[Show abstract][Hide abstract] ABSTRACT: To identify the survival and standardized mortality ratio with respect to gender, age, and treatment method of patients treated for femoral neck fractures.
A retrospective review of medical records of 736 patients treated for femoral neck fractures at Vilnius University Emergency Hospital during 2004-2006 was carried out.
The overall 1- and 2-year survival rates were 77.4% and 67.1%, respectively. Lower survival rates were observed in the internal fixation group than in the primary and secondary total hip arthroplasty groups (63.2% vs. 72.0% and 75.1%). Cox proportional hazards model analysis showed patient age to be a significant risk factor for survival (hazard ratio, 1.05; 95% CI, 1.04-1.07; P<0.001). The overall standardized mortality ratio was 2.50. The standardized mortality ratios for men and women were 3.07 and 2.27, respectively, but the difference between these groups was not significant.
Standardized mortality and survival rates decreased with increasing patients' age. Significantly lower survival rates were documented in the internal fixation group as compared with primary and secondary total hip arthroplasty groups. There was a trend toward a higher standardized mortality ratio in men than women, but the difference was not significant.
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to assess the prevalence of paraneoplastic rheumatic syndromes in a cohort of patients with newly diagnosed solid tumours and to describe their autoimmune profile, comparing it to the controls. Screening questionnaires (3,770) were distributed, and during a three-step study, 94 patients were confirmed to have both paraneoplastic syndrome and oncology diagnoses. Three control groups-patients with undifferentiated arthritis, Raynaud's phenomenon for non-malignant causes and solid tumours only-were designed to compare with the paraneoplastic cases and their immunology profile. The prevalence of paraneoplastic rheumatic syndromes was 2.65% (95% CI 0.21-3.20). The group of patients with arthritis and the group of patients with Raynaud's syndrome were found to prevail among other clinical presentations of paraneoplastic rheumatic syndromes. Both paraneoplastic syndromes were linked to malignancies of the urogenital system. Antinuclear antibodies were found to be similarly frequent in the paraneoplastic arthritis, paraneoplastic Raynaud's phenomenon and the solid tumour groups. No differences were observed when comparing paraneoplastic arthritis and undifferentiated arthritis, except that the patients with paraneoplastic arthritis were older. Comparing paraneoplastic Raynaud's to Raynaud's phenomenon, male preponderance in the paraneoplastic Raynaud's phenomenon group was observed, and the patients were obviously older. Paraneoplastic rheumatic syndromes are rare and more often occur in older patients. Among them, paraneoplastic arthritis and Raynaud's syndrome were the most frequent. The immunology profile does not help in discriminating between arthritis and paraneoplastic arthritis patients and is of limited use in Raynaud's differential diagnosis.
[Show abstract][Hide abstract] ABSTRACT: To investigate the carotid-radial pulse wave velocity, augmentation index, and flow-mediated dilation of the brachial artery and factors possibly influencing them in women with rheumatoid arthritis and systemic lupus erythematosus.
A total of 63 women with rheumatoid arthritis, 31 with systemic lupus erythematosus, and 72 controls, aged 18-55 years, were examined. Parameters of arterial stiffness, augmentation index and carotid-radial pulse wave velocity, were obtained by applanation tonometry (Sphygmocor (v.7.01) AtCor Medical). Flow-mediated dilatation of the brachial artery, reflecting endothelial function was determined by ultrasound system (Logiq 7, General Electric).
The groups of women with rheumatoid arthritis and systemic lupus erythematosus lupus differed from controls regarding augmentation index (P<0.001; P=0.008) and did not differ between each other. Women with systemic lupus erythematosus differed from controls regarding pulse wave velocity (P=0.018), while women with rheumatoid arthritis - did not. Flow-mediated dilatation in both the groups of diseases was not different from controls. In rheumatoid arthritis patients, mean blood pressure was the main explanatory factor for augmentation index and pulse wave velocity; vessel diameter and high-density lipoprotein cholesterol - for flow-mediated dilatation. In women with systemic lupus erythematosus, pulse wave velocity was not related to any of the pending parameters; augmentation index was dependent on organ damage index, age, and mean blood pressure, and flow-mediated dilatation on vessel diameter, body mass index, and disease duration.
The mean blood pressure was the major and the only one risk factor of arterial stiffening in rheumatoid arthritis, while the disease damage index played the most important role in the systemic lupus erythematosus group. The mean blood pressure in the systemic lupus erythematosus group was not as important as in the rheumatoid arthritis group, though may have a partial influence.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Temporal arteritis (TA) is usually diagnosed according to clinical criteria, and temporal artery biopsy is considered as a golden standard for the diagnosis. Temporal artery biopsy is a surgical intervention on a head site and is not well-tolerated by the patients. As an alternative for temporal artery investigation, ultrasound examination may be used. The aim of this pilot study was to evaluate the performance of ultrasound examination of a temporal artery of patients with and without TA, but with similar clinical findings. Materials and results. Th irteen patients seen at Vilnius University Hospital Santariškių Klinikos during 2006–2009 with suspicion of TA were included into this study, and ultrasound examination of their both right and left superficial temporal arteries was performed. Eight patients were diagnosed with TA according to clinical criteria, and 5 patients had headaches of another origin. Two patients had a biopsy-proven diagnosis. The thickened wall ("halo" sign) and / or stenosis / occlusion were found on ultrasound examination in three patients. The presence of abnormality was found in five patients from the setting of TA patients, and no abnormalities were detected in the control group. Although the groups were very small and the data scanty, we consider the sensitivity of the abnormalities detected by ultrasound to be 62.5%, and the specificity was close to 100% in this pilot study. Conclusions. Authors recommend bilateral ultrasound examination of temporal arteries for patients with suspicion of giant cell arteritis (temporal arteritis). Our pilot study showed a sufficient sensitivity of this diagnostic test, although it greatly depends on the experience and skills of the performer.
[Show abstract][Hide abstract] ABSTRACT: 99 Background. The main objective of this study is to understand the burden of ankylosing spond-ylitis (AS), to identify the aspects of health-related quality of life (QoL) in patients with AS and compare them with the control group (CG), to explore the factors influencing the QoL. Methods. 65 patients with AS and 67 CG patients participated in this study matching by age, sex and education. The interview comprised socio-demographic questions, the range of disease duration, number of patients with peripheral arthritis, uveitis, comorbidities. The Bath ankylosing spondylitis functional index (BASFI), the Bath ankylosing spondylitis disease ac-tivity index (BASDAI), the Bath ankylosing spondylitis global health index (BASG) have been translated, adapted and used in this study. Finally, both groups were asked to fill in the SF-36 as generic QoL instrument. Disease duration time (6.7 years) in AS group was more than twice shorter than time duration of complaints (16 years). More than one third of the patients had uveitis and more than half of them had arthritis. Results. QoL on all the scales of the SF-36, especially in physical health-related QoL, was significantly worse than in the CG. Disease-specific instruments – BASFI, BASDAI, BASG and pain – were significantly associated with the component of physical and mental health re-lated QoL. Conclusion. AS influences the subjective health of the affected person; especially the physical health related QoL. BASFI, BASDAI, BASG and pain are significantly associated with SF-36 physical and mental domains in patients with AS.
[Show abstract][Hide abstract] ABSTRACT: 1 Vilniaus universitetas, 2 Vilniaus universiteto Eksperimentinės ir klinikinės medicinos institutas Raktažodžiai: gyvenimo kokybė, reumatoidinis artritas, sisteminė raudonoji vilkligė. vilklige sergančios tiriamosios įvertino skausmą (vertinimui naudota vizualinė analogijos skalė), nesąnarinį ligos pasireiškimą, ligos aktyvumą. Be to, tiriamosios užpildė anketas funkciniam neįgalumui ir artrito naštai įvertinti. Visos tiriamųjų grupės užpildė Lietuvoje validizuotą gyvenimo kokybės klausimyną "SF-36" (angl. Medical Outcomes Study Short Form-36). Rezultatai. Palyginus reumatinėmis ligomis sergančių tiriamųjų gyvenimo kokybę, nustatyta, jog sisteminės raudonosios vilkligės grupės tiriamosios jautė didesnį skausmą (p=0,017). Reumatoidinio artrito grupės tiriamosioms nustatyta ryškesnių veiklos apribojimų dėl emocinių problemų (p=0,038 Įvadas Reumatoidinis artritas (RA) ir sisteminė raudonoji vilkligė (SRV) priskiriamos svarbiausioms reumati-nėms ligoms. RA sergančius pacientus nuolat vargina sąnarių skausmas, uždegimas, o vėliau ir destrukcijos sąlygojama fizinė negalia, kuri gerokai apriboja ligo-nio savarankiškumą, sukelia psichologinę įtampą, so-cialinę disfunkciją (1). Ligonius, sergančius SRV, be odos bėrimų, sąnarių ar raumenų skausmo vargina ir daug kitų simptomų, atsirandančių dėl vidaus organų pažeidimo ar ilgalaikio medikamentinio gydymo (2). Šiems ligoniams tenka gyventi su dažnai nenuspė-jamos eigos, potencialiai mirtina liga. Ilgą laiką reu-matinių ligų vertinimą, gydymo veiksmingumą ban-dyta įsprausti į objektyvių, t. y. klinikinių, laborato-rinių arba rentgenologinių tyrimų rėmus. Siekiant įver-tinti ligonių, sergančių sąnarių ligomis, funkcines ga-limybes, psichinę būklę, parengti specialieji klausimy-nai: funkcinio neįgalumo (angl. Functional Index of Health Assessment Questionnaire – HAQ) klausimy-nas ir skalė artrito naštai įvertinti (angl. Arthritis Im-pact Measurement Scales – AIMS) (3, 4). Tačiau šie klausimynai neatspindi žmogaus subjektyvaus gero-vės suvokimo, kuris apima fizinį, psichologinį, socia-linį ir dvasinį lygmenis. Naudojant gyvenimo kokybės klausimynus, galima įvertinti subjektyvią paciento sa-vijautą, kiek lėtinė liga, negalia turi įtakos gyvenimo pilnatvei, planuoti ar įvertinti gydymo strategiją (5). Šio straipsnio tikslas – įvertinti ir palyginti RA, SRV sergančių ligonių ir kontrolinės grupės tiriamųjų gyve-nimo kokybę.