3 articles
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.
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.
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.