Revmatologie a vnitřní lékařství

Pavel Horák, Petr Němec

Vnitr Lek 2018, 64(2):97  

Rheumatoid arthritis

Ladislav Šenolt

Vnitr Lek 2018, 64(2):98-106 | DOI: 10.36290/vnl.2018.017  

Rheumatoid arthritis is an autoimmune disease manifested by a persistent inflammation of synovial joints, bone destruction, loss of cartilage and increased risk of cardiovascular and other intercurrent diseases. The treatment of rheumatoid arthritis should be based on the strategy of treat to target therapy which is achieving remission, in some cases low activity of the disease. Essential to the treat to target therapy are more frequent checkups and optimization of treatment based on disease activity. Methotrexate continues to be the essential medicine from the group of disease modifying antirheumatic drugs for rheumatoid arthritis treatment. At the...

Axial spondyloarthritis

Leona Procházková, Vladimír Červeňák, Miroslav Souček

Vnitr Lek 2018, 64(2):108-116 | DOI: 10.36290/vnl.2018.018  

Axial spondyloarthritis (axSpA) is a common name for the non-radiographic form of the disease and radiographic axial spondyloarthritis, known as ankylosing spondylitis (AS). The disease is typically manifested at a young age, characterized by affection of axial skeleton, and in the most severe form can lead to complete ankylosis of the spine. Etiology of diseases have not yet been clarified, however, the genetic background, especially the binding to HLA-B27 antigen, is obvious. Clinical manifestations are dominated by chronic pain in the lower pain or buttocks that occurred in young age, in a large proportion of patients having the character of so-called...

The role of magnetic resonance imaging in diagnostics of axial spondyloarthritis

Martin Žlnay

Vnitr Lek 2018, 64(2):117-126 | DOI: 10.36290/vnl.2018.019  

Axial spondyloarthritis (SpA) is a chronic inflammatory rheumatic disorder that primary affects axial skeleton. It comprises wide spectrum of patients with immune mediated spine inflammation, from early, so called non-radiographic axial spondyloarthritis to clinically evident ankylosing spondylitis. Conventional radiography is still the cornerstone of diagnosis, evaluation and classification of SpA. However, it has limitations in early disease, because it can only depict the consequences of inflammation for its inability to visualize soft tissue abnormalities within bone marrow. Magnetic resonance imaging (MRI) is superior to conventional radiography...

Biological treatment of psoriatic arthritis

Jiří Štolfa

Vnitr Lek 2018, 64(2):127-135 | DOI: 10.36290/vnl.2018.020  

Psoriatic arthritis (PsA) is a heterogeneous disease affecting, besides synovial joints, also the entheses, the soft tissues of the whole finger (dactylitis) and the axial skeleton. Currently the classification criteria CASPAR are used to diagnose PsA. In a large number of patients the disease leads to irreversible joint damage (X-ray, respectively clinical) which significantly reduces life quality and limits the patient in his/her everyday activities and also considerably limits their work capacity. There is evidence showing that early commencement of treatment and treat to target principle can significantly reduce this negative development. In recent...

Life threatening manifestations of lupus and antiphospholipid syndrome in internal medicine

Pavel Horák, Martina Skácelová, Jiří Vymětal, Markéta Schubertová

Vnitr Lek 2018, 64(2):136-145 | DOI: 10.36290/vnl.2018.021  

The clinical picture of systemic lupus and antiphospholipid syndrome is remarkably varied and disease manifestations are commonly very heterogeneous. Relatively often both diseases are associated with severe, acute and life threatening manifestations, which places demands on the knowledge of differential diagnostics and experience of the physicians. This article deals with the serious and mostly acute impairment of cardiovascular, respiratory, renal, gastrointestinal, hematopoietic or nervous systems, briefly discusses the acute pregnancy complication and summarizes the basic therapeutic option. It emphasizes the role of both, sometimes inseparable,...

Systemic sclerosis in 2017

Tomáš Soukup, Tomáš Veleta

Vnitr Lek 2018, 64(2):146-154 | DOI: 10.36290/vnl.2018.022  

Systemic sclerosis is classed as a diffuse (systemic) disease of connective tissue. It is a heterogeneous disease significantly shortening life expectancy. Its etiology is unknown. Pathogenetic interplay is assumed to involve a triad of pathological autoimmune inflammation, vasculopathy and fibrosis. Clinical manifestations can be classed based on the preponderant pathogenetic process. Vasculopathy is manifested by secondary Raynaud's phenomenon with abnormal findings on the nailfold capillaroscopy, skin telangiectasias, gastric antral vascular ectasia, life threatening scleroderma renal crisis, digital ulcerations and prognostically severe pulmonary...

Idiopathic inflammatory myopathies

Jiří Vencovský

Vnitr Lek 2018, 64(2):155-163 | DOI: 10.36290/vnl.2018.023  

Idiopathic inflammatory myopathies form a heterogeneous group of acquired inflammatory diseases afflicting striated muscles. The disease is frequently accompanied by systemic and organ involvement. Dermatomyositis, polymyositis, cancer associated myositis, immune mediated necrotizing myopathy, myositis in overlap syndromes, juvenile myositis and inclusion body myositis are the most frequently encountered subtypes. The basic manifestation is usually painless muscle weakness brought about by inflammation and by other immune changes at the impacted muscles. Enzymes of muscle origin and myoglobin are found elevated in the circulation. There are changes...

Novel trends in monitoring and therapy of ANCA associated vasculitides

Radim Bečvář

Vnitr Lek 2018, 64(2):164-168 | DOI: 10.36290/vnl.2018.024  

Vasculitides with positivity of autoantibodies to neutrophil leukocytes cytoplasm (ANCA, AAV) belong to primary vasculitides involving small and less commonly medium size blood vessels. Three different clinical types of AAV can be distinguished: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. Since these autoantibodies seem to be weak activity biomarkers of AAV new molecules and factors start to come up, e.g. neutrophil extracellular traps NET, several T-lymphocyte subpopulations and different immunoglobulins classes of ANCA. In modern biological therapy rituximab is widely used, for refractory...

Diffuse alveolar hemorrhage - acute, life-threatening situation in rheumatology

Petr Bradna, Jan Maňák, Tomáš Soukup, Michal Kodeda, Marcela Drahošová, Jan Tomš

Vnitr Lek 2018, 64(2):169-172 | DOI: 10.36290/vnl.2018.025  

Diffuse alveolar hemorrhage (DAH) is a life-threatening acute manifestation of systemic diseases, the most commonly of systemic vasculitis. Clinically DAH manifests by a rapidly progressive respiratory and renal failure. The decisive for diagnose is immediate bronchoscopic examination with the bronchoalveolar lavage examination. CT mostly show bilateral pulmonary infiltrates, in blood picture rapidly come to anemia. In the majority of patients it can be found positive ANCA antibodies. DAH should be suspected in the case of acute respiratory failure also in patients without history of systemic disease. On the set of 33 patients with acute DAH episode,...

Polymyalgia rheumatica

Petr Němec, Andrea Šprláková-Puková, Zdeněk Řehák

Vnitr Lek 2018, 64(2):173-183 | DOI: 10.36290/vnl.2018.026  

Polymyalgia rheumatica is the most frequent inflammatory disease of people over 50 years of age. It mainly affects the Caucasian race and roughly 2-3 times as many women. From the viewpoint of etiology, polymyalgia rheumatica is a complex disease. Involved in its origin is genetic predisposition, factors of age and outer environment. 16-21 % of patients with polymyalgia rheumatica may at the same time have symptoms of giant cell arteritis. Diagnosis is made primarily on the basis of clinical symptoms and it is supported by the presence of laboratory signs of inflammation. There is no specific diagnostic test available for diagnosing polymyalgia rheumatica....

Treat to target in gouty arthritis

Karel Pavelka

Vnitr Lek 2018, 64(2):185-190 | DOI: 10.36290/vnl.2018.027  

Gout is a crystal-induced, metabolically determined inflammatory rheumatic disease with increasing prevalence. In clinical practice, gout causes frequent diagnostic as well as therapeutic problems. The golden diagnostic standard is crystalographic analysis and evidence of monosodium urate crystals in the polarization microscope; if this is not available, the diagnosis can be established through a combination of clinical, laboratory and imaging techniques. The acute gouty attack must be treated by quick administration of anti-inflammatory medicines, with available alternatives being nonsteroidal antirheumatic drugs (NSA), colchicine and glucocorticoids....

Nutraceuticals in therapy of knee osteoarthritis: orthopaedic view

Jiří Gallo

Vnitr Lek 2018, 64(2):191-196 | DOI: 10.36290/vnl.2018.028  

Knee osteoarthritis is one of the most frequent diagnoses of load-carrying joints encountered in orthopaedic surgeons' offices. Depending on the clinical stage, the therapy starts with conservative treatment. Corrective osteotomy is indicated in younger patients without an extensive and serious impairment. Implantation of TKR (total knee replacement) is usually indicated in more advanced stages. One of the pillars of conservative therapy is analgesics and non-steroidal antirheumatic drugs. A specific group consists of perorally administered drugs for suppression of symptoms or even deceleration of knee osteoarthrosis. These products are popular mainly...

Osteoporosis and quality of bone

Jan Štěpán

Vnitr Lek 2018, 64(2):197-208 | DOI: 10.36290/vnl.2018.029  

The risk of osteoporotic fracture is determined collectively by bone mineral density, bone mass, architecture and properties of the mineral and organic matrix composite. Changes in these distinct aspects of quality of bone with age, estrogen deficiency, diseases leading to increased risk of fracture and differential mode of action of antiresorptive and bone anabolic treatments have to be considered in clinical therapeutic strategies. In patients at high risk of low impact fracture, sequential therapy switching to antiresorptives after patients have an adequate response to 2 years teriparatide may be the optimal strategy of long term therapy.

Chronic pain therapy in inflammatory rheumatic diseases

David Suchý, Jan Lejčko

Vnitr Lek 2018, 64(2):209-217 | DOI: 10.36290/vnl.2018.030  

Chronic pain is a common health problem related to most of inflammatory rheumatic disorders. It is pain that has persisted for at least 3 month and cannot be fully relieved by standard pain medication. 40-60 % of patients do not have adequate relief of their pain. Paramount in the management of chronic pain patients is assessment of the pain and its impact on physical and psychosocial functioning. Multidisciplinary and multimodal approach is of vital importance. Non-steroidal anti-rheumatic drugs (NSA) have been used mainly due to their strong analgesic effect, especially in the treatment of acute pain as well as their anti-inflammatory effect in the...