Witold Tłustochowicz

Publications of Witold Tłustochowicz

• [Pharmacological treatment of recurrent idiopathic anterior uveitis].

  Authors: Jerzy Szaflik, Artur Bachta, Maciej Kulig, Mateusz Tłustochowicz, Andrzej Stankiewicz, Witold Tłustochowicz

  Klinika oczna. 01/2011; 113(4-6):111-6.

  Recurrent anterior uveitis (AU) is an autoimmune disease that in 20% of patients leads to severe visual loss or blindness, thereby a severe disability and significant quality of life impairment. ThatRecurrent anterior uveitis (AU) is an autoimmune disease that in 20% of patients leads to severe visual loss or blindness, thereby a severe disability and significant quality of life impairment. That is why, it is important to conduct a long term treatment after an acute phase of the disease, to keep the remission as long as possible. Up to 50% of patients with recurrent AU have no additional symptoms of systemic disease. This situation, classified as idiopathic AU (IAU), causes a lot of problems when a therapeutic strategy has to be chosen. Nevertheless, IAU is considered to be a first symptom of spondylarthropathy (SpA), even several dozen years prior to other typical manifestations of SpA. There have been published few papers concerning only small groups of patients with IAU, treated with disease modifying anti-rheumatic drugs. The authors present the recommendations for systemic treatment of IAU, based on their own clinical experience, and systematic review of the literature.

• Idiopathic retroperitoneal fibrosis: case report.

  Authors: Bartłomiej Kisiel, Robert Kruszewski, Agnieszka Jurek-Urbanowska, Rafał Kidziński, Emilia Frankowska, Marian Sułek, Małgorzata Tłustochowicz, Romana Bogusławska-Walecka, Witold Tłustochowicz

  Polskie archiwum medycyny wewnȩtrznej. 10/2009; 119(10):677-9.

  A 45-year-old woman was admitted to the hospital because of abdominal pain, fever, and weight loss. Laboratory tests performed on admission revealed raised inflammatory markers. Ultrasonography ofA 45-year-old woman was admitted to the hospital because of abdominal pain, fever, and weight loss. Laboratory tests performed on admission revealed raised inflammatory markers. Ultrasonography of the abdomen showed dilatation of the pyelocalyceal system of the left kidney, while computed tomography showed retroperitoneal concentric periaortic mass extending to common iliac arteries and entrapping the left ureter. We established the diagnosis of idiopathic retroperitoneal fibrosis (RPF). JJ catheter was placed in the left ureter, and treatment with corticosteroids and azathioprine was started. Follow-up examinations showed a gradual improvement, namely a progressive remission of the retroperitoneal mass and normalization of both erythrocyte sedimentation rate and C-reactive protein concentration. Case reports, including our paper, and small case series showed azathioprine to be particularly effective in the treatment of RPF.

• Neurological disorders with demyelinating brain white matter lesions in a patient with rheumatoid arthritis treated with etanercept.

  Authors: Joanna Kur-Zalewska, Justyna Swarowska-Knap, Witold Tłustochowicz

  Polskie archiwum medycyny wewnȩtrznej. 05/2008; 118(4):234-7.

  We present the case of a 37-year-old woman with severe, drug-resistant rheumatoid arthritis. The patient has been previously treated with several disease-modifying anti-rheumatic drugs as well asWe present the case of a 37-year-old woman with severe, drug-resistant rheumatoid arthritis. The patient has been previously treated with several disease-modifying anti-rheumatic drugs as well as infliximab alone and in combination therapy. Despite the treatment, a high disease activity persisted. For this reason, the patient was qualified to etanercept therapy. During the therapy, a gradual joint condition improvement was demonstrated, including arthritis remission. From the fourth month of etanercept administration, neurological disorders such as sight and speech disorders, amentia and muscle weakening were reported. The symptoms aggrevated with therapy continuation. The patient reported her complaints to her leading rheumatologist after 8 months of their duration. Optic fundus and visual area examination, as well as in the neurological examination no significant abnormalities were found. Magnetic resonance imaging of the head demonstrated single, small hyperintensive lesions in the T2w images located in the white matter of the frontal and parietal lobes of the left cerebral hemisphere, which could be identical with demyelization. Based on the clinical and laboratory findings, drug-induced neurological disorders associated with etanercept administration were suspected. After discontinuation of etanercept therapy, the complaints gradually subsided. The amentia episodes, concentration disorders and speech disorders were less frequent. There was no relapse of muscle weakening. Within 6 months of the drug discontinuation, neurological symptoms resolved completely.

• [Efficacy of glucosamine sulfate treatment in patients with osteoarthritis]

  Authors: Anna Dudek, Anna Raczkiewicz-Papierska, Witold Tłustochowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2007; 22(129):204-7.

  Osteoarthritis (OA) is the most common disorder of human movement system. Glucosamine sulfate, which is precursor of glucosamineglycans synthesis, plays a special role among known disease modifyingOsteoarthritis (OA) is the most common disorder of human movement system. Glucosamine sulfate, which is precursor of glucosamineglycans synthesis, plays a special role among known disease modifying drugs. THE AIM OF THE STUDY: To assess the efficacy of treatment of OA patients with glucosamine sulfate (Artreum). MATERIAL AND METHODS: 50 patients with OA of the knees (38 pts) or hips (12 pts) entered into study (41 women, 9 men, aged 50-83 yr.). 47 patients completed the study (39 women, 9 men). All patients have been treated with 500 mg of Arthreum three times daily for 12 weeks. All patients had to complete 3 visits during the study that contains of physical examination, WOMAC questionnaire, Lequesne questionnaire and self pain assessment with visual analog scale (VAS). ESR, morphology, glucose and creatinine concentration, amionotransferases activity were also evaluated. RESULTS: We found the significant improvement during treatment in 38 (80.85%) pts. as measured by WOMAC scale and in 36 (70.60%) as measured by Lequesne'a scale. Self assessed pain improved in 35 (74%) of patients. The efficacy of the treatment was characterized as "good" by 60% of patients, and it was similar to physician assessment (Cohen's kappa coefficient of agreement = 0.9359). No clinically significant adverse events were observed. CONCLUSION: In this study we found that Arthreum treatment causes significant improvement in functional status and pain measured by WOMAC, Lequesne'a and VAS scale in OA patients, and is well tolerated.

• [Amaurosis fugax: case report]

  Authors: Joanna Kur-Zalewska, Mateusz Tłustochowicz, Witold Tłustochowicz

  Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:70-2.

  We describe the case of 27-year-old woman with systemic lupus erythematosus (SLE) and the presence of anticardiolipin antibodies (aCL) IgG isotype in high titre in the plasma, who reported suddenWe describe the case of 27-year-old woman with systemic lupus erythematosus (SLE) and the presence of anticardiolipin antibodies (aCL) IgG isotype in high titre in the plasma, who reported sudden loss of vision in both eyes. We established diagnosis of acute optic neuropathy probably associated with aCL and SLE flare. Treatment with anticoagulation, high dose steroids and intravenous cyclophosphamide was followed by improvement of the visual function.

• [Prevalence of cervical spine inflammatory changes in rheumatoid arthritis patients and the value of neurological examination in their diagnosis]

  Authors: Anna Raczkiewicz-Papierska, Artur Bachta, Ewa Nagańska, Magdalena Zagrodzka, Ewa Skrobowska, Małgorzata Tłustochowicz, Anna Dudek, Witold Tłustochowicz

  Polskie archiwum medycyny wewnȩtrznej. 11/2006; 116(4):938-46.

  The aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurologicalThe aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurological symptoms in rheumatoid arthritis patients. 100 patients (88 female and 12 male) aged 23 to 85 (61.4 +/- 12.9), with the mean disease duration of 12.5 +/- 9.5 years were included in the study. According to radiological examination (lateral and antero-posterior X-ray of the cervical spine) supplemented by MR of the cervical spine or CT of the atlanto-axial joint in suspected cases, 26% of patients had only inflammation, next 15% of patients presented with instability of the atlanto-axial joint and 9% developed basilar invagination of the dens of axis. 18% of patients presented subaxial cervical instability. Neurological examitation was performed by independent neurologist in 99 patients, only 14 presented abnormalities suggesting cervical myelopathy. Two of them showed no patology of the cervical spine. Remaining patients presented: C1/C2 inflammation in 4 cases, anterior atlanto-axial subluxation (AAS) in two cases, basilar invagination in 4 cases and instability with medullary compression on lower cervical levels only--in two cases. There were 4 cases of coexisting C1/C2 changes with medullary compression due to discopathy and (in 3 of them) instability on lower cervical levels. In 6 cases surgical stabilisation was proposed (5 patients with basilar invagination and 1 patient with AAS and myelopathy). There was statistically significant correlation between symptoms (like: paraesthesiae, intermittent problems with hearing and seeing), neurological examination and degree of radiological damage of atlanto-axial joint. The authors concluded that careful medical history and neurological examination can be useful in making decision of further radiological diagnostic procedures of the cervical spine in rheumatoid arthritis.

• [The management of central nervous system involvement in the antiphospholipid syndrome]

  Authors: Joanna Kur-Zalewska, Witold Tłustochowicz, Maciej Rzeski

  Polskie archiwum medycyny wewnȩtrznej. 06/2006; 115(5):471-6.

• [Serological markers of arthritis in patients with chronic viral hepatitis]

  Authors: Anna Dudek, Marek Dudziak, Marian Sułek, Witold Tłustochowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 05/2006; 20(118):404-7.

  Wide range of different autoantibodies (e.g. rheumatoid factor, antinuclear antibodies, smooth muscle antibodies, anticardiolipin antibodies) can be detected in low titres in more than 70% ofWide range of different autoantibodies (e.g. rheumatoid factor, antinuclear antibodies, smooth muscle antibodies, anticardiolipin antibodies) can be detected in low titres in more than 70% of patients with chronic hepatitis. THE AIM OF THE STUDY: Prevalence of serological markers typical for rheumatic diseases in patients with chronic viral hepatitis was examined and the correlation between those markers and serum activity of liver enzymes was evaluated. MATERIAL AND METHODS: 80 patients (30 female and 50 male aged 43.5 +/- 10 years) with chronic viral hepatitis hospitalized in Department of Internal Diseases and Rheumatology of Medical Military Institute in Warsaw were included in the study. 16 of patients were infected with hepatitis virus B, 60 with hepatitis virus C, 4 suffered from both infections. Blood morphology, ESR, CRP aminotransferases activity, protein and bilirubin levels were measured in every patient. Serological examination included levels of antinuclear antibodies (ANA), smooth muscle antibodies (SMA), LKM-1, antineutrophil antibodies (ANCA), anticardiolipin antibodies (aCL), antimitochondrial antibodies (AMA), circulating immunological complexes (CIC), cryoglobulins and rheumatoid factor. RESULTS: At least one serological marker was found in 60 (75%) patients. Latex fixation reaction was positive in 42 (54%), rheumatoid factor was present in 25 (31%), aCL in 28 (34%), pANCA in 22 (27%) and CIC in 16 (20%). Antibodies ANA, AMA, LKM-1 and cryoglobulins were less frequently observed (6%, 5.5% and 7% respectively). The presence of autoantibodies was more frequent in patients with hepatitis C (77% vs. 62%). AMA, LKM-1 and cryoglobulins were detected only in that group of patients. There was no correlation between liver enzymes activity and presence of serological markers of rheumatic diseases. CONCLUSIONS: Serological markers considered to be typical for rheumatic disorders were detected in 75% patients (especially in patients with HCV). There is no correlation between aminotransferases activity and tested serological.

• [Rational therapeutic approach in rheumatoid arthritis]

  Authors: Witold Tłustochowicz

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:5-10.

  The natural course of rheumatoid arthritis inevitably leads to joint damage and reduced life expectancy. Therefore, active treatment of rheumatoid arthritis is indispensable. Although the etiologyThe natural course of rheumatoid arthritis inevitably leads to joint damage and reduced life expectancy. Therefore, active treatment of rheumatoid arthritis is indispensable. Although the etiology still remains unknown resulting in unsuccessful prophylaxis and incurability of rheumatoid arthritis, learning more about its pathophysiology broadens the spectrum of therapeutic possibilities. The aim of treatment is remission of the disease. Current standards of treatment are based on the idea to start aggressive treatment as early as possible to suppress the activity of the disease. This can be achieved by pharmacotherapy and rehabilitation. Physiotherapy is supplementary but there is no room for spa treatment or alternative therapies. Treatment should be introduced immediately because the "window" for successful change in the natural course of the disease covers the first three months since onset. Diagnostic difficulties during this period support the idea of "early arthritis" and "early rheumatoid arthritis". Glycocorticosteroids at a dose suitable to suppress inflammation represent the first-line treatment. Basic therapy which usually is synonymous for methotrexate 15-25 mg once weekly should be introduced from the 4th month at the latest. In case of methotrexate intolerance, leflunomide is an alternative. Lack of efficacy of monotherapy with these drugs mandates the combination therapy of methotrexate with leflunomide, cyclosporine or sulphasalazine together with hydroxychlorochine. The use of two latter drugs should be limited due to their low efficacy. Patients refractory to combination therapy should be considered as candidates to anticytokine drugs or to lymphocyte B depleting drugs. However, it should be emphasized that their high efficacy is achieved only in combination with full doses of methotrexate. The same rules should be applied to therapeutic decisions in elderly patients and in patients with long history of rheumatoid arthritis. However, lower doses of the drugs should be used at initiation of therapy. Contraindications related to side effects and concomitant diseases should be considered. In these groups, glycocorticosteroids play a more important role and cyclophosphamide is used more frequently. Surgical treatment should be reserved for patients with advanced disease. Total joint replacement is an effective method for large joints. Synovectomy should be done only exceptionally when all options of pharmacotherapy were ineffective.

• [Magnetic resonance imaging of the hand in rheumatoid arthritis]

  Authors: Renata Andrysiak, Anna Ciechomska, Leszek Królicki, Witold Tłustochowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 02/2004; 16(91):64-9.

  The aim of the study was to show the magnetic resonance (MR) images of changes in hands of patients with rheumatoid arthritis (RA). The SE sequence T1-weighted (TR600, TE15) and fat-suppressedThe aim of the study was to show the magnetic resonance (MR) images of changes in hands of patients with rheumatoid arthritis (RA). The SE sequence T1-weighted (TR600, TE15) and fat-suppressed (A-250, TR1155, TE22) were obtained with 3 mm coronal scans and matrix 256 x 512, both before and after contrast medium administration. Knee coil was used. The images in both sequences of the following changes were obtained: bone erosions, synovitis, periarticular oedema, joint effusion, tendonitis and bone marrow oedema. The administration of intravenous contrast was found very useful. Changes of the joint synovium in osteoarthritis were characterised to differentiate them from changes due to RA. The authors suggest that MR imaging--because of its exceptional diagnostic value--may become a basic imaging method in evaluation of patients with RA.

• [Ultrasonography of the hand in rheumatoid arthritis]

  Authors: Małgorzata Serafin-Król, Anna Ciechomska, Witold Tłustochowicz, Wiesław Jakubowski, Marian Cholewa

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2003; 15(89):491-4.

  Authors present the ability of ultrasonography and Color and power Doppler sonography in evaluation of the hand structures in patients with rheumatoid arthritis. Imaging of bony contours allows toAuthors present the ability of ultrasonography and Color and power Doppler sonography in evaluation of the hand structures in patients with rheumatoid arthritis. Imaging of bony contours allows to identify bone erosions. Thickness, oedema and presence of increased blood flow (hyperaemia) in the synovium in joints and tendon sheaths are characteristic features of an active inflammation. Changes of the tendon structure indicate its damage. US allows to image the carpal tunnel structures, to visualise changes of the median nerve in the carpal tunnel syndrome and gives possibilities to find the cause of its compression.

• [Left ventricular function in rheumatoid arthritis patients]

  Authors: Grzegorz Kamiński, Marian Cholewa, Witold Tłustochowicz, Andrzej Cwetsch, Andrzej Skrobowski, Mirosław Dziuk

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 05/2003; 14(82):331-5.

  BACKGROUND: The disproportion between the absence of clinical manifestations of circulatory system involvement and serious lesions in the heart found on post mortem examinations, more frequentlyBACKGROUND: The disproportion between the absence of clinical manifestations of circulatory system involvement and serious lesions in the heart found on post mortem examinations, more frequently diagnosed congestive circulatory failure and also higher mortality rate of patients with rheumatoid arthritis (RA), encouraged the authors to study the subject. THE AIM OF THE STUDY WAS: Echocardiographic assessment of the effect of rheumatoid process on left ventricular structure, and systolic and diastolic function in patients with RA without clinically overt features of heart disease. METHODS: The study was conducted in 50 patients with RA diagnosed on the basis of the ACR criteria and in 50 persons matched with the patients with respect to age, gender, body area and body mass index, heart rate and arterial pressure. Persons with manifestations and/or history of cardiovascular diseases were excluded from the study. RESULTS: The authors found that: in RA, the involvement of the myocardium by the pathological process was manifested as increased wall thickness, increased mass and mass index of the left ventricle with impairment of its diastolic function and normal systolic function. With progressing rheumatoid process, left ventricular systolic function impairment was observed. Left ventricular diastolic dysfunction in the course of rheumatoid arthritis usually was not manifested clinically.