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Susirgus lėtiniais artritais, žymiai pablogėja ligonio gyvenimo kokybė, savirūpa, atsiranda informacijos apie ligą bei jos gydymą poreikis. Tai ypač tampa aktualu pacientams, kuriems taikoma biologinė terapija, kai su liga kovoti nebepadeda įprastas medikamentinis gydymas. Tikslas – ištirti sergančių lėtiniais artritais gyvenimo kokybę, savirūpą ir žinias taikant biologinę terapiją. Uždaviniai: 1) ištirti ir palyginti sergančių lėtiniais artritais gyvenimo kokybę prieš biologinę terapiją ir jos pokyčius po 4 mėn.; 2) ištirti ir palyginti sergančių lėtiniais artritais savirūpą prieš biologinę terapiją ir praėjus 4 mėn. po jos taikymo; 3) įvertinti sergančių lėtiniais artritais žinias apie biologinę terapiją prieš jos taikymą ir praėjus 4 mėn. po jos taikymo. Tyrimo metodai – 2013 m. vasario - spalio mėn. atlikta anoniminė anketinė apklausa. Tyrime dalyvavo LSMU reumatologijos skyriaus pacientai, sergantys lėtiniais artritais: reumatoidiniu artritu, ankiloziniu spondilitu, psoriaziniu artritu, kurie atitiko atrankos kriterijus biologinei terapijai. Tyrimui naudotas ,,SF-36’’ gyvenimo kokybės klausimynas, kasdieninės veiklos klausimynas (HAQ) bei autorės papildomai kurti klausimai. Respondentams buvo pateiktos anketos prieš biologinę terapiją ir po jos, praėjus 4 mėn. Gautas Lietuvos Sveikatos mokslų universiteto Medicinos akademijos Bioetikos centro leidimas 2013-02-07, Nr. BEK - KS(M)-241 tyrimo atlikimui. Rezultatai: analizuojant bendrai gyvenimo kokybės fizinę ir psichinę... [toliau žr. visą tekstą] / In case of the diagnosis with chronic arthritis, patients’ quality of life and self-care start to deteriorate significantly, the need of information about the disease and its treatment arises. It becomes relevant in particular to patients, treated with biological therapy as traditional treatment with drugs is ineffective. The aim – to research the quality of life, self-care and knowledge of chronic arthritis patients treated with biological therapy. Tasks: 1) to research and to compare the quality of life of patients with chronic arthritis prior to biological therapy and its changes in 4 months period, 2) to research and to compare self-care of patients with chronic arthritis prior to biological therapy and after the period of 4 months treatment, 3) to evaluate the knowledge of patients with chronic arthritis about biological therapy prior to its treatment and after 4 months. The research methods – from February till October, 2013 an anonymous questionnaire was conducted. Patients, diagnosed with chronic arthritis such as: rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, corresponding the selection criteria for biological therapy from Rheumatology department at LUHS, partipated in the research. ,,SF-36“ the life quality questionnaire, the health assesment questionnaire ( HAQ) as well as extra questions, made by the author, were applied in the research. Respondents were provided with the questionnaire forms prior to biological therapy and... [to full text]

Chikungunya est un alphavirus transmis par les moustiques (Aedes) et qui provoque de la fièvre, des éruptions cutanées, des myalgies et des arthralgies. La maladie (CHIKVD) est transitoire, mais des formes sévères menant à des arthrites chroniques incapacitantes ont été signalées. Nous avons dans un premier temps étudié prospectivement les paramètres cliniques et immunologiques associés à la maladie chez des patients hospitalisés et identifiés comme étant ‘guéris’ ou 'chronique' à M12 après l'infection. Dans la deuxième partie, nous avons observé in vitro les mécanismes et le rôle de l'apoptose dans le processus infectieux permettant au virus de persister dans les sanctuaires tissulaires. En phase aiguë, une forte réponse immune dominée par une activation des cellules NK/dendritique/cellules T, la production d’anticorps spécifiques et une faible production de cytokines Th1 > Th2 a été observée mais sans aucune différence significative entre les deux groupes. Cependant, la virémie initiale s'est révélée beaucoup plus élevée dans le groupe chronique est nous avons pu identifier du matériel viral dans les macrophages du tissu synovial d'un patient chronique post-CHIKVD (M18). Dans la deuxième partie de l'étude, nous avons constaté que CHIKV est capable d'induire l'apoptose par la voie intrinsèque et extrinsèque et également par un mécanisme ‘bystander’. De plus, nous avons observé que le CHIKV présent dans des corps (blebs) apoptotiques était capable d'infecter les cellules voisines (Hela et macrophage MM6). Notre étude a permis de mettre en évidence pour la première fois que CHIKV contrôle et détourne à son profit les mécanismes de défense anti-infectieux. / Chikungunya is an Alphavirus transmitted by mosquitoes (Aedes) and which causes fever, rash, myalgia and arthralgia. The disease (CHIKVD) is transient but severe forms leading to chronic incapacitating arthritis have been reported. The study involved first a prospective cohort study of hospitalized patients from Reunion Island subsequently categorized into ‘recovered’ or ‘chronic arthralgia’ groups at M12 post infection. Clinical and immunological parameters were measured throughout the disease course. In part two, we addressed in vitro the role of apoptosis in the infection process and particularly to ascertain the mechanisms allowing the virus to persist in tissue sanctuaries. We observed that a rapid immune antiviral response was evidenced by the robust dendritic/NK//T cell activation and accompanied by a specific IgM/IgG response and a rather weak Th1/Th2 cytokine response in both groups. The viremia was much more pronounced in the chronic group and, critically, we found that CHIKV was persisting (M18) in perivascular synovial macrophages. Fibroblast hyperplasia, strong angiogenesis and acute cell deaths were observed in the injured synovial tissue. In the second part of the study, we found that CHIKV was able to trigger apoptosis through intrinsic and extrinsic pathways. Bystander apoptosis was also evidenced in neighboring cells in a caspase 8-dependent manner. Remarkably, CHIKV hiding into apoptotic blebs was able to infect neighboring cells and these events were inhibited specifically by inhibitors of caspases, blebbing and engulfment. We herein describe a novel mechanism by which CHIKV invades and escapes the host immune response and contribute to chronic arthralgia/arthritis.