Razvan Adrian Ionescu

By Mihail Virgil Boldeanu, Adrian Răzvan Ionescu, Valeriu Horațiu Popoviciu, Andreea Lili Bărbulescu, Ștefan Cristian Dinescu, Isabela Siloși, Maria Forțofoiu, Rodica Pădureanu, Andreea Meca, Vlad Pădureanu, Mircea Cătălin Forțofoiu, Ioan Sabin Poenariu, Lidia Boldeanu and Ananu Florentin Vreju

Rheumatoid arthritis is a chronic, systemic inflammatory disease, with certain evidence of multiple factors involved, but also with the strong autoimmune component, leading to a high potential for disability, through synovial inflammation and joint destruction. Diagnostic methods and management possibilities have recently improved, thus leading to a better outcome, based on the treat to target recommendation. Although biologic agents represent efficient therapeutic agents, in the last few years, the advances in understanding the mediators involved in rheumatoid arthritis pathogenesis have provided new targeted therapies, represented by small molecule inhibitors against the Janus kinases that contribute in the signaling pathways of various cytokine receptors.

Part of the book: Rheumatoid Arthritis

By Stefan Cristian Dinescu, Razvan Adrian Ionescu, Horatiu Valeriu Popoviciu, Claudiu Avram and Florentin Ananu Vreju

Musculoskeletal ultrasound had gained more and more importance lately and there is no doubt now about its role in the diagnosis and management of rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, osteoarthritis and crystal related arthropathies. We can say that now, US is a widely available, non-invasive, and cost-effective technique suitable for the evaluation of the articular and periarticular structures, such as joints, tendons, muscles, ligaments, and bursa. The real-time capabilities of the US allow continuous observation of those structures during movement and of the needle placement during musculoskeletal interventions. More than this, recently, ultrasonography (US) has gained its rights in the evaluation of Sjogren syndrome and giant cell arteritis. Thus, US can detect changes secondary to both inflammatory joint diseases, like synovitis, tenosynovitis or enthesitis, and to degenerative disease, like osteophytes or tendinosis. US can identify calcium pyrophosphate and urate deposits at the level of the cartilage and tendons and to recognize the changes at the level of the salivary glands in the context of the Sjogren’s syndrome and the ones at the level of the temporal artery, secondary to giant cell arteritis.

Part of the book: Ultrasound Imaging

By Razvan Adrian Ionescu, Horatiu Popoviciu and Florentin Ananu Vreju

Diagnostic criteria are used, as the name suggests, to make diagnosis of disease. They should encompass those characteristics that we find in every patient with the disease they are designed for. Therefore, it is extremely difficult to design such criteria. Classification criteria, on the other hand, are intended to be used only in already diagnosed patients, to classify them as having the respective disease, mainly for research purposes. Nevertheless, since classification criteria encompass those characteristics of the disease that are present in the majority of patients, it is only natural to try to use them as a helping tool in the diagnostic endeavor. This should be done appropriately, bearing in mind that the patient not fulfilling every one of them, can and may be still diagnosed as having ankylosing spondylitis, even though he/she cannot be classified as such. Classification criteria for ankylosing spondylitis (AS) have changed over time, due to the new insight obtained into the pathogenic mechanisms of the disease. Moreover, a patient fulfilling them is sometimes the initial step mandated by the paying authorities for reimbursement of therapies. All these reasons and others highlight the need to understand the different facets of the diagnostic/classification criteria and their best use.

Part of the book: Ankylosing Spondylitis