Denisa Predeteanu

Latest posts by Denisa Predeteanu (see all)

Colchicine is associated with lower cardiovascular morbidity in gout - 28/02/2017
Efficacy differences between classical and biological treatment in ankylosing spondylitis - 18/11/2016
OPTIMIZING EXISTING TOOLS FOR REACHING AN ADEQUATE DISEASE CONTROL IN PATIENTS WITH SPONDYLOARTHRITIS - 07/08/2016

Articles signed on Romanian Journal of RHEUMATOLOGY:

Colchicine is associated with lower cardiovascular morbidity in gout

Romanian Journal of Rheumatology, Volume XXV, No. 4, 2016

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

Claudiu Popescu, Warda Abukar, Alexandra Hutan and Denisa Predeteanu

ABSTRACT

Objective. This exploratory study aimes at comparing Romanian gout patients with or without colchicine treatment in order to determine if colchicine is associated with a lower cardiovascular morbidity.
Methods. The study was cross-sectionally designed to include all the patients randomly admitted to the hospital between January and July 2015 and discharged with a diagnosis of idiopathic gout according to their attending physicians. The clinical observation sheets served as retrospective sources of information regarding study variables (demographics, addictive behavior, gout phenotype and treatment, cardiovascular morbidity). Data analysis included non-parametric tests and binary logistic regressions (significant if p < 0.05).
Results. The sample included 96 subjects, predominantly men (77.1%), with a mean age of 62.7 years. 60 (62.5%) subjects received colchicine. Compared to patients who didn‘t receive colchicine, they had a significantly lower prevalence of ischemic heart disease, chronic heart failure and atherosclerosis (p < 0.05). Colchicine was a significant protective factor for atherosclerosis (OR = 0.243; 95% CI: 0.076-0.784).
Conclusions. Primary and secondary cardiovascular prevention may benefit from low doses of colchicine. Further prospective blind randomized clinical trials are needed to test these hypotheses.

Keywords: colchicine, atherosclerosis, chronic heart failure, gout

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Efficacy differences between classical and biological treatment in ankylosing spondylitis

Romanian Journal of Rheumatology, Volume XXV, No. 3, 2016

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

Claudiu Popescu, Jasmin Mehrabi, Denisa Predeteanu and Cătălin Codreanu

ABSTRACT

Objectives. The study aims at comparing classical and biological treatment of ankylosing spondylitis (AS) in terms of efficacy and to determine which treatment type is a significant predictor of low disease activity in a reallife clinical situation.
Methods. The study was cross-sectionally designed to include all the patients randomly admitted between January and July 2015 to the “Sfanta Maria” Clinical Hospital Department of Rheumatology and discharged with a diagnosis of AS according to their attending physicians. The retrospectively collected variables (demographics, disease phenotype and activity, treatment, laboratory measures) were analyzed using appropriate statistical tests (Mann Whitney, χ2, linear and logistic regression).
Results. The study sample included 105 cases of established AS with a mean age of 43.2 years: 64 patients (60.9%) were on tumor necrosis factor inhibitors (TNFi: adalimumab, etanercept or infliximab), 55 (52.4%) took non-steroidal anti-inflammatory drugs (NSAIDs) and 30 (28.6%) had sulfasalazine. TNFi were associated with lower disease activity compared to NSAIDs and sulfasalazine and they were significant predictors for low BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), either as mono-therapy or combined with NSAIDs and/or sulfasalazine.
Conclusion. TNFi are more efficacious than NSAIDs and sulfasalazine for the treatment of AS. A combination of TNFi with NSAIDs (and sulfasalazine for peripheral arthritis) would be the ideal therapeutic association.

Keywords: ankylosing spondylitis, TNF inhibitors, NSAIDs, sulfasalazine

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OPTIMIZING EXISTING TOOLS FOR REACHING AN ADEQUATE DISEASE CONTROL IN PATIENTS WITH SPONDYLOARTHRITIS

Romanian Journal of Rheumatology, Volume XXV, No. 2, 2016

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

Claudia Deaconu, Daniela Opris, Diana Mazilu, Laura Groseanu, Andreea Borangiu, Saulescu Ioana, Alexandra Peltea, Magdalena Negru, Cosmin Constantinescu, Violeta Vlad, Violeta Bojinca, Andra Balanescu, Denisa Predeteanu and Ruxandra Ionescu

ABSTRACT

Background/Objective. Disease activity in spondyloarthritis (SpA) is evaluated through conventional scores such as BASDAI or ASDAS. The aim of this study was to determine disease activity in SpA patients under biological therapy with further assessment on the quality of each activity indicator and their clinical value together with their impact on NSAID intake.
Materials and methods. Over nine months (January–August 2015) we enrolled 100 patients with SpA on anti-TNF therapy (33% IFX; 35% ADL; 32% ETA). We collected demographic, clinical (BASDAI, ASDAS, PtGA) and laboratory data (ESR, CRP). Frequency of NSAID ingestion expressed as days per week was included in a questionnaire. Considering their biologic treatment, patients were divided into disease activity groups and sample characteristics were correlated and compared. Statistical analysis was performed with SPSS 20.0, using specific tests such as Pearson, Spearman or ANOVA.
Results. Patients with active disease, stated by both activity scores had an increased NSAID intake. Out of 86% of patients with a BASDAI under 4, only 82.6% had an ASDAS-CRP lower than 1.3. BASDAI correlated to both ASDAS scores (r = 0.65 and 0.71, P<0.001) and PtGA correlated to both disease activity scales, with a stronger correlation to BASDAI (r = 0.912, P<0.01) than ASDAS (r = 0.67 and 0.71, P<0.01 for both).
Conclusion. We proved that disease activity scores have good discriminatory power, with a strong correlation between the subjective BASDAI and PtGA. However, ASDAS-CRP proves to be more rigorous than other variables when targeting high and low disease activity, thus indicating the need of an objective component in assessing these patients.

Keywords: spondyloarthritis, disease activity scores, discriminatory power, anti-TNF therapy

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ADVANCED TREATMENT IN RHEUMATOID ARTHRITIS. IS IT POSSIBLE TO TAPER THE BIOLOGICAL TREATMENT?

Romanian Journal of Rheumatology, Volume XXIV, No. 4, 2015

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Ina Cambu, Catalina Raluca Nuta and Denisa Predeteanu

ABSTRACT

Rheumatoid arthritis (RA) is a systemic autoimmune disease, leading to synovial hypertrophy and adjacent bone and cartilage destruction. The combined use of biological agents and methotrexate (MTX) has revolutionised the treatment of RA producing significant improvements in clinical, radiographic and functional outcomes. The results of clinical study and experience of the specialities of rheumatology in clinical statement showed the long treatment may be associated with side effects, in addition biological treatment means high cost. The next goal should be remission without the use of biological agents. That’s why new treatment in RA means the tapering or even stopping the biological treatment in patients with RA who reached remission. In association with the new recommendation EULAR in 2013 there are many studies which showed the possibility of tapering or discontinuing the biological therapy in patients in sustained remission.

Keywords: rheumatoid arthritis, biological therapy, treatment optimization

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STUDIUL NEOPLAZIILOR LA PACIENTII CU POLIARTRITA REUMATOIDA

Romanian Journal of Rheumatology, Volume XXIII, No. 1, 2014

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

Lorin-Iulian Adam, Marius Trandafir, Claudiu Popescu, Magdalena Negru and Denisa Predeteanu

REZUMAT

Poliartrita reumatoidă (PR), o patologie în care se utilizează pe termen lung un tratament cu medicamente ce influenţează funcţia imună, a fost dintotdeauna subiectul unor preocupări asupra unei posibile creşteri a riscului de a dezvolta o neoplazie, datorată fie tratamentului sau a bolii în sine. În articolul de faţă este prezentat un studiu retrospectiv efectuat pe un grup de pacienţi cu poliartrită reumatoidă împărţit în două subgrupuri: unul în care aceştia au utilizat agenţi biologici şi altul în care pacienţii nu au fost trataţi cu acest tip de terapie. A existat, de asemenea, şi un grup de control. S-a propus evidenţierea diferenţei în ceea ce priveşte frecvenţa neoplaziilor, între populaţia generală şi cea cu poliartrită reumatoidă, precum şi în cadrul celor cu poliartrită reumatoidă ce utilizau terapie biologică faţă de cei care nu utilizau această terapie. Terapia biologică nu pare să crească riscul de cancere la pacienţii cu PR. Există o prevalenţă mai mare a neoplaziilor la pacienţii cu anumite caracteristici ale bolii (debut precoce, durată crescută, activitate mai înaltă a bolii).

Cuvinte cheie: poliartrită reumatoidă, cancer, neoplazie, agenţi anti-TNF-α

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EFICACITATEA TRATAMENTULUI CU RITUXIMAB PE UN LOT DE PACIENTI CU POLIARTRITA REUMATOIDA ÎN FUNCTIE DE REMISIVUL CLASIC ASOCIAT SI INDICELE DE MASA CORPORALA

Romanian Journal of Rheumatology, Volume XXIII, No. 3, 2014

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Cătălina-Elena Ionescu, Luminiţa Enache, Corina Mogoşan, Cătălin Codreanu and Denisa Predeteanu

REZUMAT

Introducere. Rituximab (RTX), anticorp monoclonal anti-CD20, testat în studii clinice randomizate controlate placebo şi aprobat în practica clinică curentă, şi-a demonstrat eficacitatea în poliartrita reumatoidă (PR), la pacienţii care nu au răspuns la terapia cu blocanţi de TNFα clasici.

Obiective. Studiul de faţă şi-a propus să monitorizeze evoluţia unui lot de pacienţi cu PR, aflaţi în tratament cu RTX, pe o perioadă de 12 luni. Obiectivul principal a fost evaluarea parametrilor de activitate a bolii sub tratamentul cu RTX, la 6 luni, respectiv la 12 luni, cu scopul de a urmări activitatea bolii sub tratament. Obiectivele secundare au fost reprezentate de evaluarea răspunsului terapeutic la RTX în funcţie de remisivul clasic utilizat în asociere şi indicele de masă corporală al pacienţilor.

Material şi metodă. Lucrarea de faţă este un studiu descriptiv, retrospectiv, de tip serie de cazuri, care a inclus un lot de 30 de pacienţi cu PR în tratamentul cu RTX. Eficacitatea terapiei a fost evaluată utilizând valorile VSH, PCR, VAS, NAT28, NAD28 şi a indicelui compozit DAS28 la trei momente de timp diferite: iniţiere, 6 luni şi 12 luni. Prelucrarea statistică a datelor a fost realizată cu ajutorul programelor Microsoft Excel 2010 şi SPSS Statistics 20. Testele statistice folosite au fost: testele t împerecheate, testele t independente şi testul chi-pătrat.

Rezultate. În cadrul lotului de studiu, media scorului DAS28 scade de la 5,62 la iniţiere la 3,69 la 6 luni, iar la finalul perioadei de urmărire atinge valoarea de 3,09. Aceste valori prezintă o tendinţă de scădere lineară în timp (R2 = 0,9157) şi sunt diferite semnificativ statistic conform valorilor p obţinute. Variabilele individuale, componente ale scorului DAS28 au prezentat acelaşi trend. La 12 luni, subgrupul de pacienţi tratat cu asocierea RTX-leflunomid (LEF) a prezentat medii DAS28 şi VSH semnificativ statistic mai mici comparativ cu pacienţii în tratament cu asocierea RTX-metotrexat (MTX) (2,67 vs 3,28, p = 0,038); (16,22 mm/h vs 28,04 mm/h, p = 0,011); în plus, procente mai mari dintre aceştia au atins LDA la 6 luni (44,4% vs 0%, p = 0,001) şi respectiv la 12 luni (55,6% vs 9,5%, p = 0,006). La finalul perioadei de urmărire, subgrupul de pacienţi normoponderali prezintă valori mai mici ale VSH-ului (20,13 mm/h vs 28,86 mm/h, p = 0,045), scoruri mai mici DAS28 (2,82 vs 3,37, p = 0,042), o ameliorare superioară a valorilor DAS28 faţă de iniţiere (3,02 vs 2, p = 0,022) şi un procent mai mare de pacienţi aflaţi în remisiune (40% vs 0%, p = 0,006) faţă de subgrupul de pacienţi supraponderali.

Concluzii. Pentru lotul de studiu s-a demonstrat cu semnificaţie statistică scăderea tuturor parametrilor de activitate a bolii măsuraţi de la iniţiere, la 6 luni şi respectiv 12 luni, superioritatea asocierii RTX-LEF şi rate de răspuns mai bune la terapie ale pacienţilor normoponderali.

Cuvinte cheie: poliartrită reumatoidă, rituximab, leflunomid, indice de masă corporală

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ROLUL TNF-α ÎN UVEITA ASOCIATA CU SPONDILITA ANCHILOZANTA – DE LA PATOGENIE LA TRATAMENT

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

T.C. Mitulescu, Monica Dimăncescu, Denisa Predeteanu and Liliana-Mary Voinea

REZUMAT

Uveita este cea mai frecventă manifestare extraarticulară la pacienţii cu spondilită anchilozantă (SA), uveita acută anterioară (UAA) HLA-B27+ reprezentând cea mai importantă formă de uveită întâlnită la pacienţii cu această suferinţă reumatică. Patogenia SA este parţial înţeleasă şi mecanisme mediate imun sunt sugerate de histologia inflamatoare, niveluri serice crescute de IgA şi reactanţi de fază acută, relaţia strânsă cu HLA-B27 etc. TNF-α este o citokină proinfl amatoare implicată în patogenia atât a manifestărilor articulare ale bolii reumatice, cât şi a uveitei. Tratamentul anti-TNF-α (Infliximab, Adalimumab, Etanercept) are efect favorabil la pacienţii cu SA, scăzând semnele şi simptomele, ameliorând funcţionalitatea şi crescând calitatea vieţii pacienţilor şi productivitatea lor.

Efectul terapiei anti-TNF-α în uveita asociată cu SA este diferit: comparativ cu Etanerceptul (receptori solubili de TNFα) care poate induce ca o reacţie paradoxală uveită la pacienţii cu boli reumatice cum este SA, Infliximabul şi Adalimumabul (anticorpi monoclonali anti-TNF) au efecte favorabile în scăderea ratei recurenţelor uveitei la pacienţii cu SA.

O înţelegere mai bună a mecanismelor afectării articulare şi oculare la pacienţii cu SA şi UAA ar putea îmbunătăţi tratamentul lor.

Cuvinte cheie: TNF-α, uveită, spondilită anchilozantă

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TYPE I MONOCLONAL CRYOGLOBULINEMIA IgG KAPPA WITH SECONDARY VASCULITIS AS ONSET MANIFESTATION OF MULTIPLE MYELOMA

Romanian Journal of Rheumatology, Volume XXIII, No. 4, 2014

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

Sorina Badelita, Monica Dogaru, Camelia Dobrea, Zsofia Varady, Daniel Coriu, Adriana Tanase, Florian Berghea and Denisa Predeteanu

ABSTRACT

A 49-year-old patient initially admitted to the Rheumatology Clinic for arthralgias, swelling in the fists, knees and ankles, at a bilateral level, with RM>1h, dot-like necrotic lesions on the back side of his fingers and toes, extensive hemorrhagic lesions on the backside of his hands and feet, and, from a biological point of view, intense inflammatory syndrome and increased IgG are detected, so the patient was transferred to the Fundeni Hematology Clinic on the presumption of a monoclonal gammapathy diagnosis. The tests performed revealed IgG kappa monoclonal cryoglobulinemia and multiple myeloma stage IIIA. The skin biopsy confirmed the clinical suspicion of cryoglobulinemia vasculitis. The patient received bortezomib-based induction therapy with the multiple myeloma achieving complete remission and disappearance of rheumatoid syndrome/vasculitis. Subsequently, remission was consolidated with an autologous bone marrow transplant.

Rheumatoid syndrome and cryoglobulinemia vasculitis are rare onset manifestation in multiple myeloma. The association of multiple myeloma with symptomatic monoclonal cryoglobulinemia is an indication of chemotherapy and autologous bone marrow transplant, even in multiple myeloma stage I or II.

Keywords: rheumatoid syndrome, monoclonal cryoglobulinemia vasculitis, multiple myeloma, bortezomib, autologous bone marrow transplant

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EFFICACY AND SAFETY OF ADALIMUMAB IN ANKYLOSING SPONDYLITIS: DATA FROM REAL LIFE

Romanian Journal of Neurology, Volume XXIV, No. 1, 2015

ISSN 1843-0791 | e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

National Awards “Science and Research”

NEW! RJR has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

Claudiu Popescu, Cristina Coroama, Costin Mitulescu, Denisa Predeteanu and Ruxandra Ionescu

ABSTRACT

Rationale. Data from controlled trials showed that adalimumab, a humanized anti-TNF monoclonal antibody, is effective and safe in the treatment of ankylosing spondylitis (AS).

Objectives. The present study aimed to observe the efficacy and safety of adalimumab in AS in a real life clinical setting.

Methods. The study observed cross-sectionaly and retrospectively the efficacy and safety of adalimumab in all the patients admitted to the Rheumatology Department of “Sfânta Maria” Clinical Hospital between January 2008 and June 2013 who were classified as having AS according to the modified New York criteria. The diagnosis and follow-up of uveitic cases were done in the Ophthalmology Department of the Emergency University Hospital.

Results. Within the study time-frame, 79 AS patients met the inclusion criteria: 71 (89.9%) had adalimumab for at least 24 months; 8 (10.1%) switched from adalimumab to another biological, as follows: 3 (3.8%) because of serious adverse events, 3 (3.8%) were primary non-responders and 2 (2.5%) were secondary non-responders. The clinical response was fast: after 3 months of treatment, 59 (83.1%) patients had BASDAI < 4 and 55 (77.5%) patients had BASFI < 4. Regarding safety, the serious adverse effects recorded were: infectious arthritis, pulmonary tuberculosis, pulmonary sarcoidosis. There were no cases of cancer or demyelinating disease during the study frame.

Conclusions. Therapy with adalimumab in AS produces a prompt and lasting effect. The efficacy (remission) and safety (adverse events) of adalimumab can be monitored in the real-life clinical setting using BASDAI, BASFI, and routine clinical evaluations. Clinicians may need to expect a slightly higher rate of serious adverse events and rate of treatment discontinuation than those reported by controlled trials.

Keywords: adalimumab, ankylosing spondylitis, efficacy, safety

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