16 articles
Chronic kidney disease and COVID-19 are both associated with significant morbidity. Patients with chronic kidney disease are at risk for severe COVID-19, and SARS-CoV-2 infection may accelerate CKD progression. This study aimed to compare renal outcomes in CKD patients with and without prior COVID-19 and to identify predictors of progression.
We conducted a prospective cohort study of 280 pre-dialysis CKD patients (stages G2–G5), followed for 12 months. Of these, 140 had a history of COVID-19 (post-COVID group), and 140 had no such history (control group). Baseline assessments included renal function (eGFR, creatinine, urea), inflammatory markers (CRP, ferritin, LDH), hematologic indices (hemoglobin, leukocytes, platelets), and SF-36 quality of life scores. CKD progression was defined as a ≥30% eGFR decline or the initiation of dialysis. Analyses included group comparisons, correlations, logistic regression, and ROC curves.
Baseline characteristics and mean eGFR (~60 mL/min/1.73 m²) were similar across groups. CRP and ferritin levels were elevated in both groups without significant differences. Post-COVID patients reported lower vitality and higher social functioning on SF-36 (both p < 0.001). After 12 months, the post-COVID group showed greater eGFR decline (–3.1 vs –1.2 mL/min) and a higher progression rate (28% vs 15%, p < 0.01). Multivariable analysis identified prior COVID-19 (adjusted OR ≈2.3, 95% CI: 1.3–4.0) and low baseline hemoglobin as independent predictors of progression; CRP and ferritin were not predictive. LDH showed a modest association. Hemoglobin alone predicted progression with an AUC of 0.78; the combined model (COVID status + hemoglobin) yielded an AUC of 0.85.
CKD patients with prior COVID-19 experienced a faster renal function decline over one year than those without COVID-19. Persistent anemia and elevated LDH were also associated with increased progression risk. These findings emphasize the importance of post-COVID renal monitoring and early intervention in CKD patients to prevent deterioration.
Systemic rheumatoid vasculitis accounts for 1 to 5% of complications seen in rheumatoid arthritis, while autopsy studies report an average of 23% incidence. This enormous difference in numbers emphasizes the rate of misdiagnosis or underdiagnosis of systemic rheumatoid vasculitis. It mainly affects people with a median age of 65 years. It is particularly noteworthy, as systemic rheumatoid vasculitis has a high mortality and relapse rate. Also, the multifactorial aetiology: cytokines/immune cells and other particles determines clinical complexity of this type of angiitis.
A comprehensive literature search of articles published since 1996 was conducted using MEDLINE via PubMed and HINARI. The search included terms such as "rheumatoid vasculitis", "rheumatoid arthritis", and "endothelial dysfunction", focusing on mechanisms driving vascular damage. A total of 217 relevant sources were identified, including original studies, reviews, and book chapters. The study evaluated pathogenic factors like cytokines, immune complexes, and systemic inflammation, highlighting their roles in endothelial dysfunction and hypercoagulability.
The main pathogenetic factors in systemic rheumatoid vasculitis were immune complexes, cytokines (IL-6/TNF-α and IL-17), immune and blood cells (CD20/TH17/Platelets) and others (microparticles, blood rheology modifications). Even though, taken separately, those factors appear to have little to no impact on vascular endothelium, their synergistic effect lead to significant endothelial damage.
To conclude, each disease has its own pathogenetic factors which determine the natural course of this pathology. Understanding these mechanisms plays an important role for clinicians helping them to diagnose and effective treatment. Taking into consideration the relationships between specific factors in rheumatoid angiitis, we can make more specific decisions for its diagnosis and treatment. We can also use the pathophysiology of systemic rheumatoid vasculitis as a foundation for developing prevention measures.
Scleroderma Renal Crisis (SRC) is a life-threatening complication of systemic sclerosis (SSc), traditionally associated with anti-RNA polymerase III antibodies, corticosteroid use, and diffuse skin involvement. However, the role of COVID-19 as a potential trigger for SRC remains poorly understood. This study explores the occurrence of COVID-19-associated SRC, focusing on its clinical presentation, underlying risk factors, and outcomes.
We present a case series of two unvaccinated patients with systemic sclerosis who developed SRC following COVID-19 infection, despite the absence of traditional risk factors. Clinical features, laboratory findings, renal histopathology, and disease progression were analyzed to assess potential mechanisms linking SARS-CoV-2 infection to SRC onset. Both patients developed abrupt-onset malignant hypertension and acute kidney injury after supporting the COVID-19. Neither patient had a history of corticosteroid use or known anti-RNA polymerase III positivity, suggesting an alternative mechanism of SRC activation. Notably, both cases had pre-existing renal anomalies (renal developmental abnormality and prior nephrectomy), which may have contributed to increased susceptibility. Despite aggressive management, both patients developed dialysis-dependent renal failure and succumbed to SRC-related complications.
Our findings highlight COVID-19 as a potential trigger for SRC, possibly through endothelial dysfunction, inflammatory cytokine storms, and renal microangiopathy. The presence of pre-existing kidney conditions may further predispose SSc patients to SRC following SARS-CoV-2 infection. Additionally, the lack of vaccination in these cases raises the question of whether COVID-19 immunization could reduce SRC risk. Further research is needed to elucidate the pathophysiology, risk stratification, and long-term outcomes of COVID-19-associated SRC, as well as the role of vaccination in prevention.
Neuropsychiatric lupus erythematosus is still a disease with a very challenging diagnostic process, lacking high specificity and sensitivity assays. Autoantibodies can change this perspective, and because of their pathogenetic involvement, can become a very powerful tool for early detection and disease activity tracking. However, their biomarker potential still needs further evaluation. In this study, we focused on the pathogenetic mechanisms of neuropsychiatric lupus erythematosus and the involvement of brain-specific and systemic autoantibodies in the development of neuropsychiatric manifestations.
Medical articles addressing the correlation of autoantibodies concentrations in serum and cerebrospinal fluid and their potential pathogenetic mechanism, were reviewed. More than 100 articles were identified from databases such as PubMed, ScienceDirect, Frontiers, and Wiley, using keywords such as “neuropsychiatric lupus erythematosus”, “autoantibodies”, “pathogenesis”, “biomarker” and “neuropsychiatric manifestations”. From these, 47 articles were selected for the current review.
Autoantibodies truly are indeed a tool in the diagnostic process of neuropsychiatric lupus erythematosus, and many researchers have obtained statistically valid correlations between their presence and specific neuropsychiatric manifestations. Variations in their concentration not only reflect the disease activity but also the fact that they are involved in its development through interactions with neuronal and vascular targets. Besides autoimmunity, brain-blood barrier dysfunction is also another key part of the pathogenetic mechanism, with markers of this injury also being useful in the diagnostic methodology. With future research, specific combinations of these markers can be linked to distinct clinical manifestations by creating multi-biomarker panels, a robust framework for diagnosing neuropsychiatric lupus erythematosus.
Neuropsychiatric lupus erythematosus remains a condition that highly challenging to diagnose and manage due to the heterogeneity of symptoms and the lack of standardized diagnostic tools. Autoantibodies, along with other markers of vascular and inflammatory injury can aid specialists in dealing with this disease, but further research is needed to validate these biomarkers in diverse patient populations and to standardize assays for clinical application to improve the early detection and management of NPSLE, ultimately enhancing patient outcomes and quality of life.
Psoriatic arthritis (PsA) is a complex autoimmune disease with genetic and immunological components influencing its pathogenesis. HLA antigens are critical in determining genetic predisposition and clinical variability. This study aims to explore HLA antigen diversity in PsA patients and its relationship to clinical variants.
A cohort of 103 PsA patients, diagnosed according to CASPAR (2006) criteria, was studied. Patients were received treatment in rheumatology departments from 2005–2024. Two groups were formed: 76 patients with PsA and cutaneous psoriasis (Group I) and 27 without cutaneous manifestations (Group II). Each group was further subdivided into clinical variants: axial, oligoarticular, polyarticular, distal interphalangeal, and mutilans.
Significant correlations were identified between HLA antigens and PsA severity. Aggressive HLA antigens, including HLA-B27, B8, and B62, were associated with severe disease forms and high DAPSA scores (≥50), while protective antigens like HLA-A2 and A3 correlated with reduced activity (DAPSA <20). Group I exhibited HLA-B27/B62 and HLA-B27/A3 combinations linked to mixed articular and cutaneous involvement, whereas Group II had distinct profiles (e.g., HLA-B27/B62, HLA-B27/B11). Factorial analysis highlighted the immunogenetic variability between clinical subtypes, emphasizing HLA antigens' predictive and therapeutic relevance.
HLA antigens significantly influence PsA severity and clinical diversity. Integrating genetic profiling into clinical practice offers promising opportunities for improving diagnostic precision, therapeutic outcomes, and patient quality of life.
The objective of this study was to conduct a bibliographic analysis of current data regarding the impact of parasitic infestations on immune status and the progression of osteoarticular diseases within the context of parasitic infections.
This was a qualitative analytical study presented as a narrative literature review. Relevant primary sources published between 2016 and 2022 were identified and selected using data extraction and analysis methods.
The concept of "parasitic therapy" has generated considerable interest among researchers, the public, and patients for whom standard treatments have been ineffective or offered limited results. Although studies exploring the role of parasitic infections in arthritis are less common than in other fields, animal models suggest that parasitic infections may alleviate joint inflammation. However, further research is needed across different forms of arthritis, including clinical data collection and double-blind, controlled clinical trials.
While only a few studies have demonstrated that parasitic infections may worsen preexisting diseases, the scientific consensus is that parasitic infections can create an immunoregulatory environment, reducing the severity of coexisting conditions. Finally, more rigorous animal studies are required to thoroughly investigate immunomodulatory mechanisms and potential side effects of parasitic infections in the presence of other diseases.
COVID-19 was initially considered a predominantly respiratory infection, with mortality associated with progression of respiratory failure, but currently is recognized as a multisystem disease with a wide range of manifestations. One of the most common complications of COVID-19 is acute kidney injury (AKI), which predominantly evolved to chronic kidney disease (CKD). The objective of the study was to investigate the types of acute kidney injury and their prognostic value in hospitalized patients with COVID-19 with evolution to chronic kidney disease.
The study utilized a comprehensive database of patients admitted to general department of COVID-19 at Timofei Moșneaga Republican Clinical Hospital from 2020 to 2022 years (in total 1000 patients). The first part of the study was a retrospective study, focusing on patients with confirmed COVID-19 and lung injury was diagnosed by computer tomography. The second part was a prospective study assessing the prognostic value of inflammatory markers, renal functional status and kidney injury.
AKI occurs in 29.6% of patients with COVID-19. The risk of AKI and CKD is higher in patients with more comorbidities, a more severe course of disease, elevated levels of ASAT/ALAT > 1.6 and hematuria at admission, which significantly increases the risk of progression to CKD. Patients with a history of CKD, and who had ASAT > 40 U/L, ASAT/ALAT > 1.6 and hematuria, experience the onset of AKI before hospitalization. Independent negative predictors of hospital-developed AKI include hypertension, Charlson Comorbidity Index > 4 points, respiratory failure, ASAT/ALAT > 1.6, D-dimers > 250 ng/ml, and hematuria. Hospital mortality in patients with COVID-19 was 20.8%, compared to 8.5% in patients without AKI, and this rate increased to 50% when AKI developed (p < 0.001).
Patients who developed AKI during admission had a higher incidence of negative outcomes compared to those with AKI prior to admission. Independent predictors of in-hospital mortality in COVID-19 patients were increased serum CRP. Death in hospitalized patients with COVID-19 and AKI was independently associated with factors such as age > 75 years, history of CKD, admission to Intensive Care Unit, leukocytosis, and ASAT/ALAT > 1.6.
Early establishment of arthritis in PsA based on clinical data and ultrasound examination.
The study was conducted between 2019-2023, in the rheumatology and arthrology departments of the Timofei Moşneaga Republican Clinical Hospital, or treated in outpatient. In order to meet the requirements of the study, 100 people were examined, including 70 patients with PsA.
In patients with PsA the most common changes were an increase in the amount of intra-articular fluid and the proliferation of the synovial membrane. In total, fluid was detected in 293 out of 3,232 joints (9.1%).
Ultrasound is a highly informative method in detecting a wide range of morphological changes in the joints of patients with PsA. The highest index of sensitivity appeared when inflammatory fluid, cartilage changes, osteophytes and tenosynovitis were detected.
Parasitic arthritis is associated with infestation of the patient's body of parasitic species of worms and protozoan microorganisms. Now it has been established that parasitic arthritis can be caused by almost any species of these creatures. The objective of the study was to research the clinical-evolutionary features of cases of parasitic infections associated with damage of the osteo-articular system in helminthic pathologies.
161 patients were included in the study, which were divided into 3 groups of differentiated observation by the pathogen of infestation and the clinical variant of parasitic arthritis. The first group (97 patients) consisted of patients with parasitic arthritis associated with echinococcosis infestation, the 2nd (31 patients) – patients with parasitic arthritis associated with Toxocara canis and the 3rd (33 patients) included subjects with parasitic arthritis associated with of Giardia lamblia infestation.
Echinococcosis was manifested more often by the axial (65.67%) and peripheral (31.34%) clinical forms, while the mixed form was being extremely rare (2.98%) (p < 0.001).The power of connection with the type of arthritis has reached the degree of statistical significance (p < 0.001). Parasitic arthritis due to Toxocara canis showed an overwhelming predominance of peripheral forms of joint syndrome (70.96%), with an insignificant share of axial (12.9%) and mixed form (16.13%) (p < 0.01), with a connection to the peripheral form of parasitic arthritis (p < 0.01). The clinically developed form of parasitosis caused by Giardia lamblia manifested a predominantly mixed joint syndrome (57.89%), confirming a predominantly peripheral impairment (36.84%) of the axial (5%) with a statistically significant difference (p < 0.05), as well as a connection for the mixed-peripheral form of parasitic arthritis (p < 0.05).
Parasitic arthritis is characterized by the diversity of clinical joint manifestations, which fall into 3 clinical variants: induced by infestation with Echinococcus, Toxocara canis and Giardia lamblia, among which giardiasis correlates with a more severe clinical course, followed by echinococcosis and toxocariasis. Despite a large number of painful and inflamed joints that are also associated with an advanced radiological stage of joint damage, parasitic arthritis is characterized by a comparatively diminished articular painful syndrome.
Osteitis condensans ilii (OCI) is a condition characterized by benign sclerosis of the iliac bone in the portion adjacent to the sacroiliac joints, which is radiologically manifested by triangular opacities at the level of this portion. Among the clinical manifestations, localized low back or lumbosacral pain is often attested, which is found in the gestational or post-partum period. The pain may worsen during physical exertion or during menstruation and may be accompanied by myalgia.
The epidemiological, clinical and paraclinical data were used to highlight this study, followed by the conclusions of multidisciplinary specialists, retrieved from the inpatient medical records of 3 women with OCI, who were admitted for diagnosis and treatment.
3 cases of imaging-determined OCI will be presented, which were initially diagnosed with seronegative spondyloarthritis (SpA). Through them, we would determine the varieties between the OIC forms and their differential diagnosis with SpA. The results of the lab tests do not reveal specific changes, so the markers of inflammation (C-reactive protein, erythrocyte sedimentation rate) were normal. Also, unlike SpA, the marker HLA-B27 is in most cases negative.
According to the results of the presented clinical cases, OCI is often confused with sacroiliitis, which leads to misdiagnosing and erroneous treatment tactics. Thus, in order to establish a true diagnosis, it is necessary to collect a detailed history, perform a comprehensive objective examination, which includes the character of the pain and its triggers, the lack of inflammatory lab markers and the radiological presence of the sclerosis areas at the level of the iliac bone, not involving the sacroiliac joints.
Improvement of early diagnosis of psoriatic arthritis based on clinical data, immunological and mathematical research methods.
The study was carried out between 2019 and 2022 at the Rheumatology and Nephrology Discipline, in the arthrology and rheumatology departments of the Timofei Moşneaga Republican Clinical Hospital. To accomplish the tasks set out in the study, 110 patients were examined, including 55 patients with psoriatic arthritis (group I) and 55 patients with rheumatoid arthritis (group II).
The range with the highest probability of psoriatic arthritis for the instrumental index is between 0.54 and 1.86. Of the 55 patients with psoriatic arthritis in 95% of patients clinical, laboratory, immunological and instrumental indices were within the range of the highest probability of the disease, which indicates a fairly high reliability of the mathematical model.
Immune disorders in the early stages of rheumatoid arthritis and psoriatic arthritis are nonspecific and are characterized by an increase in CD16+ (26.2±1.5) and CD29+ (24.8±2.1) in rheumatoid arthritis, which is significantly higher than in psoriatic arthritis CD16+ (22.0±1.3) and CD29+ (17.4±3.2) (p <0.05). A mathematical model of rheumatoid arthritis and psoriatic arthritis has been developed, which serves as an additional way of diagnosing rheumatoid arthritis and early psoriatic arthritis.
Due to the heterogeneous nature of systemic sclerosis, it is difficult to predict disease progression and complications. Despite the discovery of novel autoantibodies associated with systemic sclerosis (SSc), there is an unmet need for biomarkers for diagnosis, disease progression, and response to treatment.
An analytical, qualitative study was performed with a narrative review of literature in the form of a synthesis article. Relevant primary sources published in 2020-2022 were identified and selected, using data extraction and analysis.
Anti-citrullinated protein/peptide antibody could be useful in identifying patients with a more prominent joint disease. Of most interest, the anti-carbamylated protein antibodies (anti-CarP) could be a relevant biomarker related to fibrotic skin and lung disease. Positive anti-RNA (Ribonucleic acid) polymerase III antibody and antinuclear antibodies (ANA) negativity were significantly associated with GAVE (gastral antral vascular ectasia). Autoantibodies against telomeres may help identify systemic sclerosis with lung disease. Osteopontin links myeloid activation and disease progression in systemic sclerosis. CTRP (C1q tumor necrosis factor-related proteins) 9 protein levels may be biomarker of lung disease severity. CD (cluster differentiation) 21-low B cells are linked to vascular damage. L-tyrosine, L-tryptophan, and 1-methyl-adenosine distinguished healthy controls from SSc patients. L-leucine, L-isoleucine, xanthosine, and adenosine monophosphate differentiated between progressing and stable SSc-ILD. CECs (circulating endothelial cells) are a direct indicator of systemic vascular damage. Levels of the protein, galectin-3, are associated with heart involvement in people with systemic sclerosis. Low levels of the galectin-10 protein (Gal-10) in scleroderma associate with inflammation and vascular changes in the lungs, leading to pulmonary arterial hypertension (PAH). High levels of the CD146 protein may be a potential biomarker in identifying people with systemic sclerosis. Blood levels of the protein endocan increased in scleroderma patients who are at risk for pulmonary arterial hypertension . FLCs (free light chain) could be employed as useful potential biomarker of early diagnosis and to follow disease activity.
Novel discovered biomarkers could predict disease development, activity, and severity of diverse organ involvement, predict risk of complications of systemic sclerosis.
Despite numerous fundamental clinical studies on the frequency, pathogenesis, clinical features of spondyloarthritis (SpA) in intestinal infectious diseases (IID) and intestinal damage in SpA, there are currently a number of unresolved problems, one of which is the problem of early diagnosis of arthropathies, especially associated with IID, which makes it necessary to continue the research in the scientific problem.
Purpose of the study
Appreciation of the features of early manifestations of axial arthropathies in intestinal infectious diseases in order to improve their early diagnosis.
Objectives of the study
Identification of clinical variants of axial arthropathies in patients with infectious intestinal diseases and instrumental description of axial lesion by conducting comparative analysis of clinical and laboratory parameters in these patients depending on the presence of axial arthropathies. Development of an algorithm for the early detection of axial spondyloarthritis in intestinal infectious diseases.
During 2015-2021, 141 patients were analyzed retrospectively, out of which 50 patients with SpA from the Republican Clinical Hospital „Timofei Moşneaga” and 91 patients with infectious intestinal diseases from the gastro-enterology and hepatology departments of the Republican Clinical Hospital „Timofei Moşneaga”. Depending on the etiology of IID, subjects were divided into 2 groups: the first group included patients with Yersinia enterocolitica or Campylobacter jejuni (Y±C), the second with Salmonella enteritidis or Shigella flexneri (S±Sh).
In patients with IID, the following clinical variants of arthropathies have been identified: axial lesion (spinal inflammatory pain according to ASAS criteria (2009) in 42.9%, axial spondyloarthritis (axSpA) in 28.6%, AS in 15.4%), arthralgia - 38.5%, arthritis - 13.2%. Conventional radiography imaging and magnetic resonance imaging (MRI) of the sacroiliac joints (SI) increased the incidence of SpA from 6.6% (n = 6) to 28.6% (n = 26).
In patients with IID, the following clinical variants of arthropathies have been identified: axial lesion (spinal inflammatory pain according to ASAS criteria (2009) in 42.9%, axSpA in 28.6%, ankylosing spondylitis in 15.4%), arthralgia – 38.5%, arthritis – 13.2%. Imaging in the form of conventional radiography and MRI of SI joints increased the incidence of SpA from 6.6% (n = 6) to 28.6% (n = 26). Axial arthropathies, arthralgia, arthritis, and uveitis are encountered more frequently. At the same time, the possibility of detecting axSpA is greater if arthritis, arthralgia, inflammatory back pain, uveitis is present. Patients with S±Sh have a higher chance of developing axSpA compared to patients with Y±C.
Study of clinical manifestations in psoriatic arthritis: enthesitis, dactylitis, peripheral arthritis, axial arthritis, skin manifestations, for early diagnosis, which would allow the establishment of an adjusted treatment and the elaboration of measures to prevent complications.
The performed clinical study has an analytical-observational retrospective and included the patients who were hospitalized in the Rheumatology and Arthrology departments of the “Timofei Moşneaga” Republican Clinical Hospital during 2015-2021. The study included 103 patients with psoriasis (47 men and 56 women) with various clinical forms of psoriasis and different ages.
The clinical examination of primary or referred patients with cutaneous manifestations, revealed peripheral arthritis in 15 patients (24.6%), dactylitis – in 37 (60.7%), heel pain was detected in 32 (52.5%), axial arthritis – in 30 (49.2%), enthesitis, distal interphalangeal arthritis and tendonitis were not detected. Those who primary or referred with joint manifestations, in 35 (57.4%) of patients was present peripheral arthritis, dactylitis in 40 (65.6%), enthesis of the elbow joints in 11 (18%), knee joints - in 8 (13.1%), the calcaneal region - to 25 (41%), arthritis of the distal interphalangeal joints was detected in 21 (34.4%), tendinitis - to 13 (21.3%).
The obtained results allow us to state that one of the directions in improving the diagnosis of PsA consists in the use of ultrasound examination and MRI imaging of the joints of the hands and feet. This makes it possible to effectively identify the characteristic of enthesopathy, edema of tissues, as well as destructive changes in the joints of the hands and feet.
In the study group of patients with psoriasis, in 25 (24.2%) no joint damage was detected. The frequency of detection of psoriatic arthritis and other rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis etc.) was 59.2% and 16.6%, respectively, 32 (52.5%) out of 61 (59.2%) patients with PsA were primarily diagnosed. The sensitivity and specificity of the mPEST (Psoriasis Epidemiology Screening Tool) questionnaire in relation to the CASPAR criteria were 77% and 69% respectively. The highest indicators of sensitivity, specificity and accuracy in the diagnosis of PsA has ultrasound and MRI: 88%, 92%, 89% and respectively, 89%, 94%, 91%
PsA are included in the group of HLA-B27-associated joint diseases, united in the group of seronegative spondylitis (SSA). At the same time, this disease differs from ankylosing spondylitis and other spondylitis with a particularly diverse clinical picture and the existence of only the syndromes inherent in it, for example, intermittent synovitis, palindromic rheumatism or mutilating arthritis.
Purpose of the study
Research of clinical heterogeneity of early psoriatic arthritis and the possibility of early diagnosis.
The current study included 104 patients with PsA who were admitted to the rheumatology and arthrology departments of the IMSP Republican Clinical Hospital „Timofei Moşneaga” from 2003 to October 2021.
The frequency of expression of individual clinico-anatomical variants of joint syndrome was different in patients with PsA-e and PsA-t (in PsA-e compared to PsA-t, the oligoarticular variant was significantly more likely to be observed (43.1% and 19%, respectively, p=0.01) and less often the variant of spondyloarthritis (7.8% and 19%, p=0.1), while the variant of polyarthritis (33.3% and 38%, p = 0,6) and distal interphalangeal (15,7% and 15%, p=0,9) were detected with the same frequency, as regards the mutilating variant, this was observed only in PsA-t.
The early stage of psoriatic arthritis is characterized by pronounced heterogeneity of manifestations of joint syndrome and damage to the tendon-ligament apparatus. In PsA-e oligoarthritis and polyarticular variants are the most common, less often - distal interphalangeal and spondyloarthritic. In the first 3 months after the onset of clinical manifestations of PsA, oligoarthritis was observed in 75.4% of patients and polyarthritis in 14% (p=0.0001), and after 6 months - 63% and 26.6% respectively (p=0.001). With a progression of the duration of the disease, the number of patients with arthritis increased, and by the end of the 2nd year was determined in 47.6% of patients, and oligoarthritis - in 28.6%.
To date, clinical manifestations, laboratory changes and the results of instrumental examinations of the joints and spine in axial seronegative spondyloarthritis (aSpA) caused by Chlamydia trachomatis have not been fully elucidated.
Purpose of the study: evaluation of clinical manifestations features, diagnosis, and evolution of seronegative spondyloarthritis associated with Chlamydia trachomatis infection.
Objectives of the study: To compare clinical manifestations, changes in laboratory parameters, results of instrumental examinations of the joints and spine in seronegative spondyloarthritis, the axial, peripheral, and mixed form. To appreciate the significance of Chlamydia trachomatis in the development of SpA by detecting the presence of DNA using the polymerase chain reaction (PCR) in real time and by isothermal amplification of NASBA-PCR (Nucleic acid sequence-based amplification).
During 2015-2021 were examined 138 patients with SpA hospitalized in the Republican Clinical Hospital „Timofei Moşneaga”. Chlamydia trachomatis in the form of monoinfection was detected in 87 (6.3%) patients, of which 52 (59.8%) were women and 35 (40.2%) men.
The results of the diagnosis of Chlamydia trachomatis infection in patients with arthritis: Chlamydia trachomatis infection was detected in 78 (89.7%) out of 87 patients examined by PCR, and in 9 (10.3%) cases by ELISA. The peripheral form begins mainly with inflammation of the joints of the lower extremities (81.8%), of which the knee joints are mainly involved in the pathological process (63.6%). SpA axial form associated with Chlamydia trachomatis infection occurs mainly in young men (85.7%). In more than half of the patients, large joints participate in the pathological process (58.8%), especially the lower extremities. The axial variant of the SpA can begin with an injury in any part of the spine.
SpA associated with Chlamydia trachomatis infection has more expressed clinical, laboratory and instrumental manifestations both in the onset and in the advanced stage of the disease.