CENTRE OF RHEUMATOLOGY
The In-patient Department of the Centre of Rheumatology of Vilnius University Hospital Santariškių Klinikos is the oldest department of rheumatology in Lithuania, having been established in 1960, in the-then Vilnius Clinical Red Cross Hospital. From the very first day of its establishment, this Department bore a profile of a clinical as well as scientific department, as it has always been the clinical base of scientific and training institutions (the Faculty of Medicine of Vilnius University the Institute of Experimental and Clinical Medicine,). Without any doubts, this allowed this Department to become a progressive centre of rheumatology in the country.
Over the decades of the Department’s operation, the schemes for the treatment of rheumatologic patients as well as the scope of patients who received the treatment there, changed. If upon the establishment of the Department of Rheumatology, mostly the patients with rheumatic heart diseases were treated, then nowadays most often are cured the patients with systemic diseases of the connective tissue (systemic lupus erythematosus, systemic vasculitis, systemic sclerosis, etc.), inflammatory arthritis (rheumatoid arthritis, seronegative spondyloarthropaties, microcrystal arthritides). The treatment of patients suffering from rheumatic heart diseases became the prerogative of cardiologists and most patients with degenerative joint diseases are managed in outpatient department or by general practicioners.
Since the very beginning, the Department of Rheumatology provided treatment for people with rheumatic diseases as well as carried out scientific work, prepared and trained the specialists. Over these decades, the procedure for training rheumatologists changed as well. Previously, a therapeutist could have become a rheumatologist after attending two month long rhematologist training courses, whereas from 1990 there was established a specialized residency in rheumatology, thus the Department of Rheumatology turned into the working headquarters of doctors residents of rheumatology specialty. Each year one or two Medical Faculty graduates choose rheumatology as their speciality.
In May 2003, the Department of Rheumatology moved to Vilnius University Hospital Santariškių Klinikos, thus filling up the gap of specialized rheumatology assistance between the departments of therapeutic profile.
The structure of the Centre of Rheumatology
The Centre of Rheumatology employs 1 professor (Director prof. habil. dr. Algirdas Venalis), 2 docents (Head of the Department of Rheumatology - doc. I. Butrimienė and doc. habil. dr. J. Dadonienė), 4 doctors of medicine science, 16 doctors rheumatologists, 1 traumatologist orthopaedist, 14 nurses of general practice, 4 other employees. In total, the Centre employs 35 people.
The Department of Rheumatology (30 beds) – Head - doc. I. Butrimienė; Chief Nurse - J. Šuminienė. There are 11 doctors, 9 nurses of general practice and 3 other members of the staff working in the Department.
The Rheumatologist’s Out-patient Office is staffed by 5 doctors, 4 nurses of general practice and 1 assisting staff member.
The Traumatologist-orthopaedist’s Out-patient Office is manned by 1 doctor (on rotation basis, one of the doctors from the Department of Traumatology of the Centro Affiliate of VUH SK) and 1 nurse of general practice.
Clinical work of the Centre of Rheumatology
Every year, the Department of Rheumatology provides treatment to approximately 1000 patients. Currently, the major part of patients hospitalised in the Department of Rheumatology, is comprised of those ill with inflammatory rheumatic diseases: systemic diseases of connective tissue, systemic vasculitides, rheumatoidic arthritis, seronegative spondyloarthropathies, microcrystal arthritides, inflammatory rheumatic diseases of soft tissues and other inflammatory arthropathies. Experienced staff work in the Department which underwent repairs in 2003; the surroundings are adapted to handicapped patients. In this Department, the most advanced immunological tests are performed (ANA, ENA anti-CCP and new once are introduced), which allow differentiating complicated diseases which manifest in similar ways. Needle biopsy of joint membranes and immunohistologic analysis of the biopted tissue are being implemented. DEXA for bone mineral density is performed routinely for rheumatic patients. The capillaroscopy for number of patients with vascular disorders will be implemented in the nearest future. Nuclear magnetic resonance testing is gathering momentum in differentiation of rheumatic diseases. The patients of the Department are treated in traditional and the most advanced methods for the treatment of rheumatic illnesses. Over the recent years, broader possibilities appeared to cure those suffering from rheumatoid arthritis and ankylosing spondylitis with biological therapy. Next to the applied treatment with Infliximab, these patients have been begun to treat with another medication of biological therapy – Enbrel, Humira and most innovative - Maptera. Drugs of biological therapy created a major revolution in nowadays’ treatment of rheumatic diseases, which allows to stop the progressing of rheumatic diseases. Increasing number of patients are treated with biologicals, still it is not enough and number of patients are still on a waiting list to get this quite expensive but very effective treatment.
The staff of the Centre of Rheumatology work as a cohesive, experienced and qualified team. Alongside the veterans, who have been working in the Department of Rheumatology since its foundation (doct. Leonardas Jeruslanovas), successfully labour the doctors just fresh from residency of rheumatology. Visiting rounds and consulting are held regularly.
Out-patient offices offer consulting to patients with inflammatory and degenerative rheumatic illnesses and perform the follow-up care of those suffering from all rheumatic diseases. Every year, these offices consult all the applying patients.
Science and training activities of the Centre
The Centre of Rheumatology is a formal part of the Clinic of Rheumatology, Orthopaedics and Reconstructive surgery of the Faculty of Medicine of Vilnius University (Head – prof. A. Venalis). Approximately 100 students and 10-20 specializing doctors study in the Centre every year and more than 30 doctors residents of various specialties improve their skills. In the Centre, 4 dissertations and 2 habilitation theses have been maintained; two physicians attends the doctoral studies. In 2006 dr. J.Dadoniene underwent habilitation procedure with the overview “ Systemic vasculitis in Lithuania: epidemiological, clinical, and therapeutic approaches”. In 2008 dr. I.Butrimiene presented her overview of publications: Immune arthritis: investigation and evaluation of ethiological and pathogenical factors and new methods for diagnosis and treatment. The better parts of doctors, working in the Center, alongside practical work are specialists of certain areas in the rheumatology science. The employees share their expertise by actively writing articles, reading reports in national and international congresses, publishing their works in national and international scientific journals.
The Department of Rheumatology seeks cooperation with various Lithuanian and foreign science and treatment institutions. At the initiative of the employees of the Department, a charity and support organization for the Lithuanian rheumatology was founded – the Lithuanian Arthritis Foundation. The key task of this organization is the training of patients and specialists. The Department has also actively participated in initiating the conference for the country’s specialists “Vilnius Rheumatology Seminars” which has become a traditional annual one and in which the most outstanding world rheumatologists take part as the key lecturers. In autumn 2008 the fifteenth conference of Vilnius Seminars will be held. The Center of Rheumatology is actively cooperating with the patient organization Lithuanian Arthritis Association for patients needs and uprising of awareness of rheumatic diseases in the community. Number of strategical documents were derived together with patients organization.
Publishing activities, membership in editorial boards, international societies and associations
1. Annual journal “Reumatologijos seminarai” (Seminars on Rrheumatology) has been published since 1998 (members of the editorial board – prof. A.Venalis, doc. I. Butrimienė)
2. Doc. I. Butrimienė is a member of the editorial board of the journal “Skausmo medicina” (Pain Medicine).
3. Prof. A. Venalis is a member of editorial board of the journal “Internistas” (Internist).
Employees of the Centre are the founders of the Lithuanian Arthritis Foundation and take active part in its activities. Prof. A. Venalis is on Scientific Committee of the international organization EULAR.
Articles in international and foreign publications
1. Adomaviciute D, Pileckyte M, Baranauskaite A,
Morvan J, Dadoniene J, Guillemin F. Prevalence survey of rheumatoid arthritis and spondyloarthropathy in Lithuania.
Scand J Rheumatol. 2008; 37(2): 113-9.
2. Čypienė A, Laucevičius A, Venalis A, Dadoniene J, Ryliskyte L, Petrulioniene Z, Kovaite M, Gintautas J. The impact of systemic sclerosis on arterial wall stiffness parameters and endothelial function.
Clin Rheumatol. 2008 Jul 25.
3. Čypienė A, Laucevičius A, Venalis A, Ryliškytė L, Dadonienė J, Petrulionienė Z, Kovaitė M, Laskova V, Gintautas J. Non-invasive assessment of arterial stiffness indices by applanation tonometry and pulse wave analysis in patients with rheumatoid arthritis treated with TNF-alpha blocker remicade (infliximab).
Proc West Pharmacol Soc. 2007; 50: 119-22.
4. Jarmalaitė S, Dedonytė V, Mierauskienė J, Šimkutė L, Ranceva J, Butrimiene I.
Cytogenetic effects of treatment with methotrexsate and inflixsimab in rheumatoid arthritis patients. Biologija. 2008; 54( 1): 7-11.
5. Butrimienė I, Kirdaitė G, Porvaneckas N, Rimkevičius A, Tutkus V, Jarmalaitė S, Mackiewicz Z. Tangled immunohistochemical differences between autoimune and degenerative synovites. Medicinos teorija ir praktika. 2008; 14(2): 128-134.
6. Sokka T, Häkkinen A, Kautiainen H, Maillefert JF, Toloza S, Mørk Hansen T, Calvo-Alen J, Oding R, Liveborn M, Huisman M, Alten R, Pohl C, Cutolo M, Immonen K, Woolf A, Murphy E, Sheehy C, Quirke E, Celik S, Yazici Y, Tlustochowicz W, Kapolka D, Skakic V, Rojkovich B, Müller R, Stropuviene S, Andersone D, Drosos AA, Lazovskis J, Pincus T; QUEST-RA Group. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum. 2008; 59(1): 42-50.
7. Vencevičienė L, Venalis A, Šapoka V, Butrimienė I. Kaulų mineralinis tankis sergantiesiems uždegiminėmis spondiloartropatijomis.
Medicinos teorija ir praktika. 2008; 14(3): 247-253.
8. Vencevičienė L, Venalis A, Butrimienė I. Kaulų masės netekimas: kada jis prasideda sergantiesiems imuniniais artritais. Gerontologija. 2008; 9(2): 102-107.
9. Rugiene R, Kirdaite G, Grazuleviciute E, Dadoniene J, Venalis A.
A quality of life and functional ability in patients with ankylosing spondylitis.
Acta medica Lituanica. 2008; Nr. 2.
10. Cypiene A, Laucevičius A, Venalis A, Dadoniene J, Rugiene R, Petrulioniene Z, Ryliskyte Z, Kovaite M. Arterial wall dysfunction in systemic lupus erythematosus.
Lupus. (in press)
Directions of scientific research and participation in projects
When participating in the projects financed by the European Union structural funds and the Lithuanian Science Fund, the following directions of scientific research are being pursued:
• In cooperation with the Department of Quantic Electronics of VU, dr. G. Kirdaitė commenced the research of photosensibilizators and seeks for possibilities to apply them in treatment of inflammatory joint diseases with laser light. In result the text books for students and general practioners was published in 2008 REUMATOLOGIJA I and REUMATOLOGIJA II.
• In cooperation with the Institute of Experimental and Clinical Medicine of VU, epidemiologic studies of rheumatoid diseases are carried out (doc. J. Dadonienė, dr. S. Stropuvienė, doct. D. Miltinienė) as well as of amyloidosis (dr. D. Povilėnaitė), research of pathopfhysiologic mechanisms of infections related to rheumatoid diseases (doc. I. Butrimienė, doct. J. Ranceva), studies of patients’ quality of life (dr. R. Rugienė); the development of practical fundamentals for experimental testing of steam cells has been started.