Florentin Ananu Vreju

By Mihail Virgil Boldeanu, Adrian Răzvan Ionescu, Valeriu Horațiu Popoviciu, Andreea Lili Bărbulescu, Ștefan Cristian Dinescu, Isabela Siloși, Maria Forțofoiu, Rodica Pădureanu, Andreea Meca, Vlad Pădureanu, Mircea Cătălin Forțofoiu, Ioan Sabin Poenariu, Lidia Boldeanu and Ananu Florentin Vreju

Rheumatoid arthritis is a chronic, systemic inflammatory disease, with certain evidence of multiple factors involved, but also with the strong autoimmune component, leading to a high potential for disability, through synovial inflammation and joint destruction. Diagnostic methods and management possibilities have recently improved, thus leading to a better outcome, based on the treat to target recommendation. Although biologic agents represent efficient therapeutic agents, in the last few years, the advances in understanding the mediators involved in rheumatoid arthritis pathogenesis have provided new targeted therapies, represented by small molecule inhibitors against the Janus kinases that contribute in the signaling pathways of various cytokine receptors.

Part of the book: Rheumatoid Arthritis

By Stefan Cristian Dinescu, Razvan Adrian Ionescu, Horatiu Valeriu Popoviciu, Claudiu Avram and Florentin Ananu Vreju

Musculoskeletal ultrasound had gained more and more importance lately and there is no doubt now about its role in the diagnosis and management of rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, osteoarthritis and crystal related arthropathies. We can say that now, US is a widely available, non-invasive, and cost-effective technique suitable for the evaluation of the articular and periarticular structures, such as joints, tendons, muscles, ligaments, and bursa. The real-time capabilities of the US allow continuous observation of those structures during movement and of the needle placement during musculoskeletal interventions. More than this, recently, ultrasonography (US) has gained its rights in the evaluation of Sjogren syndrome and giant cell arteritis. Thus, US can detect changes secondary to both inflammatory joint diseases, like synovitis, tenosynovitis or enthesitis, and to degenerative disease, like osteophytes or tendinosis. US can identify calcium pyrophosphate and urate deposits at the level of the cartilage and tendons and to recognize the changes at the level of the salivary glands in the context of the Sjogren’s syndrome and the ones at the level of the temporal artery, secondary to giant cell arteritis.

Part of the book: Ultrasound Imaging

By Razvan Adrian Ionescu and Florentin Ananu Vreju

Musculoskeletal ultrasound is a very important and useful tool in daily activity as a rheumatologist. It is also called “the stethoscope of rheumatologists.” It enables the clinician to “see” into and around the joint, as ultrasound can penetrate any tissue except for bone. Even though ultrasound cannot penetrate bone, they are completely reflected by bony surfaces, which allows for the appreciation of bone integrity and the visualization of erosions. Another important aspect of using ultrasound for the evaluation of inflammatory joint diseases is the fact that it can depict inflammation within the musculoskeletal system (by depicting new vessel formation, using the Doppler effect), thus being able to contribute to the early and, even, very early diagnosis of inflammatory joint diseases and, conversely, to the early initiation of treatment that enables the prevention of irreversible disability.

Part of the book: Ultrasound - The Next Step in Clinical Evaluation [Working title]