Hanna Przepiera-Bedzak

Publications of Hanna Przepiera-Bedzak

• [Addison's disease imitating fibromyalgia].

  Authors: Jacek Fliciński, Krzysztof Prajs, Hanna Przepiera-Bedzak

  Annales Academiae Medicae Stetinensis. 01/2010; 56 Suppl 1:70-2.

  We present the case of a 33-year-old female with generalized pain in the musculoskeletal system, fatigue, and many other symptoms. She was initially diagnosed with fibromyalgia but other testsWe present the case of a 33-year-old female with generalized pain in the musculoskeletal system, fatigue, and many other symptoms. She was initially diagnosed with fibromyalgia but other tests finally confirmed Addison's disease. Supplementation with adrenal hormones resulted in total remission of pain and of other symptoms. This case serves to illustrate diagnostic pitfalls in patients with a generalized pain syndrome.

• [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.

• [Cardiovascular manifestations of seronegative inflammatory spondyloarthropathies].

  Authors: Hanna Przepiera-Bedzak, Iwona Brzosko, Małgorzata Peregud-Pogorzelska, Marek Wódecki, Marek Brzosko

  Annales Academiae Medicae Stetinensis. 01/2010; 56 Suppl 1:62-5.

  Cardiovascular manifestations of seronegative spondyloarthropathies represent an important clinical problem which has not been fully elucidated. Clinically significant cardiovascular symptoms areCardiovascular manifestations of seronegative spondyloarthropathies represent an important clinical problem which has not been fully elucidated. Clinically significant cardiovascular symptoms are present in 10% of patients with ankylosing spondylitis (AS), usually in the case of long-standing disease. The following echocardiographic abnormalities have been reported in AS: ascending aortitis, aortic insufficiency (1-34%), mitral insufficiency (1-76%), mitral valve prolapse (5.7-10%), and diastolic dysfunction (20-50%). Abnormalities of the cardiac conduction system may develop in 1% to 33% of AS patients as a consequence of postinflammatory scarring of the myocardium. Cardiovascular diseases are the leading cause of death (36.2%) of patients with psoriatic arthritis (PsA). The risk of death in PsA is 1.3 times greater than in the general population. The following echocardiographic abnormalities can be seen in PsA: fibrinous pericarditis (18.2%), myocarditis (15.9%), and valvular disease (5.7%). Diastolic dysfunction in PsA correlates with the presence of articular lesions and duration of psoriasis. The importance of a thorough investigation of the cardiovascular system in patients with seronegative spondyloarthropathies is emphasized.

• [Ear involvement in Wegener's granulomatosis]

  Authors: Marek Wódecki, Iwona Brzosko, Hanna Przepiera-Bedzak, Marek Brzosko

  Wiadomości lekarskie (Warsaw, Poland : 1960). 02/2007; 60(11-12):574-7.

  Clinical manifestation of Wegener's granulomatosis could be multiorgan. Authors present the review of literature concerning on inflammatory changes in ears that in consequence could lead to hearingClinical manifestation of Wegener's granulomatosis could be multiorgan. Authors present the review of literature concerning on inflammatory changes in ears that in consequence could lead to hearing impairment or deafness.

• [The value of researches, which assess bone mineral density and bone metabolism in patients with ankylosing spondylitis, in detecting osteoporosis]

  Authors: Hanna Przepiera-Bedzak

  Annales Academiae Medicae Stetinensis. 02/2007; 53(3):39-47.

  INTRODUCTION: Purpose of the study was: 1) to assess the best localization and the method for diagnosis of osteoporosis; 2) to assess risk factors of osteoporosis; 3) to assess risk factors of spinalINTRODUCTION: Purpose of the study was: 1) to assess the best localization and the method for diagnosis of osteoporosis; 2) to assess risk factors of osteoporosis; 3) to assess risk factors of spinal fractures due to osteoporosis; 4) assessment of bone metabolism. MATERIAL AND METHODS: The study consisted of 46 male patients with confirmed diagnosis of ankylosisng spondylitis (AS) aged 23-68 years. All patients underwent the following assessment: lateral x-ray of spine, bone mineral density (BMD) assessment of lumbar spine, femoral neck and radius by DEXA method and bone mineral density assessment of radius by peripheral quantitative computed tomography (pQCT) method. Activity of bone specific alkaline phosphatase, hydroxyproline-creatinine ratio and calcium-creatinine ratio were assessed. The following indexes were assessed: BASMI, BASFI, BASDAI, BASG-t i BASG-6. Biochemical activity of the disease was assessed by C-reactive protein (CRP), mucoproteids, fibrinogen, erythrocyte sedimentation rate. RESULTS: 34.8% of AS patients had spinal fractures. There were 19 fractures of thoracic spine, 9 of cervical and 5 of lumbar spine. There was negative correlation of spinal fractures and neck osteopenia (r = -0.485; p = 0.05). There was increased relative risk of fractures in patients with increased BASFI, BASDAI and BASMI and with increased level of CRP. Older patients with longer history of disease had higher relative risk of fractures. Together along with the duration of disease there was the decrease of neck BMD and the increase of lumbar BMD. AS patients compared with control group had increased hydroxyproline-creatinine ratio. CONCLUSION: Ankylosing spondylitis patients have increased risk of spinal fractures due to osteoporosis. Assessment of BMD at femoral neck is the best for assessment of osteoporosis in AS patients.

• [SAPHO syndrome--clinical features].

  Authors: Hanna Przepiera-Bedzak, Iwona Brzosko, Jacek Fliciński, Włodzimierz Samborski, Marek Brzosko

  Polskie Archiwum Medycyny Wewnętrznej. 12/2006; 116(6):1172-7.

  Presentation of clinical features of the SAPHO syndrome. Seventeen patients (15 women and 2 men) with confirmed diagnosis of the SAPHO syndrome was presented. The culture of biopsy of pustulotic skinPresentation of clinical features of the SAPHO syndrome. Seventeen patients (15 women and 2 men) with confirmed diagnosis of the SAPHO syndrome was presented. The culture of biopsy of pustulotic skin lesions was performed in 11 patients. ESR, C-reactive protein level and Waaler-Rose test were determined in all patients, and antinuclear antibodies and bone scintigraphy were performed in 16 patients. X-ray of the sterno-clavicular joints was performed in 15 patients. The age of patients was 22-59 yr. (mean: 47.1 yr). The duration of joint symptoms was 0.1-25 yr. (mean: 4.4 years). Pustulosis was presented in 16 patients, only 1 patient had acne. All patients suffered from pain localized on the anterior chest wall. Tenderness of the peripheral joints: wrist (in 7 patients), shoulder (in 7 patients), knee (in 4 patients) was shown. In 6 patients, skin changes preceded joint symptoms, in 2 patients skin changes followed joint symptoms after 5 and 10 yr., respectively. All patients had negative the Waaler-Rose test. Active inflammatory process characterized by an increased ESR and C-reactive protein level was present in 12 patients. Abnormalities in x-ray of the sterno-clavicular joints were present in 4 patients. Characteristic alternations for the SAPHO syndrome in scintigraphic picture of the skeleton were observed in 14 patients. All patients were treated with non-steroidal anti-inflammatory drugs. In 8 patients, treatment with antibiotics, in 11 patients--with sulfasalazine, in 3 patients--with methotrexate and low doses of glucocorticosteroids, in 1 patient--with colchicines was performed. Association of typical skin changes with pain of the anterior chest wall is the key for diagnosis of the SAPHO syndrome. It seems that this syndrome is more common in Poland than it has been previously estimated.

• [Activity of the disease and selected echocardiographic abnormalities in ankylosing spondylitis]

  Authors: Hanna Przepiera-Bedzak, Małgorzata Peregud-Pogorzelska, Marek Brzosko, Iwona Brzosko, Edyta Płońska, Zdzisława Kornacewicz-Jach

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2006; 20(117):296-8.

  Cardiovascular involvement in the course of ankylosing spondylitis (AS) is a very important problem. The aim was to assess the influence of the activity of the disease on echocardiographicCardiovascular involvement in the course of ankylosing spondylitis (AS) is a very important problem. The aim was to assess the influence of the activity of the disease on echocardiographic abnormalities in ankylosing spondylitis. MATERIAL AND METHODS: We studied 38 AS patients. Activity of the disease was assessed according to the ESR and following indexes: BASMI, BASFI, BASDAI, BASG-t, BASG-6. Using 2-dimensional echo Doppler (Acuson 128XP) the heart dimensions were determined according to the American Society of Echocardiography guidelines. RESULTS: Patients with mitral valve prolapse compared with the group of the AS patients without this abnormality had significant higher (p = 0.05) activity of the disease assessed by ESR. Patients with aortic incompetence compared with the group of the AS patients without this abnormality, had significant (p = 0.04) lower disease activity assessed by BASG-6. We found significant negative correlation between EF and disease duration, and significant lower disease activity assessed by BA SG-6. Patients with pericardial effusion compared with group without this had significant shorter (p = 0.05) disease duration. CONCLUSION: There was no significant influence of the following indexes: BASMI, BASFI, BASDAI, BASG-t, BASG-6 of the activity of the disease on echocardiographic abnormalities in ankylosing spondylitis.

• [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.

• [Adult-onset Still's disease]

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

  Annales Academiae Medicae Stetinensis. 02/2006; 52 Suppl 2:111-4.

  INTRODUCTION: The authors present the course and manifestations of adult-onset Still's disease on the basis of five cases diagnosed at the Department of Rheumatology, Pomeranian Medical University inINTRODUCTION: The authors present the course and manifestations of adult-onset Still's disease on the basis of five cases diagnosed at the Department of Rheumatology, Pomeranian Medical University in Szczecin. MATERIAL AND METHODS: The usefulness of two most popular sets of diagnostic criteria of adult-onset Still's disease (Yamaguchi and Cush) was analyzed. At onset of the disease, two out of five patients met both sets of the diagnostic criteria, two others met criteria of Yamaguchi and one of Cush. During follow-up, criteria of Yamaguchi were met in all cases. RESULTS: The authors suggest to use the Cushs criteria of adult-onset Still's disease when the patient does not meet the criteria of Yamaguchi and other causes of fever are excluded.

• [Churg-Strauss syndrome--report of four cases]

  Authors: Iwona Brzosko, Marek Brzosko, Lidia Ostanek, Hanna Przepiera-Bedzak, Jerzy Grabarek

  Polskie archiwum medycyny wewnȩtrznej. 05/2005; 113(4):352-8.

  Four subsequent cases of Churg-Strauss syndrome were presented. The patients fulfilled criteria of the syndrome developed by American College of Rheumatology. They were treated with combination ofFour subsequent cases of Churg-Strauss syndrome were presented. The patients fulfilled criteria of the syndrome developed by American College of Rheumatology. They were treated with combination of systemic corticosteroids and cyclophosphamide, one patient was additionally treated with plasmapheresis. In all four cases complete remission of the disease was achieved.

• [SAPHO syndrome]

  Authors: Hanna Przepiera-Bedzak, Marek Brzosko, Iwona Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 03/2004; 111(2):265-8.

• [Skeletal changes during the course of pustulosis palmoplantaris--report of two cases]

  Authors: Hanna Przepiera-Bedzak, Iwona Brzosko, Marek Brzosko

  Polskie archiwum medycyny wewnȩtrznej. 02/2002; 107(1):59-62.

  We report two cases of coincidence palmoplantar pustulosis and joint changes. Two patients fulfilled criteria for arthroosteitis pustulosa: pustular eruptions of the palms and soles and pain ofWe report two cases of coincidence palmoplantar pustulosis and joint changes. Two patients fulfilled criteria for arthroosteitis pustulosa: pustular eruptions of the palms and soles and pain of sterno-clavicular joint. They also fulfills criteria for SAPHO syndrome: osteoarticular manifestations of palmoplantar pustulosis. Clinical examination and scintigraphy confirmed the diagnoses. Treatment was started with antibiotics and nonsteroid anti-inflammatory drugs. Oral corticosteroids therapy with methotrexate was given to one patient.

• Cardiac arrhythmias and conduction disturbances in patients with ankylosing spondylitis.

  Authors: Jaroslaw Kazmierczak, Malgorzata Peregud-Pogorzelska, Jowita Biernawska, Hanna Przepiera-Bedzak, Jaroslaw Goracy, Iwona Brzosko, Edyta Plonska, Marek Brzosko

  Angiology. 58(6):751-6.

  Conduction disturbances, aortic incompetence, and myocardial fibrosis are known complications in adult patients with ankylosing spondylitis (AS). Its incidence has been reported to be 10% to 30%;Conduction disturbances, aortic incompetence, and myocardial fibrosis are known complications in adult patients with ankylosing spondylitis (AS). Its incidence has been reported to be 10% to 30%; however, less attention has been paid to all cardiac arrhythmias. The aim of this study was to evaluate arrhythmias and conduction disturbances in patients with AS using electrocardiograms and Holter monitoring (including heart rate variability analysis) and to estimate its relationships with age, gender, clinical features, and duration of AS. Thirty-one patients with AS (20 to 69 years old, mean 50 +/- 14) and 22 healthy volunteers (26 to 69 years old, mean 49 +/- 13) underwent rheumatologic and cardiologic evaluations. Ventricular extrasystoles were present in 55% of AS patients and in 28% of controls. Supraventricular extrasystoles were present in 94% of AS patients and 100% of controls. The frequency of ventricular extrasystoles was found to be higher in the AS patients than in the control subjects. Significant differences were found in heart rate variability analyses: ultra low-frequency power and root mean square recessive difference (r-MSSD) were lower in the AS group. When the AS group was divided into subgroups (stages 3 and 4), significant differences were found between control subjects and stage 3 patients in PR interval, heart rate (HR), T-wave duration, ultra low frequency, and r-MSSD and between controls and stage 4 patients in HR, T-wave duration, and r-MSSD. QTc and QTd were not significantly different in groups and subgroups and were not correlated with any other clinical or electrocardiographic parameter. Cardiac arrhythmias were more frequent in patients with AS than in the healthy population. Simple electrocardiograms and Holter parameters do not correlate with the incidence of VESs, age, gender, clinical features, and duration of AS.