Authors:György Bernscherer, Csaba Karabélyos, and Zsolt Tarján
In their review article, the authors overview the primary and secondary pulmonary complications of rheumatoid arthritis (RA) with the help of bibliographic data. They emphasize the pulmonological complications of disease-modifying antirheumatic drugs (DMARDs) used for the pharmaceutical therapy of RA, of which they discuss the methotrexate-induced pulmonary diseases. Methotrexate is used in nearly all additive double and triple — O'Dell-scheme — combined DMARDs therapy, because of which the early detection of drug-induced pulmonological complications is important. For rheumatologists, the treatment of methotrexate-resistant RA is proving to be a great challenge. The biological therapeutical drugs act as cytokine antagonists by blocking the TNF-α and, compared to DMARDs, they can more effectively inhibit the progression of the disease. These are the biological response modifiers. Their main representatives are infliximab, adalimumab, and etanercept. At the end, the authors discuss the biological response modifiers caused secondary pulmonary complications, e.g. the biological response modifiers associated pulmonary tuberculosis, bacterial tracheobronchitis, bacterial pneumonia, bronchiectasia, pulmonary oedema, rapid fibrotising alveolitis, and coccidiomycosis. At 3% of the biological response modifiers treated RA patients living in Arizona, California, Nevada, the pulmonary and disseminated mycosis — coccidiomycosis can appear with a 15% mortality. As a consequence of frequent earthquakes, the spores rising from the ground into the air infect the biological response modifiers treated immunosuppressed patients. The authors are attentive to the fact that patients who travel to the aforementioned endemic or earthquake-active regions while receiving biological therapy are at potentially higher risk, and because of this, their consulting a doctor is indispensable. Studies and use of newer groups of biological response modifiers medicines are awaited in the near future for RA. Nowadays in patients who are nonreactive for TNF-α inhibitor treatment, the use of B-lymphocyte inhibitor rituximab, characteristic in non-Hodgkin lymphoma therapy, is possible. The pulmonary complications of RA therapy of cytokine are not yet known. Antirheumatic therapy nowadays causes a significant improvement in the quality of patients’ lives, while an increasing number of modern therapeutical methods cause more complications.
The uranium content of the thermal waters in the Chepino valley was determined in a period of increased seismic activity.
Significant changes in the uranium concentration, much above the normal background values were established. In one group of
water sources a well-expressed synchrony in the uranium content variations is observed and the maximum is reached about 1.5–2
months after the initial strong seismic shock.
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