Intravenous administration of immunoglobulins has been routinely used for more than 60 years in clinical practice, developed initially as replacement therapy in immunodeficiency disorders. Today, the use of intravenous immunoglobulins (IVIGs) is embedded in the modern algorithms for the management of a few diseases, while in most cases, their application is off-label and thus different from their registered therapeutic indications according to the summary of product characteristics. In this review, we present the state-of-the-art use of IVIGs in various autoimmune conditions and immune-mediated disorders associated with reproductive failure, as approved therapy, based on indications or off-label. IVIGs are often an alternative to other treatments, and the administration of IVIGs continues to expand as data accumulate. Additionally, new insights into the pathophysiology of immune-mediated disorders have been gained. Therefore, the need for immunomodulation has increased, where IVIG therapy represents an option for stimulating, inhibiting and regulating various immune processes.

Introduction: The end of 2019 marked the beginning of a new disease for the mankind, which changed the lives of people all over the world. Almost 3 years have passed from the declaration of a global pandemic till today, but despite this, our knowledge of the disease COVID-19 caused by SARS CoV-2 is still the object of many researches. This is because the heterogeneous manifestation of the disease and the involvement of many organs and systems in the clinical presentation. The spectrum of rheumatological manifestations that directly concern the rheumatologist is also very miscellaneus. Most common are musculoskeletal pain phenomena as a rheumatic manifestation of the disease. Objectives: The purpose of the study is to assess the frequency and intensity of pain of musculoskeletal origin - joint (arthralgia) and muscle (myalgia) and its relationship with anxiety and depressive attitudes in hospitalized patients with COVID-19 in the Rheumatology Clinic - Varna. Material and methods: In a single-center, observational study, were included patients with diagnosed COVID-19, hospitalized in the Rheumatology Clinic, UMBAL "St. Marina" - Varna. The etiological diagnosis was accepted with a positive result of polymerase chain reaction (PCR) test or rapid antigen test for SARS-CoV-2. An inclusion criterion was new-onset musculoskeletal pain during the acute phase of COVID-19. Visual analogue scales (VAS) were used to assess pain intensity (muscular and joint) and Tsung self-report scales for depression (SDS) and anxiety (SAS). Laboratory acute inflammatory indicators and thrombotic biomarkers were investigated, chest imaging was performed in all patients. Descriptive statistics, Spearman Rho correlation analysis and SPSS linear regression analysis were used. A significance level of p<0.05 was accepted. Results: 226 patients (aged 26-91 years) with musculoskeletal pain were included. 46.5% (n=105) were women and 53.5% (n=121) were men. The mean age of the study population was 65.5 years (65.57 ± SD). A significant correlation (p=0.001) and predictive value was found between the score for depression and anxiety and the intensity of pain (for the two studied pain phenomena - arthralgias and myalgias). No correlation was found between pain intensity and inflammatory markers, nor with thrombogenic markers in patients with SARS-CoV-2. Of all examined patients with musculoskeletal pain, 46.5% (n=105) were women and 53.5% (n=121) were men. The average age of the study population was 65.5 years (65.57). After the correlation and regression analysis, a significant correlation (0.001) and predictive value was found between the score for depression and anxiety and the strength of pain (for the two studied pain phenomena - arthralgias and myalgias). On the other hand, in the studied patients, we found no correlation with either inflammation indicators or thrombogenic markers in the SARS-CoV-2 patients.mong all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n =121), were men. Mean age was 65 and a half years (65.57). After correlation and regression (ANOVA) analysis made we found strongly significant correlation (correlation is significant et the 0.001 level) and predictive value between depression and anxiety scales score from one side and pain intensity from other (both arthralgia and myalgia). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients. mong all 226 COVID-19 patients with musculoskeletal pain, 46.5% (n =105) were women and 53.5% (n =121), were men. Mean age was 65 and a half years (65.57). After correlation and regression (ANOVA) analysis made we found strongly significant correlation (correlation is significant et the 0.001 level) and predictive value between depression and anxiety scales score from one side and pain intensity from other (both arthralgia and myalgia). On the other hand, musculoskeletal pain does not correlate with any of inflammation and thrombotic biomarkers assessed in SARS-CoV-2 patients. Conclusion: Musculoskeletal pain is one of the most common clinical presentations of COVID-19. The intensity of the pain correlates with anxiety and depressive symptoms in these patients and does not correlate with the levels of inflammation and thrombotic biomarkers.

Polycystic ovary syndrome (PCOS) represents a common and complex endocrine condition that impacts women at all stages of reproductive development. As 2025 marks the 90th anniversary of its first clinical description by Stein and Leventhal, this review revisits the syndrome through the metaphor of an iceberg: while hyperandrogenism, anovulation, and polycystic ovarian morphology comprise the visible «tip,» a substantial portion of the burden lies beneath the surface. The clinical criteria, while necessary for diagnosis, often overshadow the deeper systemic and psychosocial complexities of PCOS. Beneath these surface manifestations exist significant metabolic disturbances - including insulin resistance, dyslipidemia, and increased cardiometabolic risk - as well as psychological burdens such as depression, anxiety, and impaired quality of life. These dimensions remain insufficiently recognized, leading to delayed diagnosis, fragmented care, and significant unmet patient needs. The persistent underestimation of the syndrome’s breadth reflects a broader disconnect between clinical awareness and the actual experience of patients in the real world. This article explores the historical trajectory of PCOS diagnosis, unpacks the full spectrum of its concealed comorbidities, and highlights the critical importance of a multidimensional, individualized, and holistic clinical strategy. Recognizing the hidden burden of PCOS is not merely a matter of improved diagnostics - it is a call for a paradigm shift toward compassionate, interdisciplinary, and lifelong care.

Rapidly destructive coxopathy (RDC) is a rare type of coxarthritis marked by swift deterioration of the hip joint. Although its cause remains unclear, several pathophysiological mechanisms are proposed. To comprehensively analyze this poorly understood condition, a literature search was conducted focusing on associations of bilateral RDC and rheumatoid arthritis (RA). The problem of long-standing RA, bilateral RDC with a febrile episode that preceded a rapid decline in mobility and severe hip pain, with radiological assessment confirmed bilateral hip destruction, was presented. Rapidly destructive coxopathy, especially when linked to RA, poses diagnostic and therapeutic challenges. Our review confirmed by the clinical picture emphasizes the need for vigilance in RA patients with hip involvement and calls for further research to understand RDC’s mechanisms and enhance clinical care.

Introduction: Periarthritis humeroscapularis is one of the most common causes of pain in the shoulder joint. The most applied treatment is conservative. Physical therapy and therapeutic modalities are effective, but there is uncertainty about their optimal combination. Objective: To examine whether the addition of either extracorporeal shock wave therapy or interferential electrotherapy to physical therapy of shoulder would be more effective in the management of periarthritis humeroscapularis. Materials and Methods: A total of 35 subjects with periarthritis humeroscapularis were divided into Group-A and Group-B. Both groups received 10 sessions of shoulder exercises and either extracorporeal shock wave therapy (Group-A) or interferential electrotherapy (Group-B). The outcome measures represent the American Shoulder and Elbow Surgeons Shoulder Score - the patient self-evaluation section (pain and activities of daily living) and the clinical assessment section (active and passive range of motion, strength, and stability). Results: Subjects showed statistically significant differences in reducing pain, improving range of motion and functional disability in the pre and post values of both the extracorporeal shock wave therapy and interferential electrotherapy groups. Group A was superior in improving external rotation ROM from abduction and flexion and Group B in alleviating pain. Conclusion: Either extracorporeal shock wave therapy or interferential electrotherapy in combination with physical therapy seemed to be significantly effective in the management of patients of periarthritis humeroscapularis. However, the group who received interferential electrotherapy showed higher improvement in pain, and the group with extracorporeal shock wave therapy demonstrated higher improvement in range of motion.