Background: We present a case of a patient with the sequential development of clinical symptoms characteristic of multiple sclerosis, polymyositis, and malignant melanoma. Case presentation: Polymyositis occurred two years after the onset of multiple sclerosis. Clinical signs of melanoma were identified following the development of polymyositis. Treatment with corticosteroids and immunosuppressants positively affected the patient’s clinical manifestations of multiple sclerosis. It remains unclear whether there was an insidious progression of melanoma without clinical manifestations and whether the myositis developed in parallel with this melanoma. It is possible that polymyositis developed independently or preceded the onset of melanoma with lymph node metastases. Conclusion: The patient's clinical history demonstrates an overlap of demyelinating, systemic, and malignant diseases. Integrated treatment is essential for achieving clinical improvement in these patients.
Malignant melanoma is an aggressive skin tumor that accounts for 1% of all skin tumors. Immunotherapy is a new therapeutic approach for the treatment of melanoma neoplasms. Nivolumab is an immunotherapeutic product that belongs to the so-called checkpoint inhibitors. Nivolumab therapy has demonstrated a good effect in terms of overall survival and progression-free survival in patients with malignant melanoma. Nivolumab treatment is used both for therapy in patients in the metastatic stage and in the adjuvant aspect in patients with a high risk of disease recurrence. The interaction between the ligand of the programmed cell death receptor (PD-L1) and the programmed cell death receptor (PD-1) leads to suppression of autoimmune manifestations. Blocking this interaction carries a risk of various autoimmune reactions, which are expressed to varying degrees, and can sometimes be life-threatening and require prolonged immunosuppression or discontinuation of treatment with checkpoint inhibitors. Immune-related adverse reactions of varying degrees and severity have been described with the use of anti-PD-1 antibodies, such as pneumonitis, hepatitis, endocrinopathies, immune-mediated colitis, dermatitis, etc. Rheumatic immune-mediated complications such as myositis, myalgia, arthritis, arthralgia, vasculitis, scleroderma are rare with Nivolumab treatment. Most often, patients report arthritis that starts after several cycles of Nivolumab administration. The mechanism of occurrence of immune-mediated arthritis has not yet been established. A clinical case of an 84-year-old patient who developed immune-related arthritis after treatment with Nivolumab is presented. After treatment with corticosteroids and immunosuppressants led to the control of the immune-related arthritis, reinitiation of immunotherapy is being evaluated for the management of the oncological disease.
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease with multifaceted clinical manifestations, unclear etiology, and specific immunological phenomena that continue to be a challenge for modern science regarding their etiopathogenetic role in the onset and course of the disease. In SSc, different autoantibodies could be detected, and three are defined as diagnostic. They are considered potential biomarkers as they may eventually be used to distinguish distinct patient groups with specific clinical manifestations. Three specific autoantibodies and capillaroscopic abnormalities were included in the 2013 ACR/EULAR classification criteria for SSc. The autoantibodies defined as diagnostic in SSc are anti-centromere, anti-topoisomerase I, and anti-RNA polymerase III antibodies. Other SSc-associated antibodies are anti-Th/To, Ku, PDGFR, PM-Scl, etc. Growing evidence suggests an association between specific autoantibody profiles and distinct capillaroscopic patterns, indicating a link between immunological mechanisms and microvascular damage.
Background: Biosimilar infliximab agents are increasingly used in the management of axial spondyloarthritis (axSpA), primarily driven by cost considerations. While clinical outcomes after switching from originator infliximab (INF) to several biosimilars have been reported, real-world data regarding switching to Ixifi remain limited. Objectives: To evaluate clinical outcomes, treatment retention and safety following non-medical switching from originator INF to the biosimilar Ixifi in patients with axSpA. Methods: This single-center observational cohort study included adult patients with axSpA who were transitioned from originator INF to Ixifi for non-medical reasons. Clinical assessments and laboratory parameters were recorded at baseline and at 3 and 6 months after switching. Disease activity was evaluated using ASDAS, BASDAI and BASFI. Safety outcomes and treatment discontinuation were systematically recorded. Results: 72 patients were included. Inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, remained stable over 6 months (p>0.05 for all), as did ASDAS scores (p>0.05). In contrast, BASDAI and BASFI showed modest but statistically significant improvements at month 6 (p=0.008 and p=0.002, respectively). 2 serious infections (2.8%) and 2 infusion reactions (2.8%) were observed. Treatment discontinuation occurred in 13.9% of patients, exclusively due to loss of efficacy. The estimated 6-month treatment retention rate was 86.1%. Conclusion: In this real-world cohort, non-medical switching from originator infliximab to Ixifi in axSpA was associated with maintained short-term clinical stability, acceptable treatment retention and a favorable safety profile. However, the absence of a control group limits causal interpretation of these findings. Larger studies with longer follow-up are warranted to confirm long-term outcomes.
IgG4-related disease (IgG4-RD) has evolved from a series of organ-specific clusters into a recognized systemic fibroinflammatory disorder defined by a unique B-T cell axis. This review provides a comprehensive analysis of current diagnostic and therapeutic paradigms, emphasizing the pathogenic roles of CD4+ cytotoxic T lymphocytes and follicular helper T cells in driving storiform fibrosis. Despite the utility of the 2019 ACR/EULAR classification criteria, diagnostic challenges persist; notably, serum IgG4 remains a fallible biomarker, with a significant amount of patients maintaining normal concentrations during active disease. While glucocorticoids are the traditional first-line treatment, their long-term toxicity and high relapse rates have catalyzed a shift toward targeted B-cell depletion. Emerging evidence suggests that early intervention with biological agents can arrest and even reverse established fibrotic lesions, highlighting the dynamic nature of the immune-fibroblast interface. However, the current reliance on retrospective data and the lack of sensitive biomarkers for diagnosis and monitoring disease activity remain significant hurdles. This review underscores the necessity for precision-driven management and large-scale randomized trials to optimize long-term outcomes and minimize organ damage in this complex multi-organ condition.
Crystal analysis in synovial fluid (SF) is crucial for diagnosing crystal induced arthropathies which are an important cause of acute and chronic joint inflammation. Identification of crystals in synovial fluid remains a key diagnostic step in the evaluation of patients presenting with arthritis. The direct identification of crystals in synovial fluid remains the clinical reference standard for confirming gout and calcium pyrophosphate deposition disease (CPPD), while the recognition of less common particles such as basic calcium phosphate (BCP) and cholesterol crystals can also provide clinically relevant information. This review summarizes the literature from 2017 to 2026 on crystals in synovial fluid, with particular emphasis on crystal types, detection methods and their clinical relevance. It aims to provide a practical, clinician-oriented review of SF crystal analysis, highlighting crystal morphology, detection techniques, disease associations and clinical interpretation. Monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals remain the most diagnostically important. Compensated polarized light microscopy remains the gold standard for crystal identification, but it is limited by observer dependence, low crystal burden, weak birefringence and artifacts. Newer techniques, especially Raman spectroscopy and other chemistry-based approaches, are emerging as promising adjuncts. Imaging methods such as ultrasound and dual-energy CT increasingly complement aspiration-based diagnosis but do not replace synovial fluid examination, particularly when infection is a concern. Recognition of synovial fluid crystals has important clinical implications, as crystal-induced arthritis may mimic or coexist with other joint diseases, including septic arthritis. Improved diagnostic techniques and continued clinician training may enhance the accuracy and clinical utility of synovial fluid analysis. SF crystal analysis is a practical, rapid, and reliable diagnostic tool. Familiarity with crystal morphology, detection methods, and clinical implications improves diagnostic accuracy and guides therapy.
Background: Psoriatic arthritis is a chronic inflammatory musculoskeletal disease associated with psoriasis and characterized by heterogeneous clinical manifestations. Idiopathic inflammatory myopathies and antisynthetase syndrome are distinct autoimmune entities that may rarely coexist with psoriasis or psoriatic arthritis, creating diagnostic and therapeutic challenges. Case presentation: We present the case of a 42-year-old woman initially diagnosed with psoriatic arthritis after presenting with recurrent knee arthritis accompanied by mild effusion and biopsy-confirmed psoriasis vulgaris localized to the left elbow. The patient fulfilled the CASPAR classification criteria and was initially treated with conventional disease-modifying antirheumatic drugs without satisfactory response. Subsequent treatment with secukinumab also failed to achieve disease control. Despite medical recommendations, the patient continued intermittent intramuscular corticosteroid administration prescribed elsewhere for symptomatic relief. Several months later, she was reevaluated because of persistent musculoskeletal complaints and progressive muscle weakness. Physical examination revealed severe proximal muscle weakness, including inability to rise from a prone position. Laboratory investigations demonstrated markedly elevated creatine phosphokinase levels exceeding 3000 U/L. Myositis-specific antibody testing revealed strongly positive anti-Jo-1 antibodies. The diagnosis was revised to inflammatory myopathy compatible with antisynthetase syndrome overlap, and treatment with systemic corticosteroids and azathioprine was initiated. Conclusions: This case highlights the importance of continuous diagnostic reassessment in patients with presumed refractory psoriatic arthritis. Fulfillment of classification criteria should not preclude consideration of additional autoimmune diseases when atypical manifestations emerge. The temporal association with secukinumab also raises the possibility of biologic-related unmasking or triggering of inflammatory myopathy, although causality cannot be established.
Background: Rheumatoid arthritis (RA) is increasingly recognized as a systemic disease with important metabolic and endocrine features. However, the combined pattern of serum metabolic hormones in women with RA remains insufficiently characterized. Objective: The study aimed to compare serum levels of leptin, estrogen, insulin, cortisol, growth hormone (GH), and thyroid-stimulating hormone (TSH) in RA women with healthy controls and to examine their associations with selected clinical and metabolic characteristics. Methods: This cross-sectional study was conducted in Basrah Governorate, Iraq, between October and December 2022. The final analysis included 43 women: 23 patients with RA and 20 apparently healthy controls. Demographic and clinical data were collected, including age, body mass index (BMI), rheumatoid factor (RF) status, disease activity, disease duration, medication use, glucocorticoid use, menopausal status, and family history. Serum hormone levels were measured using enzyme-linked immunosorbent assay kits. Data were analyzed according to distribution. Between-group comparisons were performed using the independent-samples t-test or Mann–Whitney U test. Exploratory correlation and adjusted regression analyses were performed within the RA group. Results: RA patients had significantly higher serum cortisol [84.76 (66.10–98.29) vs. 22.80 (16.98–31.79) ng/mL, p < 0.001], insulin [15.54 (10.68–18.54) vs. 3.54 (2.09–4.65) mU/L, p < 0.001], and leptin (724.45 ± 149.79 vs. 243.98 ± 113.60 pg/mL, p < 0.001) levels compared with controls. Estrogen and TSH did not differ significantly between the groups. Within the RA group, exploratory adjusted analysis showed an association between RF status and log10 insulin after adjustment for age, glucocorticoid use, and BMI (β = −0.045, 95% CI −0.081 to −0.008, p = 0.022). Conclusion: Women with RA showed an altered serum metabolic hormone profile, mainly characterized by higher leptin, insulin, and cortisol and lower GH. Larger studies are needed to confirm these findings.
Background: Eosinophilic fasciitis is a rare scleroderma-like disorder characterized by inflammation and thickening of the fascia, typically presenting with skin induration, peripheral eosinophilia, and absence of systemic organ involvement. Its etiology remains unclear, although immune-mediated mechanisms and various triggers have been proposed. Case presentation: We report a case of a 49-year-old woman who developed progressive pain, stiffness, and skin induration of the upper extremities shortly after COVID-19 infection. Laboratory evaluation revealed eosinophilia, acute phase reactants and negative autoimmune serology. Magnetic resonance imaging demonstrated fascial involvement without muscle pathology. Histopathological examination confirmed eosinophilic fasciitis, showing inflammatory infiltrates and fibrosis within the fascia. The patient was treated with high-dose glucocorticoids and steroid-sparing agent – methotrexate, with subsequent clinical and laboratory improvement. At follow-up, complete resolution of symptoms was observed, reaching drug-free remission after approximately 18 months. Conclusion: This case highlights eosinophilic fasciitis as a potential post-infectious immune-mediated condition following COVID-19. Early recognition, appropriate imaging, and confirmatory biopsy are essential for timely diagnosis, appropriate treatment and favorable outcomes.
Pain has been a constant companion of humankind since the dawn of time. As a sensory perception, it is a complex, multidimensional phenomenon and an integral part of human life. It is always a personal experience influenced by numerous endogenous and exogenous factors. Since pain is an unpleasant sensation, it is always associated with an emotional component. In addition to being personal, it is also a multifaceted experience, and its perception and awareness change throughout a person’s life. Pain can lead to impulsive behavior, affecting decision-making and self-control. As a universal and complex phenomenon in the animal world, it has fascinated scientists, clinicians, and philosophers for centuries. It goes beyond simple sensory perception and encompasses a multidimensional experience that includes not only the recognition of harmful stimuli but also cognitive and behavioral responses. This multifaceted nature of pain makes it a subject of great interest and research in various fields, including neurology, psychology, and clinical medicine.
Background: Polyarteritis nodosa is a systemic necrotizing vasculitis affecting medium-sized arteries and, less commonly, small-caliber vessels. In the differential diagnostic context, one of the conditions that may present with a similar clinical picture is vasculopathy associated with antiphospholipid syndrome. Case presentation: We present the clinical case of a 62-year-old female patient whose symptoms began approximately three months prior to her first hospitalization in the Rheumatology Clinic. The initial manifestations included gradual appearance of a rash on the lower extremities in the form of livedo reticularis/purpura retiforme, progressing to ulcerations, accompanied by pain in the lower limbs. Following outpatient assessment the patient was admitted to the Rheumatology Clinic. After completion of a stepwise diagnostic workup, a diagnosis of polyarteritis nodosa was established based on the ACR criteria. Immunological testing demonstrated a tenfold elevation of anticardiolipin antibodies. According to the 2023 EULAR classification criteria, the patient fulfilled the required criteria for antiphospholipid syndrome/antiphospholipid vasculopathy. Pulse therapy treatment was initiated consisting of methylprednisolone and cyclophosphamide, in combination with vasodilator and anticoagulant therapy. After four months, a favorable therapeutic response was observed. However, due to secondary infection of the ulcerations, surgical intervention became necessary, along with reduction of the immunosuppressive therapy. During the subsequent follow-up period corticosteroid therapy was successfully discontinued completely, and sustained remission without new relapses was achieved. Conclusion: An open question remains regarding the extent of overlap between the two nosological entities and whether the positive antiphospholipid antibodies may represent merely an immunological phenomenon occurring in the setting of active vasculitis.
Background: Granulomatosis with polyangiitis (GPA) is a type of antineutrophilic cytoplasmic antibodies (ANCA) associated vasculitis that primarily involves upper respiratory tract, lungs and kidneys. It is a rare disease and its association with rheumatoid arthritis is even rarer. Early recognition of such overlaps enables more timely diagnosis and may have impact on disease outcome. Case presentation: Here we report a case of 29-year-old female, known case of rheumatoid arthritis (RA) since 2019, presented in February 2023 with complaint of fever and cough for 20 days. On evaluation, patient was having deranged renal function tests. Chest Xray revealed multiple thick wall cavities and nasal cavity examination showed thick crusting. Based on these findings GPA was suspected and antineutrophilic cytoplasmic antibodies directed against proteinase 3 (PR3 ANCA) levels and kidney biopsy was planned. PR3 ANCA levels were raised and kidney biopsy revealed pauci-immune glomerulonephritis. In view of RPGN rituximab therapy was started along with prednisolone. Conclusion: ANCA associated vasculitis (AAV) associated with RA may be a rare form of an AAV autoimmune overlap. Its recognition can lead to timely antibody screening of patients with the relevant clinical scenario and a more rapid initiation of appropriate management.
Introduction: Fibromyalgia is a chronic, widespread pain disorder accompanied by fatigue, nonrestorative sleep, cognitive difficulties, and psychiatric comorbidity. Diagnosis remains clinical, and no objective biomarker has been established, yet growing evidence implicates oxidative stress in its pathophysiology. Objective: To synthesize current evidence on oxidative stress biomarkers and their relationship to the clinical presentation of fibromyalgia, and to evaluate their potential diagnostic and therapeutic relevance. Methods: A narrative review of the literature indexed in PubMed, Scopus, and Google Scholar (2005–2025, English language) was conducted, focusing on enzymatic and non-enzymatic antioxidants, oxidative damage markers, and validated symptom measures. Results: Reduced activities of superoxide dismutase, glutathione peroxidase, and catalase, together with increased markers of lipid and DNA oxidation (malondialdehyde, 4-hydroxynonenal, 8-oxo-dG), are associated with greater symptom severity on validated clinical scales such as the Fibromyalgia Impact Questionnaire. Composite indices (total oxidant status, total antioxidant status, oxidative stress index) and multi-marker panels provide more robust assessments than single analytes, given compensatory changes within the antioxidant network and pre-analytical influences such as diet and sample handling. Methodological constraints of common assays (TBARS, immunoassays) argue for chromatographic and mass-spectrometric approaches for symptom-specific quantification and for standardized sampling protocols. Conclusion: Redox imbalance is mechanistically linked to the core clinical features of fibromyalgia, including pain, fatigue, and impaired quality of life. Validated, multi-layered biomarker panels combined with standardized laboratory practice may improve patient phenotyping and stratification and inform interventions targeting oxidative mechanisms, although rigorous controlled studies are required.
Background: The testing of antinuclear antibodies (ANA) has become more frequent in routine clinical practice and the interpretation of positive results may pose a significant challenge. Objective: To evaluate the current evidence on the prevalence of ANA in the general population and to discucc the clinical significance of ANA positivity in the absence of autoimmune rheumatic disease (ARD). Methodology. A literature search was conducted using the PubMed database for articles investigating antinuclear antibodies (ANA) in the general population published between 2015 and 2025. The analysis focused on large-scale population studies evaluating ANA positivity via indirect immunofluorescence (IIF) on HEp-2 cells, as well as research regarding ANA positivity of non-rheumatic origin. Furthermore, the immunological profile of ANA-positive healthy individuals is discussed. Key results: Recent data indicate an ANA prevalence ranging from 10% to 30% in the general population, significantly exceeding the estimated 2% prevalence of ARD. Studies from the US even demonstrate an increasing trend in ANA positivity over time. Immunologically, ANA-positive healthy individuals seems to exhibit a balanced, low-grade but persistent autoreactivity. Large phenome study data confirm strong associations with autoimmune diseases, Raynaud's syndrome, and alveolar fibrosing conditions, while revealing negative associations with certain non-autoimmune conditions like type 2 diabetes and viral hepatitis C. Conclusions: ANA positivity in healthy individuals may represent a persistent benign autoreactivity rather than an impending disease. Thus ANA testing without clinical suspicion of ARD is often uninformative, and may cause unnecessary patient anxiety. More studies in adherence to international guidelines (EFLM/EASI/ICAP) and the use of standardized cutoff titers (preferably ≥1:160 for pathology) as well as investigating the pathoimmunological basis of ANA-postitive healthy individuals are warranted.
Objective: To evaluate the efficacy of connected devices in promoting physical activity and rehabilitation among patients with IRD. Data sources: Keywords related to connected devices, physical activity, rehabilitation, and IRD (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis) were used to search for intervention trials published as articles and abstracts in the databases MEDLINE, Web of Science, Scopus, American College of Rheumatology (ACR) abstract archive and European Alliance of Associations for Rheumatology (EULAR) abstract archive. No restrictions were applied in terms of publication date. Study selection: Interventions consisting of connected used for promoting physical activity and rehabilitation were included. Studies reporting the following primary or secondary outcomes: physical activity measurements, function of a limb region, and performance-based physical function tests were included. Studies reporting only disease activity outcomes or only evaluating feasibility of connected programs were excluded. Data Extraction: Data from each report were extracted by two researchers independently. The obtained data were narratively summarized. Data Synthesis: The search identified584 studiesand15met the inclusion criteria. The studies’ design was: randomized controlled trials (n=9), non-randomized intervention trials (n=3), cross-sectional study (n=1), prospective observational study (n=1), and a case-control study (n=1). Promoting physical activity using a wearable device, was improved significantly in one study. Among 9 studies assessing rehabilitation, a significant improvement was found in four studies for hand strength, in 2 studies for cardiorespiratory fitness, and in 2 studies for muscle endurance. Two of the 3 studies focusing mobility showed a significant increase for intervention groups. Conclusion: The present study indicates that connected devices are simple and safe tools to improve mainly performance-based physical function in patients with IRD. However, further studies with larger population sizes and a longer follow-up period are needed to make reliable conclusions.
Background: Systemic lupus erythematosus (SLE) can affect multiple organs, presenting a diverse array of clinical symptoms. In recent years, Point-of-Care Ultrasound (POCUS) has become increasingly accessible, supported by robust evidence. POCUS can be particularly beneficial for evaluating SLE patients improving diagnostic accuracy and reducing time-to-decision. Purpose: Systematically identify the assessment of SLE patients through the use of POCUS. Methods: The data sources MEDLINE, EMBASE, LILACS, Google Scholar and ProQuest One Academic were used, English and Spanish language were included, no limits regarding publication date or age, and review articles were excluded. Articles screening and data extraction was performed by two authors independently. Disagreements were resolved through a third author. Organ or system evaluation using POCUS were collected. Results: A total of 52 articles met the inclusion criteria. Assessment using POCUS detected various acute and chronic complications arising from SLE, particularly articular and cardiac compromise. Synovitis and pericardial effusion were the most frequently reported complications. Most of the reports (92%) did not specify whether they evaluated other organs with POCUS. Limitation: Most of the studies were case reports. Conclusion: Multiorgan POCUS assessment in patients with SLE, especially those suspected of disease activity, holds the potential to offer improved evaluation of SLE complications and activity. Studies are needed to develop a standardized multiorgan assessment protocol for SLE using POCUS to improve diagnosis and treatment. PROSPERO registry number: CRD42024529087. The search was done in April 2024
Въведение: Витамините К2 и Д играят централна роля в метаболизма на калция и си взаимодействат синергично в поддържането на здравето на костите и сърдечно-съдовата система. Витамин Д стимулира синтеза на протеини, които се активират от витамин К2-зависимо карбоксилиране. Ефектите на витамин К2 върху калциевия метаболизъм, костния търновър и потенциалната му роля в превенцията и лечението на остеопорозата не са напълно изяснени. Цел: Да изследваме нивата на витамините К2 и Д при пациентки с ОП и жени в менопауза и да проучим влиянието им върху костния търновър. Материали и методи: Изследвани бяха 48 жени в менопауза, разпределени в две групи след измерване на КМП на гръбнака с ДХА: работна група, 26 жени с ОП на възраст 65.62±9.2 г. и контролна група от 22 жени без ОП на възраст 63.55±8.7 г. Бяха измерени плазмените концентрации на калций, фосфати, АФ, витамин Д, ПТХ, OC, ucOC. Витамин К2 статуса беше оценен индиректно чрез съотношението ucOC/OC. Резултати: Измерените показатели не показват сигнификантни разлики в двете групи. И в двете групи съотношението ucOC/OC е високо и показва дефицит на витамин К2. Нивата на витамин Д показват недостатъчност. В групата с ОП, ОС показва позитивна корелация с витамин Д (p = 0.015) и с АФ (p = 0.025). UcOC показва позитивна корелация с витамин Д (p = 0.033). UcOC/OC показва висока негативна корелация с ОС (p < 0.001) и негативна корелация с АФ, (p = 0.043). Заключение: Данните ни показват лош витамин К2 и Д статус. В групата с постменопаузална ОП двата витамина повлияват костния търновър чрез взаимосвързаните нива на ПТХ, АФ и ОС, което подтиска функцията на остеобластите и нарушава баланса между костно образуване и резорбция в полза на резорбцията.
Капиляроскопията е неинвазивен метод за оценка на микроциркулацията, който предоставя важна информация за състоянието на капилярите и перикапилярното пространство. Методът е ценен за диагностицирането и мониторинга на различни заболявания, с прояви на феномен на Рейно (RP), като системни заболявания на съединителната тъкан, диабет, хипертония, професионални болести и други състояния, които водят до нарушения в микроциркулацията. Изключително важно място заема при ранната диагностика и прогнозата на тези заболявания, като помага да се открият както функционални, така и структурни промени в капилярната мрежа, дори в случаи при отсъствие на множество характерни клинични симптоми. Феноменът на Рейно е заболяване, което се характеризира с обратими пристъпи на вазоспазъм, водещи до нарушено периферно кръвообращение. Той може да бъде първичен (идиопатичен) или вторичен (свързан с други заболявания). Капиляроскопията е златен стандарт в ревматологичната пратика за отдиференцирането на първичния от вторичния феномен на Рейно и от 2013 г. е включен в класификационните критерии на EULAR / ACR за системна склероза (SSc). При първичния RP се наблюдават функционални нарушения на капилярите, без структурни изменения, докато при вторичният, който е свързан със системни, общи или професионални заболявания, води до различни структурни промени с характерни признаци на микроангиопатия. Методът има не само диагностична, но и прогностична стойност при системна склероза, лупус еритематозус, дерматомиозит и др. Наблюдават се специфични капиляроскопски модели – „склеродермен“ и „склеродермо - подобен“, както могат да бъдат установени и неспецифични промени в ранните етапи на болестта. През последните години зачестиха публикациите, съобщаващи данни за различни капиляроскопски находки при пациенти с вибрационната болест. Тя е специфично професионално заболяване, причинено от продължително излагане на вибрации, което води до микроциркулационни и периферни нервни увреждания, включително феномен на Рейно. Проучванията показват, че капиляроскопията предоставя важна информация за състоянието на микроциркулацията при пациенти с професионално индуцирана микроангиопатия и по-конкретно при експозиция на вибрации от локален и общ характер. Методът може да бъде използван за диагностика и мониторинг на тези заболявания, като помага да се открият абнормални капиляроскопски находки, включващи удължени капиляри, хеморагии и аваскуларни зони. Капиляроскопията, като неинвазивен метод, е ефективна за диагностика и проследяване на прогресията на заболяванията и може да бъде използван в комбинация с други функционални изследвания за по-добра оценка на състоянието на пациента.
Fibromyalgia (FM) is characterized by chronic widespread pain lasting for a minimum of three months and pain at mechanical pressure in at least 11 of the 18 tender points. Four treatment groups with FM patients and a healthy control group were followed within 3 months in the Clinic of rheumatology, Sofia. The accompanying clinical symptoms were evaluated by a 5-point grading system. These results are useful for the everyday clinical practice and treatment of fibromyalgia.
