Hlavní téma - Aktuality v revmatologii

prof. MUDr. Pavel Horák, CSc.

Vnitr Lek 2022, 68(5):263  

Treatment of giant cell arteritis - current approach and new possibilities

Jakub Videman, Martina Skácelová, Pavel Horák, Adéla Skoumalová, Dominik Hraboš

Vnitr Lek 2022, 68(5):266-272 | DOI: 10.36290/vnl.2022.058  

Giant Cell Arteritis (GCA) is an autoimmune mediated systemic vasculitis affecting large arteries - the aorta and its branches. It has the highest incidence of all systemic vasculitides and manifests nearly exclusively in patients aged 50 or older. Amongst its non-specific and specific symptoms are headaches, mastication claudication or signs of rheumatic polymyalgia, a relatively common and immediate treatment requiring condition being acute vision loss due to optic ischemia. A GCA diagnosis is based on clinical and paraclinical findings and imaging techniques including PET/CT; with an important role still being played by histological verification...

What is new in the treatment of Systemic Lupus Erythematosus?

Martina Skácelová

Vnitr Lek 2022, 68(5):273-278 | DOI: 10.36290/vnl.2022.059  

Systemic lupus erythematosus treatment is targeted to achieve remission or low disease activity and protection from disease flares. A number of immunosupresive drugs in combination with glucocorticoids are used for this purpose and there is an increased possibility of the use of biologic treatment, especially of belimumab. Calcineurin inhibitor voclosporin is a novelty in lupus nephritis treatment. Another novelty is anifrolumab, a biologic drug which inhibits the activity of type I interferons. An integral part of care is the prevention of late disease complications, especially cardiovascular risk management.

News in the treatment of axial spondyloarthritis

Martin Žurek, Pavel Horák

Vnitr Lek 2022, 68(5):279-284 | DOI: 10.36290/vnl.2022.060  

Axial spondyloarthritis is a rheumatic disease characterized by inflammation and bone formation causing impaired function of the spine and affected joints. Basic research has highlighted the key role of dysregulation of tumor necrosis factor α, interleukin-23 and interleukin-17 cytokine production in the etiology of axial spondyloarthritis. Tumor necrosis factor α and interleukin-17 inhibitors have been shown to be effective in clinical trials and are currently approved biological disease-modifying drugs for all disease subgroups. The presumed efficacy of IL-23 blockade has not been confirmed in two clinical trials with anti-IL-23 monoclonal...

Early diagnosis of systemic scleroderma

Adéla Skoumalová, Pavel Horák, Zuzana Heřmanová, Jakub Videman, Andrea Smržová, Viktor Palla

Vnitr Lek 2022, 68(5):285-289 | DOI: 10.36290/vnl.2022.061  

Systemic scleroderma (SSc) is a systemic immune-mediated connective tissue disease characterized by fibroproductive changes in connective tissue and microvascular disorders. The disease affects the skin, musculoskeletal system and internal organs. It is a disease with a significant rate of morbidity and mortality, significantly worsening the quality of life of patients. Early initiation of therapy is necessary to prevent disease progression. This review article discusses the current possibilities of early diagnosis of systemic scleroderma.

Diffuse alveolar hemorrhage as a life‑threatening manifestation of newly diagnosed granulomatosis with polyangiitis following COVID-19 infection - a case report

Pavlína Kostelníková, Martina Skácelová, Martin Špíšek, Miroslav Šimíček, Pavel Horák

Vnitr Lek 2022, 68(5):290-294 | DOI: 10.36290/vnl.2022.062  

A case report of a patient with newly diagnosed granulomatosis with polyangiitis (GPA) after undergoing COVID-19 (Coronavirus Disease 2019) is discussed. GPA is one of the ANCA-associated vasculitis, which is characterized by the presence of autoantibodies against cytoplasmic enzymes neutrophils (Anti Neutrophil Cytoplasmatic Antibodies). It is a vasculitis that mainly affects small blood vessels, leading to damage to the kidneys, lungs, and upper respiratory tract, including the paranasal sinuses and orbits. This disease can result in an acute life-threatening condition. Such complications include diffuse alveolar hemorrhage (DAH), a condition characterized...

What's new in 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice?

Jana Obrová, Pavla Jadrníčková, Jan Václavík

Vnitr Lek 2022, 68(5):295-302 | DOI: 10.36290/vnl.2022.063  

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice provides a comprehensive view on preventive cardiology. It presents strategies to reduce the burden of atherosclerotic cardiovascular disease (CVD), both at the individual level and at the population level. Healthy lifestyle and aggressive control of cardiovascular risk factors remain the cornerstone of prevention. Classification of individuals into risk groups based on their clinical characteristics followed by a stepwise treatment-intensification is a novel recommended approach. Updated risk charts - SCORE2 and SCORE2-OP - are intended for estimation of 10-year fatal and...

Why take organ damage in hypertension seriously?

Eva Kociánová

Vnitr Lek 2022, 68(5):303-308 | DOI: 10.36290/vnl.2022.064  

The focus of recent European guidelines has been early initiation of antihypertensive therapy in risk groups, rapid achievement of target blood pressure with fixed combinations of antihypertensive drugs, and the best possible management of an individual's cardiovascular risk. Early intervention in the development of hypertension-mediated organ damage (HMOD) has been shown to have an effect on the subsequent reduction in the risk of cardiovascular events. The point of HMOD origination correlates with the magnitude and duration of blood pressure elevation, and there is no clearly defined boundary from which vascular damage begins to develop. A reduction...

Inflammation and vascular diseases

Debora Karetová, Jan Bultas

Vnitr Lek 2022, 68(5):309-314 | DOI: 10.36290/vnl.2022.065  

Chronic venous disease and cardiovascular atherothrombotic diseases have a high prevalence worldwide. The aetiopathogenesis of both these vascular conditions may share certain aetiopathogenetic moments. Abnormal blood flow, altered intravascular tension, and subsequent endothelial dysfunction may all play an important role. Another plausible alternative is the correlation of some risk factors of both diseases, in particular obesity and metabolic syndrome with all its components and an impact on atherogenesis as well as chronic venous disease. The relationship may even be causal, that is a chronic vessel wall inflammation which is present in advanced...

Time in range: new parameter to evaluate blood glucose control

Milan Flekač

Vnitr Lek 2022, 68(5):315-323 | DOI: 10.36290/vnl.2022.066  

Continuous glucose monitoring became more common in everyday clinical practice. New parameters have been created as a standard for assessing the degree of control for people with diabetes and can be used more clearly than glycated haemoglobin. The new parameter time in range represents a significant benefit not only for diabetologists, but also an important tool to help the patients in their daily lives with diabetes.

What's new in 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‑segment elevation?

Jan Mrózek, Jan Václavík

Vnitr Lek 2022, 68(5):324-331 | DOI: 10.36290/vnl.2022.067  

The article sumarizes the 2020 ESC Guidelines for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation. The diagnostics of ACS consists in assessment of chest pain, EKG and cardiac troponin. Troponin should be evaluated by high sensitivity assay. 0h/1h algorithms should be used to rule-in or rule-out ACS. Patients with a positive troponin have higher risk of cardivascular events and mortality and the early invasive treatment should be applied in these patients. In the guidelines several antithrombotic stretegies for different clinical conditions are mentioned, where the cornerstone for the...

Differential diagnosis of back pain

Hana Ciferská, Jan Vachek

Vnitr Lek 2022, 68(5):332-341 | DOI: 10.36290/vnl.2022.068  

Back pain (BP) is among the most common reasons for seeking medical attention worldwide. The nature of BP depends on the causative stimulus and its anatomical location. Clinically, BP is manifested by pain, muscle tension, and stiffness. The development of BP is a very complex, multifactorial process in which not only somatic stimuli (anatomical structures), but also psychosocial effects are involved. Using a variety of criteria, BP can be divided into specific where the cause of pain is known, nonspecific wherein the cause remains unclear, or according to its duration (i.e., acute, subacute, and chronic back pain). Simple low back pain must be distinguished...

IgG4-related disease. Clinical manifestation differential diagnosis and recent International Diagnostic Criteria for IgG4-related disease

Zdeněk Adam, David Zeman, Aleš Čermák, Milan Dastych, Martina Doubková, Theodor Horváth, Šárka Skorkovská, Zuzana Adamová, Zdeněk Řehák, Renata Koukalová, Luděk Pour, Martin Štork, Marta Krejčí, Viera Sandecká, Sabina Ševčíková, Zdeněk Král

Vnitr Lek 2022, 68(5):E20-E26 | DOI: 10.36290/vnl.2022.070  

Immunoglobulin G4- related disease (IgG4-RD) is a rare systemic fibro-inflammatory disorder. Autoimmune pancreatitis is the most frequent manifestation of IgG4-RD. However, IgG4-RD can affect any organ such as salivary glands, orbits, retroperitoneum, prostate and many others. Recent research enabled a clear clinical and histopathological description of IgG4-RD and in 2019 four Clinical phenotypes of IgG4-related disease were described. Diagnosis is based on morphological examination with typical findings of lymphoplasmocellular inflammation, storiform fibrosis and obliterative phlebitis in IgG4-RD biopsies and the tissue invading plasma cells largely...

Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation

Martin Pešl, Tomáš Kulík, Tomáš Ostřížek, Vladimír Horváth, Filip Souček, Katarína Melajová, Katarína Doležalová, Daniela Žáková, Tomasz Jadczyk, František Lehar, Jiří Jež, Zdenek Stárek

Vnitr Lek 2022, 68(5):E20-E26 | DOI: 10.36290/vnl.2022.069  

Introduction: Single stage thoracoscopic radiofrequency ablation (RFA) is a treatment method for persistent and long-term persistent atrial fibrillation (AF) offering the possibility for patients otherwise inconsolable by conventional catheter RFA. We present a pilot group of patients after the introduction of the new method at our clinical center. Patients group: A total of 52 patients aged 61.82 ± 9.7 years underwent single stage hybrid ablation (thoracoscopic isolation of pulmonary veins and box lesion followed by catheter verification of the surgical procedure effectivness) for symptomatic persistent and long-term persistent AF with significantly...

Entresto (sakubitril-valsartan) získalo prestižní mezinárodní Galénovu cenu za nejlepší farmaceutický produkt pro rok 2022

Filip Málek

Vnitr Lek 2022, 68(5):342-344  

XXXIX. dny mladých internistů v Martině

MUDr. Viktor Klementa

Vnitr Lek 2022, 68(5):345  

Critical Appraisal of Guidelines in Internal Medicine Working Group

MUDr. Zdeněk Monhart, Ph.D., FEFIM

Vnitr Lek 2022, 68(5):E27 | DOI: 10.36290/vnl.2022.074