Ivano-Frankivsk National Medical University

Pregnancy planning in patients with rheumatic diseases (RD) is a multifaceted public health issue that includes complex strategies targeting underlying disease activity and reproductive potential. Patients with autoimmune diseases, including those with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren syndrome, systemic sclerosis (SSc), and spondyloarthritis, present with heightened risks of adverse maternal and fetal outcomes, including miscarriage, fetal growth restriction, preeclampsia, preterm birth, and increased utilization of assisted reproductive technologies. Available evidence suggests that conception during sustained disease remission, alongside tailored drug therapies, enhances maternal-fetal outcomes. Critical determinants of obstetric prognosis include disease-specific activity indices, serologic markers, organ involvement, and prior gonadotoxic exposures which compromise ovarian reserve. Structured preconception counseling that integrates contraception strategies, fertility preservation, ovarian reserve assessment, and multidisciplinary follow-up is essential to mitigate these risks. Current management paradigms advocate the continuation of pregnancy-compatible disease-modifying antirheumatic drugs (DMARDs), while strictly avoiding teratogenic therapies. Despite these advances, substantial unmet needs exist in early risk stratification, patient education, and systematic integration of reproductive health counselling into routine RD management. This review synthesizes contemporary evidence, delineates existing gaps, and provides a strategic framework for optimizing pregnancy planning and reproductive outcomes in women with RDs. The review addresses the key domains, including preconception risk stratification, disease-specific considerations, fertility assessment, ovarian reserve evaluation, and optimization of drug therapies. A multidisciplinary, treat-to-target approach is essential to improve pregnancy outcomes and long-term maternal health in this high-risk population.

Rheumatic diseases (RDs) are chronic immune-mediated disorders associated with disproportionately increased cardiovascular morbidity and mortality. Accelerated atherogenesis in these diseases is driven by persistent systemic inflammation, autoantibody-mediated endothelial injury, oxidative stress, and dysregulated lipid metabolism, resulting in premature vascular remodeling manifested by increased carotid intima–media thickness, arterial stiffness, impaired flow-mediated dilation, and coronary artery calcification. This review synthesizes evidence regarding subclinical atherosclerosis and cardiometabolic risk across common RDs. In rheumatoid arthritis and systemic lupus erythematosus, vascular alterations correlate with inflammatory burden, disease duration, autoantibody profiles, renal involvement, and glucocorticoid exposure. Emerging biomarkers—including apolipoprotein B48, FIB-4 index, asymmetric dimethylarginine, and adhesion molecules—provide incremental prognostic value beyond traditional lipid parameters. Advanced imaging modalities, such as ^18F-sodium fluoride PET/CT and vascular elastography, enhance early detection of arterial calcification and stiffness. Growing evidence in primary Sjögren syndrome, Behçet disease, systemic sclerosis, and ankylosing spondylitis similarly confirms increased subclinical atherosclerosis and endothelial dysfunction. Importantly, tight disease control and targeted immunomodulatory therapies—including methotrexate, biologic agents, antimalarials, and cytokine-directed treatments—are associated with improved vascular and metabolic profiles and attenuation of disease progression. Subclinical atherosclerosis represents a critical interface between autoimmunity and cardiovascular disease in RDs. Early vascular assessment integrated with disease-specific and metabolic risk stratification is essential to implement precision-based cardiovascular prevention in this high-risk population.

Rheumatic diseases encompass diverse immune-mediated disorders that compromise musculoskeletal and systemic functions, often resulting in persistent disability. Hand muscle weakness is an early and clinically meaningful manifestation across rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). Reduced handgrip strength (HGS) is an integrative measure that reflects systemic inflammation, neuromuscular involvement, and functional deterioration, providing critical insight into disease progression. The current review aims to overview available evidence on HGS testing in rheumatic diseases, with a focus on measurement devices, clinical and prognostic significance, and perspectives for its integration into disease monitoring and patient management. HGS is a sensitive marker of muscular function and frailty. Advances in mechanical and digital dynamometry, wearable devices, and smartphone-integrated systems enable precise and remote assessments. Reduced HGS correlates with higher disease burden and impaired quality of life. Despite its growing applicability, heterogeneity in testing procedures and inter-device variability underscore the need for standardized protocols and device-specific reference values. Advances in wearable sensors, digital dynamometry, and AI-supported telerehabilitation hold promise for integrating HGS into personalized disease monitoring.

Aldosterone synthase inhibitors are a class of medication that target aldosterone biosynthensis while addressing the current limitations of conventional renin-angiotensin-aldosterone inhibitors. This review aims to explore the emerging role of lorundrostat and baxdrostat, efficacy and safety in the management of treatment-resistant and poorly controlled hypertension. A narrative review was conducted, including six (6) clinical trials published between 2016 and 2025. Lorundrostat and baxdrostat demonstrated dose-dependent reductions in blood pressure across evaluated trials. In lorundrostat studies, plasma renin activity increased in association with aldosterone suppression, and an overall favorable safety profile was reported. Baxdrostat demonstrated selective inhibition of aldosterone synthase in early-phase studies, and studies reported mild hyperkalemia and decreased renal function at higher doses. Lorundrostat was found to have comparable efficacy in patients with and without suppressed plasma renin activity, based on subgroup analyses within individual trials. Direct head-to-head comparative data between lorundrostat and baxdrostat are not currently available, and differences in selectivity or off-target effects are derived from separate clinical investigations. While current data support their efficacy and safety in early clinical trials, further large-scale studies are needed to establish their long-term outcomes, cost-effectiveness, and integration into clinical practice guidelines.

Vascular disorders of the intestine (VDI) and ischemic heart disease (IHD) are linked by shared atherosclerotic risk factors including diabetes, hypertension, and smoking. Their coexistence poses a significant threat to population health, with associated high morbidity and mortality. While advances in care have improved outcomes, evolving trends and disparities remain under-investigated at the national level. This study assessed national mortality trends and demographic disparities in deaths attributed to vascular disorders of the intestine and ischemic heart disease among all age groups in the United States from 1999 to 2023. We used the CDC WONDER Multiple Cause of Death database (1999–2023) and identified deaths in which ICD-10 code K55 (vascular disorders of the intestine) and ICD-10 codes I20–I25 (ischemic heart disease) were concurrently listed on the same death certificate. Age-adjusted mortality rates were calculated and stratified by sex, race/ethnicity, and U.S. census regions. Joinpoint regression analysis was applied to evaluate temporal trends and compute annual percent change with 95