Victor Stoica

Latest posts by Victor Stoica (see all)

Breastfeeding in rheumatoid arthritis in Romania - 28/02/2017
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

Articles signed on Romanian Journal of RHEUMATOLOGY:

Breastfeeding in rheumatoid arthritis in Romania

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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Promoting Global Health

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Anca Bobirca, Ioan Ancuţa, Florin Bobirca, Cristina Tataru, Cristina Comsa, Carina Mihai, Mihai Bojinca and Victor Stoica

ABSTRACT

Background. Rheumatoid arthritis (RA) is not a contraindication to pregnancy. It is only mandatory to observe several recommendations: planning pregnancy, adapting anti-rheumatic medication and monitoring disease activity every trimester. Postpartum, RA often relapses, therefore, breastfeeding can be exposed to anti-rheumatic drugs. Only Methotrexate, Leflunomide and Cyclophosphamide are fully contraindicated during lactation. TNF inhibitors are compatible with breastfeeding, while other biological therapies are not recommended, due to the lack of data.
Objectives. This study aimed to evaluate pregnancy outcomes among female patients with RA, who attended rheumatology clinics from different Romanian cities. Secondary objectives were disease course and anti-rheumatic medication post-partum, the occurrence of RA postpartum flares and the adherence to breastfeeding.
Patients and methods. This is a pilot observational, multicentric study, performed between October 2012 and July 2016. We have analyzed 41 patients diagnosed with RA before conception and who had at least one pregnancy after diagnosis. We recorded the pregnancy outcome, and, regarding the postpartum period, the occurrence of disease relapse and the antirheumatic medication exposure during lactation.
Results. The 41 patients had 72 pregnancies, with 39 deliveries resulting in 42 healthy infants; 30 patients chose to breastfeed. Postpartum, the disease relapsed in 23/30 patients after a mean of 9.56 weeks. Therefore, these infants were exposed to anti-rheumatic drugs during lactation (anti-inflammatory drugs, Sulphasalazine and Hydroxicloroquine). No biological therapy was administrated during breastfeeding.
Conclusion. The data obtained regarding the relapse risk and breastfeeding while using antirheumatic drugs are generally within international recommendations. We need more experience to be able to manage difficult situations and to take the best decision for our female patients with RA.

Keywords: rheumatoid arthritis, breastfeeding, anti-rheumatic therapy

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

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

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

Romanian Journal of Rheumatology, Volume XXV, No. 1, 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

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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THE TREATMENT OF RHEUMATOID ARTHRITIS DURING PRECONCEPTION AND PREGNANCY

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

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Promoting Global Health

Anca Boca, Ioan Ancuţa, Florin Bobirca, Cristina Tataru, Cristina Comsa, Carina Mihai, Mihai Bojinca and Victor Stoica

ABSTRACT

Regarding the pregnancy outcome in patients with Rheumatoid Arthritis (RA), most concerns are linked to pharmacological therapies. In order to manage the disease and obtain a favourable outcome of the pregnancy, there are several remissive or biological therapies that may be used, with minimal precautions. The anti-rheumatic drugs that may be used in RA are classified into 4 pregnancy risk categories according to the risk of inducing fetal injury: minimal risks, medium risks, high risks, and unknown risks. For many biological therapies, the lack of extensive studies is limiting the therapeutic recommendations in this sensitive area; recommendations are coming from experts in this field. However, if the preconceptual period and all the pregnancy conducts comply with the general recommendations, we may conclude that medication and pregnancy in rheumatoid arthritis may be combined with minimal risks.

Keywords: pregnancy, rheumatoid arthritis, anti-rheumatic drugs

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PREGNANCY IN RHEUMATOID ARTHRITIS IN ROMANIA

Romanian Journal of Rheumatology, Volume XXIV, No. 3, 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

Anca Boca, Ioan Ancuţa, Cristina Tataru, Cristina Comsa and Victor Stoica

ABSTRACT

Background. The new therapies have enforced another approach regarding the success of a pregnancy in rheumatoid arthritis, in a sense of a decrease in the number of complications which may interfere with the fetal or maternal outcome.
Aims. The study aim is to evaluate fertility among female patients with rheumatoid arthritis, in Romania, having as secondary objectives to appraise the pregnancy outcome, in parallel with monitoring the activity of the disease, the relation with the postpartum flare, as well as following up on the evolution status of the foetuses.
Material and method. We have analysed a number of 38 female patients diagnosed with rheumatoid arthritis that have had at least one post-diagnosis obstetrical episode, for 23 of the patients we have done it retrospectively, and for 15 patients, prospectively. The study is multicentric and has been carried out between October 2012 and July 2015. The patient evaluation criteria include: the activity of the disease and the treatment management in the pre-conceptual stage; monitoring of the disease every trimester and adequate therapeutic intervention; postpartum reactivation of the rheumatoid arthritis in connection with the breast feeding and the control of the disease during pregnancy: teratogenicity and autoimmunity bearing risks over the product of conception; outcome of pregnancies and foetuses.
Results. The 38 women have had an average age at conception of 31.02 years, at almost 6 years from diagnose and we have obtained a number of 67 pregnancies with the following outcome: 31 births at term, 3 premature births, 12 elective abortions and 21 spontaneous abortions. The pregnancy has been planned in 47.77% of cases. Patients have been exposed during preconception as well as during pregnancy at synthetic and biological disease-modifying antirheumatic drugs. During preconception, the activity of the disease was controlled for half of the patients, status that has been kept or improved during pregnancy and only 3 cases have shown a minimal reactivation. The length of the pregnancies was about 34.94 weeks, the average weight at birth was of 2,668 grams. No foetal anomalies have been identified. The postpartum flare has occurred after 9.7 weeks and in 9 of the patients we have not recorded an increase in the degree of activity of the disease.
Conclusions. The rheumatoid arthritis is not a contraindication to pregnancy, as the activity of the disease is controlled or partially controlled during the pregnancy with or without antirheumatic therapies, but the risk of an early postpartum relapse remain possible, the majority of pregnancies have a positive outcome.
Discussion. The data obtained in our country are in general superposable to the data found in the specialized literature. Giving good pre-conceptional counselling and having an eficient interdisciplinary management of pregnancies are the key elements for successfully covering this chapter in the life of our female patients.

Keywords: rheumatoid arthritis, pregnancy, fetal outcome, disease activity

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PATIENTS WITH SYSTEMIC SCLEROSIS ASSOCIATING OTHER AUTOIMMUNE DISEASES HAVE A MILDER DISEASE COURSE

Romanian Journal of Rheumatology, Volume XXIV, No. 2, 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

Alina-Mihaela Soare, Simona Pintilie, Ana Maria Gherghe, Alexandra Radu, Rucsandra Dobrota, Mariana Sasu, Mihai Bojinca, Victor Stoica and Carina Mihai

ABSTRACT

Background and objectives. Systemic sclerosis (SSc) is a multisystem connective tissue disease (CTD), being one of the most heterogeneous diseases of the spectrum of CTDs. It may associate other autoimmune diseases (AIDs), therefore in this study we aimed to evaluate the prevalence of other AIDs in a cohort of patients with SSc and to evaluate their prognosis in comparison to patients with SSc without this association.

Patients and methods. We performed a retrospective study in patients with SSc satisfying the ACR 1980 or the ACR/EULAR 2013 criteria, who were evaluated between January 2005 and May 2014 in our SSc center. These patients were investigated according to the EUSTAR recommendations, including modified Rodnan Skin Score (mRSS), lung function tests (LFT), echocardiography etc. As a control group for evaluating the prevalence of the AIDs we used all patients with Rheumatoid Arthritis (RA) visiting our clinic between January-December 2005. Data of all RA patients were collected from the electronic database of the hospital. All AIDs mentioned in the discharge diagnoses were recorded. Between-group comparisons were made with the chi-square test for nominal variables and with the independent-sample t-test for numeric variables.

Results. 144 patients with SSc were included: 88.8% females, 66.6% with the limited cutaneous subset of disease (lcSSc), mean age 53.9 ± 12.8 years, mean disease duration at study enrollment 5.1±10.5 years and a mean follow-up time of 3.7 ± 2.6 years. Prevalence of the AID in the SSc cohort was 19.4%, patients with lcSSc being more prone to associate other AID (p = 0.001). We noted a tendency towards less interstitial lung disease (p = 0.056) and less digital ulcers (p = 0.081) in patients with SSc and AIDs. Comparing skin involvement for each year of follow-up in patients with SSc with and without and AIDs we observed that the first tended to have lower and more stable values of the mRSS.

Conclusion. Patients with SSc and AIDs tend to have a better outcome than the ones without this association. mRSS remains stable across the years in patients with SSc and AID, with lower values than the SSc patients.

Keywords: systemic sclerosis, autoimmune disease, polyautoimmunity

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Victor Stoica

Latest posts by Victor Stoica (see all)

Articles signed on Romanian Journal of RHEUMATOLOGY:

Breastfeeding in rheumatoid arthritis in Romania

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