The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Anca Musetescu

Anca Musetescu

Characteristics of Anemia in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an inflammatory, chronic and systemic disease that primarily affects the synovial joints. Anemia is a common extra-articular manifestation in the absence of an effective treatment. The main mechanisms involved include shortening the lifespan of erythrocytes, inadequate bone marrow and abnormalities in iron metabolism. Eighty-eight patients over 18 years with definite diagnosis of rheumatoid were included in this study. The prevalence, respectively the characteristics of anemia were analyzed, together with demographic data, the type of symptoms, the type of comorbidities, the hematological indices and treatments. The mean age of the study population was 65.31 ± 12.57 years. Treat to target was achieved in one third of the patients (36.4%). The prevalence of anemia was 55% with higher prevalence in males (57%) than females (50%). Anemia was associated with higher disease activity (p=0.036). Out of the anemic patients, 7.14% had megaloblastic anemia, 40.48% had anemia of chronic disease and 21.43% suffered from iron deficiency anemia. Microcytic normochromic and normocytic hypochromic patterns can have mixed causes, belonging to both iron-pathophysiological processes and chronic inflammation. The prevalence of anemia at the 1-year check-up was 29.44% and the percentage of patients who achieved treat-to-target goals increased from 36.40% to 40.90%. The majority (48.80%) did not prove to have anemia neither at admission nor at follow-up. The results of the study suggest that anemic patients tend to have a higher level of RA activity, therefore screening for anemic syndrome should be part of the management of these patients, in an effort to establish the best therapeutic conduct.

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Evaluation of Treatment Response in Lupus Nephritis

Objectives: To evaluate the effectiveness of the treatment reflected by the rate of response to therapy at 6 months and 12 months of follow-up respectively. Methods: We retrospectively analyzed clinical, laboratory data, treatment regimens, the type of response and relapse rate of 51 patients diagnosed with LN between January 2017 and February 2020. Results:47.06% of the patients underwent renal biopsy, classes III and IV being the most common lupus nephritis types (totaling 35.3% of biopsied patients). All induction therapy choices analyzed in the study- CYC, Glucocorticoids (GCs) and MMF- proved effective at reducing the proteinuria of the patients (p=0.001, p=0.012 and p=0,019 respectively. The 12 months evaluation demonstrated an ascending trend of the complete response, starting from 27.45% at 6 months and almost doubling at 1 year (56.86%). Almost half of patients (49.02%) did not relapse, while most of them (27.45%) had only 1 relapse. Analyzing the risk of relapse for each induction drug used, CYC had the highest rate of recurrence (62.07%). The use of MMF as a maintenance drug associated the lowest degree of recurrence. Conclusions: Both CYC and MMF as induction therapy are significantly effective in reducing proteinuria. The complete response was more frequently identified as an endpoint at 12 months of follow-up.

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Particularities of Surgical Treatment for the Neuropathic Diabetic Foot

Diabetic neuropathy is one of the chronic complications of diabetes and along with other complications causes a pathology called diabetic foot. The present study analyzed a group of 164 patients admitted to the surgery department of the Clinical Hospital “Doctor Ioan Cantacuzino” Bucharest, between September and December 2019. The results of the study highlight the potential for contamination of neuropathic lesions and the need for curative surgery, most conservative. The conclusion of the analysis emphasizes that the imbalance of the underlying disease changes, in a negative sense, the prognosis of any complication of it.

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