, Juraj Payer2 and Manfred Herold3
(1)
National Institute for Rheumatic Diseases, Piestany, Slovakia
(2)
Fifth Department of Internal Medicine, Comenius University University Hospital, Bratislava, Slovakia
(3)
Department of Internal Medicine VI, Medical University of Innsbruck, Innsbruck, Austria
Baker’s cyst A palpable resistance or swelling in the popliteal fossa, often communicating with the joint cavity of the knee. It develops by enlargement of the gastrocnemius and semimembranosus muscles bursae. It is a frequent finding in arthritides and in osteoarthrosis. A ruptured cyst mimics the signs of deep venous thrombosis of the calf.
Ballottement of the patella This is a clinical sign of increased fluid within the knee joint (synovitis, haemarthrosis). It is examined by placing the palm of the hand on the patella, pushing caudally and eliciting pressure on the patella with the fingers of the other hand; when the fluid is increased, a wobbling of the patella as in pushing on a balloon is felt.
Balneophototherapy – see Tomesa (balneophototherapy).
Balneotherapy (BT) The use of natural healing sources (thermal springs, peloids, mineral waters) for healing purposes. The term ‘complex BT’ refers to the additional use of other forms of physical therapy (thermotherapy, aquatherapy, electrotherapy, massages), and above all therapeutic rehabilitation. In rheumatic disorders, health resorts (spas) with sulphur content or with radon content in the natural healing sources are recommended, together with complex treatment, in particular high-quality rehabilitation.
Bare lymphocytes syndrome Autosomal recessive primary immunodeficiency. The fundamental of the syndrome is the absence of class I or II HLA antigens or the absence of both classes of HLA antigens on the surface of lymphocytes causing inefficient or defective cooperation between immunocompetent cells. This leads to an increased risk of infection from various infective agents. Patients with this syndrome suffer from opportunistic and recurrent infections, chronic diarrhoea and eventually aplastic anaemia. Laboratory findings include decreased levels of immunoglobulins, impaired specific immune responses and decreased numbers of T-lymphocytes (particularly CD4+), but the numbers of B-lymphocytes are normal or slightly increased.
Barthel’s index A clinical assessment tool used to measure the activities of daily living and mobility (functioning) of a patient. It is commonly used in evaluating functioning in different disorders, mainly neurological (multiple sclerosis, stroke).
Bartter’s syndrome A term for a group of diseases with autosomal recession type of inheritance. The disease is characterised by impaired or missing return transport of salts in the thick, ascending segment of the loop of Henle. The remaining kidney functions are normal. The result is loss of urine salts manifested by decreased blood pressure, hypokalemia, hypochloraemic metabolic alkalosis and hypercalciuria with various levels of the risk of nephrolithiasis. Five genes have been defined so far, the mutation of which leads to the manifestation of the Bartter’s syndrome (types I–V). In addition, prenatal manifestations of the disease are connected with overproduction of prostaglandin E which leads to hypercalcaemia and bone resorption. The disease may also be acquired, induced by diuretics or antibiotics.
Basilar impression The condition occurs rarely as an isolated congenital anomaly. Most often, it is connected with other congenital defects, based on congenital clivus hypoplasia, with cleidocranial dysplasia or achondroplasia, in Klippel–Feil syndrome but also in hypoplasia or assimilation of the atlanto-occipital articulation or formamen magnum stenosis.
It may also be acquired – in Paget’s disease, fibrous dysplasia, hyperparathyroidism, osteomyelitis, osteogenesis imperfecta and osteomalacia. Weight of the head on softened base leads to invagination into foramen magnum. If this happens during an injury (rarely), the condition is usually fatal.
Bassett current A pulsatile, monophasic, sinus, 72 Hz current used to stimulate bone formation. It facilitates the influx of Ca2+ ions into cells. Selectively it acts on osteoblast sensitivity towards parathormone and so increases the rate of bone tissue formation. Usage: non-healing fractures, pseudoarthroses, osteoporosis.
Bath ankylosing spondylitis indices (BAS indices) – see Instruments of assessing (health status measurements, outcome measurement).
Bechterew’s disease – see Ankylosing spondylitis.
Behçet’s disease A vasculitis which affects skin, mucosa, eyes and the central nervous system. Significant clinical signs include recurrent mouth ulcers appearing at least three times a year plus at least two of the following signs: recurrent genital ulcers, ocular signs (uveitis, retinal vasculitis) and cutaneous signs (erythema nodosum, pseudofolliculitis, papulopustulous lesions or acneiform morphae and patergic phenomenon read by a physician). Behçet’s disease is most prevalent (and more virulent) in the Mediterranean region, Middle East and Far East, with an estimated prevalence of 1 case per 10,000 persons.
Beighton criteria – see Hypermobility syndrome (HMS), Beighton–Horan score.
Beighton–Horan score The assessment of the degree of joint hypermobility consists of five manoeuvres:
1.
Passive hyperextension of the fifth MCP (metacarpophalangeal) joint over 90°
2.
Passive backwards belong of the thumb to the volar side of the forearm
3.
Hyperextension of the elbows over 10°
4.
Hyperextension of the knees 10°
5.
Anteflexion without bending the knees, the palms rest on the floor
The manoeuvres are rated bilaterally; bilateral involvement with two points, the anteflexion with one point. Hypermobility has a score of 4 and more points; a generalised hypermobility has a score of 9. Hypermobility is assessed also by the test of Janda.
Belimumab Belimumab (Benlysta®) is a human monoclonal IgG1λ antibody that binds to the soluble cytokine, B-lymphocyte stimulator (BLyS) and inhibits its action. BLyS is important for the survival of B-lymphocytes, which are overexpressed in patients with systemic lupus erythematosus (SLE). By blocking the action of BLyS, belimumab reduces the life span of B-lymphocytes, thereby reducing the inflammation and organ damage that occur in SLE. In 2011 the US Food and Drug Administration (FDA) as well as the European Medicines Agency (EMA) approved the use of belimumab as add-on therapy in adult patients with active autoantibody-positive systemic lupus erythematosus (SLE) with a high degree of disease activity despite standard therapy. The safety and effectiveness of belimumab was demonstrated in two clinical trials that randomised a total of 1684 patients to receive either belimumab or placebo in combination with standard therapy. Benlysta is given as an infusion into a vein over a 1-h period. The recommended dose is 10 mg per kilogram body weight. The first three doses are given at 2-week intervals. After this, Benlysta is given once every 4 weeks.
Bence-Jones proteins (BJ-proteins) A monoclonal globulin protein found in blood or urine, consisting of identical light chains of immunoglobulins (kappa or lambda), which are produced in the course of multiple myeloma and malignant transformation of plasma cells (gammopathy). Their daily secretion increases depending on disease intensity. They precipitate when heated to 40–60 °C and redissolve at 90–100 °C. According to their low molecular weight, BJ-proteins are completely eliminated by kidneys. BJ-proteins can first be detected in urine. BJ-protein in serum is only found if renal function rate is disturbed or BJ-protein formation is greater than the clearance rate.
Benlysta Trade name of Belimumab.
Bicipital tendinitis This is due to degenerative changes of the long head of the biceps tendon, which may evoke tenosynovitis, subluxation or luxation and partial or total tendon rupture. Pain over the anterior shoulder area and pain provoked by pressure applied to the biceps tendon and sometimes on movement of the tendon are typical.
Bisphosphonates Synthetic analogues of pyrophosphate which are resistant to endogenous pyrophosphatase. They have high affinity for bone minerals. More advanced bisphosphonates, so-called nitrogen bisphosphonates (pamidronate, neridronate, olpadronate, alendronate, ibandronate, risedronate, zoledronate), have an attenuating effect on some catalyctic enzymes, of which the most important is farnesyl diphosphate synthase. Thus, interference with mevalonate and rarely protein prenylation occurs. The final consequence is impaired function, damage to cytoskeleton and decreased osteoclast survival. The bone tissue resorption is reduced and the bone turnover suppressed. Effects of bisphosphonates are used in the treatment of osteoporosis to reduce the risk of fractures.
Bioengineering technologies These techniques represent the possibility of repairing tissue defects such as in cartilage. It may, for example, lead to the successful transplantation of autologous chondrocytes, allogenic chondrocytes, perichondral grafts and biodegradable membranes.
Biolamp (bioptron lamp) The effect (biostimulation) is based on the use of polarised light, but unlike a laser, it is not monochromatic nor coherent. In rheumatology used to treat painful conditions of soft tissue structures (tendinitis, epicondylitis and bursitis). It has practically no contraindications, but care must be taken not to expose to the eyes.
Biological drugs (BD) BDs are biotechnological produced drugs, also called biologics or biologicals. They are made from a living organism or its products and are composed of proteins, sugars, nucleic acids or complex combinations of these substances. BDs have to be administered parenterally. Biologics are used to treat chronic inflammatory rheumatic diseases that have not responded adequately to other treatments.
In rheumatology research of BDs is focusing on the inhibition of a number of functional antigens of B- and T-cells, adhesive molecules and blocking the activity of pro-inflammatory cytokines. Of these, especially tumour necrosis factor-alpha (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-1), are associated with destruction of the joints, erosions and development of deformities. The inhibition of TNF-α is rather well developed, and there are several agents such as adalimumab, certolizumab, etanercept, golimumab and infliximab that have been used in the treatment of severe forms of rheumatoid arthritis (RA) and psoriasis arthritis (PsA), either individually or in combination with methotrexate, and are used as monotherapy in spondylarthritis. Adalimumab is a fully humanised monoclonal antibody against TNF-α and is administered subcutaneously. Certolizumab is a humanised monoclonal antibody against TNF-α with a PEGylated (polyethylene glycol) Fab’ fragment and is administered subcutaneously. Etanercept is a recombinant fusion protein of the soluble type II TNF receptor on a human IgG1 and is administered subcutaneously. Golimumab is a fully humanised monoclonal antibody against TNF-α and is administered subcutaneously or intravenously. Infliximab is a chimeric monoclonal antibody against TNF-α containing 75 % human protein and 25 % murine protein; it is administered intravenously. Treatment with these antibodies is associated with an increased incidence of septic complications, especially mycobacterial infection.
All TNF-α blocking agents are now licensed for the treatment of active RA not responding to monotherapy or combined treatment with disease-modifying antirheumatic drugs (DMARDs), severe juvenile idiopathic arthritis and severely active and resistant forms of ankylosing spondylitis and psoriatic arthritis. As TNF-α undoubtedly participates in the development of osteoporotic changes in chronic inflammations, the agents improve bone mineral density in these patients.
Also other biological drugs have been developed. Anakinra is a recombinant human IL-1 receptor antagonist (IL-1Ra) that binds avidly to type 1 IL-1 receptors but does not stimulate any intracellular responses. Anakinra is approved for the treatment of the signs and symptoms of RA in combination with methotrexate, in patients with an inadequate response to methotrexate alone. Tocilizumab is a monoclonal antibody targeted towards the IL6-receptor and is given either as infusion monthly or as subcutaneous injection every 2 weeks. Tocilizumab is indicated in combination with methotrexate for the treatment of severe, active and progressive RA in adults not previously treated with MTX and is indicated for the treatment of active systemic juvenile idiopathic arthritis (sJIA) in patients 2 years of age and older. In a head-to-head comparison (ADACTA trial), tocilizumab monotherapy was superior to adalimumab monotherapy for reduction of signs and symptoms of rheumatoid arthritis in patients for whom methotrexate was deemed inappropriate. Rituximab is a B-cell depleting monoclonal anti-CD20 antibody, licensed for RA and severe SLE. Abatacept is a soluble fusion protein causing co-stimulation blockade by blocking CD28.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
