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Andreoli L, Gerardi MC, Gerosa M, Rozza D, Crisafulli F, Erra R, Lini D, Trespidi L, Padovan M, Ruffilli F, Serale F, Cuomo G, Raffeiner B, Semeraro P, Tani C, Chimenti MS, Conigliaro P, Hoxha A, Nalli C, Fredi M, Lazzaroni MG, Filippini M, Taglietti M, Franceschini F, Zatti S, Loardi C, Orabona R, Ramazzotto F, Zanardini C, Fontana G, Gozzoli G, Barison C, Bizioli P, Caporali RF, Carrea G, Ossola MW, Maranini B, Silvagni E, Govoni M, Morano D, Verteramo R, Doria A, Del Ross T, Favaro M, Calligaro A, Tonello M, Larosa M, Zen M, Zambon A, Mosca M, Zucchi D, Elefante E, Gori S, Iannone F, Anelli MG, Lavista M, Abbruzzese A, Fasano CG, D'Angelo S, Cutro MS, Picerno V, Carbone T, Padula AA, Rovere-Querini P, Canti V, De Lorenzo R, Cavallo L, Ramoni V, Montecucco C, Codullo V, Milanesi A, Pazzola G, Comitini G, Marvisi C, Salvarani C, Epis OM, Benedetti S, Di Raimondo G, Gagliardi C, Lomater C, Crepaldi G, Bellis E, Bellisai F, Garcia Gonzalez E, Pata AP, Zerbinati M, Urban ML, Mattioli I, Iuliano A, Sebastiani G, Brucato AL, Bizzi E, Cutolo M, Santo L, Tonetta S, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A. Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study. RMD Open 2024; 10:e004091. [PMID: 38663885 PMCID: PMC11043763 DOI: 10.1136/rmdopen-2024-004091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. METHODS Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database. RESULTS We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. CONCLUSIONS Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.
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Affiliation(s)
- Laura Andreoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Chiara Gerardi
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Gerosa
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Davide Rozza
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Erra
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Lini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melissa Padovan
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Giovanna Cuomo
- Precision Medicine Department, University of Campania L. Vanvitelli, Naples, Italy
| | - Bernd Raffeiner
- Department of Rheumatology, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Paolo Semeraro
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Sole Chimenti
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Ariela Hoxha
- General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Filippini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Taglietti
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sonia Zatti
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Loardi
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Rossana Orabona
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | | | - Cristina Zanardini
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Giulia Fontana
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giorgia Gozzoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Barison
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paola Bizioli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Felice Caporali
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Giulia Carrea
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Maranini
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ettore Silvagni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Danila Morano
- Dipartimento Materno Infantile, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Ferrara, Italy
| | - Rosita Verteramo
- Dipartimento Cure Primarie, UO Servizi Sanitari 1- AUSL Ferrara, Ferrara, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Genoa, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandra Zambon
- Unit of Obstetrics and Gynecology, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Gori
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Marlea Lavista
- Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
| | - Anna Abbruzzese
- Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
| | | | | | | | - Valentina Picerno
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Teresa Carbone
- Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
| | | | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Canti
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ludovica Cavallo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Véronique Ramoni
- Internal Medicine Department, ASST Lodi - Ospedale Maggiore di Lodi, Lodi, Italy
| | | | - Veronica Codullo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Milanesi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- PhD Program in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Giulia Pazzola
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Department of Obstetrics and Gynecology, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Benedetti
- Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Di Raimondo
- Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Clizia Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Lomater
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gloria Crepaldi
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Bellisai
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Estrella Garcia Gonzalez
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Paola Pata
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Martina Zerbinati
- General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Antonio Luca Brucato
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Emanuele Bizzi
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Leonardo Santo
- Rheumatology Unit, "Mons. Dimiccoli" Hospital, Barletta (BT), Italy
| | - Sara Tonetta
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Gianpiero Landolfi
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Alessandra Bortoluzzi
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Scirè
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Rheumatology Unit, IRCCS San Gerardo dei Tintori Foundation, Milan, Italy
- School of Medicine, Bicocca University, Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Gerardi MC, Crisafulli F, García-Fernandez A, Lini D, Bazzani C, Cavazzana I, Filippini M, Fredi M, Gorla R, Lazzaroni MG, Nalli C, Taglietti M, Lojacono A, Ramazzotto F, Zanardini C, Zatti S, Franceschini F, Tincani A, Andreoli L. Stopping bDMARDs at the beginning of pregnancy is associated with disease flares and preterm delivery in women with rheumatoid arthritis. Front Pharmacol 2022; 13:887462. [PMID: 35991899 PMCID: PMC9384697 DOI: 10.3389/fphar.2022.887462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Women with Rheumatoid Arthritis (RA) can experience flares during pregnancy that might influence pregnancy outcomes. We aimed at assessing the disease course during pregnancy and identifying risk factors for flares. Methods: Data about prospectively-followed pregnancies in RA were retrospectively collected before conception, during each trimester and in the post-partum period. Clinical characteristics, disease activity (DAS28-CRP3), medication use, and pregnancy outcomes were analysed with regard to disease flares. Results: Among 73 women who had a live birth, 64 (88%) were in remission/low disease activity before conception. During pregnancy, a flare occurred in 27 (37%) patients, mainly during first and second trimester. Flares during pregnancy were associated with the discontinuation of bDMARDs at positive pregnancy test (55% of patients with flare vs. 30% of patients with no flare, p 0.034, OR 2.857, 95% CI 1.112–8.323) and a previous use of >1 bDMARDs (33% of patients with flare vs. 10% of patients with no flare, p 0.019, OR 4.1, 95%CI 1.204–13.966). Preterm pregnancies were characterised by higher values of CRP [10 mg/L (5–11) vs. 3 mg/L (2.5–5), p 0.01] and DAS28-CRP3 [4.2 (1.9–4.5) vs. 1.9 (1.7–2.6), p 0.01] during the first trimester as compared with pregnancies at term. Preterm delivery was associated with the occurrence of flare during pregnancy (flare 27% vs. no-flare 7%, p 0.034, OR 4.625, 95%CI 1.027–20.829). Conclusion: Preterm delivery in RA patients was associated with flares during pregnancy. Flares occurred more frequently after the discontinuation of bDMARDs at positive pregnancy test. Women with aggressive RA on treatment with bDMARDs should be considered as candidates for continuing bDMARDs during pregnancy in order to reduce the risk of flare and adverse pregnancy outcomes.
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Affiliation(s)
- Maria Chiara Gerardi
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Daniele Lini
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Bazzani
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Filippini
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Gorla
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Taglietti
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Lojacono
- Obstetrics and Gynaecology Unit, ASST Garda Ospedale of Desenzano, Desenzano del Garda, Italy
| | | | | | - Sonia Zatti
- Obstetrics and Gynaecology, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- *Correspondence: Laura Andreoli,
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Andreoli L, Gerardi MC, Crisafulli F, Zanetti A, Rozza D, Gerosa M, Lini D, Filippini M, Fredi M, Nalli C, Lazzaroni MG, Taglietti M, Franceschini F, Caporali R, Trespidi L, Erra R, Mosca M, Tani C, Zucchi D, Melissa P, Ruffilli F, Maranini B, Rovere-Querini P, Canti V, De Lorenzo R, Cutro MS, Picerno V, Montecucco C, Ramoni V, Anelli MG, Abbruzzese A, Serale F, Romeo N, Chimenti MS, Cuomo G, Larosa M, Pata AP, Iuliano A, Crepaldi G, Brucato A, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A. OP0125 THE MANAGEMENT OF PREGNANCY IN AUTOIMMUNE RHEUMATIC DISEASES: ANALYSIS OF 758 PREGNANCIES FROM THE PROSPECTIVE NATIONWIDE P-RHEUM.IT STUDY (THE ITALIAN REGISTRY OF PREGNANCY IN THE RHEUMATIC DISEASES). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPregnancy is a topic of fundamental importance for women living with autoimmune rheumatic diseases (ARD). Efforts at national and international levels have been put in the collection and harmonization of data in order to implement an evidence-based management of pregnant patients.ObjectivesThe P-RHEUM.it study was designed as a nationwide, web-based longitudinal observational cohort study to collect data about pregnancy in ARD in 26 centers in Italy. The study started in May 2018 and has been supported by the Italian Society for Rheumatology.MethodsPregnant patients with a definite rheumatic disease according international criteria were enrolled up to gestational week (GW) 20. The course of maternal disease activity, the use of medications, fetal and maternal complications, and the quality of life (EuroQoL questionnaire) were collected for each trimester, as well as pregnancy outcome, mode of delivery, neonatal complications, and maternal and children’s follow-up to 6 months after delivery, including the screening for post-partum depression by means of EPDS (Edinburgh Postnatal Depression Scale).ResultsAs of December 2021, 758 pregnancies had been enrolled, 205 (27%) ongoing and 553 (73%) with outcome. Pregnancy loss occurred in 54 (9.8%) cases (40 spontaneous miscarriages; 6 voluntary terminations). Live births were 495 (89.5%), perinatal death occurred in 4 (0.7%) cases. Table 1 reports on the group of 495 live births, along with subgroups of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), the two most represented diseases. Regarding treatments, 166 (30%) pregnancies were exposed to corticosteroids, 239 (43%) to hydroxychloroquine, 59 (10.7%) to csDMARDs, 84 (15.2%) to TNF inhibitors, 1 (0.2%) to non-TNFi bDMARDs, 299 (54%) to low dose acetylsalicylic acid, and 126 (22.8%) to heparin.Table 1.PREGNANCIES WITH LIVE BIRTHS, EXCLUDING PERINATAL DEATHSTotal pregnancies (n=495)RA pregnancies (n=69)SLE pregnancies (n=93)Age at conception (years)34 (31 - 37)34.5 (32 - 38)34 (31 - 36)Disease duration (years)6.1 (2.2 - 11.1)7.1 (4.3 - 11.6)9.3 (5.9 - 15.9)Caucasian431 (87.8%)53 (79.1%)75 (80.6%)Never smokers358 (73.8%)53 (80.3%)66 (71.7%)Body Mass Index >3045 (9.5%)7 (10.3%)5 (5.6%)Arterial Hypertension6 (1.2%)0 (0%)2 (2.2%)Time to pregnancy (months)3 (1 - 6)3 (1 - 6)3 (0 - 10)Physician-reported flares in the 12 months prior to conception107 (23%)22 (34.4%)13 (14.8%)Physician global assessment at enrolment (VAS 0-100)5 (0 - 17)5 (0 - 20)4 (0 - 10)Patient global health at enrolment (VAS 0-100)18 (7 - 30)10 (5 - 29)10 (5 - 25)EuroQoL at enrolment (-1.6 – 1)1 (0.8 - 1)1 (0.8 - 1)1 (0.8 - 1)Flares during pregnancy35 (7.1%)6 (8.7%)7 (7.5%)Hypertensive disturbances*8 (1.7%)1 (1.6%)6 (6.6%)Delivery at term (≥37 GW)410 (85.1%)53 (77.9%)74 (80.4%)Spontaneous vaginal delivery173 (35.9%)23 (33.8%)23 (25.3%)Congenital malformations11 (2.4%)2 (3.1%)1 (1.1%)Small for gestational age (SGA) neonate24 (4.9%)1 (1.4%)9 (9.9%)Breastfeeding in the first 4 weeks after delivery341 (79.7%)45 (77.6%)59 (76.6%)EPDS score at risk for post-partum depression22 (14.1%)0 (0%)3 (10.3%)Continuous variables are expressed as median (interquartile range); *gestational hypertension/preeclampsia/HELLP syndrome/eclampsia.ConclusionMultiple factors may have contributed to the high rate of live births, including good disease control before and during pregnancy thanks to the use of anti-rheumatic drugs and low frequency of general risk factors. SLE pregnancy was affected by a higher frequency of complications (hypertensive disturbances, SGA babies) as compared to RA pregnancy. Nearly 80% of patients breastfed in the first month after delivery. For the first time, data about the screening questionnaire for post-partum depression were collected, showing at least 1 out 10 patients can be at risk.References[1]Meissner Y et al. Arthritis Res Ther;21(1):241; Ann Rheum Dis. 2021;80(1):49-56.AcknowledgementsP-RHEUM.it study is supported by the Italian Society for Rheumatology (SIR). All the Investigators are acknowledged for their contribution.Disclosure of InterestsNone declared
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Lini D, Gerardi MC, Zanetti A, Carrara G, Bortoluzzi A, Crisafulli F, Filippini M, Fredi M, Gorla R, Lazzaroni MG, Nalli C, Taglietti M, Lojacono A, Zatti S, Scirè CA, Andreoli L, Franceschini F, Tincani A. POS0476 CAN LOW-DOSE ASPIRIN DURING PREGNANCY PREVENT THE DEVELOPMENT OF ADVERSE PREGNANCY OUTCOMES IN WOMEN WITH ARTHRITIS? DATA FROM THE P-RHEUM.it STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In rheumatic diseases, specifically in chronic inflammatory arthritis (IA), there are no data about the effectiveness of LDA in preventing pregnancy complications.Objectives:To assess the potential benefit of LDA administration during pregnancy to prevent adverse pregnancy outcomes (APO) in IA.To compare pregnancy outcomes in IA pregnancies treated during pregnancy with LDA with those untreated.Methods:Italian P-RHEUM.it register is designed as a nationwide, web-based longitudinal observational cohort study collecting data on pregnancies in inflammatory rheumatic diseases. At baseline, socio-demographic parameters, obstetric history, comorbidities and clinical/laboratoristic characteristics are registered. During pregnancy, the course of maternal disease, medications, development of fetus and complications are collected for each trimester.Results:From May 2018 to May 2020, 349 patients were enrolled. Forty-five patients with IA had completed their pregnancy with known outcome (20 Rheumatoid Arthritis, 10 Psoriatic Arthritis, 6 Ankylosing spondylitis, 5 Juvenile Idiopathic Arthritis, 4 Undifferentiated Arthritis): 13 (28.89%) treated with LDA during pregnancy and 32 (71.11%) without LDA prophylaxis. LDA was used with a higher frequency in women with previous APO, anti-phospholipid positivity and on biological DMARDs even if it’s not statistically significant (Table 1). All the LDA-treated women had a live-birth rate of 100%, whereas among women not treated with LDA the live birth rate was of 84.4% with 27 live-birth pregnancies, 3 early miscarriages, 1 fetal loss and 1 stillbirth observed. There were no significant differences between the LDA and the not LDA groups regarding pregnancy/peripartum obstetric complications (p=0.14), although less adverse pregnancy/peripartum outcomes were registered in LDA patients’ group (Table 1).Conclusion:The preliminary data of this prospective cohort study show that LDA improve pregnancy outcome in IA even if women treated with LDA had more risk factors for APO. The extension of this cohort will allow us to further investigate these important results.References:[1]Roberge S, et al. AmJObstetGynecol.2017;216:110-120.e6.[2]Andreoli L et al. Annals of the Rheumatic Diseases 2017;76: 476–85.[3]Sammaritano L et al. Arthritis & Rheumatology 2020; 72: 529–56.Table 1.Comparison between inflammatory arthritis pregnancies treated with low-dose aspirin and those untreated.LDA (n 19)Not LDA (n 39)pMaternal age at conception, median (IQR)33 (30.5 - 36.5)33 (28.2 - 35)BMI, median (IQR)25.4 (22.9 - 28.5)22.5 (20.4 - 24.5)Smoking, n (%)3 (15.8%)4/36 (11.1%)0.68Previous APO, n (%)7/11 (63.7%)7/13 (56.1%)0.34aPL+, n (%)3 (15.8%)1/36 (2.8%)0.1CRP+, n (%)5/15 (33.3%)11/27 (40.7%)0.75GC at baseline, n (%)9 (47.4%)15/34 (44.1%)0.82cDMARDs at baseline, n (%)1 (5.3%)3/34 (8.8%)1bDMARDs at baseline, n (%)6 (31.6%)11 (28.2%)0.79Live-birth pregnancy, n (%)18 (94.7%)32 (82.1%)0.25Pregnancy loss, n (%)1 (5.3%)7 (17,9%)0.25Hypertensive disorders, n (%)2/18 (11.1%)6/38 (15,8%)1HELLP syndrome, n (%)0 (0%)0 (0%)1PROM, n (%)0 (0%)3/38 (7.9%)0.54Preterm delivery, 34-37 GW, n (%)2 (10.5%)2 (5.2%)0.59Preterm delivery, <34 GW, n (%)1 (5.3%)1 (2.6%)1IUGR, n (%)0 (0%)3 (7.8%)0.54SGA, n (%)0 (0%)0 (0%)1Pregnancy/Peripartum complications, n (%)3 (15.8%)11 (28.9%)0.35Legend: aPL, Antiphospholipid syndrome; bDMARDs, biological disease-modifying antirheumatic drugs; BMI, Body mass index; cDMARDs, Conventional disease-modifying antirheumatic drugs; CRP, C-reactive protein; GC, Glucocorticoids; GW, gestational week; HELLP, haemolysis, elevated liver enzymes, and low platelets; Hypertensive disorder defined as gestational hypertension, preeclampsia and eclampsia; IQR, Interquartile range; IUGR, intrauterine growth restriction; LDA, Low-dose Aspirin; Pregnancy loss defined as early fetal-loss, miscarriage and still-birth; PROM, Premature rupture of membranes; SGA, Small for gestational age.Acknowledgements:I would like to acknowledge the Epidemiology Unit of the Italian Society for Rheumatology and the Investigators of the Italian Registry.Disclosure of Interests:None declared
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Crisafulli F, Reggia R, Filippini M, Fredi M, Gerardi MC, Gorla R, Lazzaroni MG, Lini D, Nalli C, Taglietti M, Lojacono A, Zatti S, Zanardini C, Tani C, Zucchi D, Mosca M, Franceschini F, Andreoli L, Tincani A. POS0760 MONITORING C3 AND C4 VARIATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS PREGNANCIES IS USEFUL TO RECOGNIZE COMPLICATIONS. DATA FROM 2 ITALIAN CENTERS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In SLE pregnancies adverse pregnancy outcomes (APO) are more frequent than in general obstetric population (GOP). In clinical practice, low C3 and C4 levels are associated with active disease and, during pregnancy, complement activation products are shown to be associated with APO.Objectives:To analyse complement variations during SLE pregnancies, focusing on disease flares and APO.Methods:Data on SLE pregnancies prospectively-followed by multidisciplinary team in 2 Italian Centers from 1987 to 2018 were retrospectively analysed. C3 and C4 normal levels were calculated in general obstetric population (GOP) as previously described1, and related to maternal and fetal outcome. Non categorical variables were compared using Mann-Whitney test or Wilcoxon test when appropriate.Results:Two hundred forty-six pregnancies in 172 SLE patients were analysed (mean age at conception 31.3 ±4.9 years; mean disease duration 8.3 ±7.1). Anti-Ro antibodies were positive in 64 patients (37%) and anti-phospholipid antibodies (aPL) were positive in 84 (48%), with single positivity in 54%, double in 24% and triple in 21%; 9 patients (5%) had also a diagnosis of obstetric-antiphospholipid syndrome (APS) and 8 (4%) had thrombotic-APS. Seventy-one patients (41%) had history of Lupus Nephritis.Thirty-five flares were recorded in 30 pregnancies (12%). APO occurred in 47 pregnancies (19%) and were: 27 fetal loss (20 early miscarriage <10th week and 7 intrauterine fetal death), 11 severe preterm birth (<34th week) and 15 hypertensive disorder (11 pre-eclampsia and 5 pre-eclampsia+HELLP syndrome).In GOP, C3 progressively increased throughout pregnancy and C4 increase from the 1st trimester to the 2nd trimester, as well as in SLE pregnancies without flares and without APO, from preconception (Fig 1). In the other SLE groups, C3 and C4 showed a different trend: in pregnancies with flares, they did not increase from preconception to the 1st trimester; in fetal losses and severe pre-term births, they remained stable throughout pregnancy; in hypertensive disorders they increased only between preconception and the 1st trimester.C3 and C4 levels were higher in GOP than in all SLE pregnancies groups (including those without flares and without APO) in each trimester. SLE pregnancies without flares showed higher C3 and C4 levels than pregnancies with flares, at preconception and in each trimester. SLE pregnancies without APO had higher C3 and C4 levels than pregnancies with fetal death at 2nd trimester, higher C3 levels than severe pre-term births in each trimester and higher C4 at 3rd trimester (Fig.1).At preconception, pregnancies with flares showed a higher frequency of low C3 and of low C4 than in pregnancies without flares (76% vs 42%, p=0.01; 76% vs 26%, p<0.001, respectively). Using the normality range previously calculated in GOP, SLE pregnancies with flares had higher frequency of low C4 in every trimester as compared with pregnancies without flares (1st: 82% vs 48%, p=0.003; 2nd: 82% vs 64%, p=0.01; 3rd: 64% vs 30%, p=0.002). At multivariate analysis, low C4 at preconception was associated with flare (OR [95% CI]: 10.34 [2.52-42.39]; p=0.001).Figure 1.Variations of C3 and C4 median levels (mg/dL) throughout pregnancy in GOP1 and in SLE pregnancies without and with flare (a) and without and with APO (b).* p <0.05^as compared with SLE groups: p<0.05; § as compared with SLE pregnancies without flare: p<0.05; + as compared with SLE pregnancies without APO: p<0.05Conclusion:In SLE pregnancies, monitoring of C3 and C4 is important: its failure to increase can be useful to recognize potential risk situations which deserve particular monitoring.References:[1]Reggia R. et al. Rheumatology 2012;51:2186-2190.Disclosure of Interests:None declared
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Panaro S, Gerardi MC, Filippini M, Crisafulli F, Fredi M, Gorla R, Lazzaroni MG, Lini D, Nalli C, Moschetti L, Regola F, Taglietti M, Bortoluzzi A, Zanetti A, Lojacono A, Zatti S, Scirè CA, Carrara G, Ramazzotto F, Andreoli L, Franceschini F, Tincani A. AB0822 BREASTFEEDING AMONG WOMEN WITH RHEUMATIC DISEASES: ANALYSIS OF DATA FROM THE P-RHEUM.IT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The World Health Organization recommends that infants should be exclusively breastfed until the age of 6 months. The aim of this study was to assess the ratio of breastfeeding patients with Rheumatic Diseases (RD) and to identify possible causes of its discontinuation.Objectives:The aim of this study was to assess the ratio of breastfeeding patients with Rheumatic Diseases (RD) and to identify possible causes of its discontinuation.Methods:This study was embedded in the P-RHEUM.it register, as a nationwide prospective cohort study collecting data of pregnancies in inflammatory RD. Pregnancies, enrolled until the 20th week of pregnancy, are followed from pregnancy until 6 months postpartum. At baseline, sociodemographic parameters, obstetric history, comorbidities are reported. During pregnancy, the course of maternal disease, development of foetus and complications are reported. After delivery, the pregnancy outcome, data on lactation and child development are collected.Results:From May 2018 to May 2020 data of 349 patients were available. Data on lactation were available in 44 pregnancies. Two months after delivery 37 were continuing breastfeeding (n=26) or mixed feeding (n=11), while 7 were using formula feeding. Among patients using formula feeding 2 had a diagnosis of rheumatoid arthritis (RA), 1 of juvenile idiopathic arthritis, 1 of undifferentiated arthritis (UA), 1 of anti-phospholipid syndrome (APS), 1 of vasculitis and 1 of systemic lupus erythematosus. The reasons of formula feeding were the following: 2 for agalactia, 2 for personal preferences, 3 for drug-related concerns (1 for physician’s decision in a patient with APS; 2 for maternal concerns about drugs in patients with RA and UA treated respectively with Adalimumab and Tocilizumab). At 6 months 30 continued breastfeeding (n=23) or mixed feeding (n=7) and 14 formula feeding. The reasons of formula feeding were available in 9 patients: 3 for agalactia, 2 for personal preferences, 2 for physician’s decision in a patient with APS and in a patient positive for anti-phospholipid antibodies; 2 for maternal concerns about drugs.Conclusion:Preliminary data of this prospective study demonstrate a high percentage of breastfeeding/mixed feeding after delivery and after 6 months among women with RD. Drug related concerns are the main reason of discontinuation of breastfeeding, although medication results compatible with lactation. Using our results, strategies supporting patients with RD whishing to breastfeed may be developed.References:[1]Carina Gotestam Sporken et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016.[2]Sammaritano et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and muscoloskeletal diseases, Arthritis Rheumatol. 2020.Acknowledgements:Authors would like to thank SIR study center and all patients who accepted to partecipate to our studyDisclosure of Interests:None declared
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Toniati P, Piva S, Cattalini M, Garrafa E, Regola F, Castelli F, Franceschini F, Airò P, Bazzani C, Beindorf EA, Berlendis M, Bezzi M, Bossini N, Castellano M, Cattaneo S, Cavazzana I, Contessi GB, Crippa M, Delbarba A, De Peri E, Faletti A, Filippini M, Filippini M, Frassi M, Gaggiotti M, Gorla R, Lanspa M, Lorenzotti S, Marino R, Maroldi R, Metra M, Matteelli A, Modina D, Moioli G, Montani G, Muiesan ML, Odolini S, Peli E, Pesenti S, Pezzoli MC, Pirola I, Pozzi A, Proto A, Rasulo FA, Renisi G, Ricci C, Rizzoni D, Romanelli G, Rossi M, Salvetti M, Scolari F, Signorini L, Taglietti M, Tomasoni G, Tomasoni LR, Turla F, Valsecchi A, Zani D, Zuccalà F, Zunica F, Focà E, Andreoli L, Latronico N. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev 2020; 19:102568. [PMID: 32376398 PMCID: PMC7252115 DOI: 10.1016/j.autrev.2020.102568] [Citation(s) in RCA: 541] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia. A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring ventilatory support was analyzed to determine whether intravenous administration of tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 (IL-6) receptor, was associated with improved outcome. Tocilizumab was administered at a dosage of 8 mg/kg by two consecutive intravenous infusions 12 h apart. A third infusion was optional based on clinical response. The outcome measure was an improvement in acute respiratory failure assessed by means of the Brescia COVID Respiratory Severity Score (BCRSS 0 to 8, with higher scores indicating higher severity) at 24-72 h and 10 days after tocilizumab administration. Out of 100 treated patients (88 M, 12 F; median age: 62 years), 43 received TCZ in the intensive care unit (ICU), while 57 in the general ward as no ICU beds were available. Of these 57 patients, 37 (65%) improved and suspended noninvasive ventilation (NIV) (median BCRSS: 1 [IQR 0-2]), 7 (12%) patients remained stable in NIV, and 13 (23%) patients worsened (10 died, 3 were admitted to ICU). Of the 43 patients treated in the ICU, 32 (74%) improved (17 of them were taken off the ventilator and were discharged to the ward), 1 (2%) remained stable (BCRSS: 5) and 10 (24%) died (all of them had BCRSS≥7 before TCZ). Overall at 10 days, the respiratory condition was improved or stabilized in 77 (77%) patients, of whom 61 showed a significant clearing of diffuse bilateral opacities on chest x-ray and 15 were discharged from the hospital. Respiratory condition worsened in 23 (23%) patients, of whom 20 (20%) died. All the patients presented with lymphopenia and high levels of C-reactive protein (CRP), fibrinogen, ferritin and IL-6 indicating a HIS. During the 10-day follow-up, three cases of severe adverse events were recorded: two patients developed septic shock and died, one had gastrointestinal perforation requiring urgent surgery and was alive at day 10. In conclusion, our series showed that COVID-19 pneumonia with ARDS was characterized by HIS. The response to TCZ was rapid, sustained, and associated with significant clinical improvement.
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Affiliation(s)
- Paola Toniati
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Simone Piva
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Cattalini
- Pediatric Rheumatology, Children's Hospital, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Laboratory Diagnostics, ASST Spedali Civili, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesca Regola
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Airò
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Bazzani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Eva-Andrea Beindorf
- Division of Anesthesiology and Critical Care Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Michela Bezzi
- Division of Endoscopic Pneumology, ASST Spedali Civili, Brescia, Italy
| | - Nicola Bossini
- Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Sergio Cattaneo
- Division of Cardio-Thoracic Intensive Care, ASST Spedali Civili, Brescia, Italy
| | - Ilaria Cavazzana
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | | | - Massimo Crippa
- Division of Internal Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Andrea Delbarba
- University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Elena De Peri
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Angela Faletti
- Division of Anesthesiology and Critical Care Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Matteo Filippini
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Matteo Filippini
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Micol Frassi
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Mario Gaggiotti
- Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Michael Lanspa
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Silvia Lorenzotti
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Rosa Marino
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; University Division of Diagnostic Radiology, ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Division of Cardiology, ASST Spedali Civili, Brescia, Italy
| | - Alberto Matteelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Denise Modina
- Division of Pneumology, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Moioli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Montani
- Third Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Maria-Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Elena Peli
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Silvia Pesenti
- Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Maria-Chiara Pezzoli
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Ilenia Pirola
- University Division of Internal Medicine and Endocrinology, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Pozzi
- Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Proto
- Division of Internal Medicine, Gardone Val Trompia Hospital, ASST Spedali Civili, Brescia, Italy
| | - Francesco-Antonio Rasulo
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Renisi
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Gastroenterology, ASST Spedali Civili, Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Internal Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Geriatric Internal Medicine, Montichiari Hospital, ASST Spedali Civili, Brescia, Italy
| | - Mara Rossi
- Third Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Division of Internal Medicine, ASST Spedali Civili, Brescia, Italy
| | - Francesco Scolari
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Division of Nephrology and Dialysis, ASST Spedali Civili, Brescia, Italy
| | - Liana Signorini
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Marco Taglietti
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Gabriele Tomasoni
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Lina-Rachele Tomasoni
- University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Fabio Turla
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Davide Zani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Zuccalà
- First Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy
| | - Fiammetta Zunica
- Pediatric Rheumatology, Children's Hospital, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emanuele Focà
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- University Division of Anesthesiology and Critical Care Medicine, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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Crisafulli F, Gerardi MC, Filippini M, Gorla R, Fredi M, Lazzaroni MG, Taglietti M, Nalli C, Zatti S, Zanardini C, Lojacono A, Andreoli L, Franceschini F, Tincani A. SAT0202 C4 LEVELS AS PREDICTOR OF DISEASE FLARES AND ADVERSE PREGNANCY OUTCOMES IN SYSTEMIC LUPUS ERYTHEMATOSUS PREGNANCIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:SLE pregnancies have an increased risk of Adverse Pregnancy Outcomes (APO). In clinical practice, low C3 and C4 levels are associated with active disease and, during pregnancy, complement activation products are shown to be associated with APO.Objectives:To analyse potential association between C3 and C4 variations and disease flares and APO during SLE pregnancies.Methods:Demographic, clinical and laboratory data on SLE pregnancies prospectively-followed by a multidisciplinary team in a pregnancy clinic from 1987 to 2015 were retrospectively analysed at preconception and at each trimester. Hypocomplementemia was defined according to the normality range calculated in healthy pregnancies by Reggia et al1. APO were defined as: early miscarriage (<10thweek), intrauterine fetal death (>10thweek), perinatal death (<30thday of life), pre-eclampsia (PE), severe preterm birth (<34thweek).Results:134 pregnancies in 98 SLE patients were analysed. APO occurred in 22 (16%) pregnancies: 9 early miscarriages, 4 intrauterine fetal deaths, 3 severe preterm births, 6 PE (hesitated in 1 intrauterine fetal death, 1 perinatal death; 2 preterm birth between 34thand 37thweeks and 2 term births). 13 flares (2 renal, 4 articular, 6 cutaneous and 1 neurological) were recorded in 11 (8%) pregnancies.The mean C3 and C4 levels at each trimester are shown in table 1.Table 1.C3 and C4 mean levels (mg/dL) at pre-conceptional visit (T0), 1sttrimester (T1), 2ndtrimester (T2) and 3rdtrimester (T3).C3 T0C3 T1C3 T2C3 T3p T0-T1p T1-T2p T2-T3Pregnancies with flares73.282.283.897.50.040.020.06Pregnancies without flares85.391.8104.4114.7<0.001<0.001<0.001Pregnancies with APO*84.791.598.5106.30.030.030.89Pregnancies without APO*84.590.9102.8112.8<0.001<0.001<0.001C4 T0C4 T1C4 T2C4 T3p T0-T1p T1-T2p T2-T3Pregnancies with flares8.611.810.911.40.010.430.27Pregnancies without flares13.214.716.316.6<0.001<0.0010.98Pregnancies with APO**13.116.115.914.70.010.30.13Pregnancies without APO**12.914.215.816.1<0.001<0.0010.42Comparison of C3 and C4 mean levels between pregnancies with APO vs without APO:* T0, T1, T2, T3: ns; ** T0, T1, T2, T3: nsBoth in pregnancies with flares and with APO, there was no increase of C3 between the 2ndand the 3rdtrimester and of C4 between the 1stand the 2ndtrimester.At preconception, mean levels of C4 were lower in pregnancies with flares compared to those without flares (images 1 and 2); during the 2ndand the 3rdtrimesters the mean levels of both C3 and C4 were lower in pregnancies with flares.In pregnancies with APO, the variation of C4 levels between the 2ndand the 3rdtrimester was lower than in pregnancies without APO (-3.18 vs 0.27; p=0.01).A higher frequency of low C4 was observed at pre-conceptional visit, 1sttrimester and 3rdtrimester (6/7 vs 25/103 p=0.002; 8/9vs56/106 p=0.04; 9/11 vs 33/96 p=0.003) in pregnancies with flare as compared with pregnancies without flares.Figure 1.Image 1: comparison of C3 mean levels between pregnancies with faresvswithout flaresFigure 2.Image 2: comparison of C4 mean levels between pregnancies with faresvswithout flaresConclusion:In our cohort of prospectively-followed SLE pregnancies, low C4 levels at preconception seems to predict flares during pregnancy. Low increase of C4 levels between the 2ndand the 3rdtrimester could predict an APO.References:[1]Reggia R. et al. Rheumatology 2012;51:2186-90Disclosure of Interests:None declared
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Cruz-Machado AR, Crisafulli F, Gerardi MC, Filippini M, Fredi M, Gorla R, Lazzaroni MG, Nalli C, Taglietti M, Lojacono A, Zinardini C, Zatti S, Andreoli L, Franceschini F, Tincani A. AB0678 RISK FACTORS FOR ADVERSE PREGNANCY OUTCOMES IN SPONDYLOARTHRITIS: DISEASE PHENOTYPE AND DISEASE ACTIVITY MAY PLAY A ROLE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pregnant patients (pts) with spondyloarthritis (SpA) seem at increased risk for adverse pregnancy outcomes (APO), however limited and conflicting data have been published so far and risk factors for APO in these pts remain poorly understood.Objectives:To assess APO and identify possible risk factors for those in a cohort of SpA pregnant pts.Methods:Data on SpA pts prospectively-followed in a pregnancy clinic from 2010 to 2019 were retrospectively analysed before conception and during each trimester. Pregnancies complicated by APO were compared with those that were uneventful for demographic and clinical variables. Active disease was defined as a DAS-28-CRP>3.2 or an ASDAS-CRP ≥ 2.1 according to peripheral or axial dominant disease respectively.Results:56 pregnancies (mean age 34±5 years; median disease duration 60 months, IQR 24-123) in 47 pts were analysed: 37 psoriatic arthritis, 7 axial SpA, 6 undifferentiated SpA, 3 enteropathic SpA, 2 reactive arthritis and 1 enthesitis-related juvenile idiopathic arthritis. APO were recorded in 23/56 (41%) pregnancies: 5 (9%) early miscarriages, 1 (2%) medical abortion (central nervous system malformation), 3 (5%) preterm births (≥34 gestational week, all for preterm premature rupture of membranes - PROM); 2 (4%) PROM; 7 (13%) small for gestational age newborns (SGA); 3 gestational diabetes and 2 cholestasis of pregnancy. Table 1 displays the comparison between pregnancies with and without APO. A higher number of pts with active disease were detected during the 2ndtrimester in both groups, however differences between those were only significant at the 3rdtrimester (p=0.03). History of inflammatory bowel symptoms (IBS) was also associated with an increased risk for APO (p=0.02). Although not reaching statistical significance, APO occurred more frequently in pts with a previous use of > 1 conventional synthetic (cs) or biological (b) disease-modifying antirheumatic drug (DMARD) (p=0.05), suggesting a more difficult to treat phenotype. Likewise, pts with APO were less often treated with low dose aspirin (LDA) during pregnancy.Conclusion:SGA was the main APO recorded. History of IBS, a more difficult to treat phenotype and the presence of active disease during pregnancy influenced APO in this cohort, reinforcing the need for tight disease control before and during pregnancy. Larger and prospective data are warranted to confirm these results and to assess the potential protective role of LDA.References:[1]Molto 2018; Zbinden 2018.Table 1.Differences between patients with and without APOPregnancieswith APOPregnancies without APOpN, %23, 41.133, 58.9Maternal age at conception,mean±SD (years)33.8±533.8±4.9NSHx previous APO– N, %4,17.43, 9.1NSDisease duration,median (IQR), (months)96 (36-132)48 (24-96)NSAxial dominant disease– N, %6, 26.16, 18.2NSPeripheral dominant disease –N, %11, 47.820, 60.6NSHx enthesitis– N, %9, 39.113, 39.4NSHx dactylitis– N, %5, 21.711, 33.3NSHx psoriasis– N, %10, 43.518, 54.5NSHx uveitis–N, %1, 4.34, 12.1NSHx inflammatory bowel symptoms– N, %4, 17.40, 00.02HLA-B27– N, %8, 34.87, 21.2NS>1 cs or bDMARDs before conception –N, %13, 56.510, 30.30.05LDA during pregnancy– N, %7, 30.417, 51.5NSActive disease before conception- N, %5, 21.72, 6.1NSActive disease 1sttrimester- N, %1, 4.34, 12.1NSActive disease 2ndtrimester- N, %6, 26.15, 15.2NSActive disease 3rdtrimester- N, %3, 130, 00.03Legend: Hx – history of; NS – non significant.Disclosure of Interests:None declared
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Crisafulli F, Cruz-Machado AR, Gerardi MC, Filippini M, Fredi M, Gorla R, Lazzaroni MG, Nalli C, Taglietti M, Lojacono A, Zanardini C, Zatti S, Andreoli L, Franceschini F, Tincani A. SAT0368 PREGNANCY IN WOMEN WITH SPONDYLOARTHRITIS: WHO ARE THE PATIENTS AT RISK OF DISEASE FLARE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with Spondyloarthritis (SpA) can experience flares during pregnancy and postpartum even though the available data are limited and not conclusive.Objectives:To assess disease activity and treatment modification during pregnancy and postpartum in patients with SpA and to identify risk factors for disease flare.Methods:Data on SpA pregnancies prospectively-followed in a pregnancy clinic from 2010 to 2019 were retrospectively analysed. Disease activity was assessed during each trimester and postpartum using ASDAS-CRP or DAS28-CRP. Flare was defined as an increase of disease activity leading to treatment modification (introduction or increase ≥5mg/day of prednisone, introduction of cDMARD or bDMARD)1.Results:Data on 50 pregnancies in 46 patients were collected (mean age at conception 33±4.7 years; median disease duration: 60 months (IQR 24-132); 33 psoriatic arthritis, 6 axialSpA, 2 reactive arthritis, 2 IBD-related SpA; 6 undifferentiated SpA, 1 juvenile idiopathic arthritis). Six pregnancies ended in miscarriage, so they weren’t considered for the analysis of flares during pregnancy (table 1). Fifteen out of 44 (34%) pregnancies had at least one flare during pregnancy (6, 7 and 4 during 1st, 2ndand 3rdtrimester respectively; 2 pregnancies had multiple flares). A higher rate of flare was observed in pregnancies of patients with axial involvement (p=0.01), on treatment with bDMARDs at preconceptional visit (p=0.03) and who stopped TNFi at positive pregnancy test (p=0.03). Peripheral involvement was associated with a lower rate of flares (p=0.02). Medications resumed during pregnancy were steroids (in 6 pregnancies), cDMARDs (2 sulfasalazine, 1 cyclosporine) and bDMARDs (4 certolizumab, 4 etanercept). During postpartum period flares were recorded in 46% of patients.Table 1.clinical features, medication and disease activity in pregnancies with flare vs without flareCLINICAL FEATURESFLARE (15)NO FLARE (29)pAxial involvement, n (%)11/15 (73)9/29 (31)0.01Peripheral arthritis, n (%)8/15 (53)26/29 (90)0.02Enthesitis, n (%)5/15 (33)14/29 (48)nsDactilitis, n (%)3/15 (20)8/29 (28)nsPsoriasis, n (%)6/15 (40)17/29 (59)nsIBD, n (%)2/15 (13)0nsUveitis, n(%)1/15 (7)3/29 (10)nsHLAB27 +7/11 (64)5/12 (42)nsMEDICATION HISTORYbDMARDs, n (%)11/15 (73)7/29 (24)0.003bDMARDs at preconception visit, n (%)8/15 (53)6/29 (21)0.04bDMARDs stopped at positive pregnancy test, n (%)7/15 (47)4/29 (14)0.03cDMARDs, n (%)12/15 (80)25/29 (86)nsDISEASE ACTIVITYACTIVE DISEASE* preconception visit, n(%)3/14 (21)4/23 (17)nsACTIVE DISEASE 1sttrimester, n(%)6/15 (40)1/29 (3)0.004ACTIVE DISEASE 2ndtrimester, n(%)8/15 (47)2/29 (7)0.001ACTIVE DISEASE 3rdtrimester, n(%)2/15 (13)1/29 (3)ns*DAS28-CRP>3.2 or ASDAS-CRP≥2.1Conclusion:In our cohort of prospectively-followed SpA pregnancies, 34% experienced a flare during pregnancy and 46% during postpartum. Flares occurred especially in those patients who discontinued TNFi early in pregnancy and with axial involvement. When resumed during pregnancy, TNFi was able to control the disease. At preconception counselling, the continuation of TNFi during pregnancy should be considered to ensure a better control of disease.References:[1]Fischer-Betz R et al.Arthritis Rheumatol. 2015; 67.Disclosure of Interests: :None declared
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Romão VC, Talarico R, Scirè CA, Vieira A, Alexander T, Baldini C, Gottenberg JE, Gruner H, Hachulla E, Mouthon L, Orlandi M, Pamfil C, Pineton de Chambrun M, Taglietti M, Toplak N, van Daele P, van Laar JM, Bombardieri S, Schneider M, Smith V, Cutolo M, Mosca M, Mariette X. Sjögren's syndrome: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000789. [PMID: 30402274 PMCID: PMC6203093 DOI: 10.1136/rmdopen-2018-000789] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023] Open
Abstract
Sjögren's syndrome (SS) is a complex autoimmune rheumatic disease that specifically targets salivary and lachrymal glands. As such, patients typically had ocular and oral dryness and salivary gland swelling. Moreover, skin, nasal and vaginal dryness are frequently present. In addition to dryness, musculoskeletal pain and fatigue are the hallmarks of this disease and constitute the classic symptom triad presented by the vast majority of patients. Up to 30% to 50 % of patients with SS may present systemic disease; moreover, there is an increased risk for the development of non-Hodgkin's lymphoma that occurs in a minority of patients. The present work was developed in the framework of the European Reference Network (ERN) dedicated to Rare and Complex Connective Tissue and Musculoskeletal Diseases (ReCONNET). In line with its goals of aiming to improve early diagnosis, treatment and care of rare connective and musculoskeletal diseases, ERN-ReCONNET set to review the current state of clinical practice guidelines (CPGs) in the rare and complex connective tissue diseases of interest of the network. Therefore, the present work was aimed at providing a state of the art of CPGs for SS.
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Affiliation(s)
- Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | | | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ana Vieira
- Núcleo Síndrome de Sjögren, Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Chiara Baldini
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), INSERM-UMRS 1109, F-67000, Strasbourg, France
| | - Heidi Gruner
- Unidade de Doenças Auto-imunes, Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Martina Orlandi
- Department of Clinical and Experimental Medicine, Division of Rheumatology and Scleroderma Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Cristina Pamfil
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Marc Pineton de Chambrun
- Service de Médecine Interne 2, Hôpital La Pitié-Salpêtrière, Institut E3M, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marco Taglietti
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Paul van Daele
- Department of Internal Medicine and Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology and Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Xavier Mariette
- Université Paris-Sud: AP-HP, Hôpitaux Universitaires Paris-Sud; INSERM UMR 1184, Le Kremlin Bicêtre, France
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Allegri F, Sanmarco M, Cinquini M, Taglietti M, Balestrieri G, Koike T, Ichikawa K, Meroni P, Boffa MC, Tincani A. Anticardiolipin Antibody Assay: a Methodological Analysis for a better Consensus in Routine Determinations. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616089] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryDespite the widely recognized practical importance of anticardiolipin (aCL) ELISA, the reliability of this test has been recently discussed. In order to investigate this area on European scale, we sent to 30 experienced centers a questionnaire focusing on the diagnostic procedures applied to patients with antiphospholipid syndrome (APS) and on the detailed protocols used to perform aCL. Anticardiolipin ELISA was found to be the most frequently performed test in patients with suspected APS, but significant difference was shown among the various protocols. The cross-laboratory multiple examination of ten serum samples evaluated independently by the 24 centers pointed out the difficulty in getting comparable results. Therefore a “consensus” protocol was derived from the aCL methods giving the best performance. The materials and reagents necessary to perform the “consensus” method, including, as putative standards, one IgG and one IgM monoclonal antibody (HCAL and EY2C9) were distributed to 19 Centers. The results of one IgG and one IgM aCL high positive sera measured in serial dilutions were compared. A progressive decrease in the variability of the values obtained for a given sample appeared evident when all the laboratories used the same standard, in their own in-house ELISA and even more in the “consensus” ELISA.Our data show that aCL ELISA standardization is necessary in order to obtain comparable results in different laboratories.
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Levin JM, Holtzman SH, Maraganore J, Hastings PJ, Cohen R, Dahiyat B, Adams J, Adams C, Ahrens B, Albers J, Aspinall MG, Audia JE, Babler M, Barrett P, Barry Z, Bermingham N, Bloch S, Blum RI, Bolno PB, Bonney MW, Booth B, Bradbury DM, Brauer SK, Byers B, Cagnoni PJ, Cali BM, Ciechanover I, Clark C, Clayman MD, Cleland JL, Cobb P, Cooper R, Currie MG, Diekman J, Dobmeier EL, Doerfler D, Donley EL, Dunsire D, During M, Eckstein JW, Elenko E, Exter NA, Fleming JJ, Flesher GJ, Formela JF, Forrester R, Francois C, Franklin H, Freeman MW, Furst H, Gage LP, Galakatos N, Gallagher BM, Geraghty JA, Gill S, Goeddel DV, Goldsmith MA, Gowen M, Goyal V, Graney T, Grayzel D, Greene B, Grint P, Gutierrez-Ramos JC, Haney B, Ha-Ngoc T, Harris T, Hasnain F, Hata YS, Hecht P, Henshaw L, Heyman R, Hoppenot H, Horvitz HR, Hughes TE, Hutton WS, Isaacs ST, Jenkins A, Jonker J, Kaplan J, Karsen P, Keiper J, Kim J, Kindler J, King R, King V, Kjellson N, Koenig S, Koenig G, Kolchinsky P, Laikind P, Langer RB, Lee JJ, Leff JS, Leicher BA, Leschly N, Levin A, Levin M, Levine AJ, Levy A, Liu DR, Lodish HF, Lopatin U, Love TW, Macdonald G, Maderis GJ, Mahadevia A, Mahanthappa NK, Martin JF, Martin A, Martucci WE, McArthur JG, McCann CM, McCarthy SA, McDonough CG, Mendlein J, Miller L, Miralles D, Moch KI, More B, Myers AG, Narachi MA, Nashat A, Nelson W, Newell WJ, Olle B, Osborn JE, Owens JC, Pande A, Papadopoulos S, Parker HS, Parmar KM, Patterson MR, Paul SM, Perez R, Perry M, Pfeffer CG, Powell M, Pruzanski M, Purcell DJ, Rakhit A, Ramamoorthi K, Rastetter W, Rawcliffe AA, Reid LE, Renaud RC, Rhodes JP, Rieflin WJ, Robins C, Rocklage SM, Rosenblatt M, Rosin JG, Rutter WJ, Saha S, Samuels C, Sato VL, Scangos G, Scarlett JA, Schenkein D, Schreiber SL, Schwab A, Sekhri P, Shah R, Shenk T, Siegall CB, Simon NJ, Simonian N, Stein J, Su M, Szela MT, Taglietti M, Tandon N, Termeer H, Thornberry NA, Tolar M, Ulevitch R, Vaishnaw AK, VanLent A, Varsavsky M, Vlasuk GP, Vounatsos M, Waksal SG, Warma N, Watts RJ, Werber Y, Westphal C, Wierenga W, Williams DE, Williams LR, Xanthopoulos KG, Zohar D, Zweifach SS. US immigration order strikes against biotech. Nat Biotechnol 2017; 35:204-206. [PMID: 28267733 DOI: 10.1038/nbt.3824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Ron Cohen
- Acorda Therapeutics, Inc., Ardsley, New York, USA
| | | | - Julian Adams
- Clal Biotechnology Industries (CBI), Cambridge, Massachusetts, USA
| | - Chris Adams
- Cydan Development Inc., Cambridge, Massachusetts, USA
| | | | - Jeff Albers
- Blueprint Medicines, Cambridge, Massachusetts, USA
| | | | - James E Audia
- Constellation Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Martin Babler
- Principia Biopharma, South San Francisco, California, USA
| | | | | | | | | | - Robert I Blum
- Cytokinetics, Inc., South San Francisco, California, USA
| | - Paul B Bolno
- Wave Life Sciences, Cambridge, Massachusetts, USA
| | | | - Bruce Booth
- Atlas Venture, Cambridge, Massachusetts, USA
| | | | | | - Brook Byers
- Biotech Venture Capitalist since 1978, Menlo Park, California, USA
| | - Pablo J Cagnoni
- Tizona Therapeutics, Inc., South San Francisco, California, USA
| | - Brian M Cali
- Ironwood Pharmaceuticals, Cambridge, Massachusetts, USA
| | | | - Chip Clark
- Genocea Biosciences, Inc., Cambridge, Massachusetts, USA
| | | | | | - Paula Cobb
- Decibel Therapeutics, Cambridge, Massachusetts, USA
| | - Ron Cooper
- Albireo Pharma Inc., Boston, Massachusetts, USA
| | - Mark G Currie
- Ironwood Pharmaceuticals, Cambridge, Massachusetts, USA
| | | | | | | | | | - Deborah Dunsire
- Southern Cross Biotech Consulting, Waltham, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simba Gill
- Evelo Biosciences, Cambridge, Massachusetts, USA
| | | | | | - Maxine Gowen
- Trevena Inc., King of Prussia, Pennsylvania, USA
| | | | - Tom Graney
- Ironwood Pharmaceuticals, Cambridge, Massachusetts, USA
| | | | - Barry Greene
- Alnylam Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Paul Grint
- Regulus Therapeutics, San Diego, California, USA
| | | | - Bill Haney
- Dragonfly Therapeutics, Inc., Cambridge, Massachusetts, USA
| | | | - Tim Harris
- SV Life Sciences, Boston, Massachusetts, USA
| | | | | | - Peter Hecht
- Ironwood Pharmaceuticals, Cambridge, Massachusetts, USA
| | | | | | | | - H Robert Horvitz
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | | | | | - Jeff Jonker
- NGM Biopharmaceuticals, Inc., South San Francisco, California, USA
| | - Jeff Kaplan
- Deerfield Management, New York, New York, USA
| | - Perry Karsen
- Intellia Therapeutics, Cambridge, Massachusetts, USA
| | - Jeb Keiper
- Nimbus Therapeutics, Cambridge, Massachusetts, USA
| | - Jean Kim
- Deerfield Management, New York, New York, USA
| | - Jeff Kindler
- Centrexion Therapeutics Inc., Boston, Massachusetts, USA
| | - Rachel King
- GlycoMimetics, Inc., Rockville, Maryland, USA
| | - Vanessa King
- Luc Therapeutics, Inc., Cambridge, Massachusetts, USA
| | | | | | | | | | | | - Robert Bob Langer
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - John J Lee
- Decibel Therapeutics, Cambridge, Massachusetts, USA
| | | | - Bruce A Leicher
- Momenta Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | | | - Andrew Levin
- RA Capital Management, LLC, Boston, Massachusetts, USA
| | - Mark Levin
- Third Rock Ventures, Boston, Massachusetts, USA
| | | | - Alan Levy
- Chrono Therapeutics, Hayward, California, USA
| | - David R Liu
- Editas Medicine, Cambridge, Massachusetts, USA
| | | | | | - Ted W Love
- Global Blood Therapeutics, South San Francisco, California, USA
| | | | - Gail J Maderis
- Antiva Biosciences, Inc., South San Francisco, California, USA
| | | | | | - Joel F Martin
- Dauntless Pharmaceuticals, Inc., San Diego, California, USA
| | - Alex Martin
- Realm Therapeutics, Malvern, Pennsylvania, USA
| | | | | | | | | | | | | | - Larry Miller
- Macrolide Pharmaceuticals, Watertown, Massachusetts, USA
| | | | - Kenneth I Moch
- Cognition Therapeutics, Inc., Pittsburgh, Pennsylvania, USA
| | - Bob More
- Alta Partners, San Francisco, California, USA
| | | | | | - Amir Nashat
- Polaris Partners, Boston, Massachusetts, USA
| | - Wendy Nelson
- Boston Biotech Forum, Cambridge, Massachusetts, USA
| | | | - Bernat Olle
- Vedanta Biosciences, Inc., Cambridge, Massachusetts, USA
| | | | - Julia C Owens
- Millendo Therapeutics, Inc., Ann Arbor, Michigan, USA
| | - Atul Pande
- Verity BioConsulting, San Diego, California, USA
| | - Stelios Papadopoulos
- Biogen Inc., Exelixis Inc. &Regulus Therapeutics Inc., Great Neck, New York, USA
| | | | | | | | - Steve M Paul
- Voyager Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Rob Perez
- Life Science Cares, Boston, Massachusetts, USA
| | | | | | - Mike Powell
- Sofinnova Ventures, Menlo Park, California, USA
| | | | | | | | | | | | | | | | - Ron C Renaud
- RaNa Therapeutics, Cambridge, Massachusetts, USA
| | | | | | - Chad Robins
- Adaptive Biotechnologies, Seattle, Washington, USA
| | | | | | | | | | | | | | - Vicki L Sato
- Harvard Business School, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | - Rajeev Shah
- RA Capital Management, LLC, Boston, Massachusetts, USA
| | - Thomas Shenk
- Lewis Thomas Laboratory, Princeton, New Jersey, USA
| | | | - Nick J Simon
- Clarus Ventures LLC, South San Francisco, California, USA
| | | | - Jeff Stein
- Cidara Therapeutics, San Diego, California, USA
| | - Michael Su
- Decibel Therapeutics, Cambridge, Massachusetts, USA
| | - Mary T Szela
- Novelion Therapeutics, Vancouver, British Columbia, USA
| | | | | | - Henri Termeer
- Genzyme Corporation (former CEO), Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | - George P Vlasuk
- Navitor Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | | | | | - Neil Warma
- Opexa Therapeutics, Inc., The Woodlands, Texas, USA
| | - Ryan J Watts
- Denali Therapeutics Inc., South San Francisco, California, USA
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Agosti M, Andreoli L, Bazzani C, Nalli C, Reggia R, Gorla R, Taglietti M, Lojacono A, Motta M, Tincani A. SAT0159 Long-Term Follow-Up of Children Born to Mothers with Chronic Arthritides and Exposed in Utero to Anti-TNF-Alpha Agents: A Case-Control Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Lazzaroni M, Lupoli F, Aggogeri E, Bettiga E, Andreoli L, Fredi M, Reggia R, Lojacono A, Zatti S, Taglietti M, Gorla R, Filippini M, Tincani A. FRI0409 The Association Between Antiphospholipid Antibody Profile and Adverse Pregnancy Outcome in 217 Prospectively Followed, Treated Pregnancies in a Single Center Over 30 Years of Experience. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Taraborelli M, Martinazzi N, Lazzaroni M, Andreoli L, Fredi M, El Masri Y, Cartella S, Cavazzana I, Taglietti M, Frassi M, Franceschini F, Tincani A. AB0591 Organ Damage Evaluation and Risk Factors in a Cohort of 511 Sle Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Borella E, Lojacono A, Gatto M, Andreoli L, Taglietti M, Iaccarino L, Casiglia E, Punzi L, Tincani A, Doria A. Predictors of maternal and fetal complications in SLE patients: a prospective study. Immunol Res 2014; 60:170-6. [DOI: 10.1007/s12026-014-8572-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Dall’Ara F, Reggia R, Taraborelli M, Andreoli L, Taglietti M, Frassi M, Franceschini F, Tincani A. Patients with longstanding primary antiphospholipid syndrome: retrospective analysis of organ damage and mortality. Lupus 2014; 23:1255-8. [DOI: 10.1177/0961203314534308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the prevalence of disease- and therapy-related complications and of the organ damage after a follow-up of 15 years or more in patients with primary antiphospholipid syndrome (PAPS). Methods Medical records of patients prospectively followed in our centre for at least 15 years were retrospectively reviewed. Results Thirty-five Caucasian patients (33 female, two male) with diagnosis of PAPS followed from 1984 to 2013 with a mean age at onset of 32 years (SD 8.17) and a median follow-up of 20.5 years (range 15–30) were included. The occurrence of systemic autoimmune disease was observed in 14% of patients. Haemorrhagic, infective and neoplastic events were recorded in 34%, 6% and 9% respectively. Organ damage was present in 20% of patients at the end of the follow-up (17% neurological and 3% renal) and was significantly associated with the occurrence of thrombotic events ( p: 0.027), particularly arterial ( p < 0.001). A 48-year-old patient died from sepsis. Conclusion During long-term follow-up of PAPS systemic autoimmunity is not unexpected. Organ damage progresses in a significant proportion of patients especially if they have suffered previous arterial events. Our study clearly shows the possible evolution of the disease and of organ damage, suggesting that optimal therapy and optimal prophylaxis of each PAPS patient should be carefully identified and strictly applied.
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Affiliation(s)
- F Dall’Ara
- Department of Clinical and Experimental Science, University of Brescia, Italy
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - R Reggia
- Department of Clinical and Experimental Science, University of Brescia, Italy
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - M Taraborelli
- Department of Clinical and Experimental Science, University of Brescia, Italy
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - L Andreoli
- Department of Clinical and Experimental Science, University of Brescia, Italy
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - M Taglietti
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - M Frassi
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - F Franceschini
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
| | - A Tincani
- Department of Clinical and Experimental Science, University of Brescia, Italy
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Italy
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Lazzaroni MG, Taglietti M, Tincani A. Malignancies: a possible "first hit" in the development of catastrophic antiphospholipid syndrome? Isr Med Assoc J 2014; 16:583-584. [PMID: 25351019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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20
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Cervera R, Serrano R, Pons-Estel GJ, Ceberio-Hualde L, Shoenfeld Y, de Ramón E, Buonaiuto V, Jacobsen S, Zeher MM, Tarr T, Tincani A, Taglietti M, Theodossiades G, Nomikou E, Galeazzi M, Bellisai F, Meroni PL, Derksen RHWM, de Groot PGD, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Fernández-Nebro A, Haro M, Amoura Z, Miyara M, Tektonidou M, Espinosa G, Bertolaccini ML, Khamashta MA. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis 2014; 74:1011-8. [DOI: 10.1136/annrheumdis-2013-204838] [Citation(s) in RCA: 392] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/05/2014] [Indexed: 12/20/2022]
Abstract
ObjectivesTo assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later.MethodsIn 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10 years.Results53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10 years was 90.7%.ConclusionsPatients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications.
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Govoni M, Bombardieri S, Bortoluzzi A, Caniatti L, Casu C, Conti F, De Vita S, Doria A, Farina I, Ferraccioli G, Gremese E, Mansutti E, Mosca M, Padovan M, Piga M, Tincani A, Tola MR, Tomietto P, Taglietti M, Trotta F, Valesini G, Zen M, Mathieu A. Factors and comorbidities associated with first neuropsychiatric event in systemic lupus erythematosus: does a risk profile exist? A large multicentre retrospective cross-sectional study on 959 Italian patients. Rheumatology (Oxford) 2011; 51:157-68. [DOI: 10.1093/rheumatology/ker310] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Taglietti M, Hawkins CN, Rao J. Novel topical drug delivery systems and their potential use in acne vulgaris. Skin Therapy Lett 2008; 13:6-8. [PMID: 18648713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A vast spectrum of topical anti-acne agents has emerged in response to new insights that have been gained through the understanding of disease pathophysiology and the need for clinicians to adopt an individualized therapeutic approach. Because topical agents are most commonly used for acne management, this article reviews some novel vehicle delivery advances that are poised to further enhance the efficacy of topical acne formulations, and/or offer the possibility of simplified dosing regimens that may improve treatment outcomes.
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Affiliation(s)
- M Taglietti
- Forest Research Institute, Jersey City, NJ, USA
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23
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Zatti S, Rebaioli CB, Lojacono A, Rovetto B, Barbolini E, Taglietti M, Nuzzo M, Tincani A. Antiphospholipid syndrome and pregnancy. Womens Health (Lond) 2006; 2:873-880. [PMID: 19804007 DOI: 10.2217/17455057.2.6.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Since the 1960s, antiphospholipid antibodies have been known to be associated with repeated miscarriages and fetal losses. Other complications of pregnancy, such as preterm birth, with pre-eclampsia or severe placental insufficiency were also frequently reported and are included in the current classification criteria of the antiphospholipid syndrome. The titer, isotype or antigen specificity of the antibodies may be important in risk determination. The pathogenesis of pregnancy failures is not only linked to the thrombophilic effect of antiphospholipid antibodies but also to a direct effect of antibodies on trophoblast differentiation and invasion. The study of experimental animal models provided sound evidence of the pathogenic role of antiphospholipid antibodies both in lupus-prone and -naive mice. The classification of pregnant antiphospholipid syndrome patients as being at a 'high risk' has completely changed their prognosis due to obstetric monitoring and the application of effective therapy. In fact, despite the high rates of complications and preterm delivery, a successful outcome can now be achieved in a large majority of cases.
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Affiliation(s)
- Sonia Zatti
- Ostetricia e Ginecologia, Ospedale Civile e Università di Brescia, Italy
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24
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Tincani A, Rebaioli CB, Taglietti M, Shoenfeld Y. Heart involvement in systemic lupus erythematosus, anti-phospholipid syndrome and neonatal lupus. Rheumatology (Oxford) 2006; 45 Suppl 4:iv8-13. [PMID: 16980725 DOI: 10.1093/rheumatology/kel308] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cardiac involvement is one of the main complications substantially contributing to the morbidity and mortality of patients suffering from systemic autoimmune diseases. All the anatomical heart structures can be affected, and multiple pathogenic mechanisms have been reported. Non-organ-specific autoantibodies have been implicated in immune complex formation and deposition as the initial triggers for inflammatory processes responsible for Libman-Sacks verrucous endocarditis, myocarditis and pericarditis. Anti-phospholipid antibodies have been associated with thrombotic events in coronary arteries, heart valve involvement and intra-myocardial vasculopathy in the context of primary and secondary anti-phospholipid syndrome. Antibodies-SSA/Ro and anti-SSB/La antigens play a major pathogenic role in affecting the heart conduction tissue leading to the electrocardiographic abnormalities of the neonatal lupus syndrome and have been closely associated with endocardial fibroelastosis.
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Affiliation(s)
- A Tincani
- Reumatologia e Immunologia Clinica, Ospedale Civile, Piazza Spedali Civili 1, 25125 Brescia, Italy.
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Tincani A, Rebaioli CB, Frassi M, Taglietti M, Gorla R, Cavazzana I, Faden D, Taddei F, Lojacono A, Motta M, Trepidi L, Meroni P, Cimaz R, Ghirardello A, Doria A, Pisoni MP, Muscarà M, Brucato A. Pregnancy and autoimmunity: Maternal treatment and maternal disease influence on pregnancy outcome. Autoimmun Rev 2005; 4:423-8. [PMID: 16137607 DOI: 10.1016/j.autrev.2005.03.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2004] [Accepted: 03/09/2005] [Indexed: 11/25/2022]
Abstract
If a woman suffers from autoimmune disease (AD), several factors can affect pregnancy or neonatal outcome: repeated spontaneous pregnancy losses (frequently related to antiphospholipid antibodies (aPL)), neonatal lupus with complete congenital heart block (CHB) (linked to transplacental passage of IgG anti Ro/SS-A antibodies) and the disease activity itself that can affect the mother, the pregnancy and fetal outcome. If appropriately managed, the antiphospholipid syndrome (APS) is "one of the few tractable causes of pregnancy losses." A recent case control study, on babies from APS-mothers and healthy mothers, did not show any difference in the occurrence of neonatal complications. There are few data about the long-term outcome of babies born to patients with AD. We recently reported increased occurrence of learning disabilities in children born to aPL positive mothers with systemic lupus erythematosus (SLE). The modern management of pregnancy in patients with AD includes the treatment of disease flares, using drugs effective but safe for fetus. Corticosteroids and some immunosuppressive drugs can be used in pregnancy to control maternal disease. A prolonged fetal exposure to dexamethasone was reported to impair cerebral development, but we recently studied 6 children, born to patients treated with dexamathasone because of CHB, showing a normal intelligence quotient. The last 10-year experience shows that fetal exposure to antimalarial drugs should not be regarded as an important risk factor for gestational nor neonatal complications. However, information about long-term outcome of children exposed to immunosuppressive drugs "in utero" are still lacking and more efforts are needed in this research area.
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Saviola G, Abdi Ali L, Shams Eddin S, Davoli C, Taglietti M. Clarithromycin in adult-onset Still's disease. Case report with a 1-year follow-up. Clin Exp Rheumatol 2004; 22:379. [PMID: 15144141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Cimaz R, Casadei A, Rose C, Bartunkova J, Sediva A, Falcini F, Picco P, Taglietti M, Zulian F, Ten Cate R, Sztajnbok FR, Voulgari PV, Drosos AA. Primary Sjögren syndrome in the paediatric age: a multicentre survey. Eur J Pediatr 2003; 162:661-5. [PMID: 12898241 DOI: 10.1007/s00431-003-1277-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2003] [Revised: 06/02/2003] [Accepted: 06/03/2003] [Indexed: 11/24/2022]
Abstract
UNLABELLED Primary Sjögren syndrome (SS) is very rare in childhood. We collected a series of primary paediatric SS cases from different centres. A data collection form was prepared and sent to rheumatologists who were willing to participate. Data on 40 cases of primary SS with onset before the 16th birthday were collected. Almost all patients (35/40) were females, age at onset varied from 9.3 to 12.4 years (mean 10.7 years). Signs and symptoms at disease onset were mainly recurrent parotid swelling followed by sicca symptoms. Abnormal laboratory tests were found in the majority of cases. Regarding treatment, 22 patients were treated at some time with oral corticosteroids, seven with non-steroidal anti-inflammatory drugs, and five with hydroxychloroquine; two patients needed cyclosporine and one cyclophosphamide. Follow-up varied from 0 to 7.5 years from onset, without major complications in the majority of patients. CONCLUSION recurrent parotid swelling is a common feature of primary Sjögren syndrome in childhood and often occurs as a presenting feature. Sicca symptoms may be rarer.
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Affiliation(s)
- Rolando Cimaz
- Clinica Pediatrica, Istituti Clinici di Perfezionamento, Via Commenda 9, 20122 Milano, Italy.
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Tincani A, Lojacono A, Taglietti M, Motta M, Biasini C, Decca L, Zatti S, Frassi M, Barbetti L, Gorla R, Danieli E, Balestrieri G, Chirico G, Faden D. Pregnancy and neonatal outcome in primary antiphospholipid syndrome. Lupus 2003; 11:649. [PMID: 12413058 DOI: 10.1191/0961203302lu269oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Tincani
- Department of Obstetrics and Gynecology, Neonatal Intensive Care Unit, Rheumatology and Clinical Immunology, University Hospital, Brescia, Italy
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Tincani A, Taglietti M, Biasini C, Frassi M, Gorla R, Balestrieri G. Thromboembolic events after fetal loss in patients with antiphospholipid syndrome: comment on the article by Erkan et al. Arthritis Rheum 2002; 46:1126-7; author reply 1127. [PMID: 11953995 DOI: 10.1002/art.10165] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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30
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Tincani A, Allegri F, Sanmarco M, Cinquini M, Taglietti M, Balestrieri G, Koike T, Ichikawa K, Meroni P, Boffa MC. Anticardiolipin antibody assay: a methodological analysis for a better consensus in routine determinations--a cooperative project of the European Antiphospholipid Forum. Thromb Haemost 2001; 86:575-83. [PMID: 11522006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Despite the widely recognized practical importance of anticardiolipin (aCL) ELISA, the reliability of this test has been recently discussed. In order to investigate this area on European scale, we sent to 30 experienced centers a questionnaire focusing on the diagnostic procedures applied to patients with antiphospholipid syndrome (APS) and on the detailed protocols used to perform aCL. Anticardiolipin ELISA was found to be the most frequently performed test in patients with suspected APS, but significant difference was shown among the various protocols. The cross-laboratory multiple examination of ten serum samples evaluated independently by the 24 centers pointed out the difficulty in getting comparable results. Therefore a "consensus" protocol was derived from the aCL methods giving the best performance. The materials and reagents necessary to perform the "consensus" method, including, as putative standards, one IgG and one IgM monoclonal antibody (HCAL and EY2C9) were distributed to 19 Centers. The results of one IgG and one IgM aCL high positive sera measured in serial dilutions were compared. A progressive decrease in the variability of the values obtained for a given sample appeared evident when all the laboratories used the same standard, in their own in-house ELISA and even more in the "consensus" ELISA. Our data show that aCL ELISA standardization is necessary in order to obtain comparable results in different laboratories.
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Affiliation(s)
- A Tincani
- Clinical Immunology Unit, Brescia Hospital, Italy.
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Tincani A, Balestrieri G, Allegri F, Cinquini M, Vianelli M, Taglietti M, Sanmarco M, Ichikawa K, Koike T, Meroni P, Boffa MC. Overview on anticardiolipin ELISA standardization. J Autoimmun 2000; 15:195-7. [PMID: 10968908 DOI: 10.1006/jaut.2000.0399] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Tincani
- Clinical Immunology Unit, Brescia Hospital, Brescia, Italy.
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Brugnoni D, Airò P, Tosoni C, Taglietti M, Lodi-Rizzini F, Calzavara-Pinton P, Leali C, Cattaneo R. CD3-CD4+ cells with a Th2-like pattern of cytokine production in the peripheral blood of a patient with cutaneous T cell lymphoma. Leukemia 1997; 11:1983-5. [PMID: 9369436 DOI: 10.1038/sj.leu.2400839] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case of cutaneous T cell lymphoma associated with mild eosinophilia and rise of IgE levels is reported. A population of CD3-CD4+ cells was observed in the peripheral blood. After activation, these purified CD3-CD4+ cells showed a Th2 pattern of cytokine production, secreting higher levels of IL-5 and IL-4 and lower levels of IFN-gamma compared to the patient's and controls' CD3+CD4+ cells. Moreover, high levels of IL-5 and soluble CD30, a marker of Th2 cell activation, were detected in the patient's serum.
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Affiliation(s)
- D Brugnoni
- Servizio di Immunologia Clinica, Spedali Civili, Brescia, Italy
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Affiliation(s)
- M Taglietti
- Schering-Plough Research Institute, Kenilworth, NJ 07033, USA
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Abstract
The adaptation to repeated periods of intermittent normobaric hypoxia (oxygen:nitrogen = 10:90, 12 hr daily for 5 days) of some specific enzymatic activities related to energy metabolism has been observed in different rat brain areas (cerebral cortex, hippocampus, corpus striatum, hypothalamus, cerebellum, and medulla oblongata). The evaluation of the maximum rate (Vmax) of the enzymes was carried out on: the homogenate "in toto," the nonsynaptic mitochondrial fraction, and the crude synaptosomal fraction. The adaptation to intermittent normobaric hypoxic exposure was characterized by significant modifications of some enzyme activities in the homogenate "in toto" (decrease of hexokinase activity in cerebellum), in the nonsynaptic mitochondrial fraction (increase of succinate dehydrogenase activity in corpus striatum and decrease of cytochrome oxidase activity in cerebral cortex), and, particularly, in the synaptosomal fraction (decrease of cytochrome oxidase activity in cerebral cortex, hippocampus, corpus striatum, and cerebellum, and decrease of malate dehydrogenase and lactate dehydrogenase activity in cerebellum). The adaptation to normobaric intermittent hypoxia differs according to the brain area, subcellular fraction, and enzyme activity tested.
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Pastoris O, Gorini A, Vercesi L, Taglietti M, Dossena M. Modification of the skeletal muscle energy metabolism induced by intermittent normobaric hypoxia and treatment with biological pyrimidines. Farmaco Sci 1985; 40:442-53. [PMID: 4029389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Muscular glycolytic fuels, intermediates and end-products (glycogen, glucose, glucose-6-phosphate, pyruvate, lactate), Krebs cycle intermediates (citrate, alpha-ketoglutarate, succinate, malate), related free amino acids (glutamate, alanine), ammonia, energy store (creatine phosphate), energy mediators (ATP, ADP, AMP) and energy charge potential were evaluated. Furthermore the maximum rate (Vmax) of the following enzyme activities was evaluated in the crude extract and/or mitochondrial fraction: for the anaerobic glycolytic pathway: hexokinase, phosphofructokinase, pyruvate kinase, lactate dehydrogenase; for the tricarboxylic acid cycle: citrate synthase, malate dehydrogenase; for the electron transfer chain: total NADH cytochrome c reductase, cytochrome oxidase. The rat gastrocnemius muscles were analysed in normoxia and after normobaric intermittent hypoxia (12 hours continuously daily; for 5 days). Cytidine and/or uridine were administered daily at the dose of 120 mg/kg, i.p., 30 min before the beginning of the experimental hypoxia. The intermittent normobaric hypoxia induced a biochemical adaptation characterized by the decrease of the muscular contents of creatine phosphate, citrate, alpha-ketoglutarate and glutamate. This adaptation occurred in the absence of significant changes in the Vmax of the tested muscle enzymes. In gastrocnemius muscle from hypoxic rats, the two biological pyrimidines tested induced various discrete, but often related, modifications of the contents of some Krebs cycle intermediates (i.e., alpha-ketoglutarate, malate) and related free amino acids (i.e., glutamate, alanine). In any case, the treatment with cytidine and/or uridine did not modify the Vmax of marker enzymes related to energy transduction.
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Dagani F, Marzatico F, Curti D, Taglietti M, Zanada F, Benzi G. Influence of intermittent hypoxia and pyrimidinic nucleosides on cerebral enzymatic activities related to energy transduction. Neurochem Res 1984; 9:1085-99. [PMID: 6493441 DOI: 10.1007/bf00964804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The effect of intermittent normobaric hypoxia and of biological pyrimidines (uridine and cytidine) on the specific activities of some enzymes related to cerebral energy metabolism were studied. Measurement were carried out on the following: homogenate in toto; purified mitochondrial fraction; crude synaptosomal fraction, in different areas of rat brain: cerebral cortex, hippocampus, corpus striatum, hypothalamus, cerebellum, and medulla oblongata. Intermittent normobaric hypoxia (12 hours daily for 5 days) caused modifications of the enzyme activities in the homogenate in toto (decrease of hexokinase in cerebellum; increase of pyruvate kinase in medulla oblongata), in the purified mitochondrial fraction (increase of succinate dehydrogenase in the corpus striatum) and in the crude synaptosomal fraction (decrease of cytochrome oxidase activity in cerebral cortex, hippocampus, and cerebellum; decrease of malate dehydrogenase in hippocampus and cerebellum; decrease of lactate dehydrogenase in cerebellum). Daily treatment with cytidine or uridine altered some enzyme activities either affected or unaffected by intermittent hypoxia.
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Benzi G, Villa RF, Dossena M, Vercesi L, Gorini A, Taglietti M, Pastoris O. Recovery period after profound hypoglycemia. Influence of some metabolic modulators on the cerebral endogenous substrate utilization. Farmaco Sci 1984; 39:430-449. [PMID: 6734818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The content of "energy-rich" phosphates was markedly decreased in rat cerebral cortex after 20 min of severe hypoglycemia, followed by partial restitution during the recovery period. The adenine nucleotide pool remained reduced even if the energy charge returned to normal. During hypoglycemia the non-glucose endogenous substrates were provided by glycolytic intermediates, by Krebs' cycle intermediates and by related amino acids. Other substrates for brain oxidation were provided by the breakdown of phospholipids and fatty acids. After a 20 min period of post-hypoglycemic recovery, partial restoration of carbohydrates and amino acids occurred, the amino acid pool size being still reduced. The alterations in phospholipids and fatty acids persisted, while there was a tendency towards normalization of the free fatty acid cerebral content. During the post-hypoglycemic recovery, treatment with some specific metabolic modulators (i.e., uridine, L-acetylcarnitine, hopantenate, 6-amino-nicotinamide) suggests the possibility of an alternative cerebral substrate utilization due to the modulation of the cerebral biochemical machinery. Thus, increased carbohydrate utilization by hopantenate was consistent with decreased lipid breakdown, while increased carbohydrate utilization by uridine was concomitant with decreased amino acid degradation. On the other hand, decreased cerebral carbohydrate utilization by 6-aminonicotinamide was concomitant with increased lipid and amino acid breakdown. Furthermore, the increased loss of cerebral phospholipids and fatty acids by L-acetylcarnitine occurred in the presence of a large glucose availability and was concomitant with an extensive reduction on cerebral glycolytic flux.
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Pastoris O, Dossena M, Vercesi L, Migliavacca C, Taglietti M, Benzi G. On the possible pharmacological role of UDP-glucose on some muscular metabolites. Farmaco Sci 1984; 39:246-54. [PMID: 6714417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The effects of intraperitoneal administration of UDP-glucose were studied on male rat gastrocnemius muscle. Muscular glycolytic substrates and metabolites (glycogen, glucose, glucose-6-phosphate, pyruvate, lactate), Krebs' cycle intermediates (citrate, alpha-ketoglutarate, malate), related aminoacids (glutamate, alanine), ammonia, energy store and mediators (creatine phosphate, ATP, ADP, AMP) and the energy charge potential were evaluated. UDP-glucose was administered intraperitoneally at doses of 0.8, 2.0 and 5.0 mg/kg daily for 1, 2 and 4 weeks. The influence of the factors: "dose" of UDP-glucose and "time-course" of treatment was defined. After two weeks, the administration of the three doses tested of UDP-glucose changed the muscular concentration of few glycolytic metabolites, and of some Krebs' cycle intermediates, while after 1 or 4 weeks of treatment there was negligible response.
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Pastoris O, Dossena M, Fulle D, Taglietti M, Benzi G. Action of testosterone on some biochemical parameters related to the energy metabolism of the skeletal muscle. Arch Int Pharmacodyn Ther 1983; 263:129-38. [PMID: 6615079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The effect of intramuscular administration of testosterone propionate was studied on rat gastrocnemius muscle. Muscular glycolytic substrates and Krebs' cycle metabolites (glycogen, glucose, glucose-6-phosphate, pyruvate, lactate, citrate, alpha-ketoglutarate, succinate, malate), related aminoacids (glutamate, alanine, ammonia), energy store and mediators (creatine phosphate, ATP, ADP, AMP) and the energy charge potential were evaluated. The influence of the factors: testosterone dose, time course of treatment and sex of animals was investigated, no relevant changes being noticed.
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Benzi G, Gorini A, Dossena M, Taglietti M, Fulle D, Pastoris O. Recovery after hypoglycemic brain injury. Action of some biological substances on the cerebral metabolism. Biochem Pharmacol 1983; 32:1083-91. [PMID: 6340690 DOI: 10.1016/0006-2952(83)90629-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In artificially ventilated beagle dogs a severe hypoglycemic condition was induced by insulin injection, while the posthypoglycemic recovery was induced by glucose treatment at the end of a 20-min period of spontaneous electroencephalographic silence. The motor area of the cerebral cortex was analyzed for glycolytic metabolites, related amino acids, energy mediators, fatty acids, phospholipids and free fatty acids. The effects on the posthypoglycemic recovery of a intracarotid infusion with some agents (i.e. uridine, cytidine, DL-carnitine, DL-acetylcarnitine, papaverine) were tested. Severe hypoglycemia induced an extensive derangement of the brain metabolism, with partial restitution during the posthypoglycemic recovery. During this condition, the intracarotid perfusion with some biological pyrimidines (uridine, cytidine) interfered with the glycolytic and amino acid metabolites, inducing a decrease in glucose, pyruvate and lactate contents, and an increase in succinate, alanine and glutamine cerebral concns. The lipid carriers (DL-carnitine, DL-acetylcarnitine) interfered with the fatty acid degradation inducing a magnification of the decrease in the individual (palmitic acid, oleic acid) and total fatty acids, the vasodilating agent (papaverine) being practically inactive.
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