Tsvetoslav Georgiev

Medical University of Varna · Department of Internal Medicine

Optimal management of knee osteoarthritis (KOA) should include, where possible, modification of risk factors through targeted interventions. The objectives of the present narrative review were to identify, summarize, and cluster all the potentially modifiable risk factors that influence the course of KOA, and discuss their susceptibility to alterat...

Our aim was to appraise publications from Bulgaria, to assess their global impact, and to describe features and challenges unique to the rheumatology practice in Bulgaria characterized by stringent cost constraints. The Scopus database was queried on 25th July 2018 and data on the number of published documents, their Hirsch-indices and citations nu...

Psoriatic arthritis (PsA) is a pleiotropic inflammatory disease from the spectrum of spondyloarthritides which can potentially affect many organ systems. The chronic nature of the inflammatory milieu presented in rheumatic diseases, is similar to that of atherosclerosis, suggesting a common pathogenic basis. Effector cells of innate and adaptive im...

Background: Osteoarthritis (OA) is a prevalent musculoskeletal disorder, often complicated by comorbid conditions such as cardiovascular diseases, metabolic syndromes, and mental health issues. These comorbidities significantly impact the progression of OA and the effectiveness of its management, posing challenges for comprehensive patient care. Ob...

Ankylosing Spondylitis (AS) stands as a chronic inflammatory arthritis within the spondyloarthritis spectrum, notably increasing cardiovascular (CV) risk and mortality through accelerated atherosclerosis compared to the non-affected population. While evidence in some studies supports a higher cardiovascular morbidity in AS patients, results from ot...

Background Axial Spondyloarthritis (AxSpA) is a chronic inflammatory condition affecting the axial skeleton, accompanied by pain and restricted movement, resulting in the accumulation of cardiovascular diseases, early disability, and death. Upadacitinib, as a novel Janus kinase 1 (JAK1) inhibitor, seems to offer new therapeutic possibilities for pa...

Background Chronic inflammation has long been recognized as a driving factor in atherosclerosis and cardiovascular events, particularly in rheumatoid arthritis patients. However, the extent of available data on seronegative spondyloarthritis, specifically ankylosing spondylitis (AS) and psoriatic arthritis (PsA), remains limited, underscoring the n...

Background Musculoskeletal pain is a prevalent symptom in various diseases. Both rheumatic and nonrheumatic conditions may manifest with joint or muscle pain, influenced by diverse mechanisms dependent on the pain’s acute or chronic nature. Biochemical reactions, along with biological, physiological, and social factors, contribute to its pathogenes...

Axial Spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated rheumatic disease that comprises two subsets, non-radiographic and radiographic axSpA, and belongs to a heterogeneous group of spondyloarthritides (SpA). Over the years, the concept of SpA has evolved significantly, as reflected in the existing classification criteria. Cons...

Rapidly destructive coxopathy (RDC) is a rare type of coxarthritis marked by swift deterioration of the hip joint. Although its cause remains unclear, several pathophysiological mechanisms are proposed. To comprehensively analyze this poorly understood condition, a literature search was conducted focusing on associations of bilateral RDC and rheuma...

Objective: Polycystic ovary syndrome (PCOS) is a prevalent hormonal and metabolic disorder, wherein the adipose tissue and gut microbiome have been demonstrated to contribute to its pathogenesis. This study aims to assess the concentrations of the adipokine, meteorin-like protein (Metrnl) and the protein, zonulin, related to intestine permeability,...

Introduction Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Give...

Introduction. Axial spondyloarthritis (axSpA) is an inflammatory disorder affecting the axial skeleton, accompanied by pain, restricted mobility, and other symptoms. The Ankylosing Spondylitis Disease Activity Score (ASDAS) is a metric expressing disease activity, assessing inflammation and symptoms. In clinical trials, Upadacitinib has demonstrate...

To determine the scope of recommended vaccination uptake among patients with inflammatory arthritis (IA) receiving biologic and targeted synthetic disease-modifying antirheumatic agents (bDMARDs and tsDMARDs, respectively) and to determine factors, which influence their decision and are subject to modification. A single-center, cross-sectional stud...

This narrative review provides a comprehensive examination of the complex interplay between inflammatory arthritis (IA) and cardiovascular pathology. It particularly illuminates the roles of atherosclerosis initiation, endothelial dysfunction, and glycocalyx shedding. IA not only provokes tissue-specific inflammatory responses, but also engenders a...

Background Radiologic evidence of sacroiliitis is important for the diagnosis, classification, and management of patients with ankylosing spondylitis (AS)[1]. Conventional radiography (CR) has been the most widely utilized imaging modality for the assessment of sacroiliac involvement in axial spondyloarthritis (AxSpA) because of the low radiation d...

Background The existing EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis (OA) were published in 2013. A considerable number of new studies on various non-pharmacological treatment modalities have been published since then. Hence, it is time to update the Recommendations for the non-pharmacological cor...

Background Vaccines are one of the most efficient tools to prevent infectious diseases at a population level. Their importance is even greater in immunocompromised patients providing efficient and safe protection against common viral and bacterial infections. According to the current EULAR recommendations based on solid evidence over the recent yea...

Background The absence of categorical radiographic evidence of structural changes in the sacroiliac joints serves to distinguish AS from nr-axSpA. Both groups of patients are characterized by active inflammatory changes, established by magnetic resonance tomography (MRI) of the sacroiliac joints, which, with the progression of the disease, are stru...

Background Chronic inflammatory joint diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are most common rheumatic diseases that may cause musculoskeletal pain [1]. The genesis of pain is very complex and many different mechanisms are involved. It is the result of multiple biochemical reactions and...

Objectives: Aim of the study was to assess the therapeutic efficacy and safety of upadacitinib in Rheumatoid arthritis patients with moderate to high disease activity in real-world clinical practice and to identify predictors of therapeutic success. Materials and methods: A retrospective single-center study was performed in RA patients treated with...

Background: Rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD), with inflammation playing a key role. Biologic and targeted synthetic drugs used to treat RA can induce systemic immunomodulation and may have pleiotropic effects on vascular function, making it crucial to investigate their impact on CVD risk in RA patients....

While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quickly spread across the globe, our understanding of its pathogenic mechanisms evolved. Importantly, coronavirus disease 2019 (COVID-19) is now considered a syndromic multisystem inflammatory disease involving not only the respiratory system but also the cardiovascular, excretory,...

Takayasu’s arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may t...

Although it has been almost three years since the World Health Organization (WHO) declared a pandemic, COVID-19 is still an unsolved problem, thereby attracting great scientific interest. The disease has a heterogeneous clinical picture with multiple manifestations from different organs and systems. Currently, COVID-19 is perceived as a polysyndrom...

Intravenous administration of immunoglobulins has been routinely used for more than 60 years in clinical practice, developed initially as replacement therapy in immunodeficiency disorders. Today, the use of intravenous immunoglobulins (IVIGs) is embedded in the modern algorithms for the management of a few diseases, while in most cases, their appli...

Background: The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)", caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence...

Osteoarthritis (OA) is traditionally considered an age-related disease. Therefore, repurposing drugs with the potential to reduce cell senescence is a justified therapeutic strategy. Such is the case of metformin, the most widely used antidiabetic medicine with well-known pharmacokinetics, acceptable toxicity, and beneficial metabolic effects. Metf...

Background: Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) (1), our understanding of the underlying pathophysiology is constantly evolving in order to explain the wide range of heterogenic clinical manifestations (2). Nevertheless, limited data are avai...

Background Bulgaria is among the countries with the lowest vaccination rate of adult population in Europe. The presence of autoimmune rheumatic disease could further contribute to vaccine hesitancy and skepticism and influence patients’ attitudes towards vaccination [1, 2]. However, little is still known about the willingness and particular causes...

Objective: Our aim was to analyze levels of proinflammatory biomarker interleukin-18 (IL-18) in healthy controls and patients with polycystic ovary syndrome (PCOS) focusing on its association with obesity, clinical, hormonal, and metabolic characteristics. Methods: Fifty-eight patients with PCOS were enrolled in the study fulfilling the Rotterda...

Introduction: Ovarian folliculogenesis requires a fine balance between extra- and intra-ovarian factors. Endocannabinoids are found in the female reproductive system and are essential for a normal follicular growing process and ovulation. First, our study aimed to analyze levels of the endocannabinoid-2-arachidonoylglycerol (2-AG)-in patients with...

Background: The endocannabinoid system is involved in the regulation of energy balance and ovarian function and may be implicated in the pathogenesis of polycystic ovary syndrome (PCOS). The purpose of the present study is to determine anandamide (AEA) levels in PCOS patients and controls and to analyze its association with metabolic and hormonal...

MY LIFE AS A CLINICIAN, RESEARCHER AND EDITOR

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease and polymorphisms in the cytokine genes and their receptors are thought to influence its development. The aim of this case–control study was to investigate the association of the IL-17A rs2275913, IL-17RC rs708567 and TGFB1 rs1800469 polymorphisms with SLE, its clinical manif...

Type 2 diabetes (T2D) is one of the most common chronic metabolic disorders in adulthood worldwide, whose pathophysiology includes an abnormal immune response accompanied by cytokine dysregulation and inflammation. As the T2D-related inflammation and its progression were associated with the balance between pro and anti-inflammatory cytokines, antic...

Introduction: The study aimed to analyze clinical data for early-stage knee osteoarthritis, assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire among patients with polycystic ovary syndrome (PCOS) and healthy volunteers and to examine their relationship with hyperandrogenism in PCOS. Methods: The study included 54 pa...

The close link between osteoarthritis (OA) and metabolic disorders on the one hand and hormonal disorders on the other suggests a possible association between OA and endocrine-metabolic disorders, such as PCOS. The aim of this review is to analyze the relationship between PCOS and OA, to consider the common pathogenetic mechanisms between the two c...

Background Recently evolved from a monochromic flu-like disease to a polysyndromic “spectrum of disease”, our understanding of coronavirus disease 2019 (COVID-19) is still far from being complete [1]. Hyperinflammation involving not only the lungs but also the musculoskeletal system, skin, cardiovascular, genitourinary systems is immune-mediated re...

Background Sustainability, the ability of drugs to maintain remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA), plays a crucial role for the prevention of structural damage to joints and thus, preserving patients’ functional capacity, health-related quality of life and general sense of well-being. Therefore, studying...

Background Osteoarthritis (OA) is a slowly progressive disease that probably begins in young adulthood when a timely treatment would present the possibility to reverse or slow down the disease process. Obesity and sex hormones play an essential role in the pathogenesis of OA in women and their influence on joint function persists throughout the who...

Introduction: OBJECTIVES: Our aim was to analyze the link between hyperandrogenism and early clinical manifestations of osteoarthritis (OA), knee cartilage thickness, and serum cartilage oligomeric matrix protein (sCOMP) levels in patients with polycystic ovary syndrome (PCOS) and to compare them with healthy volunteers. Methods: Fifty-four PCOS...

Introduction: Two of the most studied members of the endocannabinoid system (ECS) are arachidonoyl ethanolamide (anandamide, AEA) and 2-arachidonoyl glycerol (2-AG). The ECS has been confirmed to have effects on metabolism, energy and appetite control, ovarian function, and woman reproduction. Its role in polycystic ovary syndrome (PCOS) pathogene...

Coronavirus disease 2019 (COVID-19) pandemic has become challenging even for the most durable healthcare systems. It seems that vaccination, one of the most effective public-health interventions, presents a ray of hope to end the pandemic by achieving herd immunity. In this review, we aimed to cover aspects of the current knowledge of severe acute...

Introduction. Sarcopenia or muscle atrophy is a common feature of many chronic diseases of the musculoskeletal system including those accompanied by chronic low back pain (LBP). Purpose. The aim of the study was to evaluate the morphological changes of the muscles in the lumbosacral region in patients with axial spondyloarthritis (AxSpA) who underw...

Introduction: Polycystic ovary syndrome (PCOS) has been associated with a variety of proinflammatory conditions such as obesity, type 2 diabetes, dyslipidemia, hypertension, and metabolic syndrome. Interleukin-18 (IL-18) is a strong proinflammatory biomarker. Our goal was to analyze the IL-18 levels in PCOS patients and to determine which parameter...

The expectations from any future disease-modifying treatment for knee osteoarthritis (KOA) are extremely high as it has to impact the joint as a whole leading to favorable alterations of diverse tissues and functions. In this light, targeting the knee only from the inside may not be biologically justified for the management of a whole joint disease...

Objective: To evaluate serum matrix metalloproteinase (MMP)-3 levels as a prognostic marker for the progression of cartilage damage in patients with knee osteoarthritis (KOA). Methods: Fifty-six patients who met the ACR criteria for KOA, were included in a one-year observational prospective clinical study. Complete baseline and follow-up data were...

Recent advances in our understanding of coronavirus disease 2019 (COVID-19) and the associated acute respiratory distress syndrome might approximate the cytokine release syndrome of severe immune-mediated disease. Importantly, this presumption provides the rationale for utilization of therapy, until recently reserved mostly for autoimmune diseases...

Background: Osteoarthritis (OA) is a leading cause of disability worldwide and pain is its cardinal symptom. Ranging from structural injuries to central sensitization, multifactorial mechanisms play an important role in pain perception in patients with knee OA (KOA) defining a discrepancy between pain and structural damage. Imaging modalities such...

Purpose: Our study aims at assessing the clinical effectiveness and comparing treatment response in patients injected with intra-articular high-molecular-weight cross-linked hyaluronic acid (HMWHA) or platelet-rich plasma (PRP) in the routine clinical practice. Methods: Fifty-one consecutive patients aged 40 to 80 years were included in this open-l...

A significant place in the treatment of osteoarthritis (OA) is taken by physical therapy. Its modalities may be grouped into the following three categories, which could be used alone or in combination: 1) physiotherapeutic (preformed); 2) kinesitherapeutic; 3) resort-climatic (natural) means. The purpose of this review is to outline the place of ph...

Background Hyaluronic acid (HA) is a natural polysaccharide, which is an important structural component of synovial fluid and cartilage. There are different injectable forms of HA used for clinical application. Highly cross-linked/high-molecular-weight hyaluronans (HMWHA) provide additional stability and improve functionality [1], resulting in long...

Objectives Although knee osteoarthritis (KOA) is a leading cause of impaired functioning among older adults globally, little is still known about the complex mechanisms of disability accumulation in these patients. The aim of the study was to analyze the clinical parameters of patients with KOA in a Bulgarian population and to determine which of th...

The aim of the present study was to investigate the relationship between CRP and clinical parameters of the disease, including quality of life of patients with knee osteoarthritis (KOA) in Bulgarian population. 132 patients (81% female) with symptomatic KOA (mean age of 63.45 years) and 31 healthy volunteers were included in the study. Their clinic...

Background Extrusion of the medial meniscus is a consequence of the complex interactions among joint structures and altered tissue mechanics involved in the osteoarthritis (OA) process.[1] Potential contributing factors are cartilage loss, meniscal tears, obesity and knee malalignment [2–4] – features strongly associated with knee OA. Ultrasound (U...

Biochemical markers reflecting joint remodeling in osteoarthritis (OA) are a promising diagnostic tool. The aim of this study was to investigate serum levels of candidate biomarkers in subjects with and without knee OA and assess their correlation with clinical parameters and knee structural damage. 56 patients with primary knee OA and 31 healthy c...

Cartilage oligomeric matrix protein (COMP) is an oligomeric tissue-specific glycoprotein synthesized by chondrocytes. It represents structural damage in knee OA observed by imaging modalities such as radiography and MRI. The purpose of this study was to correlate serum COMP levels with MRI-detected structural damage of different joint elements in p...

There is a wide variety of tools to measure different aspects of health in patients with knee osteoarthritis (KOA). These include the visual analogue scale for determining pain intensity, disease-specific self-reported questionnaires or interviews, and generic questionnaires for overall health assessment, which evaluate quality of life and the degr...

Introduction. Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder characterized by axial and peripheral joint involvement as well as extra-articular manifestations such as skin and nail disease, enthesitis, dactylitis, uveitis, etc. Given the broad clinical spectrum, the assessment of the natural course, activity, therapeut...

The article analyzes the opportunities of combining homogeneous data derived from diversified sources of information. The emphasis in the analysis is placed on the possibility of applying parametric empirical Bayesian methods for the purposes of medical diagnostic tests for purposes of medical analysis of various diseases or in studies on the impac...

The article analyzes the opportunities of combining homogeneous data derived from diversified sources of information. The emphasis in the analysis is placed on the possibility of applying parametric empirical Bayesian methods for the purposes of medical diagnostic tests for purposes of medical analysis of various diseases or in studies on the impac...

Osteoarthritis is a degenerative joint disease characterized by loss of joint cartilage, projections along the bone edges (osteophytes) and changes in the underlying bone (subchondral osteosclerosis), and a number of biochemical and morphological changes, involving both the synovial membrane and joint capsule and periarticular structures. It is the...

This paper concerns the reliability assessment of sensors networks, shaped in line with hierarchic structures. Proper reliability indices for this purpose are suggested and mathematically expressed. An approach to reliability assessment of sensor networks is also suggested and applied to two case studies concerning medical purpose implementation an...

This paper concerns the reliability assessment of sensors networks, shaped in line with hierarchic structures. Proper reliability indices for this purpose are suggested and mathematically expressed. An approach to reliability assessment of sensor networks is also suggested and applied to two case studies concerning medical purpose implementation an...

Остеоартрозата (OA) е най-честото заболяване, водещо до ставна болка, придружена в различна степен от функционален дефицит и намалено качество на живот. ОА е бавен, прогресиращ и инвалидизиращ процес с висока честота в човешката популация. Според статистически данни тя засяга 12-15% от възрастното население, а във възрастта над 75 години от ОА стра...

Summary. Plain film radiography still remains the “gold” standard in the assessment of knee osteoarthritis. It is a two-dimensional projection of three-dimensional joint structures. Radiographic changes include joint space narrowing, formation of osteophytes, subchondral osteosclerosis and cysts, deformity of the bone contour to complete ankylosis....

In this article is looking for adequate solution of the task to the unification of uniform information from diverse sources for purposes of medical analysis of the research of various diseases or the impact of new drugs on the state of patients.

During the last few years, the expenses for therapy number with biological agents of patients with RA are progressively increasing due to the increased of cases undergoing biological treatment. This pattern is one of the main causes for increased expenditure on the part of the National Health Insurance Fund. There are several problems that make the...

Intraarticular application of hyaluronans improves the biomechanical properties of the osteoarthritis synovial fluid restoring its viscosity and elasticity. Over the past years attention has also been paid to antiinflammatory and anti-nociceptive properties of the hyaluronic acid which are not quite fully understood yet. The total clinical effect i...

The main feature of osteoarthritis is the disruption of the articular cartilage induced by complex interaction of genetic, metabolic, biochemical and biomechanical factors followed by secondary inflammation. The process includes increased levels of catabolic processes of the cartilage and suboptimal reparative response to its destruction. Although...

The contemporary concept of osteoarthritis (OA) considers the disease a pathological process which involves whole joint structure - cartilage, synovium, subchondral bone, ligaments and periarticular muscles. Changes in these tissues are an essential part of the pathogenic mechanisms of the disease and present an interesting target for research of p...

Vitamin D3 is part of the group of fat-soluble vitamins and controls the calcium concentration in the blood and in the bones. Researchers present more and more data concerning its effects that reach far beyond what is known by now. Before the era of antibiotics sunbathing was part of the treatment against infections such as tuberculosis. Today it i...