Lidia Ostanek

Publications of Lidia Ostanek

• The distribution of human endogenous retrovirus K-113 in health and autoimmune diseases in Poland.

  Authors: Maja Krzysztalowska-Wawrzyniak, Magdalena Ostanek, Jeremy Clark, Agnieszka Binczak-Kuleta, Lidia Ostanek, Mariusz Kaczmarczyk, Beata Loniewska, Lucjan S Wyrwicz, Marek Brzosko, Andrzej Ciechanowicz

  Rheumatology (Oxford, England). 02/2011; 50(7):1310-4.

  During the evolution of the human genome, a number of retroviral integrations have occurred creating a group of human endogenous retroviruses (HERVs). As of now several studies have pointed to theDuring the evolution of the human genome, a number of retroviral integrations have occurred creating a group of human endogenous retroviruses (HERVs). As of now several studies have pointed to the association of HERVs with certain autoimmune diseases such as RA, SLE, multiple sclerosis (MS) and SS as well as various neoplasms. In this study, we investigated the prevalence of HERV-K113 in patients with RA, SLE and in healthy subjects in the Polish population. Genomic DNA samples from 155 RA patients, 139 SLE patients and 261 newborns (as controls) were tested for the presence of the HERV-K113 allele using PCR. Each individual's DNA was genotyped for null, homozygous or heterozygous insertion of HERV-K113. Our data revealed statistically significant differences in the insertion frequencies of HERV-K113 between the groups of RA and SLE patients vs healthy controls (provirus DNA was found in 14.19, 15.11 and 8.05% of individuals, respectively). No homozygous individuals for the K113 allele were found in each of the groups. There was no evidence for HERV-K113 association with clinical features in either group. Our study-the first such performed for the Polish population-provides a consistent observation with previous reports on the genetic association of HERV-K113 integrations in autoimmune disorders. Here, we found that the prevalence of insertionally polymorphic HERV-K113 was significantly increased in Polish patients with SLE and RA.

• [Adverse effects of cyclosporin a observed in rheumatoid arthritis and psoriatic arthritis].

  Authors: Krzysztof Prajs, Jacek Fliciński, Hanna Przepiera-Bedzak, Iwona Brzosko, Lidia Ostanek

  Annales Academiae Medicae Stetinensis. 01/2010; 56 Suppl 1:48-51.

  INTRODUCTION: Rheumatoid arthritis (RA) and psoriatic arthritis (PA) represent diseases which often demand aggressive therapy in order to control the process and inhibit lesion formation in jointsINTRODUCTION: Rheumatoid arthritis (RA) and psoriatic arthritis (PA) represent diseases which often demand aggressive therapy in order to control the process and inhibit lesion formation in joints and organs. This kind of therapy can be achieved with cyclosporin A (CsA), particularly when combined with methotrexate (MTX). This combination is far more effective than single-drug therapy and is capable of significantly reducing the number of articular lesions. Considering the fact that monotherapy is associated with many adverse effects, it is feared that both drugs in combination may produce cumulative toxicity. The aim of this work was to determine the frequency of adverse effects caused by CsA in patients treated for RA and PA at the Outpatient Rheumatology Clinic of the First Public Hospital in Szczecin. MATERIAL AND METHODS: Our study group consisted of 61 patients, including 47 with RA--35 females, mean age 51 yrs (range: 21-69 yrs), mean disease duration 9.9 yrs (range: 2-23 yrs); 12 males, mean age 51.8 yrs (range: 33-74 yrs), mean disease duration 8 yrs (range: 3-14 yrs) and 14 with PA--6 females, mean age 41.1 yrs (range: 33-55 yrs), mean disease duration 7.8 yrs (range: 2-16 yrs); 8 males, mean age 42.9 yrs (range: 35-50 yrs), mean disease duration 7.0 yrs (range: 0.5-21 yrs). All patients were on MTX. During 11 years of follow-up, CsA was withdrawn due to adverse effects in 20 patients (32.8%). The following adverse effects were observed: arterial hypertension (n=19), hand tremor (n=11), hirsutism (n=7), elevated creatinine (n=17), gingival hypertrophy (n=9), abnormal appetite (n=2), peripheral neuropathy (n=1), lymphocytosis (n=1), skin lesions (n=1), diarrhea (n=2), recurrent infections (n=1), candidiasis (n=1), zoster (n=1), and neoplasm (n=2). Adverse effects responsible for withdrawal of CsA in 14 patients (23%) appeared more frequently during the first 12 months of therapy. Our observations indicate that CsA is well tolerated. The majority of adverse effects subsided after dose reduction or temporary withdrawal of the drug.

• Ocular circulation in systemic lupus erythematosus.

  Authors: Monika Modrzejewska, Lidia Ostanek, Danuta Bobrowska-Snarska, Danuta Karczewicz, Grazyna Wilk, Marek Brzosko, Alon Harris

  Medical science monitor : international medical journal of experimental and clinical research. 11/2009; 15(11):CR573-8.

  BACKGROUND: Mean vascular resistance in the retrobulbar arteries of SLE patients and the statistical relationship between its parameters and the presence of certain antibodies were determined.BACKGROUND: Mean vascular resistance in the retrobulbar arteries of SLE patients and the statistical relationship between its parameters and the presence of certain antibodies were determined. MATERIAL/METHODS: Forty-three eyes of 43 SLE female patients aged 46.28+/-8.45 years with disease duration of 10.03+/-7.96 years were examined. Physical and ophthalmic examinations with assessments of the immunological markers ANA/IgG-IgM, aCL, anti-beta2GPI, LA, and anti-dsDNA antibodies were performed. color Doppler imaging (CDI) was used in the OA, CRA, LPCA, and MPCA vessels. The vascular resistance indices (RIs) were compared with those of 43 eyes of 43 female controls. Covariance and multiple regression analysis with chi squared, Pearson, Shapiro-Wilk, and Levene tests were used in the statistical analysis (significance levels at p<or=0.01 and p<or=0.05). RESULTS: Significantly increased RIs in the OA, CRA, LPCA, and MPCA were recorded. aCL, abeta2GPI, and LAC correlated significantly with increased RI in the CRA. SLE diagnosis significantly correlated with RI in the OA and PCAs. Significant relationship between age and RI in the CRA and LPCA was detected. CONCLUSIONS: Retrobulbar resistance disturbances were detected in SLE patients by CDI. SLE diagnoses and presence of aPLs antibodies were associated with an increased resistivity index in ophthalmic and retino-choroidal vessels.

• High prevalence of anti-beta-2 glycoprotein-I and anti-prothrombin antibodies in adult-onset Still's disease. Comment on "Portal vein thrombosis in adult-onset Still's disease: a case report and literature review"

  Authors: Marcin Milchert, Katarzyna Fisher, Jacek Fliciński, Lidia Ostanek, Marek Brzosko

  Rheumatology international. 10/2009;

• [Chorea as a rare symptom of systemic lupus erythematosus in the elderly]

  Authors: Danuta Bobrowska-Snarska, Lidia Ostanek, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 02/2008; 118 Suppl:75-9.

  The opinion that systemic lupus erythematosus (SLE) is a young people disease translates into its rare diagnosing in subjects in their 6th decade of life and older. The variability ofThe opinion that systemic lupus erythematosus (SLE) is a young people disease translates into its rare diagnosing in subjects in their 6th decade of life and older. The variability of neuropsychiatric disorders that may be the first symptoms of the disease suggest the need for their in-depth diagnostics and treatment. Chorea is one of the rarest neuropsychiatric symptoms of SLE. It may be present in an early stage of the disease and it is one of the most common motor disorders in SLE. The presented case of diagnosing SLE in a 79-year-old male shows the importance of individual and thorough assessment of the clinical picture of every patient regardless of his/her age and gender. In the discussed case the clinical course of the disease denies common opinions about the picture of SLE in the elderly.

• White matter lesions in a group of six patients with relapsing polychondritis.

  Authors: Marcin Milchert, Lidia Ostanek, Monika Mak, Lech Cyrylowski, Marek Brzosko

  The New Zealand medical journal. 02/2008; 121(1275):96-9.

• [Eosinophilic fasciitis--diagnostic and therapeutic difficulties]

  Authors: Danuta Bobrowska-Snarska, Lidia Ostanek, Marek Brzosko

  Annales Academiae Medicae Stetinensis. 02/2008; 54(2):47-51.

  Eosinophilic fasciitis is a rare disease classified by some authors to scleroderma like syndromes. It occurs the most frequently between the second and the sixth decade of life, mainly in Caucasians.Eosinophilic fasciitis is a rare disease classified by some authors to scleroderma like syndromes. It occurs the most frequently between the second and the sixth decade of life, mainly in Caucasians. It usually appears in young males and exceptionally in children. It has an abrupt onset. The etiology of this disease is unknown. Hardening of the skin and subcutaneous tissue, eosinophilia in peripheral blood and hypergammaglobulinaemia are the most characteristic features of the disease. Inflammation and fibrosis of the fascia that spreads over into the deeper layers of skin and muscles are typical for its histological picture. The infiltration is composed of the lymphocytes, plasmocytes and eosinophiles. The involvement of internal organs in the course of the disease is rare. The course of eosinophilic fasciitis can be different. Prognosis is generally good, however recurrences of the disease can happen. The treatment with nonsteroidal anti-inflammatory drugs and/or with glucocorticosteroids is not satisfactory in some cases. It is not uncommon that intense immunosuppressive treatment is required.

• [Fasciitis eosinophilica: personal observations and a review of the literature]

  Authors: Danuta Bobrowska-Snarska, Lidia Ostanek, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 05/2007; 117(4):64-71.

  Eosinophilic fasciitis is a rare disease that is classified by some authors to scleroderma-like syndromes. Symmetrical induration of skin and subcutaneous tissue associated by eosinophilia inEosinophilic fasciitis is a rare disease that is classified by some authors to scleroderma-like syndromes. Symmetrical induration of skin and subcutaneous tissue associated by eosinophilia in peripheral blood are characteristic features of the disease. Internal organ involvement is uncommon. It is often difficult to diagnose eosinophilic fasciitis and its course may be variable. Glucocorticosteroids are most commonly used in the treatment but in many cases they are ineffective. Then other immunosuppressive therapy must be considered. Prognosis is rather favorable. The remission is not always achieved and sometimes flares of the disease are observed as evidenced by the described cases. It should be emphasized that a majority of our patients were females. In four out of five patients anti-thyreoglobulin antibodies and/or anti-thyroid peroxidase antibodies were present suggesting their involvement in the pathogenesis of eosinophilic fasciitis. Neither indicators of inflammation nor peripheral blood eosinophilia were pathognomonic. Results of glucocorticosteroid treatment were satisfactory in three patients, but two patients required combined immunosuppressive treatment.

• Chronic urticaria and mild arthritis associated with autoimmune thyroid disease: successful treatment with L-thyroxine.

  Authors: Marcin Milchert, Jacek Fliciński, Lidia Ostanek, Marek Brzosko

  Acta dermato-venereologica. 02/2007; 87(3):263-4.

• [Significance of antiphospholipid syndrome and antiphospholipid antibodies in patients with systemic lupus erythematosus in estimation of risk of subclinical atherosclerosis development]

  Authors: Katarzyna Fischer, Marek Brzosko, Anna Walecka, Lidia Ostanek, Marcin Sawicki

  Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:13-7.

  INTRODUCTION: Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations.INTRODUCTION: Atherosclerosis is an important clinical problem in patients with systemic lupus erythematosus (SLE), because of very severe cardiovascular and central nervous system manifestations. OBJECTIVES: Estimation if antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are risk factors for subclinical atherosclerosis in patients with SLE. PATIENTS AND METHODS: We examined 103 patients with SLE and 30 healthy volunteers, included as the control group. Coexistence of APS was confirmed in 35 patients. Evaluation of subclinical atherosclerosis was done on the basis of measurement of intima-media thickness (IMT) in B-mode ultrasound examination. We considered classical atherosclerotic risk factors and determined profile of aPL: anti-cardiolipine antibodies (aCL), anti beta2 glycoprotein-I antibodies, antiprothrombin antibodies (aPT), anti-oxidized low-density lipoprotein antibodies and lupus anticoagulant (LA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. RESULTS: Thickened IMT was significantly more frequent in patients with SLE than in controls (p = 0.0002). We found that coexistence of APS is a risk factor for moderate thickening of IMT (OR: 3.41; 95% CI: 1.0-11.5). We also confirmed that the presence of aPL is significantly correlated with IMT ranging from 0.66 to 0.86 mm. The highest risk was found in patients with the presence of aPT IgA (OR: 5.50; 95% CI: 1.1-30.2), aCL IgM (OR: 4.36; 95% CI: 1.1-20.7), LA (OR: 4.02; 95% CI: 1.1-19.4) and aCL IgG (OR: 2.99; 95% CI: 1.1-9.7). Moreover, we found that ischaemic heart disease, nephropathy and myocardial infarction were significantly more frequent in patients with thickened IMT. CONCLUSIONS: Patients with SLE develop subclinical atherosclerosis significantly more frequent than the general population. Coexistence of APS and presence of aPL are risk factors for subclinical atherosclerosis development in patients with SLE. Thickened intima-media in patients with SLE is significantly associated with an increased risk of cardiovascular manifestations.

• [Ocular manifestations in patients with systemic lupus erythematosus and antiphospholipid syndrome]

  Authors: Lidia Ostanek, Monika Modrzejewska, Danuta Bobrowska-Snarska, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:18-23.

  INTRODUCTION: Systemic lupus erythematosus (SLE) is a systemic disease of connective tissue with broad band of symptoms. It could be the reason for many organs and tissues impairment. Changes in eyesINTRODUCTION: Systemic lupus erythematosus (SLE) is a systemic disease of connective tissue with broad band of symptoms. It could be the reason for many organs and tissues impairment. Changes in eyes that occurr in SLE are not frequent, but can lead to severe impairment of sight including blindness. OBJECTIVES: The aim of the work was to asses the frequency of eye changes among patients with SLE and SLE with antiphospholipid syndrome (APS). Another aim was to asses the association between antiphospholipid antibodies and ocular lesions. PATIENTS AND METHODS: There were 75 patients enrolled with SLE, 26 of them ha APS. All of patients had a comprehensive ophthalmological and physical examination. Moreover biochemica analysis including lipid profile and glucose metabolism and serological markers of APS and SLE were performe RESULTS: Thirty-six patients complained of ophthalmologic disturbances (48%), with "dry eyes" being the most common symptom (20 patients). The reduced visual acuity was detected in 17 patients (22.6%). Conjunctivitis was found in 8 patients (10.67%), corneal involvement in 31 (41.3%), and sclera changes in 40 patients (53.3%). Changes in retina were found in 15 (20%) of patients, the most frequent were sub-retinal edema in the region of yellow spot. Changes in yellow spot were found in 8 patients; in 2 of them it was associated with dry degenerative changes, in 6 patients exudates with or without hemorrhages were found. Vascular changes including their lumen diameter were found in 33 patients (44%). In 4 patients there were changes in optical nerve disc. Schirmer's test was pathological in 43 patients (57.3%), but in only 4 patients Sjögren's syndrome was diagnosed. In the group of SLE patients intraocular pressure was significantly higher. The presence of anticardiolipin antibodies IgG class (aCL IgG) was associated with reduced visual acuity. The presence of lupus anticoagulant and anti-beta2, glycoprotein-I antibodies (anti-beta2GPI) was associated with conjunctive involvement. The presence of aCL IgM and anti-beta2GPI was associated with less frequent symptoms of eye dryness. CONCLUSIONS: We found the following significant factors of the occurrence of eye involvement in our series of SLE patients: high activity of disease (conjuctiva, iris, uvea, retina, spot, vessels and optical nerve disc involvement), late diagnosis of SLE (retinopathy and conjuctive involvement), arterial hypertension (reduced visual acuity, cornea involvement, vessels involvement), age (reduced visual acuity, cornea involvement, retinopathy), glucose metabolism disorders (changes in optical nerve disc) and presence of anti-double stranded DNA antibodies (retinopathy).

• [Therapy resistance antiphosholipid syndrome in the course of systemic lupus erythematosus: case report]

  Authors: Danuta Bobrowska-Snarska, Lidia Ostanek, Beata Trzcińska-Butkiewicz, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 02/2007; 117 Suppl:65-9.

  Antiphospholipid syndrome (APS) is one of the most common reasons of thromboembolic complications in the course of connective tissue diseases. There is a strong relationship between presence ofAntiphospholipid syndrome (APS) is one of the most common reasons of thromboembolic complications in the course of connective tissue diseases. There is a strong relationship between presence of antiphospholipid antibodies and the risk of thrombosis. APS related thromboembolic complications range from superficial vein thrombosis up to rapidly developing, life threatening, multi-organ embolism. We present a case of a 21-year old female who presented with myocardial infarction as the first symptom of systemic lupus erythematosus and APS. Afterwards she was consequently treated with antithrombotic and anti-aggregation agents but it did not prevent her from reoccurrence of middle retinal vein. During the 10-year follow up she presented with reoccurring neurological symptoms i.e.: headache, memory deficits, concentration loss and impairment of the cognitive functions. She was found many times to be positive for IgG and IgM anticardiolipin antibodies, anti-beta2glicoprotein-I antibodies and lupus anticoagulant.

• Fungal spondylodiscitis in a patient with ulcerative colitis - case report.

  Authors: Małgorzata Lukjanowicz, Lidia Ostanek, Andrzej Bohatyrewicz, Dariusz Bielicki, Marek Brzosko

  Ortopedia, traumatologia, rehabilitacja. 01/2007; 8(6):708-13.

  We report a case of a 34 year old women with spondylodiscitis due to Candida albicans infection. One and a half year earlier a ulcerative colitis she was diagnosed and treated with sulfasalazine,We report a case of a 34 year old women with spondylodiscitis due to Candida albicans infection. One and a half year earlier a ulcerative colitis she was diagnosed and treated with sulfasalazine, short course of glucocorticosteroids and with azathioprine. The diagnosis of fungal spondylodiscitis was made by culture of material collected from involved part of vertebral column during the surgery. Initially the patient was treated with fluconazole intravenously for 20 days, then the treatment was continued orally for one year. During the treatment all complaints disappeared and reduction of the laboratory acute phase indices was observed. Follow-up magnetic resonance's have shown gradual improvement. To our knowledge no similar case has been reported in the Polish literature before.

• [Antiphospholipid syndrome and antiphospholipid antibodies as a risk factors of ischaemic heart disease and myocardial infarction in patients with systemic lupus erythematosus]

  Authors: Lidia Ostanek, Marek Brzosko, Katarzyna Fischer, Edyta Płohska

  Polskie archiwum medycyny wewnȩtrznej. 06/2006; 115(5):407-13.

  Ischemic heart disease and myocardial infarction in patients with SLE--are usually secondary to early coronary atherosclerosis. Estimation if antiphospholipid syndrome and antiphospholipid antibodiesIschemic heart disease and myocardial infarction in patients with SLE--are usually secondary to early coronary atherosclerosis. Estimation if antiphospholipid syndrome and antiphospholipid antibodies are the risk factor for myocardial infarction and ischemic heart disease in patients with TRU. We examined 129 patients with SLE (114 women and 15 men). All the patients underwent comprehensive physical examination. ECG, ultrasound heart examinations were performed. They were followed by heart scintygraphic examination if indicated. Routine biochemical and hematological laboratory tests were performed including fasting glucose level, concentration of homocysteine, uric acid and lipids. Wide range of immunological essays were performed, testing for antinuclear antibodies (ANA), extractable nuclear antigen antibodies (ENA), antiphospholipid antibodies (anticardiolipin antibodies--aCL, lupus anticoagulant--LA, antiprothrombine antibodies aPT, anti-beta2glicoprotein-I antibodies), anti-dsDNA antibodies, anti-nucleosome antibodies, antihistone antibodies, antineutrophil cytoplasmic antibodies (ANCA) and antiendothelial antibodies (AECA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. Ischemic heart disease was found in 20 (15.5%) SLE patients, myocardial infarctions were diagnosed in 9 (6.97%). Ischemic heart disease and myocardial infarction were significantly related to presence of secondary antiphospholipid syndrome (SAPS), OR: 4.21, p = 0.008 and OR: 12.8; p = 0.02 respectively). They were also related to high activity of SLE, OR: 7.18; p = 0.012 and OR: 27.3; p = 0.006 respectively. Ischemic heart disease was significantly more common in older patients (52.75 years versus 42.15 years; p = 0.0008) and in patients with hypertension (p < 0.05). Impaired glucose tolerance (OR: 8.44; p = 0.03), presence of aCL IgG (OR; 2.93; p = 0.05) and p-ANCA anti-MPO (OR: 6.08; p = 0.036) were found to be risk factors of ischemic heart disease. Myocardial infarction was significantly associated with high uric acid level (OR: 5.01; p = 0.052) and impaired glucose tolerance (OR: 7.42; p = 0.047) and with presence of the following antibodies: aCL IgG and/or aCL IgM (OR: 5.61; p = 0.039), ANCA in the indirect immunofluorescence essay (OR: 5.78; p = 0.035), anti-MPO antibodies (OR: 6.58; p = 0.051) and AECA (OR: 11.10; p = 0.026). Presence of antiphospholipid antibodies and SAPS are significant risk factors of ischemic heart disease and myocardial infarction in SLE patients. The risk factors of ischemic heart disease and myocardial infarction in SLE patients significantly differ from the ones in general population.

• [Severe neurological and obstetrical complications in a patient with antiphospholipid syndrome]

  Authors: Danuta Bobrowska-Snarska, Lidia Ostanek, Barbara Nesterowicz, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 05/2006; 115(5):457-62.

  Antiphospholipd syndrome (APS) is a disease characterised by venous and arterial thrombosis or recurrent foetal loss, which are associated with antiphospholipid antibodies or/and lupus anticoagulant.Antiphospholipd syndrome (APS) is a disease characterised by venous and arterial thrombosis or recurrent foetal loss, which are associated with antiphospholipid antibodies or/and lupus anticoagulant. Clinical symptoms ofAPS are assocciated with presence of noninflammatory thrombosis ocluding arteries or venes. Symptoms of APS are often very dramatic what can be illustrated by the presented case of 40 year patient. At the age of 25 after a miscarriage the patient developed tetraparesis and motor aphasia in the course of thrombosis in central nervous system vessels. In physical examination besides neurological symptoms reticular livedo was found on the trunk and limbs. Serological tests have revealed presence of high titre of IgG and IgM anticardiolipin antibodies and lupus anticoagulant (LA). CT examination revealed hypodensic foci in left parietal lobe, and abnormal EEG findings were observed in fronto-temporal leads of left hemisphera of brain. At that point the patient did not meet the criteria of connective tissue diseases, including lupus. The diagnosis of primary APS was suggested. The patient received anti-aggregation treatment and also immunosuppressive drugs (azathioprine and prednison) due to progression of neurological manifestations. 3 years later, the second pregnancy ended in the 27th week with intrauterine fetal death. During the 3rd pregnancy, 2 years afterwards, the patient was treated with heparin, aspirin and intravenous immunoglobulin. The pregnancy finished with a successful delivery at term, the newborn was in good condition. During the following pregnancy the symptoms of preeclampsia occurred at 36/37th week but the newborn was delivered in a good condition after a caesarean section. At the age of 36 patient developed ischemic brain stroke with left-side hemiparesis inspite of anti-aggregation and immunosupressive (prednison and azathioprine) treatment. At that time homogenic type antinuclear antibodies (ANA) 1:2560, anti-beta2-glycoprotein antibodies (beta2-GPI), aCL antibodies in medium titer and thrombocytopenia were found. The patient was treated with heparin, cyclophosphamide and methyloprednisolon intravenously. During rehabilitation process gradual improvement of cognitive functions, speech and motorical functions was observed. Recently high titre of ANA and recurent thrombocytopenia < 100,000/mm3 were present. Maybe during the further follow-up, 14 years after the first symptoms of APS, the patient will develop full blown symptoms of SLE.

• [Cardiovascular abnormalities in systemic lupus erythematosus patients in echocardiographic assessment]

  Authors: Lidia Ostanek, Edyta Płońska, Małgorzata Peregud-Pogorzelska, Krzysztof Mokrzycki, Marek Brzosko, Katarzyna Fischer, Jacek Fliciński

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2006; 20(117):305-8.

  Cardiovascular system involvement is the third most common reason of death in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the cardiac involvement in the SLECardiovascular system involvement is the third most common reason of death in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the cardiac involvement in the SLE patients with a regard to clinical, serological and environmental risk factors. MATERIAL AND METHODS: 103 patients were included into the study, 91 women and 12 men, aged 16-74 yrs, the control group included 25 subjects. Physical examination, two-dimensional guided M-mode and Doppler echocardiographic recordings were performed. The tests for the presence of ANA, ENA, antiphospholipid antibodies (aCL, LA, anti-beta2GPI and antiprothrombin antibodies), ANCA (anti-neutrophil cytoplasm antibodies), AECA (anti endothelial cell antibodies) were carried out. RESULTS: The following pathologies were significantly more common in the SLE patients: pericardial involvement (58%), organic changes of the mitral valve cusps (54%), organic changes of the aortic valve cusps (36%), widening of the aortal lumen (35%), enlargement of the left atrium (18%), hypokinesis of the left ventricle myocardial muscle (15%). Ultrasound cardiac pathologies were associated with presence of antiphospholipid antibodies, ANCA, anti-hitone antibodies and AECA. High activity of SLE increased risk of pericarditis and ascending aortic wall thickening. Cardiovascular manifestations occurred most frequently in patients with short time duration of SLE. CONCLUSION: Cardiac involvement is a frequent and early systemic complication of SLE and it is the most commonly related to pericardium and valvular apparatus. Cardiovascular manifestations in SLE patients are the most frequently related to the presence of serological risk factors, mainly antiphospholipid antibodies. It suggests their major role in the pathogenesis of the cardiovascular involvement in SLE. Pericarditis are markers of high activity of SLE.

• [Primary hypertrophic osteoarthropathy as a rare cause of joint pain]

  Authors: Marcin Milchert, Beata Trzcińska-Butkiewicz, Lidia Ostanek, Andrzej Bohatyrewicz, Marek Brzosko

  Wiadomości lekarskie (Warsaw, Poland : 1960). 02/2006; 59(11-12):873-8.

  Primary hypertrophic osteoarthropathy (HOA) is a rare cause ofjoint pain. The diagnosis is often delayed, due to mild complaints. However, finger clubbing combined with joint pain should suggestPrimary hypertrophic osteoarthropathy (HOA) is a rare cause ofjoint pain. The diagnosis is often delayed, due to mild complaints. However, finger clubbing combined with joint pain should suggest considering HOA in the diagnosis. The progression of toes and fingertips widening is slow and can be overlooked by a patient. It is common that patient seeks physician's aid only when the joint pain occurs. The presented case is an example of delayed diagnosis. Due to the fact that secondary HOA coexists with some diseases associated with serious prognosis it is recommended to exclude other possible causes before diagnosing primary HOA. Some clues, like the age of disease onset or positive family history allow the diagnosis of primary HOA with high probability. This case report contains clinical symptoms and new diagnostic criteria, differential diagnosis, and possible complications.

• [Pregnancy associated with connective tissue disease]

  Authors: Lidia Ostanek, Marcin Milchert

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:11-6.

  The majority of connective tissue diseases, with the exception of scleroderma which is usually diagnosed past the age of 40 years, may affect women of reproductive age. Questions concerning theThe majority of connective tissue diseases, with the exception of scleroderma which is usually diagnosed past the age of 40 years, may affect women of reproductive age. Questions concerning the impact of the connective tissue disease upon pregnancy, interactions of pregnancy with the disease, and influence of the disease on fetal development are not easily answered. However, our knowledge on the pathogenesis of connective tissue diseases and the mechanisms of action of various antibodies is increasing, enabling improved disease control and reduction of adverse pregnancy outcomes. Multicenter, prospective clinical studies verified some unproven opinions about the adverse influence of pregnancy on scleroderma or systemic lupus erythematosus, as well as about their unavoidably fatal interactions with pregnancy. Careful pregnancy planning and cooperation of the rheumatologist, obstetrician and neonatologist helps avoid disease exacerbation and fetal misdevelopment. Acetylsalicylic acid and heparin reduce the adverse effect of antiphospholipid antibodies. Still, miscarriage, intrauterine fetal death, intrauterine growth retardation, and prematurity are more often encountered in women with systemic lupus erythematosus. However, the risk of adverse pregnancy outcome in these patients is gradually falling. Active lupus nephritis, hypertension, presence of antiphospholipid antibodies, and history of miscarriage are important risk factors. Pregnancy in women with diffuse type of scleroderma is of worse prognosis, often resulting in prematurity and low birthweight. Establishing the risk of immunosupressive and anti-inflammatory therapies enables better treatment of connective tissue diseases in pregnancy. Currently there is no doubt that pregnancy is contraindicated only in a small group of high-risk patients with connective tissue disease.

• [Quality of life and activity of disease in patients with rheumatoid arthritis]

  Authors: Krzysztof Prajs, Jacek Fliciński, Iwona Brzosko, Hanna Przepiera-Bedzak, Lidia Ostanek, Marek Brzosko

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:39-43.

  PURPOSE: The aim of this study was to evaluate the quality of life in patients with rheumatoid arthritis (RA) considering their age, activity of the disease, its duration and radiological stage.PURPOSE: The aim of this study was to evaluate the quality of life in patients with rheumatoid arthritis (RA) considering their age, activity of the disease, its duration and radiological stage. MATERIAL AND METHODS: The study group consisted of 151 women (mean age 55.0 years, mean duration of RA 9.4 years) and 45 men (mean age 55.0 years, mean duration of RA 9.4 years). All subjects were treated at the Department of Rheumatology and at the SPSK-1 rheumatology outpatient clinic in Szczecin. Diagnosis of RA was established according to ARA criteria of 1987. The radiological stage of the disease was established according to Steinbrocker's criteria. The patient's quality of life was evaluated with the Health Assessment Questionnaire. The activity of RA was determined with the Disease Activity Score DAS 28. RESULTS: Significant correlation between HAQ score and DAS 28 was found (correlation coefficient--R = 0.38; p < 0.001). Age (R = 0.31, p < 0.001) and radiological stage of RA (R = 0.26, p < 0.001) were also found to affect the quality of life. CONCLUSIONS: The quality of life of patients with rheumatoid arthritis is significantly influenced by their age, activity of the disease, and radiological stage of RA.

• [Spastic tetraparesis and heart thrombus in a male patient as first symptoms of the antiphospholipid syndrome]

  Authors: Danuta Bobrowska-Snarska, Lidia Ostanek, Edyta Płońska, Marek Brzosko

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:75-9.

  PURPOSE: The antiphospholipid syndrome (APS) manifests itself with circulating anticardiolipid antibodies (aCL) and/or lupus anticoagulant (LA) associated with thrombi and emboli or with recurrentPURPOSE: The antiphospholipid syndrome (APS) manifests itself with circulating anticardiolipid antibodies (aCL) and/or lupus anticoagulant (LA) associated with thrombi and emboli or with recurrent complications of pregnancy. MATERIAL AND METHODS: We present a case of a 50-year-old man who was diagnosed with the antiphospholipid syndrome on the basis of serologic findings and results of diagnostic imaging. Neurological symptoms in the form of memory deficits, disorders of orientation, and pyramidal-type bilateral hemiparesis more evident on the left side were reported by the patient over a period of two years. Magnetic resonance imaging (MRI) of the head revealed numerous vascular foci located in the cortical-subcortical areas of the brain. Ultrasound (USG) disclosed a large, irregular thrombus adhering to the margins of the mitral valve with signs of inflammation. aCL (high titers in both classes), LA, and anti-beta2-glycoprotein I antibodies (a-beta2GPI) were found in serum. a-beta2GPI and anti-nDNA antibodies were disclosed in the cerebrospinal fluid. RESULTS: Combined anticoagulant and anti-aggregation therapy was unsuccessful. It was then decided to use immunosuppression with intravenous cyclophosphamide and methylprednisone pulses every 4 weeks (7 cycles). USG at follow-up showed marked regression of the mitral thrombus with swollen margins of the mitral valve. MRI of the brain confirmed progression of the lesions described previously. CONCLUSION: The diagnosis of secondary antiphospholipid syndrome associated most probably with systemic lupus erythematosus (SLE) was made. It should be remembered, however, that diagnostic criteria for APL and SLE partially overlap.