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CNAA / Theses / 2007 / July /

Rheumatoid Arthritis in men: clinical-evolutionary and laboratory features


Author: Laura Vremiş
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2007
Scientific adviser: Liliana Groppa
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Zinaida Anestiadi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 20 July, 2007
Approved by NCAA on the 20 September, 2007

Abstract

Adobe PDF document0.39 Mb / in romanian

Thesis

CZU 616.72-002.77-055.1

Adobe PDF document 1.72 Mb / in romanian
136 pages


Keywords

rheumatoid arthritis, male, androgen hormones, joint features, extraarticular manifestations, hypothalamic-pituitary-gonadal axe

Summary

This paper provides a comparative analysis of the clinical picture of the joints syndrome and other extra-joints manifestations of the rheumatoid arthritis in men and women based on complex clinical, laboratory and x-ray studies. 100 patients with confirmed Rheumatoid Arthritis (RA) syndrome were surveyed. These were divided in two numerically equal groups: female and male. The groups were comparable by age and average duration of disease.

The following causes for RA onset were determined: AVRI, considerably higher than in women, physical overload, stress and overcooling. Evidence was obtained that the onset of RA in men is more frequently witnessed by mono- and oligoarthritis predominantly affecting the large joints in lower extremities, while in manifest stage the joints syndrome has features of poliarthiritis involving small joints of the extremities typically for RA. It is important to mention that, although the small joints of men’s legs have a more advanced X-Ray, the values of the Ritchie’s, 28 and functional Lee indexes are relatively better than in women. The quality of life HAQ index for the male patients is more favourable also better than for female ones. From all extraarticular manifestations in the male group the most frequent are the following: vasculitis, a more evidenced tendency to respiratory diseases (chronic bronchitis), a higher risk of cardio-vascular diseases (through a marked incidence of HTA, dislipidemies, tabacism), digestive diseases (hepatic stheathosis, iatrogenic diseases), as well as in cases of renal amiloidosis exclusively observed in the male group.

Low seric testosterone and high estradiol indexes coupled with increased levels of gonadotropic hormones, comparative with the control group. The study has also revealed opposite correlations between the average level of testosterone and the markers of the disease’s activity (DAS28, duration of morning stiffness), with the number of painful and swelling joints, determined according to the joints counter 28 and with an x-ray rate of joint’s affection. The study also revealed less obvious shifts in the level prolactine and cortisol.