Rheumatoid Arthritis: Babić-Naglić D

Babić-Naglić D, Laktasić N, Jajić Z, Anić B, Morović-Vergles J, Curković B, Anonymous00257. · Klinika za reumatske bolesti i rehabilitaciju Medicinskoga fakulteta Sveucilista u Zagrebu, KBC Zagreb, Kispatićeva 12, 10000 Zagreb. · Reumatizam. · Pubmed #18450273 No free full text.

Abstract: Spondyloarthritides (SpA) as a group are one of the most common rheumatic disorders with a predominant affection of the spine. Conventinal disease modifying antirheumatic drugs which are effective in rheumatoid arthritis have poor effect on spinal inflammation. Today there is confirmed efficacy ofbiologics in spondylitis. This therapy is expensive and potentially hazaradous. Croatian Society for Rheumatology set up recommendations for the use of TNF-alpha blockers in SpA. There are several important points to be considered before their use: diagnosis of Spa, duration and disease activity, previous therapy and it's efficacy, application and efficacy ofbiologics, contraindications and safety preacutions and finally a decision for continuous tretament with biologics.

Babić-Naglić D. · Klinika za reumatske bolesti i rehabilitaciju, Referentni centar MZSS RH za reumatoidni artritis, Klinicki bolnicki centar Zagreb. · Reumatizam. · Pubmed #19024271 No free full text.

Abstract: Rheumatoid arthritis (RA) is chronic joint disease which if untreated leads to permanent structural damage and disability. Early diagnosis and therapy are the main requests for good clinical practice. Early diagnosis tools include specific clinical assesment, serological, immunogenetic and radiological evaluation. Disease activity score is cornerstone in clinical assesment, rheumatoid factor and anti-cyclic citrullinated peptide antibodies (anti-CCP) are very specific serological parameters. The shared epitope containing HLA-DRB1* alleles represent the most significant genetic risk for RA. Magnetic resonance and ultrasound imaging are very sensitive methods in early phase of disease.

Curković B, Babić-Naglić D, Morović-Vergles J, Anić B, Grazio S. · Hrvatsko reumatolosko drustvo HLZ-a, Subićeva 9, 10000 Zagreb. · Reumatizam. · Pubmed #18450272 No free full text.

Abstract: Rheumatoid arthritis is a chronic, inflammatory disease with the prevalence about 1%. Rheumatoid arthritis is characterized with synovitis, erosive changes of the joints, pain and functional deficit. Etiology of the disease is unknown. In the pathogenesis of rheumatoid arthritis the key role have proinflammatory citokines, particularly, tumour necrosis factor (TNFalpha). TNFalpha blockers have documented, fast and continuous efficacy with generaly well accepted safety profile. Nowadays, TNFalpha antagonists are established drugs in early and late phase of rheumatoid arthritis. Prescription of TNFalpha antagonists is controlled, according local restrictions, regarding high costs of the therapy. On behalf of the Croatian Society for Rheumatology we propose recommendations for the TNFalpha antagonist therapy in rheumatoid arthritis.

Babić-Naglić D. · Klinika za reumatske bolesti i rehabilitaciju Medicinskoga fakulteta Sveucilista u Zagrebu Klinicki bolnicki centar Zagreb, Kispatićeva 12, 10000 Zagreb. · Reumatizam. · Pubmed #15098369 No free full text.

Abstract: Basic principles of drug treatment for rheumatoid arthritis are described. Nonsteroidal antirheumatic drugs are available and efficacious and part of almost each therapeutic approach. Corticosteroids have antiinflammatory and symptomatic properties with fast signs of improvement and potential anti-erosive action. Methotrexate, sulfasalazine, chloroquine, azathioprin, cyclosporin and leflunomide are the most frequently administered disease modifying antirheumatic drugs with delayed clinical effects. The biologic agents (anticytokines) offer new opportunities because they inhibit proinflammatory cytokines activity and very first stages of inflammation. Combination therapy of almost all drugs is eligible if it is efficacious and not increasing risk of adverse events. The outcome of rheumatoid arthritis is related to early diagnosis and early treatment with monitoring of efficacy and adverse events.

Babić-Naglić D. · Klinika za reumatske bolesti i rehabilitaciju Medicinskoga fakulteta Sveucilista u Zagrebu KBC Zagreb, Zagreb. · Reumatizam. · Pubmed #11552610 No free full text.

Abstract: Rheumatic diseases are frustrating issue for the rheumatologists because ethiologic remedy is still missing and much more, they are great socio-economic burden for patients and society. In the last 10 years there was bustling endeavour in creating new products with exact known action. This article deal the new options to treat rheumatoid arthritis with leflunomide, infliximab, etanercept and anakinra and osteoarthritis with hyaluronan, diacerhein, glucosamino sulphate, chondroitin sulphate and avocado/soya unsaponifiables. In particular patients all mentioned products have their place in the treatment plan but critical risk-benefit assessment is needed.

Curković B, Babić-Naglić D, Morović-Vergles J, Anić B, Grazio S. · Hrvatsko reumatolosko drustvo HLZ-a, Subićeva 9, 10000 Zagreb. · Reumatizam. · Pubmed #19024266 No free full text.

Abstract: Rheumatoid arthritis is a chronic, inflammatory disease with the prevalence about 1%. Rheumatoid arthritis is caracterized with synovitis, erosive changes of the joints, pain and functional deficit. Etiology is unknown. In the pathogenesis of rheumatoid arthritis the key role have proinflammatory citokines, particularly, tumour necrosis factor (TNFalpha). TNFalpha blockers have documented, fast and continuous efficacy with generally well accepted safety profile. Nowdays, TNFalpha antagonists are established drugs in early and late phase of rheumatoid arthritis. Prescription of TNFalpha antagonists is controlled, according local restrictions, regarding high costs of the therapy. On behalf of Croatian Society for Rheumatology we propose recommendations for the TNFalpha antagonist therapy in rheumatoid arthritis.

Pavlović R, Curković B, Babić-Naglić D, Kehler T. · Specijalna bolnica za medicinsku rehabilitaciju, Gajeva 2, 49217 Krapinske Toplice. · Reumatizam. · Pubmed #17580545 No free full text.

Abstract: Nonsteroidal anti-inflammatory drugs are the first choice in the tretment of rheumatic diseases. Nonsteroidal-antiinflammatory drugs show high efficacy, but they could be responsible for gastrointestinal and cardiovascular adverse events. When the gastrointestinal risk is generally accepted, cardiovascular risk is still without consensus. Did the discussion about potential cardiovascular risk with nonsteroidal anti-inflammatory drugs influenced their prescription in real life? Data on 201 patients with rheumatoid arthritis show that the prescription of nonselective, nonsteroidal anti-inflammatory drugs remain unchanged. More than two third of the patients use nonsteroidal anti-inflammatory drugs despite they have established cardiovascular disease.

Zerjavić NL, Juresa DS, Babić-Naglić D, Curković B, Potocki K, Zunec R, Ivanisević G. · Klinika za reumatske bolesti i rehabilitaciju Medicinskog fakulteta Sveucilista u Zagrebu, KBC Zagreb. · Reumatizam. · Pubmed #16689106 No free full text.

Abstract: Genetic association between particular HLA-DRB1 genes and severity of rheumatoid arthritis (RA) has been documented in various clinical investigations. Susceptible alleles are *0401, *0404, *0405, *0408, *0101, *1001, *1402. According to the Shared epitope hypothesis presence of these alleles were considered as poor prognostic sign. The aim was to investigate HLA-DRB1 distribution in Croatian arthritis patients. Group of 90 patients with non-specific joint arthritis, non-erosive RA and erosive RA were typed for DRB1 alleles by PCR-SSP method. Susceptible alleles were identified in 58 (64.44 %) patients. The most frequent genes were DRB1 *0101 (43.33 %), *0401 (17.77 %), *0404 (10 %). 9 out of 58 DRB1* positive patients had 2 susceptible alleles, and the rest (49 patients) had only one susceptible allele. The patients with non-specific joint arthritis and non-erosive RA will bee closely followed for more destructive disease course in DRB1* positive patients.

Babić-Naglić D, Jajić Z, Gnjidić Z, Stambuk B. · Klinika za reumatske bolesti i rehabilitaciju, KBC Zagreb, Zagreb. · Reumatizam. · Pubmed #12476759 No free full text.

Abstract: Incorrect treatment of chronic pain is common cause of patient's discontentment and suffering. The problem is mostly occurring because of inappropriate pain treatment. The WHO guidelines recommends declining of prejudices and using of strong opioids in therapy after the unsatisfactory treatment with weaker analgesics. Strong opioid analgesic fentanyl in transdermal system (Durogesic TTS) is introduced. In rheumatology, it is recommended for all conditions characterised by chronic pain with intensity 4 and more on the VAS scale (0-10). It is mostly used in rheumatoid arthritis, osteoarthritis, low back pain and neuropathic pain. Durogesic TTS provides continuous pain relief for 72 hours, with constant serum concentrations. It has to be gradually titrated and starting dose is 25 micrograms/h. Possible adverse events (nausea, vomiting, constipation, sedation, itching) are short termed, transitory and easily managed. Results of some clinical trials and personal experiences that are proving its efficacy and safety are presented.

Babić-Naglić D. · Klinika za reumatske bolesti i rehabilitaciju, Medicinski fakultet Sveucilista u Zagrebu. · Reumatizam. · Pubmed #12476743 No free full text.

Abstract: General principles of physical medicine and rehabilitation of rheumatic diseases are described. In knee and hip osteoarthritis it is important to protect full extension and in evolutive phase treat with drugs, unloading and physical therapy. Rest and ice are efficacious in active rheumatoid arthritis and in chronic phase all procedures and exercises are recommended with respect to pain threshold. Physical therapy for spondy larthropathies is directed to maintenance range of motion exercise for spine and breathing exercises. Swimming is the most appropriate recreational activity for spondylarthropathies.

Babić-Naglić D, Potocki K, Curković B. · Department of rheumatology University hospital Rebro Kispaticeva 12 CRO-Zagreb 10000, Croatia. · Z Rheumatol. · Pubmed #10502018 No free full text.

Abstract: Atlantoaxial (AA) instability is frequent radiological finding in patients with rheumatoid arthritis (RA). Mostly no serious neurological disorders are expected in such patients. The purpose of the study was to assess the sagittal spinal canal diameter according to Steel's rule of third and its relationship to clinical symptoms. Radiological and clinical evaluation was performed in 65 in-patients with RA. Fifty four patients complained of neck pain, 39 had vertebrobasilar symptoms, and 25 mild neurological disorders. Hyperreflexy tendon responses were registered in 16 patients. Only 1 patient had extensor plantar response. Forward AA dislocation was verified in 28 (43%) cases with a mean value of 8.3mm (4-17 mm). Still free space for spinal cord in spinal canal was obtained in 62 (95%) of patients, which can explain such a low incidence of serious neurological disorders.Our results suggest an association among duration of disease, atlantodental distance, and sagittal spinal canal diameter. We consider that it is important to detect early the most jeopardized patients on the basis of radiological analysis at C1 level according to Steel's rule of third and recognize when rising dbl quote, left (low)safe zone" has exceeded and enters the area of impending spinal cord compression.

Babić-Naglić D. · Klinika za reumatske bolesti i rehabilitaciju Medicinskoga fakulteta i Klinickoga bolnickog centra u Zagrebu, Kispatićeva 12, 10000 Zagreb. · Reumatizam. · Pubmed #11552603 No free full text.

Abstract: Rheumatoid arthritis is progressive systemic disorder with poor outcomes. Better recognizing of the disease patophysiology resulted in changing therapeutic approaches in DMARDs treatment and creating new drugs. Combined therapy is accepted worldwide in the last 10 years. The rationale for combined treatment is that different drugs with different mechanisms of action can affect different disease pathways to achieve better outcomes.