Background: Rheumatoid Arthritis (RA) is a chronic, autoimmune rheumatic disease, frequently affecting women. Evidence suggests that a family history of autoimmune diseases (ADs) increases the risk of RA. Overall, family aggregation studies can bring valuable information regarding the genetic background of this autoimmune disease. Objectives: To determine the frequency and disease-related characteristics of familial autoimmune diseases co-aggregation in patients with rheumatoid arthritis. Methods: In this cross-sectional study, we registered 160 consecutive patients diagnosed with RA, according to the 2010 ACR/EULAR Classification Criteria, from a Rheumatology Department in Bucharest, between June 2022 and September 2023. The data regarding the presence of ADs among first to third degree relatives, as well as RA features were collected at hospital admissions, using surveys. For the comparative analysis, the cohort was divided into two subgroups: the patients with at least one relative with an AD and the patients without affected family (Group A and Group B, respectively). Results: The mean(SD) age of the cohort was 54.8 (14.7) years old, female sex being predominant (88.1%). The disease’s duration had a mean of 14.0 (10.9) years. The frequency of familial co-aggregations was 33.8% as follows: 26.3% had first degree relatives with ADs, 10% had second degree relatives and 3.1% had third degree relatives affected. The most common AD diagnosed among relatives was rheumatoid arthritis, followed by autoimmune hypothyroidism. Moreover, the frequency of patients with relatives diagnosed with RA was 10.0% for first degree relatives, 5.6% for second degree relatives and 1.3% for third degree relatives. First degree relatives were most often identified, with a total of 10 pairs of parent-child and 6 pairs of sibling-sibling diagnosed with RA.The patients from Groups A had more frequent poliautoimmunity, RA seropositivity and were more frequently treated with biological therapy than Group B (Table 1). Moreover, patients with at least one relative with AD were significantly younger at disease onset, mean (SD) of 35.8 (15.1) years old, compared with 43.3 (15.9) years old (p=0.007). Conclusion: One third of RA patients appear to have a familial aggregation of ADs, with first degree relatives, particularly parent-child relationships, being more significant. Furthermore, patients with familial aggregation are predisposed to develop the disease at a younger age. REFERENCES: [1] Kuo CF et al; Familial aggregation of rheumatoid arthritis and co-aggregation of autoimmune diseases in affected families: a nationwide population-based study. Rheumatology (Oxford). 2017 Jun 1;56(6):928-933. Acknowledgements: NIL. Disclosure of Interests: None declared.Table 1Comparison of the two subgroups:CharacteristicsGroup APatients with familial aggregationGroup BPatients without familial aggregationp-valueAge mean(SD) years old50.9(14.8)57.0(13.9)0.035Disease duration mean (SD) years15.09(12.1)13.5(10.3)0.502Female sex n, %51, 94.4%90, 84.9%0.078Age at disease onset mean(SD) years old35.8(15.1)43.3(15.9)0.007Seropositivity n, %49, 90.7%91, 85.8%0.376Extra-articular manifestation n, %19, 35.2%25, 23.6%0.120Necessity of biological therapy n, %39, 72.2%62, 58.5%0.089Poliautoimmunity n, %21, 38.9%28, 26.4%0.106
There are analyzed the difficulties and accuracy of diagnosis, in conjunction to the moment technical opportunities at long interval after registration (2009, 2012) in two cases of posterior Morbidly Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS), with deep myometrial invasion (grade 3B) and uterine serosa perforation (grade 3E), a contemporary serious disease generating severe maternal coagulation disorders, multiple organ failure and hemorrhagic shock up to death, after total hemostasis hysterectomy. Undiagnosed or suspicious second trimester posterior MAP/PAS, in low-lying placenta, morbid obesity (BMI>40), in an intact uterus, or in a scar uterus post cesarean delivery (CD) were followed by maternal death. In countries with low-to-middle income/ resources, and few centers of excellence, medical staff surgical qualities, and well trained interdisciplinary team must meet patients’ and their families trust and cooperation, and timely available life-saving resources for complex therapies in critical care cases, and hospital infrastructure to benefit from actual expanded knowledge and guidelines.
Human Bocavirus was described in 2001 by Tobias Allander et al. (
Global travelling increases every year and according to a report released during the COVID-19 pandemic by the UN World Tourism Organization, international travel doubled in 2022, compared to levels in 2021. his fact led also to travel-imported cases of arboviral infections and physicians are often confronted with tropical diseases, such as dengue or chikungunya. Since there is are no pathognomonic cues for these tropical illnesses, early diagnosis is still a big challenge and it depends on many factors, such as exposure risk factors, the epidemiological context, the incubation period, and the wide spectrum of differential diagnoses, including cosmopolitan or exotic infections. Since the clinical presentation of dengue is not typical and there are other febrile illnesses similar to arboviral diseases, misdiagnosis is common even among experienced doctors. Differential diagnosis needs up to date knowledge considering the short viraemic period, the antibody cross-reactivity, and the traps in recognising the nonspecific symptom picture. We present two cases of Dengue diagnosed in Romania which were initially clinically misconstrued, despite the characteristic symptom picture. The main purpose is to increase the level of awareness and to underline the difficulties that clinicians face in recognizing travel-related imported dengue virus disease.
