**Meet the editor**

Dr. Miroslav Harjaček is the Head of Division of Pediatric and Adolescent Rheumatology at the Children's Hospital Srebrnjak, Zagreb, Croatia. He graduated in Pediatrics in 1992 (Children's Hospital, Buffalo, NY, USA) and in Pediatric Rheumatology 1996 (Floating Hospital for Children at NEMC, Boston, MA, USA). In 1998, he obtained his PhD in Medical Sciences at the University of Zagreb. He

became an Associate Professor of Pediatrics in 2009 at the Medical School Zagreb, Croatia. He is a Fellow of American College of Rheumatology (ACR), member of Pediatric Rheumatology European Society (PRES), and national coordinator of PRINTO (Pediatric International Trial Organization). In 2009 he joined the Children's Hospital Srebrnjak, Zagreb, Croatia, and for the last seven years he has served as co-chairman for the International Summer School in Dubrovnik organized by IUC. Professor Miroslav Harjaček has published numerous papers and given a notable number of invited lectures on Pediatric Rheumatology. He is a reviewer for several international rheumatologic journals.

Contents

**Preface IX** 

Chapter 2 **Economic Evaluations in** 

**Part 2 Etiopathogenesis 25** 

Chapter 3 **Role of Bone Marrow in** 

Shunsei Hirohata

Chapter 4 **Estrogens Involvement in the** 

**Part 3 Clinical Manifestations and** 

Chapter 6 **Juvenile Spondyloarthritis 89** 

Chapter 7 **Ultrasonography in Diagnosis and** 

Moslemi Safa, Demoor Magali,

Ophir Vinik, Theodore Marras, Shane Shapera and Shikha Mittoo

Miroslav Harjaček, Lovro Lamot,

**Part 1 Economic Impact of Rheumatic Diseases 1** 

**Systemic Lupus Erythematosus 13** 

Gerardo Quintana L. and Paola Coral-Alvarado

**the Pathogenesis of Rheumatoid Arthritis 27** 

**Physiopathology of Articular Cartilage 41** 

**Diagnosis of Rheumatic Diseases 63** 

Chapter 5 **Rheumatoid Arthritis Interstitial Lung Disease 65** 

Boumediene Karim, Galera Philippe and Maneix Laure

Lana Tambić Bukovac, Mandica Vidović and Rik Joos

**Follow-Up of Temporal Arteritis: An Update 129**  Giovanni Ciancio, Marco Bruschi and Marcello Govoni

Gerardo Quintana, Helena Avella Bolivar and Paola Coral-Alvarado

Chapter 1 **Economic Impact of Rheumatic Diseases 3** 

## Contents

## **Preface XI**


	- **Part 2 Etiopathogenesis 25**
	- **Part 3 Clinical Manifestations and Diagnosis of Rheumatic Diseases 63**

#### X Contents

### **Part 4 Management and Therapy 143**


## Preface

*Challenges in Rheumatology* aims to provide a general review for those who need quick up-to-date information on various aspects and impacts of rheumatic diseases. Rheumatology is a subspecialty of medicine that focuses on the biology, cause, diagnosis and treatment of a variety of musculoskeletal and other systemic diseases. Rheumatic diseases can present themselves in a number of familiar ways but sometimes are atypical and occasionally puzzling. Patients may appear insidiously or acutely ill and the impact of the disease can range from a temporary irritation, to a condition that is persistent and increasingly disabling, and sometimes a severe, even life-threatening illness. Most clinicians have a basic understanding of common disorders, yet they are often challenged by specific questions regarding the optimal diagnosis and care for patients with rheumatic diseases. More than ever, the care for patients with rheumatic diseases requires a multidisciplinary approach. In addition, the magic of the Internet has allowed our patients to be far better informed about their own health issues. They are demanding, and have the right to be active participants and decision-makers in their own care. If we are to act as their educators and advisors, we must continually strive to expand our own knowledge base.

The field of rheumatology is expanding rapidly and several very exciting developments have occurred in recent years. Firstly, there has been a dramatic shift in our understanding of the nature of inflammation and the possibility of specifically regulating the aberrant immune inflammatory response. Secondly, an understanding of the pathogenesis has lead to the development of new, more targeted therapies. As a practicing pediatric rheumatologist, I have always enjoyed treating the broad range of conditions that challenge my diagnostic skills and treatment abilities on a daily basis. Early in my career, treatment options were far more limited than today, but with the development of biologic therapies, primarily anti-tumor necrosis factor alpha (TNF-α), and others as well, therapeutic success has consequently increased significantly. That development has clearly changed the lives of many of our patients and revitalized an entire generation of rheumatologists.

*Challenges in Rheumatology* has assembled an impressive group of international experts who have studied specific aspects of certain rheumatic diseases and have extensive experience either in pathophysiology or an in-depth diagnosis and/or management of rheumatic patients. They communicate their knowledge and experience to the reader

#### X Preface

in chapters that are conveniently organized as pathophysiology, clinical manifestations and diagnosis of selected rheumatic diseases, medical and perioperative orthopedic management, and the economic impact of rheumatic diseases.

I am extremely grateful to the many authors who contributed to this book. I too, have learned a lot on various aspects of experimental and clinical rheumatology form editing the text. My hope is that this book will help our trainees become better physicians and scientists, and practicing rheumatologists to provide better care, and ultimately, improve the quality of life of our patients.

## **Prof. Dr. Miroslav Harjacek MD, PhD**,

Children's Hospital Srebrnjak, Department of Pediatric and Adolescent Rheumatology, University of Zagreb, School of Medicine, Croatia

X Preface

in chapters that are conveniently organized as pathophysiology, clinical manifestations and diagnosis of selected rheumatic diseases, medical and perioperative orthopedic

I am extremely grateful to the many authors who contributed to this book. I too, have learned a lot on various aspects of experimental and clinical rheumatology form editing the text. My hope is that this book will help our trainees become better physicians and scientists, and practicing rheumatologists to provide better care, and

**Prof. Dr. Miroslav Harjacek MD, PhD**,

University of Zagreb, School of Medicine,

Department of Pediatric and Adolescent Rheumatology,

Children's Hospital Srebrnjak,

Croatia

management, and the economic impact of rheumatic diseases.

ultimately, improve the quality of life of our patients.

**Part 1** 

**Economic Impact of Rheumatic Diseases** 
