. Nevertheless, its function is rarely evaluated. Patients with systemic sclerosis (SSc) could be at risk of diaphragmatic dysfunction because of multiple factors. These patients often develop interstitial lung disease (SSc-ILD) and earlier studies have indicated that patients with different ILDs have decreased diaphragmatic mobility on ultrasound (US). This study aimed to evaluate diaphragmatic function in SSc patients using US with regard to the ILD, evaluated with the Warrick score on high-resolution computed tomography (HRCT), and to investigate associations between ultrasonic parameters and dyspnea, lung function, and other important clinical parameters. In this cross-sectional study, we analyzed diaphragm mobility, thickness, lung function, HRCT findings, Modified Medical Research Council (mMRC) dyspnea scale, modified Rodnan skin score (mRSS), autoantibodies, and esophageal diameters on HRCT in patients with SSc. Fifty patients were enrolled in the study. Patients with SSc-ILD had lower diaphragmatic mobility in deep breathing than patients without ILD. The results demonstrated negative correlations between diaphragmatic mobility and mMRC, mRSS, anti-Scl-70 antibodies, esophageal diameters on HRCT, and a positive correlation with lung function. Patients with SSc who experience dyspnea should be evaluated for diaphragmatic dysfunction for accurate symptom phenotyping and personalized pulmonary rehabilitation treatment.

Background: Pleural irregularity visualized by ultrasound has a higher specificity for interstitial lung disease (ILD) than B lines. It is manifested as a loss of the normal hyperechoic pleural contour. Diaphragm mobility has not been studied so far in patients with systemic sclerosis (SSc). Patients may have reduced diaphragm function due to ILD, disuse atrophy, malnutrition, corticosteroid therapy, etc. Aims and objectives: To investigate whether pleural irregularity is associated with diaphragm mobility in patients with SSc. Methods: In this cross sectional multicentric research participated 50 patients with systemic sclerosis. The patients underwent an ultrasound of the pleura. The mobility of the right diaphragm was measured in M mode with convex probe. We applied reference values for diaphragm mobility in deep breathing according to Boussuges et al. (1). Results: In patients with reduced mobility of the diaphragm in deep breathing, regression analysis pointed that irregular pleura on ultrasound was an independent factor predicting reduced diaphragm mobility (OR=40.0, 95% CI: 1.98 to 807.1). Conclusion: According to the results, irregular pleura on ultrasound is independent factor that predicts reduced mobility of the diaphragm in deep breathing among the patients with SSc. Literature: 1. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391-400.

Background: Systemic sclerosis can affect multiple organs. Diaphragm function has not been evaluated in this group of patients so far. Diaphragm dysfunction is often unrecognized due to a lack of available diagnostic tests. Aims and objectives: This study aimed to evaluate the mobility of the diaphragm in respiration measured by ultrasound in patients with systemic sclerosis (SSc) compared to known values for healthy subjects. In a study from Boussuges,A. et al.Chest 2009;135:391-400 on 200 healthy subjects lower values of normal diaphragm mobility on the right side were 3.6cm for women and 4.7cm for men during deep breathing and 1cm for women and 1,1cm for men in quiet breathing. Methods: In this multicentric cross-sectional study ultrasonic parameters of diaphragm mobility in deep and quiet breathing on the right side as well as mMRC scale, spirometry and diffusing capacity for carbon monoxide (DLCO) were analyzed in patients with SSc. Differences in observed values in relation to diaphragm mobility were compared. Results: A total of 50 patients were included. Ten patients (20%) had lower diaphragm mobility in deep breathing and 6 (12%) patients had lower diaphragm mobility in quiet breathing. Patients with lower values of diaphragm mobility in deep breathing had lower values of DLCO (Mann Whitney U test; p= 0.01), alveolar volume (p= 0.007), higher mMRC score (p=0,02), and lower height (p=0.009). Conclusion: Patients with SSc are at increased risk for diaphragm dysfunction. Patients with lower diaphragm mobility in deep breathing had lower values of DLCO and more pronounced dyspnea (mMRC) score. Ultrasound of the diaphragm is a useful test for diaphragmatic dysfunction and should be considered in patients with SSc with dyspnea.

Background: Some patients after severe COVID-19 pneumonia (B.1.1.7 variant SARS-CoV-2) experienced prolongled oxygen desaturation. According to some studies corticosteroids could be considered for treatment of persistent radiological sequelae and respiratory symptoms. Aims and objectives: to investigate lung function, symptoms, and lung sequelae on CT in patients treated with corticosteroid therapy in two dose regimens with control group of patients without additional corticosteroid therapy. Methods: Study included 93 patients who were hospitalized for severe pneumonia with prolonged respiratory insufficiency (for 20 days from the symptoms onset). Group I (N 30) received prednisone 40 mg with dose tapering for 14 days after discharge from the hospital, group II (N 40) received prednisone 40 mg for 3 months with dose tapering, and control group consisted of 19 patients who did not receive additional therapy. Lung function (FVC, FEV1, DLCO, KCO, TLC), symptoms, and lung abnormalities were scored in three months follow-up. Consolidations, crazy paving, ground glass opacities, and residual fibrotic-like abnormalities were evaluated on CT. Results: Patients who received corticosteroid therapy for three months did not have better CT findings, lung function, or dyspnea symptoms in comparison to the patients treated with 14 days of therapy or with control group of patients. Onwards, control group had significantly fewer dyspnea symptoms (Chi-square test, p=0,04) and higher DLCO (Kruskal Wallis test, p=0,03). Conclusions: Prolonged corticosteroid therapy did not have positive impact on lung function, dyspnea symptoms or lung sequelae on CT.

Ultrazvuk dijafragme dijagnostička je metoda kojom se može utvrditi dijafragmalna disfunkcija ili paraliza. Dijafragmalna disfunkcija može uzrokovati otežano disanje i intoleranciju napora. Rijetko se utvrđuje u kliničkoj praksi te prava incidencija...

Rheumatoid arthritis (RA) is among the most prevalent and debilitating autoimmune inflammatory chronic diseases. Although it is primarily characterized by destructive peripheral arthritis, it is a systemic disease, and RA-related extraarticular manifestations (EAMs) can affect almost every organ, exhibit a multitude of clinical presentations, and can even be asymptomatic. Importantly, EAMs largely contribute to the quality of life and mortality of RA patients, particularly substantially increased risk of cardiovascular disease (CVD) which is the leading cause of death in RA patients. In spite of known risk factors related to EAM development, a more in-depth understanding of its pathophysiology is lacking. Improved knowledge of EAMs and their comparison to the pathogenesis of arthritis in RA could lead to a better understanding of RA inflammation overall and its initial phases. Taking into account that RA is a disorder that has many faces and that each person experiences it and responds to treatments differently, gaining a better understanding of the connections between the joint and extra-joint manifestations could help to create new treatments and improve the overall approach to the patient.