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Mihaela Milicescu

Latest posts by Mihaela Milicescu (see all)

  • Excellent reliability of semi-quantitative nailfold capillaroscopy in patients with systemic sclerosis – a pilot study - 28/02/2017
  • DISEASE COURSE IN EARLY RHEUMATOID ARTHRITIS: AN OBSERVATIONAL STUDY - 10/05/2016
  • SINDROM POLIMIALGIC PARANEOPLAZIC LA UN PACIENT CU NEOPLASM GASTRIC - 22/09/2015

Articles signed on Romanian Journal of RHEUMATOLOGY:

Excellent reliability of semi-quantitative nailfold capillaroscopy in patients with systemic sclerosis – a pilot study

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Romanian Journal of Rheumatology, Volume XXV, No. 4, 2016
ISSN 1843-0791  |  e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

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HIGHLIGHTS

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

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.

Excellent reliability of semi-quantitative nailfold capillaroscopy in patients with systemic sclerosis – a pilot study

Ana Maria Gheorghiu, Raida Oneata, Mihai Bojinca, Rucsandra Dobrota, Alina Soare, Liviu Macovei, Mihaela Milicescu, Mariana Sasu, Marilena Gorga, Roxana Sfrent-Cornateanu, Victor Stoica and Carina Mihai

ABSTRACT

Background. Semi-quantitative nailfold capillaroscopy (NFC) scoring represents a promising tool for assessing disease activity, severity and change in systemic sclerosis (SSc), however there is no consensus yet over which capillaroscopy abnormalities should be analyzed and how.
Objective. Investigation of the reliability of the qualitative and semi-quantitative scoring of NFC assessment between two raters and test-retest for each rater in a SSc cohort.
Methods. This is a single-center pilot study where 2 raters assessed the NFC images of 48 consecutive patients with SSc. Data were analyzed in 3 ways: 1. Qualitatively by “normal”/“abnormal” category; 2. Qualitatively by the following categories: “early”, “active”, “late” SSc patterns, “normal”, and unclassifiable in any pattern, and step; 3. Semi-quantitatively by calculating the mean score for capillary loss, disorganization of the microvascular array, giant capillaries, microhaemorrhages and capillary ramifications and combinations of giant capillaries and microhaemorrhages (as a surrogate for vascular activity). Disorganization and ramifications (surrogate for vascular damage) were also assessed. Variables for all steps were calculated for all fingers and for each finger. Inter-rater/intra-rater agreement was assessed by Cohen’s kappa coefficients for qualitative variables and by intraclass correlation coefficients (ICC) for mean score values of abnormalities.
Results. Inter-rater reliability ranged from good to excellent agreement for mean score values of abnormalities in all fingers (ICC coefficients 0.745 to 0.897) and was excellent for activity (ICC coefficient of 0.923) and damage combinations (ICC coefficient of 0.918). Assessment of abnormalities in a qualitative manner (normal/abnormal or with capillaroscopy patterns) showed weaker inter-rater agreement than the semi-quantitative assessment (k coefficient <0.7). Intra-rater variability was good to excellent for mean score values of abnormalities and activity and damage combinations in all fingers and separate fingers for both raters; for qualitative assessment, only one of the raters had good test-retest reliability.
Conclusion. Reliability of NFC assessment is essential in SSc trials/clinical practice to ensure quality of data. This pilot study demonstrates very good reliability between raters of the semi-quantitative NFC assessment in a SSc cohort. Combinations of NFC abnormalities had very good reliability and might be preferred because they are less time consuming.

Keywords: systemic sclerosis, capillaroscopy, agreement, reliability, quantitative

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DISEASE COURSE IN EARLY RHEUMATOID ARTHRITIS: AN OBSERVATIONAL STUDY

SELECT ISSUE

Romanian Journal of Rheumatology, Volume XXV, No. 1, 2016
ISSN 1843-0791  |  e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
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HIGHLIGHTS

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

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.

DISEASE COURSE IN EARLY RHEUMATOID ARTHRITIS: AN OBSERVATIONAL STUDY

Teodora Serban, Iulia Sătulu, Oana Vutcanu, Mihaela Milicescu, Carina Mihai, Mihai Bojinca and Victor Stoica

ABSTRACT

Background. In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset - a period called “window of opportunity” – is significantly superior to the delayed start of the same therapy. Clinical remission is more frequently obtained in patients with a disease duration no longer than 4 months and is the main aim of the treatment, therefore the “treat to target” (T2T) and “tight control” strategies were proposed.

Objective. The aim of this study is to evaluate the therapy used for patients with early RA (ERA) and the impact of this medication on the clinical outcomes at 12 months after the first evaluation.

Methods. Patients with early arthritis who were referred to the Early Arthritis Research Center of “Dr. I. Cantacuzino” Hospital between 2010-2014 and who fulfilled the 2010 EULAR/ACR Classification Criteria for RA (and who did not satisfy classification criteria for other inflammatory rheumatologic diseases) were enrolled. Only patients who received treatment with Methotrexate (MTX) associated or not with corticosteroids (CS) and patients who fulfilled the classification criteria for RA but did not received any DMARDs therapy were enrolled.

Results. Forty-three patients were enrolled in the study, 62.8% females, mean age 55.47±13.71 years, median (interquartile range) DAS28 5.07 (4.31-5.60), SDAI 29.02 (20.92-34.61). At the first presentation, 40 patients (93.0%) received treatment with Methotrexate (MTX) in doses ranging from 5 mg/week to 20 mg/week, with a mean dose of 11.16±4.47 mg/week, the most frequently used doses ranging from 10 mg/week to 15 mg/week. 26 patients (60.5%) received corticosteroids (CS), either oral or intra-articular. During the study both the total number of patients receiving MTX and the mean dose of MTX increased, while the number of patients receiving CS decreased and at the end of the study only low-dose oral CS were still administered in 8 patients. At 12 months, median (interquartile range) DAS 28 was 1.77 (1.43-3.16), SDAI 3.58 (2.32-11.82). The evolution under treatment assessed by DAS28 and SDAI wasn’t significantly different between patients who received, at baseline, MTX in association with CS (mean value: ΔDAS28=-2.58±1.72, ΔSDAI=-20.44±16.49) and those who received MTX monotherapy (mean value: ΔDAS28=-2.91±1.17, ΔSDAI=-21.80±9.89) (p>0.05). There was no significant difference in change from baseline of DAS28 and SDAI at 12 months between patients who received low-dose oral CS and those who received intermittent intra-articular CS (p>0.05).

Conclusions. Treatment with MTX and/or CS led to clinical and laboratory improved outcomes at 12 months of follow-up. There was no significant difference regarding long-term outcomes between patients who received lowdose oral CS and those who received intra-articular CS. As this study was performed on a relatively small number of real-life patients with ERA, the results obtained should be validated on larger cohorts of patients.

Keywords: early rheumatoid arthritis, treatment, “treat to target”, clinical remission

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SINDROM POLIMIALGIC PARANEOPLAZIC LA UN PACIENT CU NEOPLASM GASTRIC

SELECT ISSUE

Romanian Journal of Rheumatology, Volume XXIII, No. 1, 2014
ISSN 1843-0791  |  e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
Scopus
NLM Catalog
Ebsco Host - Medline
Google Academic
Semantic Scholar

HIGHLIGHTS

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

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.

SINDROM POLIMIALGIC PARANEOPLAZIC LA UN PACIENT CU NEOPLASM GASTRIC

Mihaela Milicescu, Teodora Mazdrag, Oana Vutcanu, I. Marin and M. Bojincă

REZUMAT

Polimialgia reumatică (PMR) este o afecţiune caracterizată de dureri şi redoare la nivelul musculaturii proximale a centurilor scapulo-humerale şi coxo-femurale. Boala afectează persoanele cu vârsta peste 50 de ani. Majoritatea pacienţilor prezintă valori crescute ale reactanţilor de fază acută. În practică sunt întâlniţi frecvent pacienţi care se prezintă cu sindroame polimialgice, dar la care diagnosticul este reîncadrat la evaluările ulterioare. Sindroamele paraneoplazice sunt determinate de secreţia hormonilor, peptidelor sau citokinelor de către tumori sau prin imunitatea încrucişată între ţesuturile normale şi cele maligne. Prezentăm cazul unei paciente care la prima evaluare în clinică prezenta manifestări clinice, teste biologice şi modificări imagistice sugestive pentru polimialgia reumatică. Deşi sub tratament corticosteroid se obţine o ameliorare a simptomatologiei, la următoarea evalure se observă o schimbare netă a tabloului clinic, biologic şi imagistic, ceea ce duce la reîncadrarea diagnosticului în sindrom polimialgic paraneoplazic (SPP) secundar unui neoplasm gastric.

Cuvinte cheie: sindrom polimialgic paraneoplazic, polimialgie reumatică

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ROLUL ECOGRAFIEI MUSCULO-SCHELETALE ÎN DECIZIA DE SCHIMBARE A TERAPIEI LA PACIENTII CU POLIARTRITA REUMATOIDA ÎN TRATAMENT CU ANTICORPI ANTI-TNF ALFA

SELECT ISSUE

Romanian Journal of Rheumatology, Volume XXIII, No. 1, 2014
ISSN 1843-0791  |  e-ISSN 2069-6086
ISSN-L 1843-0791
DOI: 10.37897/RJR

Indexed

DOI - Crossref
Similarity Check by iThenticate, worldwide No 1 professional plagiarism checking system
DOAJ
Scopus
NLM Catalog
Ebsco Host - Medline
Google Academic
Semantic Scholar

HIGHLIGHTS

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

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.

ROLUL ECOGRAFIEI MUSCULO-SCHELETALE ÎN DECIZIA DE SCHIMBARE A TERAPIEI LA PACIENTII CU POLIARTRITA REUMATOIDA ÎN TRATAMENT CU ANTICORPI ANTI-TNF ALFA

Mihaela Milicescu, Iulia Sătulu, Teodora Mazdrag, Andreea Ciucu, Oana Vutcanu and M. Bojincă

REZUMAT

Poliartrita reumatoidă (PR) este o afecţiune inflamatorie cronică ce produce leziuni structurale articulare încă de la debut. Evoluţia bolii este influenţată de instituirea precoce a tratamentului remisiv şi monitorizarea atentă a acesteia. Ecografia musculo-scheletală s-a distins în ultimii ani ca fiind o metodă eficientă de detectare a inflamaţiei intraarticulare restante, fiind utilă în determinarea gradului de activitate a bolii. Prezentăm cazul unei paciente cu PR la care examinarea ecografică musculo-scheletală a avut un rol esenţial în decizia de schimbare a clasei de tratament biologic.

Cuvinte cheie: poliartrita reumatoidă, ecografie musculo-scheletală, anticorpi anti -TNF alfa

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