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Clinical and serological characteristics of the early systemic lupus erithematosus


Author: Garabajiu Maria
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2020
Scientific adviser: Lucia Mazur-Nicorici
doctor habilitat, associate professor (docent)
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 19 March, 2020 at the meeting of the Scientific Council and now it is under consideration of the National Council.

Abstract

Adobe PDF document0.64 Mb / in romanian
Adobe PDF document0.57 Mb / in english

Thesis

CZU 616.5-002.525.2-031.81-02-092-08

Adobe PDF document 1.81 Mb / in romanian
118 pages


Keywords

early systemic lupus erythematosus, quality of life, comorbidities, adherence to treatment

Summary

Summary of the thesis. The thesis is presented on 118 pages of electronic text consisting of introduction, 4 chapters, 2 clinical cases, conclusions and recommendations, bibliographic indices (126 titles). The paper is illustrated with 25 figures, 16 tables and 10 annexes. The conduct of the study obtained the favourable opinion of the Research Ethics Committee (No. 66 of 16.06.2016) of the PI SUMPh "Nicolae Testemitanu". The researched subjects signed the voluntary informed consent prior to participating in the study.

Thesis based publications. The study materials were reflected in 35 publications, including 8 articles in reviewed journals, 2 monoauthor publications, 5 clinical cases in scientific collections, cassettes from the national clinical protocol on SLE in adults; 18 participations in national and international scientific forums through summary presentations and communications. Keywords: early systemic lupus erythematosus, quality of life, comorbidities, adherence to treatment.

The aim of the research was to evaluate the clinical and immunological manifestations of early lupus in relation to late lupus for the elaboration of optimal patient management.

To achieve the goal were outlined the following objectives: 1. Estimation of the symptoms that preceded SLE 2. Highlighting the consecutive appearance of clinical signs in early SLE 3. Assessment of the activity of the disease, the organ damage and the quality of life in the patients with early SLE vs late SLE 4. Determining the degree of adherence to the treatment and the predicting factors that diminish it 5. Elaboration of the scheme of management of patients with early SLE 4 The novelty and the scientific originality: In this study, for the first time, the early clinical signs of SLE and the succession of their occurrence were evaluated, in order to detect their relevance for approving the diagnosis and preventing the irreversible organic damage. The patients' attitude towards the indicated medication according to the self-administered questionnaire MMAS-8, as well as the quality of life in the patients with early and late SLE were analysed.

The scientific problem solved in the thesis. The need to identify the spectrum of early manifestations of SLE, as well as the utility of assessing the characteristics of early disease through modern clinical instruments for proper management in the evolution of the disease, has been made.

Theoretical significance of the work. The research described the types of clinical and serological manifestations in patients with early SLE in correlation with their occurrence, disease activity and organic lesions according to SLAM, SLICC / ACR versus LES after 2 years.

The applicative value of the work. The results of the study argued the implementation in practice of patient management scheme for the early diagnosis of SLE, which will lead to the prompt initiation of treatment, to prevent exacerbations, to improve the prognosis of the disease and to maintain the capacity to work. Consistently, we have supported the informativity and usefulness of the clinical instruments for the evaluation of the disease in its early stage.

Main scientific results submitted for support: ~Determining the clinical and immunological manifestations that preceded SLE diagnosis ~Assessment of the consecutive appearance of clinical and paraclinical signs in early SLE ~ Reasoning the usefulness of the clinical instruments for evaluation of the disease activity, organ damage and the quality of life in the patients with early versus late SLE ~ Argumenting the usefulness of the degree of adherence to treatment and estimating the predictive factors that diminish it ~ Developing a prototype for the patients management in early SLE Implementation of scientific results. The results of the study were used in the teaching process of the Department of Internal Medicine and were used in the elaboration of the National Clinical Protocol "Systemic lupus erythematosus in adults" and the sessions of "School of the patient with lupus".

Approval of scientific results. The results of the research were reported at 17 national and international forums: International Congresses: The 9th European Lupus Meeting, Athens, 2014; “MedEspera”, Chisinau, 2016; EULAR, Madrid, 2016; Balkan Medical Week, Bucharest, 2016; Balkan Medical Week, Sofia, 2017; LUPUS & ACA 2017, Melbourne, 2017; EULAR, London, 2017; The IMS Congress of Bucharest, Bucharest, 2017; “MedEspera”, Chisinau, 2018; Balkan Medical Week, Athens, 2018; ERS International Congress, Paris, 2018; PANLAR, 2018; EULAR, Amsterdam, 2018; EULAR, Madrid, 2019; national forums: University Days and the Annual Scientific Conference of USMF Collaborators and Students "Nicolae Testemitanu", Chisinau, 2017, 2018, 2019.