Jerzy Swierkot

Publications of Jerzy Swierkot

• [Practical comments on the use of immunoglobulins].

  Authors: Aleksandra Lewandowicz-Uszyńska, Jerzy Swierkot

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 06/2011; 30(180):448-51.

  The paper contains basic information relating to treatment with immunoglobulin. Presented indications for their use, among others: primary immunodeficiency, Kawasaki disease, Guillain-Barre syndrome,The paper contains basic information relating to treatment with immunoglobulin. Presented indications for their use, among others: primary immunodeficiency, Kawasaki disease, Guillain-Barre syndrome, chronic lymphocytic leukemia, primary thrombocytopenia. The factors to consider when choosing a preparation: the content of IgG, IgA, method of administration (intravenous or subcutaneous). The most frequent side effects, depending on the organ localization. Presented at risk (obesity, diabetes, renal failure, hypovolemia) in which these symptoms may occur especially frequently, which should be taken into account in the conduct of therapy (adequate hydration, low-dose, slow infusion).

• [The role of intravenous immunoglobulin in the treatment of rheumatic diseases in adults].

  Authors: Jerzy Swierkot, Aleksandra Lewandowicz-Uszyńska

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 06/2011; 30(180):435-40.

  Intravenous immunoglobulin (IVIG) preparations have been used as substitutional treatment in hypogammaglobulinemia for a long time. IVIG has now become an important treatment option in a number ofIntravenous immunoglobulin (IVIG) preparations have been used as substitutional treatment in hypogammaglobulinemia for a long time. IVIG has now become an important treatment option in a number of clinical indications including autoimmune and acute inflammatory conditions. The mechanism of action is complex and not fully understood. The role of IVIG in many rheumatic diseases remain unclear and controversial because there are no randomized studies to support the use of IVIG. In 2006 the Department of Health in the UK started a process to review the use of immunoglobulin in various clinical indications and in 2008 the clinical guidelines for immunoglobulin use were published. Despite the introduction of newer biologic treatments IVIG could be a good treatment options in same patients with rheumatic diseases. Frequently they are used as second-line drugs after failure of therapy with corticosteroids and immunosuppressive drugs. As a first-line drugs in addition to Kawasaki disease the use of IVIG can be considered in the treatment of systemic connective tissue diseases when there are contraindications to the use of corticosteroids or immunosuppressive drugs, there are associated infections (including tuberculosis) and in pregnant women.

• [The meaning of biologic therapy in the treatment of rheumatoid arthritis with the focus on clinical remission. Part II. Tocilizumab, Abatacept, Rituximab--drugs characterised by a different mechanism of action than TNF-alpha inhibitors].

  Authors: Jerzy Swierkot, Marta Madej

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2011; 30(178):289-94.

  Current aims of management of rheumatoid arthritis (RA) patients are remission of the disease, or at least, achievement of its low activity. Early diagnosis of RA is highly important, allowingCurrent aims of management of rheumatoid arthritis (RA) patients are remission of the disease, or at least, achievement of its low activity. Early diagnosis of RA is highly important, allowing immediate start of therapy with classic disease modifying anti-rheumatic drugs (DMARDs). However, that kind of therapy does not guarantee achievement of therapeutic goals in all patients. In case of failure, introduction of biological drugs is necessary Despite a significant progress noted in RA therapy since introduction of tumour necrosis factor alpha (TNF-alpha) inhibitors several years ago, also that scheme failed to be effective in all cases of RA. New biological drugs characterised by a different mechanism of action than TNF-alpha inhibitors: Tocilizumab, Rituximab and Abatacept, are hope for non-responders to previous therapies.

• [The meaning of biologic therapy in the treatment of rheumatoid arthritis with the focus on clinical remission. Part I. Tumor necrosis factor alpha inhibitors].

  Authors: Jerzy Swierkot, Marta Madej

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2011; 30(178):283-8.

  Aims of management of rheumatoid arthritis (RA) patients are not only a delay in progression of the disease and improvement of motor function, but also inhibition of progress of joint damage andAims of management of rheumatoid arthritis (RA) patients are not only a delay in progression of the disease and improvement of motor function, but also inhibition of progress of joint damage and achievement of remission. Early RA diagnosis is important, allowing introduction of active therapy as early as possible. Immediate treatment with disease modifying anti-rheumatic drugs (DMARDs) is necessary. In case DMARDs fail to evoke an adequate therapeutic response, introduction of biological drugs should be considered. Failure to achieve remission in case of many patients treated with classic DMARDs was a stimulus for intensive research on new drugs. Introduction of tumour necrosis factor alpha (TNF-alpha) inhibitors to therapy of RA 15 years ago caused a significant progress in management of the disease. Five TNF-alpha inhibitors are currently authorised (Infliximab, Etanercept, Adalimumab, Certolizumab and Golimumab) for RA treatment. Numerous clinical trials and observational programs proved higher efficacy of a combination therapy consisting of MTX and a TNF-alpha inhibitor in terms of RA remission. That applies mainly to patients burdened with risk factors of fast progression of the disease.

• [The importance of pharmacogenetic tests in evaluation of the effectiveness of methotrexate treatment in rheumatoid arthritis (part 2)].

  Authors: Jerzy Swierkot, Ryszard Slęzak

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2011; 65:207-15.

  Much hope is currently associated with individualization of therapy provided to rheumatoid arthritis (RA) patients. The search is underway for biochemical and clinical markers that would be useful inMuch hope is currently associated with individualization of therapy provided to rheumatoid arthritis (RA) patients. The search is underway for biochemical and clinical markers that would be useful in prediction of a good response to methotrexate (MTX) therapy. Along with clinical factors, genetic predisposition may also be helpful. Polymorphism of genes participating in MTX metabolism may affect the drug’s efficacy and the rate of adverse effects. Pharmacogenetic studies may contribute to more effective individualization of therapy for RA patients. The purpose of the study was to determine the significance of gene polymorphisms MTHFR C677T and A1298C for efficacy of MTX therapy in RA patients. Patients possessing determined polymorphisms should be particularly carefully evaluated because of a higher risk of occurrence of adverse effects.

• [The importance of pharmacogenetic tests in evaluation of the effectiveness of methotrexate treatment in rheumatoid arthritis (part 1)].

  Authors: Jerzy Swierkot, Ryszard Slęzak

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2011; 65:195-206.

  Methotrexate (MTX) is still the gold standard in the treatment of rheumatoid arthritis and is used worldwide in more than 0.5 million patients with RA. Much hope is currently associated with theMethotrexate (MTX) is still the gold standard in the treatment of rheumatoid arthritis and is used worldwide in more than 0.5 million patients with RA. Much hope is currently associated with the individualization of therapy provided to RA patients. The search is underway for biochemical and clinical markers that would be useful in predicting good response to MTX therapy. Along with clinical factors, genetic predisposition may also be helpful. Polymorphism of genes participating in MTX metabolism may affect the drug’s efficacy and the rate of adverse effects. Pharmacogenetic studies may contribute to more effective individualization of therapy for RA patients. There are many potential enzymes and transport proteins present in polymorphic forms, which are involved in transport of MTX into the cell, its metabolism and elimination from the cell. There is a chance that in the future through individualized therapy we will be able to customize therapy (type of drug, dose, route of administration) to the molecular subtype of the disease and the genotype of the patient. Patients with a specific type of polymorphism would require more frequent monitoring of the efficacy and safety of treatment. Note, however, that genetic predisposition is only one of the factors contributing to differences in pharmacotherapy in individual patients.

• [The role of Th1, Th17, and Treg cells in the pathogenesis of rheumatoid arthritis including anti-inflammatory action of Th1 cytokines].

  Authors: Agata Kosmaczewska, Jerzy Swierkot, Lidia Ciszak, Piotr Wiland

  Postȩpy higieny i medycyny doświadczalnej (Online). 01/2011; 65:397-403.

  Dysregulation in the immune system plays an important role in the pathogenesis of rheumatoid arthritis (RA). The persistent nature of arthritis strengthens the suggestion of immune dysfunction,Dysregulation in the immune system plays an important role in the pathogenesis of rheumatoid arthritis (RA). The persistent nature of arthritis strengthens the suggestion of immune dysfunction, consisting in predominance of the pro-inflammatory response. It seems that both local and systemic immune abnormalities, including PBMC secreting abnormal levels of pro- and anti-inflammatory cytokines, may be involved in the evolution of the disease. Helper T cells (Th) differentiate towards Th1, Th2, Th17, and Treg cells according to the cytokine microenvironment. Active RA results from the imbalance in distribution of functional pro-inflammatory Th17 and anti-inflammatory Treg cells. Affected Th1 cytokine secretion observed in the course of RA contributes to the increase in IL-17 production and Th17 infiltration in the synovial tissue. Current studies have demonstrated that pro-inflammatory Th1 cytokines may also exert an anti-inflammatory action on the balance between Th17 and Treg cells by promotion of Treg differentiation. In the paper, we also show the influence of TNF-alpha and its inhibitors on the distribution of Th subpopulations in RA patients.

• [Rheumatic disorders in diabetes mellitus]

  Authors: Jerzy Swierkot, Katarzyna Gruszecka-Marczyńska, Dariusz Sowiński, Jacek Szechiński

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2006; 19(114):843-7.

  Diabetes mellitus affects the connective tissue in a variety of ways and so we observe a variety of alterations in the locomotor system including neuroarthropathy, hyperostosis, osteoporosis,Diabetes mellitus affects the connective tissue in a variety of ways and so we observe a variety of alterations in the locomotor system including neuroarthropathy, hyperostosis, osteoporosis, cheiroarthropathy, limited joint mobility, muscular infarctions. The locomotor problems in diabetes may be considered articular, skeletal and soft-tissue lesions. Although some syndromes are observed exclusively in patients with diabetes, the majority of the rheumatic diseases found in patients with diabetes are also seen in the non-diabetes population, albeit at a much lower prevalence. Recent date show that more then 30% of patients with 1 or type 2 diabetes have some rheumatic manifestation. Some of the relations have known pathogenic mechanism, but most are based on epidemiologic findings. Some are the consequence of diabetic complications, others probably share pathogenic mechanisms with microvascular disease. There are also some disorders whose association with diabetes is not yet well established. The musculoskeletal complications of diabetes appear particularly when the disease is poorly controlled. Although the cardiovascular, renal and ocular complications of diabetes are the most severe, why shouldn't forgot about rheumatic syndromes.

• [Lupus erythematosus or human immunodeficiency virus infection? Diagnostic problems in rheumatologic practice--two case reports]

  Authors: Beata Nowak, Jerzy Swierkot, Jacek Szechiński

  Polskie archiwum medycyny wewnȩtrznej. 12/2005; 114(5):1098-102.

  It may bring a lot of diagnostic difficulties to differenciate the systemic lupus erythematosus (SLE) and the infection with human immunodeficiency virus (HIV), since there are many multiorganIt may bring a lot of diagnostic difficulties to differenciate the systemic lupus erythematosus (SLE) and the infection with human immunodeficiency virus (HIV), since there are many multiorgan symptoms that are common for both of these diseases. Two case reports of patients with lupus-like syndrome, being the first manifestation of HIV infection, are described in this article. The aim of the article is to stress the importance of a very careful differentiating of SLE and HIV infection.

• [Behçet's disease--difficulty in diagnostic and management]

  Authors: Jerzy Swierkot, Krzysztof Borysewicz, Jacek Szechiński

  Polskie archiwum medycyny wewnȩtrznej. 07/2005; 113(6):580-4.

  We present a 31-year-old female patient with Behçet's disease. Behcet's disease is a systematic vasculitis of unknown cause involving veins and arteries of all sizes and having reccurentWe present a 31-year-old female patient with Behçet's disease. Behcet's disease is a systematic vasculitis of unknown cause involving veins and arteries of all sizes and having reccurent mucocutaneous and frequent ocular involvement. Our patient was suffering from oral and genital ulcers, fever, painful left knee and erythema nodosum. After having excluded differential diagnoses Behçet's disease was diagnosed. The treatment must be individual and it depends on the presence and severity of symptoms. The optimal improvement was observed after treatment with azathioprine, cyclosporine A and metylprednisolon. Behçet's disease is very seldom in our country but perhaps sometimes it isn't good diagnosed.

• [The arthritic pathologies accompanying primary immunodeficiencies with antibody synthesis disturbances]

  Authors: Jerzy Swierkot, Aleksandra Lewandowicz-Uszyńska, Adam Jankowski, Jacek Szechiński

  Postȩpy higieny i medycyny doświadczalnej (Online). 06/2005; 59:219-23.

  The problem of arthritis in patients with primary antibody defects is presented in this study. We describe the most common kinds of arthritis (septic, viral, and aseptic), their etiology andThe problem of arthritis in patients with primary antibody defects is presented in this study. We describe the most common kinds of arthritis (septic, viral, and aseptic), their etiology and treatment. Other diseases characterized by a lack of immunoglobulin are also shown. The most common diseases in primary hypogammaglobulinemia, especially autoimmune disorders, are dealt with. Many disease-modifying drugs (gold, D-penicillamine, sulfasalazine, azathioprine) cause symptomatic hypogammaglobulinemia in some patients. We emphasize the role of intravenous immunoglobulin replacement therapy in the reduction of the arthritis. The possibility of immunodeficiency should be kept in mind when evaluating patients with arthritis.

• [Systemic lupus erythematosus and human immunodeficiency virus infection]

  Authors: Jerzy Swierkot, Beata Nowak, Jacek Szechiński

  Postȩpy higieny i medycyny doświadczalnej (Online). 02/2005; 59:433-40.

  As a consequence of the increasing number of people infected with human immunodeficiency virus (HIV), also among rheumatology patients, it has become very important to investigate associationsAs a consequence of the increasing number of people infected with human immunodeficiency virus (HIV), also among rheumatology patients, it has become very important to investigate associations between retroviral infection and autoimmunologic diseases, such as systemic lupus erythematosus (SLE). The aim of the article is to present current knowledge about the coincidence of SLE and HIV infection and to point out possible ways to differentiate these disorders.

• [Renal tubular dysfunction in patients with rheumatoid arthritis starting with low dose of methotrexate]

  Authors: Piotr Wiland, Anna Wiela-Hojeńska, Jerzy Swierkot, Magdalena Hurkacz, Krystyna Orzechowska-Juzwenko, Jacek Szechiński

  Polskie archiwum medycyny wewnȩtrznej. 09/2003; 110(2):855-62.

  BACKGROUND: The elevation of N-acetyl-beta-D-glucosaminidase (NAG) in urine has been shown to be associated with reversible renal tubular damage. OBJECTIVES: The aim of the study was to examine theBACKGROUND: The elevation of N-acetyl-beta-D-glucosaminidase (NAG) in urine has been shown to be associated with reversible renal tubular damage. OBJECTIVES: The aim of the study was to examine the effect of first oral low dose methotrexate (MTX) on urinary excretion of NAG comparing with MTX concentration in serum and urine in a cohort of patients with rheumatoid arthritis (RA). METHODS: Urinary NAG to urinary creatinine ratio (NAG index) determined in 43 patients (5 males, 38 females) with RA who started taking the first oral dose of 10 mg of MTX. Urinary NAG index was observed at 24 h and 48 h after the first MTX dose. MTX concentration was measured in blood at 90 minutes and in blood and urine at 24 h after the drug administration. RESULTS: NAG-enzymuria was increased in 72.1% of the patients before administration of MTX therapy (10.8 UI/g creatinine). There was no change in NAG index at 24 and 48 h after first dose of MTX (9.1 and 10.7 UI/g of creatinine). No differences of NAG-enzymuria in non-steroidal anti-inflammatory drug (NSAID)-treated patients and NSAID-free patients before and after MTX administration were revealed. The patients with decreased creatinine clearance had before treatment higher NAG index than those with normal creatinine clearance but there was not any significant increase of NAG activity after first dose of MTX in the patients with decreased creatinine clearance. Continued treatment with MTX resulted in a decrease in NAG activity accompanied by serum C-reactive protein concentration. CONCLUSION: The use of low dose MTX with or without NSAIDs does not influence the renal tubular function in patients with RA.

• [The role of diagnostic tests in the identification of Chlamydia trachomatis infection in reactive arthritis]

  Authors: Jerzy Swierkot, Irena Choroszy-Król, Katarzyna Marczyńska-Gruszecka, Dorota Teryks-Wołyniec, Joanna Czepułkowska, Jacek Szechiński

  Polskie archiwum medycyny wewnȩtrznej. 08/2003; 110(1):711-8.

  Reactive arthritis (ReA) is a sterile inflammation of the synovial membrane of one or more joints developing after urogenital or gastro-intestinal infection. The syndrome most frequently followsReactive arthritis (ReA) is a sterile inflammation of the synovial membrane of one or more joints developing after urogenital or gastro-intestinal infection. The syndrome most frequently follows infection with Chlamydia trachomatis. Useful for the diagnosis can be the serological tests. At present there is the possibility to identify the specific antibodies (IgG, IgA, IgM) to Chlamydia trachomatis. The subject of the study was the group of 87 patients in age 19-78; 58 women and 29 men from whom urogenital smear and serum were tested. The control group were 30 people age 25-70 without rheumatological disorders. Chlamydia trachomatis was found in urogenital smear in 42 (48%), in 56 (64%) patients immunoglobulin IgG were positive, and immunoglobulin IgA in 16 (18%). The laboratory tests and clinical symptoms allow to make a diagnosis of ReA in 38 (43%) and possible ReA in 5 (5.7%) of patients. CONCLUSIONS: 1. There is no gold standard for the diagnosis of ReA. 2. None of the tests or the clinical symptoms alone are strong enough to make a definite diagnosis of ReA. 3. Tests to identify Chlamydia trachomatis, with respect of typical clinical symptoms are useful the diagnosis of ReA. 4. The diagnosis of ReA is most probable if we have typical clinical symptoms, clinical evidence of a preceding infection plus a positive result of serology or PCR plus positivity for HLA-B27.

• [Diagnostic and therapeutic problems in SARA syndrome (sexually acquired reactive arthritis) particularly considering the role of Chlamydia trachomatis]

  Authors: Jerzy Swierkot, Katarzyna Marczyńska-Gruszecka, Jacek Szechiński

  Postȩpy higieny i medycyny doświadczalnej. 02/2003; 57(2):171-84.

  Reactive arthritis triggered by a sexually transmitted infection is referred to as sexually acquired reactive arthritis (SARA). There is no gold standard for the diagnosis of SARA. None of the testsReactive arthritis triggered by a sexually transmitted infection is referred to as sexually acquired reactive arthritis (SARA). There is no gold standard for the diagnosis of SARA. None of the tests or the clinical symptoms alone are strong enough to make a definite diagnosis of SARA. Tests to identify Chlamydia trachomatis, when respect typical clinical symptoms are helpful to make the diagnosis of ReA.

• [Can non-steroidal anti-inflammatory drugs be improved?]

  Authors: Jerzy Swierkot

  Neurologia i neurochirurgia polska. 39(4):345-50.

• Methotrexate in rheumatoid arthritis.

  Authors: Jerzy Swierkot, Jacek Szechiński

  Pharmacological reports : PR. 58(4):473-92.

  A variety of disease-modifying antirheumatic drugs (DMARDs) are available to control the clinical activity of rheumatoid arthritis (RA). Methotrexate (MTX), an analogue of folic acid and ofA variety of disease-modifying antirheumatic drugs (DMARDs) are available to control the clinical activity of rheumatoid arthritis (RA). Methotrexate (MTX), an analogue of folic acid and of aminopterin, is the most commonly used DMARD and is now prescribed worldwide to at least 500,000 patients with RA. The mechanism by which MTX used at a low dose modulates inflammation in RA is still unknown. Monitoring of the therapy in terms of MTX concentration in patients with RA seems not to have a significant influence on the effectiveness of the treatment. Two meta-analyses showed that MTX has one of the best efficacy/toxicity ratios. It should be the first DMARD used in the majority of patients with RA at this time. However, a significant number of patients treated only with MTX fail to achieve optimal disease control, so there are many combinations of DMARD regimes. It is hoped that more aggressive use of conventional DMARDs and biological agents will result in less disability and a higher proportion of patients achieving remission. The therapy of RA is a dynamic process and requires maintaining a delicate balance between benefits and risks. Even with the newer biological agents, MTX continues to serve as a reference point and there is still a role for MTX in the treatment of RA patients.