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Gentileschi S, Gaggiano C, Damiani A, Coccia C, Bernardini P, Cazzato M, D'Alessandro F, Vallifuoco G, Terribili R, Bardelli M, Baldi C, Cantarini L, Mosca M, Frediani B, Guiducci S. Impact of age and cardiovascular risk factors on the incidence of adverse events in patients with rheumatoid arthritis treated with Janus Kinase inhibitors: data from a real-life multicentric cohort. Clin Exp Med 2024; 24:62. [PMID: 38554250 PMCID: PMC10981583 DOI: 10.1007/s10238-024-01325-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 04/01/2024]
Abstract
Inhibiting Janus Kinases (JAK) is a crucial therapeutic strategy in rheumatoid arthritis (RA). However, the use of JAK inhibitors has recently raised serious safety concerns. The study aims to evaluate the safety profile of JAKi in patients with RA and identify potential risk factors (RFs) for adverse events (AEs). Data of RA patients treated with JAKi in three Italian centers from January 2017 to December 2022 were retrospectively analyzed. 182 subjects (F:117, 64.3%) underwent 193 treatment courses. 78.6% had at least one RF, including age ≥ 65 years, obesity, smoking habit, hypertension, dyslipidemia, hyperuricemia, diabetes, previous VTE or cancer, and severe mobility impairment. We identified 70 AEs (28/100 patients/year), among which 15 were serious (6/100 patients/year). A high disease activity was associated with AEs occurrence (p = 0.03 for CDAI at T0 and T6; p = 0.04 for SDAI at T0 and T6; p = 0.01 and p = 0.04 for DAS28ESR at T6 and T12, respectively). No significant differences in AEs occurrence were observed after stratification by JAKi molecules (p = 0.44), age groups (p = 0.08) nor presence of RFs (p > 0.05 for all of them). Neither the presence of any RFs, nor the cumulative number of RFs shown by the patient, nor age ≥ 65 did predict AEs occurrence. Although limited by the small sample size and the limited number of cardiovascular events, our data do not support the correlation between cardiovascular RFs-including age-and a higher incidence of AEs during JAKi therapy. The role of uncontrolled disease activity in AEs occurrence should by emphasized.
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Affiliation(s)
- Stefano Gentileschi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy.
| | - Carla Gaggiano
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Arianna Damiani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carmela Coccia
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pamela Bernardini
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimiliano Cazzato
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco D'Alessandro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Vallifuoco
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Riccardo Terribili
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Univeristaria Senese, University of Siena, Siena, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Damiani A, Orlandi M, Bruni C, Bandini G, Lepri G, Scaletti C, Ravaglia C, Frassanito F, Guiducci S, Moggi-Pignone A, Matucci-Cerinic M, Poletti V, Tofani L, Colby TV, Randone SB, Tomassetti S. The role of lung biopsy for diagnosis and prognosis of interstitial lung disease in systemic sclerosis: a systematic literature review. Respir Res 2024; 25:138. [PMID: 38521926 PMCID: PMC10960984 DOI: 10.1186/s12931-024-02725-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The prognostic and theragnostic role of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) have been largely neglected due to the paucity of treatment options and the risks associated with surgical lung biopsy. The novel drugs for the treatment of ILDs and the availability of transbronchial cryobiopsy provide a new clinical scenario making lung biopsy more feasible and a pivotal guide for treatment. The aim of our study was to investigate the usefulness of lung biopsy in SSc ILD with a systematic literature review (SLR). METHODS PubMed, Embase and Cochrane databases were searched up to June 30, 2023. Search terms included both database-specific controlled vocabulary terms and free-text terms relating to lung biopsy and SSc-ILD diagnostic and prognosis. The SLR was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Studies were selected according to the PEO (population, exposure, and outcomes) framework and Quality assessment of diagnostic accuracy studies (QUADAS) were reported. RESULTS We selected 14 articles (comprising 364 SSc-ILD patients). The paucity and heterogeneity of the studies prevented a systematic analysis. Diffuse cutaneous SSc was present in 30-100% of cases. Female predominance was observed in all studies (ranging from 64 to 100%). Mean age ranged from 42 to 64 years. Mean FVC was 73.98 (+/-17.3), mean DLCO was 59.49 (+/-16.1). Anti-Scl70 antibodies positivity was detected in 33% of cases (range: 0-69.6). All patients underwent surgical lung biopsies, and multiple lobes were biopsied in a minority of studies (4/14). Poor HRCT-pathologic correlation was reported with HRCT-NSIP showing histopathologic UIP in up to 1/3 of cases. Limited data suggest that SSc-UIP patients may have a worse prognosis and response to immunosuppressive treatment compared to other histopathologic patterns. CONCLUSIONS The data from this SLR clearly show the paucity and heterogeneity of the studies reporting lung biopsy in SSc ILD. Moreover, they highlight the need for further research to address whether the lung biopsy can be helpful to refine prognostic prediction and guide therapeutic choices.
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Affiliation(s)
- A Damiani
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - M Orlandi
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
- Department of Medical and Surgical for Children and Adults, Modena, Italy
| | - C Bruni
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - G Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | - G Lepri
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - C Scaletti
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - C Ravaglia
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
| | - F Frassanito
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - S Guiducci
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - A Moggi-Pignone
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Careggi University Hospital, Florence, Italy
| | - M Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - V Poletti
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Bologna University, Forlì, Italy
| | - L Tofani
- Department of Statistics, Informatics and Applications, University of Florence, Florence, Italy
| | - T V Colby
- Department of Pathology and Laboratory Medicine (Emeritus), Mayo Clinic, Scottsdale, AZ, 13400, USA
| | - S Bellando Randone
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Careggi University Hospital, Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence and Interventional Pulmonology Unit, Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy.
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Cometi L, Francesconi P, Bellini B, Turco L, Voller F, Nacci F, Bellando-Randone S, Matucci-Cerinic M, Guiducci S. Rheumatic diseases in migrant patients resident in Tuscany: epidemiological data analysis and single-center experience. Reumatismo 2024; 76. [PMID: 38523585 DOI: 10.4081/reumatismo.2024.1547] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 11/30/2023] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE In the last decades, the number of foreigners in Tuscany has considerably increased with a multiethnic distribution. We reviewed the main rheumatic diseases in the foreign population resident in Tuscany and also reported the experience at the Rheumatology Division of the University Hospital of Careggi, Florence, in order to identify the areas of origin of these patients and the main rheumatic diseases observed in them. METHODS The collaboration with the Tuscan Region provided data about foreign patients residing in Tuscany on January 1, 2021 (country of origin, chronic diseases). Moreover, we conducted a retrospective review of the clinical charts of our Rheumatologic Division from January 1, 2019, to December 31, 2020. RESULTS In Tuscany, on January 1, 2021, there were 61,373 patients with chronic inflammatory rheumatic diseases, and 3994 of them (6.51%) were foreigners. Most patients were born in Europe (39.03%), followed by the Balkans (15%), South America (11.27%), and North Africa (10.31%). Inflammatory joint diseases, Sjögren syndrome, and systemic lupus erythematosus were the most frequent diseases. In the period 2019-2020, 511 foreign patients visited our Rheumatology Division and mainly originated from the Balkans (34.64%), South America (18%), and European countries (16.44%). In these patients, chronic inflammatory joint diseases and connective tissue diseases (systemic sclerosis, Sjögren syndrome, and systemic lupus erythematosus) were the most prevalent diseases. CONCLUSIONS This study provides a picture of the rheumatic diseases affecting foreign patients residing in Tuscany that are in agreement with the epidemiological data previously provided.
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Affiliation(s)
- L Cometi
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Florence.
| | | | - B Bellini
- Regional Health Authority, Florence.
| | - L Turco
- Regional Health Authority, Florence.
| | - F Voller
- Regional Health Authority, Florence.
| | - F Nacci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Florence.
| | - S Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Florence.
| | - M Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Florence; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan.
| | - S Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Florence.
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Romanazzo S, Ceccatelli S, Mansueto G, Sera F, Guiducci S, Matucci Cerinic M, Cosci F. Well-Being Therapy in systemic sclerosis outpatients: a randomized controlled trial. Rheumatology (Oxford) 2024:keae114. [PMID: 38366929 DOI: 10.1093/rheumatology/keae114] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES Systemic Sclerosis (SSc) patients have psychological distress and poor well-being and need a tailored treatment. Psychological interventions, rarely tested for efficacy, showed poor benefits. The present randomized controlled trial tested the efficacy of Well-Being Therapy (WBT) in SSc patients. METHODS Thirty-two outpatients were randomized (1:1) to WBT (n = 16) or Treatment As Usual (i.e. routine medical check-ups) (TAU) (n = 16). Primary outcome was well-being. Secondary outcomes included functional ability related to SSc, psychological distress, mental pain, suffering. All participants were assessed at baseline (T0). The WBT group was assessed after two months (end of WBT session 4) (T1), after four months (end of WBT session 8) (T2), after seven months (3-month follow-up) (T3), and after 10 months (6-month follow-up) (T4). The TAU group was assessed two (T1), four (T2), seven (T3), and ten (T4) months after baseline. RESULTS WBT produced a significant improvement in subjective well-being (p ≤ 0.001), personal growth (p = 0.006), self-acceptance (p = 0.003) compared with TAU, maintained at T3 as what concerns subjective well-being (p = 0.012). WBT produced greater decrease in psychological distress (p = 0.010), mental pain (p = 0.010), suffering (p ≤ 0.001) compared with TAU, maintained at T4 as what concerns suffering (p ≤ 0.001). Participants reported high satisfaction with WBT. CONCLUSION The study provides preliminary evidence on the benefits of WBT as short-term approach for in- and out-patient SSc healthcare paths. Studies with larger samples are needed to have the evidence for recommending WBT to SSc patients.
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Affiliation(s)
- Sara Romanazzo
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sara Ceccatelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications G. Parenti, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Fiammetta Cosci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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D'Alessandro F, Cazzato M, Laurino E, Morganti R, Bardelli M, Frediani B, Buongarzone C, Moroncini G, Guiducci S, Cometi L, Benucci M, Ligobbi F, Marotto D, Mosca M. ToRaRI (Tofacitinib in Rheumatoid Arthritis a Real-Life experience in Italy): Effectiveness, safety profile of tofacitinib and concordance between patient-reported outcomes and physician's global assessment of disease activity in a retrospective study in Central-Italy. Clin Rheumatol 2024; 43:657-665. [PMID: 38135860 PMCID: PMC10834550 DOI: 10.1007/s10067-023-06836-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION The use of Janus Kinase Inhibitors (JAK-Is) in rheumatoid arthritis (RA) has entered in daily practice. In consideration of ORAL-Surveillance trial and the new EULAR recommendations, real-world data are needed to assess Jak-Is safety and effectiveness. The multicenter study presented here aimed to evaluate effectiveness and safety of tofacitinib in a real-life cohort. METHODS A retrospective analysis was performed from September 2021 to December 2022. Data were collected when tofacitinib was started (T0) and after 3 (T3), 6 (T6) and 12 (T12) months of treatment. The primary objective was to analyze the efficacy and safety of tofacitinib. Safety was assessed by recording adverse events (AEs) with and without discontinuation. The secondary objective was to assess the difference between Patient-Reported Outcomes (PROs) and Physician's Global Assessment of disease activity (PhGA). RESULTS 122 patients were included in the study from the following rheumatology Centers: Pisa, Ancona, Florence (two Centers), Siena, and Sardinia. A statistically significant improvement in DAS-28-CRP, CDAI and SDAI score was observed at T3, T6, compared to baseline (p < 0.001). Improvement was confirmed in patients who reach T12. Patients naïve to bDMARDs showed a shorter remission time and higher remission rates. There was also a statistically significant improvement in PROs compared to baseline (p < 0.001). The improvement was rapid and was consistent with PhGA. The 12-month retention rate for tofacitinib was 89.35%. Reasons to stop tofacitinib were: insufficient response (7), gastrointestinal symptoms (2), infection (1), malignancy (1), Zoster (1), pruritus sine materia (1). CONCLUSIONS Tofacitinib is safe and effective in our RA cohort. It induces higher remission rates in patients naive to bDMARDs, suggesting that there may be a benefit using it as first-line therapy. Additionally, improvement in PROs was consistent with PhGA scores, demonstrating how tofacitinib affects both the objective and subjective components of disease activity. Key Points 1. JAK inhibitors are considered at a similar level as biologic agents in terms of effectiveness. 2. After ORAL-Surveillance results, real-world data are needed to assess the benefit/risk profile of Jaki. 3. Disagreement between patients and physicians has been previously reported with biologic therapy among patients with rheumatoid arthritis, with patients rating disease activity higher than physicians. 4. Jak inhibitors could reduce this discrepancy, due to their mechanism of action.
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Affiliation(s)
| | | | | | | | - Marco Bardelli
- Rheumatology Unit-Department of Medicine, Surgery and Neurosciences-University Hospital Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit-Department of Medicine, Surgery and Neurosciences-University Hospital Siena, Siena, Italy
| | - Claudia Buongarzone
- Internal Medicine Residency Programme, Marche Polytechnic University, Ancona, Italy
| | | | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Maurizio Benucci
- Rheumatology Unit, S.Giovanni Di Dio Firenze Hospital, Florence, Italy
| | - Francesca Ligobbi
- Rheumatology Unit, S.Giovanni Di Dio Firenze Hospital, Florence, Italy
| | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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6
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Riccieri V, Pellegrino G, Cipolletta E, Giuggioli D, Bajocchi G, Bellando-Randone S, Dagna L, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Lepri G, Girelli F, Zanatta E, Bosello SL, Cavazzana I, Ingegnoli F, De Santis M, Murdaca G, Abignano G, Romeo N, Della Rossa A, Caminiti M, Iuliano A, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Di Vico C, Gigante A, Saccon F, Grazia Lazzaroni M, Franceschini F, Generali E, Mennillo G, Barsotti S, Pagano Mariano G, Calabrese F, Furini F, Vultaggio L, Parisi S, Peroni CL, Bianchi G, Conti F, Cozzi F, D’Angelo S, Doria A, Fusaro E, Govoni M, Guiducci S, Iannone F, Salvarani C, Sebastiani GD, Ferri C, Matucci-Cerinic M, De Angelis R. Practice pattern for the use of intravenous iloprost for the treatment of peripheral vasculopathy in systemic sclerosis: A case-control study from the Italian national multicenter "SPRING" (Systemic Sclerosis Progression InvestiGation) Registry. J Scleroderma Relat Disord 2024; 9:38-49. [PMID: 38333531 PMCID: PMC10848931 DOI: 10.1177/23971983231209809] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 02/10/2024]
Abstract
Background Intravenous iloprost has been widely used for the treatment of systemic sclerosis peripheral vasculopathy. No agreement has been found on the regimen and the dosage of intravenous iloprost in different scleroderma subset conditions. This study aimed to evaluate the modalities of intravenous iloprost administration within a large cohort of systemic sclerosis patients from the SPRING Registry and to identify any associated clinical-demographic, instrumental or therapeutic data. Patients and Methods Data of systemic sclerosis patients treated with intravenous iloprost for at least 1 year (case group) were retrospectively analyzed, including different timing and duration of intravenous iloprost session, and compared with those of untreated patients (control group). Results Out of 1895 analyzed patients, 937 (49%) received intravenous iloprost treatment, while 958 (51%) were assigned to the control group. Among cases, about 70% were treated every 4 weeks, 24% with an interval of more than 4 weeks, and only 6% of less than 4 weeks. Most patients receiving the treatment every 4 weeks, or less, underwent infusion cycle for 1 day only, while if it was scheduled with an interval of more than 4 weeks, a total number of 5 consecutive days of infusions was the preferred regimen. The comparison between the two groups revealed that patients treated with intravenous iloprost had a higher frequency of DUs (p < 0.001), pitting scars (p < 0.001), diffuse cutaneous involvement (p < 0.001), interstitial lung disease (p < 0.002), as well as higher rates of anti-topoisomerase I, "late" scleroderma pattern at nailfold videocapillaroscopy. These findings were confirmed by multivariate analysis. Conclusion Our data provide a picture on the Italian use of intravenous iloprost among systemic sclerosis patients and showed that it was usually employed in patients with a more aggressive spectrum of the disease. The disparity of intravenous iloprost treatment strategies in the different centers suggests the need of a rational therapeutical approach based on the clinical characteristics of different patients' subsets.
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Affiliation(s)
- Valeria Riccieri
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Greta Pellegrino
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of Rheumatology, IRCCS Ospedale Galeazzi–Sant’Ambrogio, Milan, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Rosario Foti
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy
| | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro,” Bari, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Francesco Girelli
- Department of Medicine, Rheumatology Unit, Ospedale GB Morgagni—L Pierantoni, Forlì, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Silvia Laura Bosello
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini, Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milan, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppina Abignano
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy
| | | | | | - Maurizio Caminiti
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | | | - Giovanni Ciano
- Hospital of Ariano Irpino, Local Health Department, Ariano Irpino, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ennio Lubrano
- Department of Rheumatology, University of Molise, Campobasso, Italy
| | - Ilenia De Andres
- Rheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale ed Alta Specializzazione “Garibaldi,” Catania, Italy
| | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Federica Lumetti
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Amelia Spinella
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Magnani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Veronica Codullo
- Department of Rheumatology, Policlinico San Matteo, Pavia, Italy
| | - Elisa Visalli
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy
| | - Claudio Di Vico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - Elena Generali
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Gianna Mennillo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy
| | | | | | - Francesca Calabrese
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Federica Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Licia Vultaggio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Simone Parisi
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Clara Lisa Peroni
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gerolamo Bianchi
- Rheumatology Unit, Department of Musculoskeletal Sciences, Local Health Trust 3, La Colletta Hospital, Genoa, Italy
| | - Fabrizio Conti
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Franco Cozzi
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Salvatore D’Angelo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Enrico Fusaro
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro,” Bari, Italy
| | - Carlo Salvarani
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Clodoveo Ferri
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Rossella De Angelis
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Lepri G, Bruni C, Tofani L, Moggi-Pignone A, Orlandi M, Tomassetti S, Hughes M, Del Galdo F, Irace R, Distler O, Riccieri V, Allanore Y, Gheorghiu AM, Siegert E, De Vries-Bouwstra J, Hachulla E, Tikly M, Damjanov N, Spertini F, Mouthon L, Hoffmann-Vold AM, Gabrielli A, Guiducci S, Matucci-Cerinic M, Furst D, Bellando-Randone S. The Performance of Pulmonary Function Tests in Predicting Systemic Sclerosis-Interstitial Lung Disease in the European Scleroderma Trial and Research Database. Diagnostics (Basel) 2024; 14:295. [PMID: 38337811 PMCID: PMC10855256 DOI: 10.3390/diagnostics14030295] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES In SSc, ILD is a major cause of morbidity and mortality. We aimed to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) delta change (Δ) and baseline values in predicting the development of SSc-ILD. METHODS Longitudinal data of DLCO, FVC, and ILD on the HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t0) and after 12 (±4) (t1) and 24 (±4) (t2) months. RESULTS 474/17805 patients were eligible for the study (403 females); 46 (9.7%) developed ILD at t2. Positivity for anti-topoisomerase antibodies (117 patients) showed an association with ILD development at t2 (p = 0.0031). Neither the mean t0 to t1 change (Δ) of DLCO nor the mean t0 to t1 FVCΔ predicted the appearance of ILD at t2. Investigating the possible role of baseline DLCO and FVC values in predicting ILD appearance after 24 (±4) months, we observed a moderate predictive capability of t0 DLCO < 80%, stronger than that of FVC < 80%. CONCLUSIONS We suggest that an impaired baseline DLCO may be predictive of the appearance of ILD after 2 years of follow-up. This result advances the hypothesis that a reduction in gas exchange may be considered an early sign of lung involvement. However, further rigorous studies are warranted to understand the predictive role of DLCO evaluation in the course of SSc.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Lorenzo Tofani
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Alberto Moggi-Pignone
- Division of Internal Medicine, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Martina Orlandi
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Sara Tomassetti
- Interventional Pulmonology Unit, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Michael Hughes
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Francesco Del Galdo
- Raynaud’s and Scleroderma Programme, NIHR Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Rosaria Irace
- Rheumatology Unit, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | | | - Yannick Allanore
- Rheumatology Department, Hopital Cochin, University of Paris, 75019 Paris, France
| | - Ana Maria Gheorghiu
- Internal Medicine & Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Elise Siegert
- Rheumatology, Charite University Hospital, 10117 Berlin, Germany
| | - Jeska De Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Eric Hachulla
- Service de Médecine Interne, Centre Hospitalier Universitaire, 59000 Lille, France
| | - Mohammed Tikly
- Department of Internal Medicine, Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Nemanja Damjanov
- Institute of Rheumatology, University Belgrade Medical School, 11000 Belgrade, Serbia
| | | | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, University Paris Descartes, 75006 Paris, France
| | | | - Armando Gabrielli
- Department of Clinical and Molecular Science, Università Politecninca delle Marche, 60121 Ancona, Italy
| | - Serena Guiducci
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Daniel Furst
- Division of Rheumatology, AOU Careggi, University of Florence, 50121 Florence, Italy
- Division of Rheumatology, University California Los Angeles, Los Angeles, CA 90095, USA
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8
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Treppo E, Isola M, De Martino M, Padoan R, Giollo A, Urban ML, Monti S, Sartorelli S, Fassio A, Argolini LM, Marvisi C, Gattamelata A, Regola F, Ferro F, Cassone G, Motta F, Berti A, Conticini E, Guiducci S, Matucci-Cerinic M, Lo Gullo A, Manfredi A, Frediani B, Bortolotti R, Selmi C, Baldini C, Franceschini F, Conti F, Caporali R, Rossini M, Dagna L, Montecucco C, Emmi G, Schiavon F, Salvarani C, Quartuccio L. Validation of the Italian version of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire. Rheumatol Adv Pract 2024; 8:rkae001. [PMID: 38515585 PMCID: PMC10956719 DOI: 10.1093/rap/rkae001] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives The primary objective of this study was the translation and validation of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire into Italian, denoted as AAV-PRO_ita. The secondary objective was to evaluate the impact of ANCA-associated vasculitis (AAV) on quality of life (QoL) and work impairment in a large cohort of Italian patients. Methods The study design took a prospective cohort study approach. First, the AAV-PRO was translated into Italian following the step guidelines for translations. The new AAV-PRO_ita questionnaire covered three disease domains: organ-specific and systemic symptoms and signs; physical function; and social and emotional impact. Second, Italian-speaking AAV patients were recruited from 17 Italian centres belonging to the Italian Vasculitis Study Group. Participants completed the AAV-PRO_ita questionnaire at three time points. Participants were also requested to complete the work productivity and activity impairment: general health questionnaire. Results A total of 276 AAV patients (56.5% women) completed the questionnaires. The AAV-PRO_ita questionnaire demonstrated a good internal consistency and test-retest reliability. Female AAV patients scored higher (i.e. worse) in all thee domains, especially in the social and emotional impact domain (P < 0.001). Patients on glucocorticoid therapy (n = 199) had higher scores in all domains, especially in the physical function domain (P < 0.001), compared with patients not on glucocorticoid therapy (n = 77). Furthermore, patients who had at least one relapse of disease (n = 114) had higher scores compared with those who had never had one (n = 161) in any domain (P < 0.05). Finally, nearly 30% of the patients reported work impairment. Conclusion The AAV-PRO_ita questionnaire is a new 29-item, disease-specific patient-reported outcome measuring tool that can be used in AAV research in the Italian language. Sex, glucocorticoids and relapsing disease showed the greatest impact on QoL.
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Affiliation(s)
- Elena Treppo
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
| | - Miriam Isola
- Institute of Statistics, Department of Medicine, University of Udine, Udine, Italy
| | - Maria De Martino
- Institute of Statistics, Department of Medicine, University of Udine, Udine, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Sartorelli
- IRCCS San Raffaele Scientific Institute, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), Milano, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | - Chiara Marvisi
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Angelica Gattamelata
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Motta
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milano, Italy
| | - Alvise Berti
- Center for Medical Sciences (CISMed), University of Trento, and Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Marco Matucci-Cerinic
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Roberto Bortolotti
- Center for Medical Sciences (CISMed), University of Trento, and Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabrizio Conti
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Istituto Gaetano Pini—CTO, Milano, Italy
| | | | - Lorenzo Dagna
- IRCCS San Raffaele Scientific Institute, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), Milano, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
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9
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Baldi C, Parisi S, Falsetti P, Sota J, Ditto MC, Capassoni M, D’alessandro M, Conticini E, Nacci F, Peroni CL, Cometi L, Fusaro E, Frediani B, Guiducci S. Efficacy and Safety of Upadacitinib in Rheumatoid Arthritis: Real-Life Experience from a Prospective Longitudinal Multicentric Study. J Clin Med 2024; 13:401. [PMID: 38256535 PMCID: PMC10816893 DOI: 10.3390/jcm13020401] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/31/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND We provide the first prospective longitudinal multicenter experience on Upadacitinib efficacy and safety profile in Rheumatoid Arthritis (RA) in a real-life context, focusing on clinimetric and ultrasonographic (US) data. METHODS RA patients referred to three Italian tertiary Centers who started Upadacitinib were enrolled as per ACR/EULAR classification criteria and prospectively reviewed. The primary aim of this study was to assess changes in clinimetric and ultrasonographic scores through time (at baseline, after 1 month, 3 months, and 6 months from the beginning of the therapy). Secondary aims were to: (i) estimate the impact of biologic lines of treatment and concomitant therapies on response to therapy; (ii) explore changes in laboratory parameters; and (iii) find potential predictive factors associated with response to therapy. RESULTS Seventy-one patients (49 Females and 22 Males) were included. Clinimetric scores, including the Disease Activity Score (DAS28-CRP) and Simplified Clinical Disease Activity Index (SDAI), and US findings (synovial hypertrophy and power Doppler) significantly improved (p = 0.029, p = 0.001, p = 0.001, p = 0.001, respectively). Regression analysis revealed a significant association between the concomitant csDMARDs therapy at baseline and the lack of improvement in synovial hypertrophy [OR -4.824, p = 0.010] as well as with DAS28-CRP [OR -0.690, p = 0.045], whereas the presence of increased ESR or CRP at baseline was able to predict a significant improvement in SDAI [OR 8.481, p = 0.003]. No adverse events, such as deep venous thrombosis, pulmonary embolism, or herpes zoster virus infection, were reported during this study observation. CONCLUSION Our real-life experience confirms the efficacy of Upadacitinib in terms of clinical and ultrasonographic improvement, as well as displaying a good safety profile.
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Affiliation(s)
- Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Simone Parisi
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Jurgen Sota
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Maria Chiara Ditto
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Marco Capassoni
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
| | - Miriana D’alessandro
- Respiratory Disease and Lung Transplantation Unit, University of Siena, 53100 Siena, Italy;
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Francesca Nacci
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
| | - Clara Lisa Peroni
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Laura Cometi
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, 10126 Torino, Italy; (M.C.D.); (C.L.P.); (E.F.)
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (C.B.); (P.F.); (J.S.); (E.C.); (B.F.)
| | - Serena Guiducci
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy; (M.C.); (F.N.); (L.C.); (S.G.)
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10
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Russo E, Bellando-Randone S, Carboni D, Fioretto BS, Romano E, Baldi S, El Aoufy K, Ramazzotti M, Rosa I, Lepri G, Di Gloria L, Pallecchi M, Bruni C, Melchiorre D, Guiducci S, Manetti M, Bartolucci GL, Matucci-Cerinic M, Amedei A. The differential crosstalk of the skin-gut microbiome axis as a new emerging actor in systemic sclerosis. Rheumatology (Oxford) 2024; 63:226-234. [PMID: 37154625 DOI: 10.1093/rheumatology/kead208] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES We characterized the microbiota in SSc, focusing on the skin-oral-gut axis and the serum and faecal free fatty acid (FFA) profile. METHODS Twenty-five SSc patients with ACA or anti-Scl70 autoantibodies were enrolled. The microbiota of faecal, saliva and superficial epidermal samples was assessed through next-generation sequencing analysis. GC-MS was used to quantify faecal and serum FFAs. Gastrointestinal symptoms were investigated with the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument (UCLA GIT-2.0) questionnaire. RESULTS The ACA+ and anti-Scl70+ groups displayed different cutaneous and faecal microbiota profiles. The classes of cutaneous Sphingobacteriia and Alphaproteobacteria, the faecal phylum Lentisphaerae, the levels of the classes Lentisphaeria and Opitutae, and the genus NA-Acidaminococcaceae were significantly higher in faecal samples from the ACA+ patients than in samples from the anti-Scl70+ patients. The cutaneous Sphingobacteria and the faecal Lentisphaerae were significantly correlated (rho = 0.42; P = 0.03). A significant increase in faecal propionic acid was observed in ACA+ patients. Moreover, all levels of faecal medium-chain FFAs and hexanoic acids were significantly higher in the ACA+ group than in the anti-Scl70+ group (P < 0.05 and P < 0.001, respectively). In the ACA+ group, the analysis of the serum FFA levels showed an increasing trend in valeric acid. CONCLUSION Different microbiota signatures and FFA profiles were found for the two groups of patients. Despite being in different body districts, the cutaneous Sphingobacteria and faecal Lentisphaerae appear interdependent.
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Affiliation(s)
- Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Davide Carboni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Scleroderma Unit, AOU Careggi, Florence, Italy
| | | | - Eloisa Romano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical Science "Mario Serio", University of Florence, Florence, Italy
| | - Irene Rosa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Leandro Di Gloria
- Department of Biomedical, Experimental and Clinical Science "Mario Serio", University of Florence, Florence, Italy
| | - Marco Pallecchi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Scleroderma Unit, AOU Careggi, Florence, Italy
- Rheumatology, University Hospital of Zürich, Zürich, Switzerland
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mirko Manetti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gian Luca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Scleroderma Unit, AOU Careggi, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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11
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Landini N, Orlandi M, Calistri L, Nardi C, Ciet P, Bellando-Randone S, Guiducci S, Benkert T, Panebianco V, Morana G, Matucci-Cerinic M, Colagrande S. Advanced and traditional chest MRI sequence for the clinical assessment of systemic sclerosis related interstitial lung disease, compared to CT: disease extent analysis and correlations with pulmonary function tests. Eur J Radiol 2024; 170:111239. [PMID: 38056347 DOI: 10.1016/j.ejrad.2023.111239] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND MRI is a radiation-free emerging alternative to CT in systemic sclerosis related interstitial lung disease (SSc-ILD) assessment. We aimed to compare a T2 radial TSE and a PD UTE MRI sequence with CT in SSc-ILD extent evaluation and correlations with pulmonary function tests (PFT). MATERIAL AND METHODS 29 SSc-ILD patients underwent CT, MRI and PFT. ILD extent was visually assessed. Lin's concordance correlation coefficients (CCC) and Kruskal Wallis test (p-value < 0.05) were computed for inter-method comparison. Patients were divided in limited and extended disease, defining extended ILD with two methods: (A) ILD>30% or 10%20% or 20% with FVC%<70%. MRI Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy were assessed. Pearson correlation coefficients r (p-value<0.025) were computed between ILD extents and PFT (FVC% and DLCO%). RESULTS Median ILD extents were 11%, 11%, 10% on CT, radial TSE and UTE, respectively. CCC between CT and MRI was 0.95 for both sequences (Kruskal-Wallis p-value=0.64). Sensitivity, Specificity, PPV, NPV and Accuracy in identifying extended disease were: (A) 87.5 %, 100 %, 100 %, 95.5 and 96.6 % with radial TSE and 87.5 %, 95.2 %, 87.5 %, 95.2 and 93.1 % with UTE; (B) 86.7 %, 86.4 %, 66.7 %, 95.0 % and 86.2 % for both sequences. Pearson r of CT, radial TSE and UTE ILD extents with FVC were -0.66, -0.60 and -0.68 with FVC, -0.59, -0.56 and -0.57 with DLCO, respectively (p<0.002). CONCLUSIONS MRI sequences may have similar accuracy to CT to determine SSc-ILD extent and severity, with analogous correlations with PFT.
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Affiliation(s)
- Nicholas Landini
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy.
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, Florence, Italy.
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC, Florence, Italy.
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC, Florence, Italy.
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC - Sophia, Rotterdam, Netherlands; Department of Radiology, Policlinico Universitario, Cagliari, Italy.
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, Florence, Italy.
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, Florence, Italy.
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany.
| | - Valeria Panebianco
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, "Sapienza" Rome University, Rome, Italy.
| | - Giovanni Morana
- Department of Radiology, S. Maria Ca' Foncello Regional Hospital, Treviso, Italy.
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy.
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence & Radiodiagnostic Unit n. 2 AOUC, Florence, Italy.
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12
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Scagnellato L, Collesei A, Doria A, Cozzi G, Lorenzin M, Atzeni F, Bugatti S, Caporali R, Cauli A, Conti F, Corrado A, Carletto A, Chimenti MS, Foti R, Frediani B, Gerli R, Gorla R, Govoni M, Gremese E, Guiducci S, Iagnocco A, Iannone F, Parisi S, Rossini M, Salaffi F, Santo L, Sarzi Puttini P, Sebastiani M, Semerano A, Ferraccioli G, Lapadula G, Ramonda R. Comorbidities in the Spondyloarthritis GISEA Cohort: an average treatment effect analysis on patients treated with bDMARDs. Clin Exp Rheumatol 2024; 42:104-114. [PMID: 37650298 DOI: 10.55563/clinexprheumatol/q38lu0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES We aimed to investigate the effectiveness of tumour necrosis factor inhibitors (TNFi), anti-interleukin-17 or interleukin-12/23 monoclonal antibodies (anti-IL) on comorbidities in a cohort of patients with spondyloarthritis (SpA), using an average treatment effect (ATE) analysis. METHODS SpA patients from the multicentre Italian GISEA Registry were divided into groups according to pharmacological exposure: no treatment (G0), TNFi (G1) and non-responders to TNFi switched to anti-IL (G2). In each group, we recorded the prevalence and incidence of infectious, cardiopulmonary, endocrinological, gastrointestinal, oncologic, renal and neurologic comorbidities. Each comorbidity was then fitted for ATE and baseline features were evaluated for importance. RESULTS The main findings of this study comprising 4458 SpA patients relate to cancer, other gastrointestinal diseases (OGID) and fibromyalgia. ATE showed no increased risk of solid cancer in G1 (0.42 95% CI 0.20-0.85) and G2 (0.26 95% CI 0.08-0.71) vs. G0, with significantly higher incidence in G0 (14.07/1000 patient-years, p=0.0001). Conversely, a significantly higher risk of OGID and fibromyalgia was found in G1 (1.56 95% CI 1.06-2.33; 1.69 95% CI 1.05-2.68, respectively) and G2 (1.91 95% CI 1.05-3.24; 2.13 95% CI 1.14-3.41, respectively) vs. G0. No treatment risk reduction was observed in haematological malignancies, cardiovascular events and endocrinological comorbidities. CONCLUSIONS Overall, our study confirms the safety of TNFi and anti-IL in SpA patients, albeit with some caveats pertaining to solid cancers, OGID and fibromyalgia. Furthermore, taking into consideration causality with observational data may yield more reliable and relevant clinical information.
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Affiliation(s)
- Laura Scagnellato
- Rheumatology Unit, Department of Medicine DIMED, University Hospital of Padova, Italy
| | - Antonio Collesei
- Cancer Genomics Core-Lab, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University Hospital of Padova, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine DIMED, University Hospital of Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine DIMED, University Hospital of Padova, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Therapeutics, University of Pavia; and Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Roberto Caporali
- Rheumatology Clinic, Department of Rheumatology and Medical Sciences, ASST G.Pini-CTO, Milan, Italy
| | - Alberto Cauli
- UOC di Reumatologia, AOU e Università di Cagliari, Monserrato, Cagliari, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Addolorata Corrado
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Antonio Carletto
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Policlinico Borgo Roma, Verona, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Rosario Foti
- Rheumatology Unit, Policlinico San Marco University Hospital of Catania, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Roberto Gorla
- Reumatologia e Immunologia Clinica, ASST- Spedali Riuniti Civili Brescia, Italy
| | - Marcello Govoni
- Reumatologia, Dipartimento di Scienze Mediche, Azienda Ospedaliera Sant'Anna, Ferrara, Italy
| | - Elisa Gremese
- Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Italy
| | - Annamaria Iagnocco
- Rheumatology Unit, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Azienda Ospedaliera Ordine Mauriziano di Torino, Italy
| | | | - Simone Parisi
- Rheumatology Unit, University Hospital Città della Salute e della Scienza di Torino, Italy
| | - Maurizio Rossini
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Policlinico Borgo Roma, Verona, Italy
| | - Fausto Salaffi
- Rheumatology Clinic, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | | | - Piercarlo Sarzi Puttini
- Rheumatology Unit, University Statale di Milano, IRCCS Galeazzi-Sant' Ambrogio, Milan, Italy
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Semerano
- Rheumatology, ASL Taranto P.O. "Valle d'Itria" Martina Franca, Taranto, Italy
| | | | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University Hospital of Padova, Italy.
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13
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Gargani L, Bruni C, Todiere G, Pugliese NR, Bandini G, Bellando-Randone S, Guiducci S, D’Angelo G, Campochiaro C, De Luca G, Stagnaro C, Lombardi M, Dagna L, Pepe A, Allanore Y, Moggi-Pignone A, Matucci-Cerinic M. Digital Ulcers and Ventricular Arrhythmias as Red Flags to Predict Replacement Myocardial Fibrosis in Systemic Sclerosis. J Clin Med 2023; 13:89. [PMID: 38202095 PMCID: PMC10779804 DOI: 10.3390/jcm13010089] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Cardiac involvement in systemic sclerosis (SSc) affects the prognosis of the disease. Echocardiography is the first line imaging tool to detect cardiac involvement, but it is not able to routinely detect myocardial fibrosis. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for replacement myocardial fibrosis assessment, but its availability is currently limited. AIM We aimed to assess the clinical and instrumental parameters that would be useful for predicting the presence of LGE-CMR, to achieve a better selection of patients with SSc that could benefit from third-level CMR imaging. METHODS 344 SSc patients underwent a comprehensive echocardiogram and LGE-CMR on the same day; for 189 patients, a 24 h ECG Holter monitoring was available. RESULTS CMR showed non-junctional replacement myocardial fibrosis via LGE in 25.1% patients. A history of digital ulcers (OR 2.188; 95% C.I. 1.069-4.481) and ventricular arrhythmias at ECG Holter monitoring (OR 3.086; 95% C.I. 1.191-7.998) were independent predictors of replacement myocardial fibrosis. CONCLUSIONS CMR can detect patterns of clinical and subclinical cardiac involvement, which are frequent in SSc. A history of digital ulcers and evidence of ventricular arrhythmias at ECG Holter monitoring are red flags for the presence of replacement myocardial fibrosis in CMR. The association between digital ulcers and myocardial fibrosis suggests that a similar pathological substrate of abnormal vascular function may underlie peripheral vascular and cardiac complications.
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Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica Specialistica, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | | | - Giulia Bandini
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Gennaro D’Angelo
- U.O.C. Risonanza Magnetica Specialistica, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Chiara Stagnaro
- Department of Rheumatology, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, Policlinico San Donato, 20097 Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35122 Padua, Italy
| | - Yannick Allanore
- French National Institute of Health and Medical Research (INSERM) U1016, Université de Paris, Hôpital Cochin, 75014 Paris, France
| | - Alberto Moggi-Pignone
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
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14
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Tani C, Cardelli C, Depascale R, Gamba A, Iaccarino L, Doria A, Bandeira M, Dinis SP, Romão VC, Gotelli E, Paolino S, Cutolo M, Di Giosaffatte N, Ferraris A, Grammatico P, Cavagna L, Codullo V, Montecucco C, Longo V, Beretta L, Cavazzana I, Fredi M, Peretti S, Guiducci S, Matucci-Cerinic M, Bombardieri S, Burmester GR, Fonseca JE, Frank C, Galetti I, Hachulla E, Müller-Ladner U, Schneider M, Smith V, Tamirou F, Van Laar JM, Vieira A, D'Urzo R, Cannizzo S, Gaglioti A, Marinello D, Talarico R, Mosca M. Long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases: The ERN-ReCONNET VACCINATE study. J Transl Autoimmun 2023; 7:100221. [PMID: 38162456 PMCID: PMC10755036 DOI: 10.1016/j.jtauto.2023.100221] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Vaccination is one of the most important measures to contain the COVID-19 pandemic, especially for frail patients. VACCINATE is a multicentre prospective observational study promoted by the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET) aimed at assessing the long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases (rcCTDs) in terms of efficacy and safety. Methods Adult rcCTDs patients were eligible for recruitment. Demographic, clinical and vaccination data were collected at enrolment. Follow-up visits were scheduled 4, 12, 24, 36 and 48 weeks after completion of the first vaccination cycle; data on adverse events, disease exacerbations and the occurrence of new SARS-CoV-2 infections were collected at these time-points. Findings 365 rcCTDs patients (87 % female, mean age 51.8 ± 14.6 years) were recruited. Overall, 200 patients (54.8 %) experienced at least one adverse event, generally mild and in most cases occurring early after the vaccination. During follow-up, 55 disease exacerbations were recorded in 39 patients (10.7 %), distributed over the entire observation period, although most frequently within 4 weeks after completion of the vaccination cycle. The incidence of new SARS-CoV-2 infections was 8.9 per 1000 person-months, with no cases within 12 weeks from vaccine administration and an increasing trend of infections moving away from the primary vaccination cycle. Only one case of severe COVID-19 was reported during the study period. Interpretation COVID-19 vaccination seems effective and safe in rcCTDs patients. The rate of new infections was rather low and serious infections were uncommon in our cohort. No increased risk of disease flares was observed compared to previous disease history; however, such exacerbations may be potentially severe, emphasising the need for close monitoring of our patients.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Roberto Depascale
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Anna Gamba
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Sara Paiva Dinis
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Emanuele Gotelli
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Niccolò Di Giosaffatte
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Alessandro Ferraris
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Paola Grammatico
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Veronica Codullo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Longo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Referral Center for Systemic Autoimmune Diseases, Milan, Italy
| | - Lorenzo Beretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Referral Center for Systemic Autoimmune Diseases, Milan, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Silvia Peretti
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | | | - Gerd R. Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - João E. Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders, Koersel, Belgium
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - 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
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology and Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Louvain, Belgium
| | - Jacob M. Van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | - Rossella D'Urzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Cannizzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Gaglioti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diana Marinello
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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15
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Ferri C, Raimondo V, Giuggioli D, Gragnani L, Lorini S, Dagna L, Bosello SL, Foti R, Riccieri V, Guiducci S, Cuomo G, Tavoni A, De Angelis R, Cacciapaglia F, Zanatta E, Cozzi F, Murdaca G, Cavazzana I, Romeo N, Codullo V, Pellegrini R, Varcasia G, De Santis M, Selmi C, Abignano G, Caminiti M, L'Andolina M, Olivo D, Lubrano E, Spinella A, Lumetti F, De Luca G, Ruscitti P, Urraro T, Visentini M, Bellando-Randone S, Visalli E, Testa D, Sciascia G, Masini F, Pellegrino G, Saccon F, Balestri E, Elia G, Ferrari SM, Tonutti A, Dall’Ara F, Pagano Mariano G, Pettiti G, Zanframundo G, Brittelli R, Aiello V, Dal Bosco Y, Foti R, Di Cola I, Scorpiniti D, Fusaro E, Ferrari T, Gigliotti P, Campochiaro C, Francioso F, Iandoli C, Caira V, Zignego AL, D'Angelo S, Franceschini F, Matucci-Cerinic M, Giacomelli R, Doria A, Santini SA, Fallahi P, Iannone F, Antonelli A. Impact of COVID-19 and vaccination campaign on 1,755 systemic sclerosis patients during first three years of pandemic. Possible risks for individuals with impaired immunoreactivity to vaccine, ongoing immunomodulating treatments, and disease-related lung involvement during the next pandemic phase. J Transl Autoimmun 2023; 7:100212. [PMID: 37854035 PMCID: PMC10580042 DOI: 10.1016/j.jtauto.2023.100212] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction The impact of COVID-19 pandemic represents a serious challenge for 'frail' patients' populations with inflammatory autoimmune systemic diseases such as systemic sclerosis (SSc). We investigated the prevalence and severity of COVID-19, as well the effects of COVID-19 vaccination campaign in a large series of SSc patients followed for the entire period (first 38 months) of pandemic. Patients and method This prospective survey study included 1755 unselected SSc patients (186 M, 1,569F; mean age 58.7 ± 13.4SD years, mean disease duration 8.8 ± 7.3SD years) recruited in part by telephone survey at 37 referral centers from February 2020 to April 2023. The following parameters were carefully evaluated: i. demographic, clinical, serological, and therapeutical features; ii. prevalence and severity of COVID-19; and iii. safety, immunogenicity, and efficacy of COVID-19 vaccines. Results The prevalence of COVID-19 recorded during the whole pandemic was significantly higher compared to Italian general population (47.3 % vs 43.3 %, p < 0.000), as well the COVID-19-related mortality (1.91 % vs 0.72 %, p < 0.001). As regards the putative prognostic factors of worse outcome, COVID-19 positive patients with SSc-related interstitial lung involvement showed significantly higher percentage of COVID-19-related hospitalization compared to those without (5.85 % vs 1.73 %; p < 0.0001), as well as of mortality rate (2.01 % vs 0.4 %; p = 0.002). Over half of patients (56.3 %) received the first two plus one booster dose of vaccine; while a fourth dose was administered to 35.6 %, and only few of them (1.99 %) had five or more doses of vaccine. Of note, an impaired seroconversion was recorded in 25.6 % of individuals after the first 2 doses of vaccine, and in 8.4 % of patients also after the booster dose. Furthermore, the absence of T-cell immunoreactivity was observed in 3/7 patients tested by QuantiFERON® SARSCoV-2 Starter Set (Qiagen). The efficacy of vaccines, evaluated by comparing the COVID-19-related death rate recorded during pre- and post-vaccination pandemic periods, revealed a quite stable outcome in SSc patients (death rate from 2.54 % to 1.76 %; p = ns), despite the significant drop of mortality observed in the Italian general population (from 2.95 % to 0.29 %; p < 0.0001). Conclusions An increased COVID-19 prevalence and mortality rate was recorded in SSc patients; moreover, the efficacy of vaccines in term of improved outcomes was less evident in SSc compared to Italian general population. This discrepancy might be explained by concomitant adverse prognostic factors: increased rate of non-responders to vaccine in SSc series, low percentage of individuals with four or more doses of vaccine, ongoing immunomodulating treatments, disease-related interstitial lung disease, and/or reduced preventive measures in the second half of pandemic. A careful monitoring of response to COVID-19 vaccines together with adequate preventive/therapeutical strategies are highly recommendable in the near course of pandemic in this frail patients' population.
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Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy
- Rheumatology Clinic ‘Madonna Dello Scoglio’ Cotronei, Crotone, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic ‘Madonna Dello Scoglio’ Cotronei, Crotone, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy
| | - Laura Gragnani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Serena Lorini
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | | | - Silvia Laura Bosello
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Rosario Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | | | - Rossella De Angelis
- Rheumatology Clinic, Department of Clinical & Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | | | | | | | - Giuseppe Murdaca
- Ospedale Policlinico S. Martino-University of Genova, Genova, Italy
| | | | | | | | | | | | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Maurizio Caminiti
- UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Massimo L'Andolina
- Rheumatology Outpatient Clinic, ASP- Vibo Valentia-Tropea Hospital, Italy
| | - Domenico Olivo
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
| | - Ennio Lubrano
- Rheumatology, Università Del Molise, Campobasso, Italy
| | - Amelia Spinella
- Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy
| | - Federica Lumetti
- Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy
| | | | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Teresa Urraro
- Rheumatology Unit, "M. Scarlato" Hospital, Scafati, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | | | - Davide Testa
- Clinical Immunology, University of Pisa, Pisa, Italy
| | | | | | | | | | - Eugenia Balestri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Francesca Dall’Ara
- Child and Adolescent Neuropsychiatric Service (UONPIA) Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Vincenzo Aiello
- Rheumatology Clinic ‘Madonna Dello Scoglio’ Cotronei, Crotone, Italy
| | | | - Roberta Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza, Torino, Italy
| | | | | | | | - Francesca Francioso
- Rheumatology Clinic, Department of Clinical & Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Carlo Iandoli
- University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Virginia Caira
- U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Italy
| | - Anna Linda Zignego
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
| | | | | | | | - Roberto Giacomelli
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Doria
- Rheumatology, University of Padova, Padova, Italy
| | - Stefano Angelo Santini
- Department of Basic, Clinical, Intensive and Perioperative Biotechnological Sciences, Catholic University School of Medicine, Rome, Italy
- Synlab Lazio, Roma, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - for the COVID-19 & ASD Italian Study Group
- Rheumatology Unit, University of Modena & RE., School of Medicine, Modena, Italy
- Rheumatology Clinic ‘Madonna Dello Scoglio’ Cotronei, Crotone, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence, Center for Research and Innovation CRIA-MASVE, AOU Careggi, Florence, Italy
- Department of Ospedale S. Raffaele, Milano, Italy
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- AOU Policlinico Vittorio Emanuele, Catania, Italy
- Rheumatology, Sapienza-University of Rome, Roma, Italy
- Rheumatology, University of Florence, Italy
- University of Campania, Luigi Vanvitelli, Napoli, Italy
- Clinical Immunology, University of Pisa, Pisa, Italy
- Rheumatology Clinic, Department of Clinical & Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- UO Reumatologia - DETO, Università di Bari, Bari, Italy
- Rheumatology, University of Padova, Padova, Italy
- Ospedale "Villa Salus", Mestre, Italy
- Ospedale Policlinico S. Martino-University of Genova, Genova, Italy
- Rheumatology, Spedali Civili di Brescia, Brescia, Italy
- ASO S. Croce e Carle, Cuneo, Italy
- Rheumatology, Policlinico San Matteo, Pavia, Italy
- U.O.C. Medicina Interna 'M.Valentini" P.O, Annunziata, Cosenza, Italy
- U.O.S. Reumatologia, Ospedale Castrovillari, Cosenza, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- AOR San Carlo di Potenza, Potenza, Italy
- UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Rheumatology Outpatient Clinic, ASP- Vibo Valentia-Tropea Hospital, Italy
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
- Rheumatology, Università Del Molise, Campobasso, Italy
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Rheumatology Unit, "M. Scarlato" Hospital, Scafati, Italy
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
- Child and Adolescent Neuropsychiatric Service (UONPIA) Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Rheumatology Unit, Azienda Ospedaliero Universitaria Città Della Salute e Della Scienza, Torino, Italy
- U.O.T. Specialistica Ambulatoriale ASP 201, Cosenza, Italy
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Basic, Clinical, Intensive and Perioperative Biotechnological Sciences, Catholic University School of Medicine, Rome, Italy
- Synlab Lazio, Roma, Italy
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Lepri G, Airò P, Distler O, Andréasson K, Braun-Moscovici Y, Hachulla E, Balbir-Gurman A, De Langhe E, Rednic S, Ingegnoli F, Rosato E, Groseanu L, Ionescu R, Bellando-Randone S, Garzanova L, Beretta L, Bellocchi C, Moiseev S, Novikov P, Szabo I, Krasowska D, Codullo V, Walker UA, Manolaraki C, Guiducci S, Truchetet ME, Iannone F, Tofani L, Bruni C, Smith V, Cuomo G, Krusche M, Matucci-Cerinic M, Allanore Y. Systemic sclerosis and primary biliary cholangitis: Longitudinal data to determine the outcomes. J Scleroderma Relat Disord 2023; 8:210-220. [PMID: 37744053 PMCID: PMC10515998 DOI: 10.1177/23971983231155948] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 09/26/2023]
Abstract
Background Several studies described the cross-sectional characteristics of systemic sclerosis patients and coexisting primary biliary cholangitis, but longitudinal prognostic data are lacking. Aims To describe the systemic sclerosis-primary biliary cholangitis phenotype, including baseline characteristics and outcomes. Methods We performed a multicentre the European Scleroderma Trials and Research Group study of systemic sclerosis patients with primary biliary cholangitis or with primary biliary cholangitis-specific antibodies, matched with systemic sclerosis controls free from hepatobiliary involvement matched for disease duration and cutaneous subset. Data were recorded at baseline and at the last available visit. Results A total of 261 patients were enrolled (115 primary biliary cholangitis-systemic sclerosis, 161 systemic sclerosis). At baseline, systemic sclerosis-primary biliary cholangitis patients had a higher prevalence of anti-centromere antibodies (p = 0.0023) and a lower prevalence of complete absence of digital ulcers. The milder vascular involvement was confirmed at follow-up when crucial differences emerged in the percentage of patients experiencing digital ulcers; a significantly higher number of patients who never experienced digital ulcers were observed among primary biliary cholangitis-systemic sclerosis patients (p = 0.0015). Moreover, a greater incidence of pulmonary arterial hypertension (p < 0.001) and of conduction blocks (p = 0.0256) was observed in systemic sclerosis patients without primary biliary cholangitis. Patients with primary biliary cholangitis had higher levels of liver enzymes at baseline than systemic sclerosis patients; a significant decrease in liver enzymes was observed at follow-up. Out of 18 patients with cholangitis, one received a liver transplant at follow-up. Conclusion Our data show that systemic sclerosis-primary biliary cholangitis exhibit a mild systemic sclerosis and primary biliary cholangitis phenotype with outcomes being in general favourable.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yolanda Braun-Moscovici
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, Lille, France
| | - Alexandra Balbir-Gurman
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ellen De Langhe
- ERN ReCONNET, Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Francesca Ingegnoli
- Clinical Rheumatology Unit, ASST Pini-CTO, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Groseanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Ionescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Liudmila Garzanova
- Laboratory of Microcirculation and Inflammation, VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Lorenzo Beretta
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Chiara Bellocchi
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Iulia Szabo
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | | | - Ulrich A. Walker
- Department of Rheumatology, Universitätsspital Basel, Basel, Switzerland
| | | | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit – DETO, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital and Department of Internal Medicine, Ghent University, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Giovanna Cuomo
- Department of Precision of Medicine, University of Campania – L. Vanvitelli, Naples, Italy
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Yannick Allanore
- Rheumatology, Cochin Hospital, APHP, Paris Cité University, Paris, France
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Iagnocco A, Ciccia F, Conti F, D'Angelo S, Epis OM, Govoni M, Guiducci S, Iannone F, Mosca M, Salaffi F, Sebastiani GD, Sonnati M, Caporali RF. Adherence to therapy in people with rheumatic and musculoskeletal diseases in Italy and the role of the digital health: results of an expert Delphi consensus survey. Clin Exp Rheumatol 2023; 41:1917-1925. [PMID: 37382465 DOI: 10.55563/clinexprheumatol/uip1u1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To present the results of a Delphi consensus survey among Italian rheumatologists on adherence to therapy in people with rheumatic and musculoskeletal diseases (RMDs) in Italy and the role of digital health. METHODS A taskforce of 12 rheumatologists comprehensively discussed the applicability of the 2020 EULAR Points to Consider (PtCs) for Italian rheumatology practice and formulated 44 new country-specific statements. Through an on-line survey, the panellists voted on their level of agreement with the statements using a 10-point Likert scale (0: no agreement; 10: total agreement). A combination of two distinct criteria, a mean agreement level ≥8 and a percentage of at least 75% of responses with a value ≥8, was deemed acceptable. RESULTS The consensus threshold was reached for 43 of the 44 country-specific statements. The following were acknowledged among the barriers to applicability of the recommendations: visit time too short; lack of resources; lack of a clear operational flow-chart; lack of communication skills and poor knowledge of techniques to improve patient adherence by healthcare professionals (HCPs). CONCLUSIONS This consensus initiative helps contribute to more widespread implementation of EULAR PtCs in Italian rheumatology practice. Optimisation of visit time, greater availability of resources, specific training, use of standardised and validated protocols, and active involvement of patients represent the main goals. Digital health can provide valuable support for the application of PtCs and, more generally, in improving adherence. A collaborative effort between HCPs, patients and their associations, scientific societies, and policymakers is strongly advocated to overcome some of the barriers.
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Affiliation(s)
- Annamaria Iagnocco
- Academic Rheumatology Centre, AO Mauriziano Torino, and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Italy.
| | - Francesco Ciccia
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabrizio Conti
- Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | | | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | - Marta Mosca
- Department of Rheumatology, University of Pisa, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Roberto Felice Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Italy
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Benucci M, Bardelli M, Cazzato M, Laurino E, Bartoli F, Damiani A, Li Gobbi F, Panaccione A, Di Cato L, Niccoli L, Frediani B, Mosca M, Guiducci S, Cantini F. ReLiFiRa (Real Life Filgotinib in Rheumatoid Arthritis): Retrospective Study of Efficacy and Safety in Common Clinical Practice. J Pers Med 2023; 13:1303. [PMID: 37763071 PMCID: PMC10532886 DOI: 10.3390/jpm13091303] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Filgotinib (FIL) is a selective JAK1 inhibitor with an affinity 30-fold higher than JAK2, approved to treat moderate to severe active rheumatoid arthritis (RA), in adults with inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). METHODS We conducted a retrospective, multicentric study in order to evaluate efficacy and safety of FIL 200 mg daily therapy, after 3 and 6 months, in 120 patients affected by RA, managed in Tuscany and Umbria rheumatological centers. The following clinical records were analyzed: demographical data, smoking status, previous presence of comorbidities (Herpes zoster -HZ- infection, venous thromboembolism -VTE-, major adverse cardiovascular events -MACE-, cancer, diabetes, and hypertension), disease duration, presence of anti-citrullinated protein antibodies (ACPA), rheumatoid factor (RF), number of biological failures, and prior csDMARDs utilized. At baseline, and after 3 (T3) and 6 (T6) months of FIL therapy, we evaluated mean steroid dosage, csDMARDs intake, clinimetric indexes (DAS28, CDAI, HAQ, patient and doctor PGA, VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and body mass index (BMI). RESULTS At baseline, the mean disease duration was 9.4 ± 7.5 years; the prevalence of previous HZ infection, VTE, MACE, and cancer was respectively 4.12%, 0%, 7.21%, and 0.83%, respectively. In total, 76.3% of patients failed one or more biologics (one biological failure, 20.6%; two biological failures, 27.8%; three biological failures, 16.5%; four biological failures, 10.3%; five biological failures, 1.1%). After 3 months of FIL therapy, all clinimetric index results significantly improved from baseline, as well as after 6 months. Also, ESR and CRP significatively decreased at T3 and T6. Two cases of HZ were recorded, while no new MACE, VTE, or cancer were recorded during the observation time. CONCLUSION Despite the limitations of the retrospective study and of the observational period of only 6 months, real-life data on the treatment of RA patients with FIL demonstrate that this Jak inhibitor therapy is safe in terms of CV, VTE events, and occurrence of cancer, and is also effective in a population identified as "difficult to treat" due to failure of previous b-DMARD therapy.
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Affiliation(s)
- Maurizio Benucci
- Rheumatology Unit, San Giovanni di Dio Hospital, 50143 Florence, Italy;
| | - Marco Bardelli
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (M.B.); (B.F.)
| | - Massimiliano Cazzato
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy; (M.C.); (E.L.); (M.M.)
| | - Elenia Laurino
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy; (M.C.); (E.L.); (M.M.)
| | - Francesca Bartoli
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (F.B.); (A.D.); (S.G.)
| | - Arianna Damiani
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (F.B.); (A.D.); (S.G.)
| | | | - Anna Panaccione
- Internal Medicine and Rheumatology Unit, Santa Maria General Hospital, 05100 Terni, Italy; (A.P.); (L.D.C.)
| | - Luca Di Cato
- Internal Medicine and Rheumatology Unit, Santa Maria General Hospital, 05100 Terni, Italy; (A.P.); (L.D.C.)
| | - Laura Niccoli
- Division of Rheumatology, Prato Hospital, 59100 Prato, Italy; (L.N.); (F.C.)
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (M.B.); (B.F.)
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy; (M.C.); (E.L.); (M.M.)
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (F.B.); (A.D.); (S.G.)
| | - Fabrizio Cantini
- Division of Rheumatology, Prato Hospital, 59100 Prato, Italy; (L.N.); (F.C.)
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Benucci M, Gobbi FL, Fusi P, Damiani A, Russo E, Guiducci S, Manfredi M, Grossi V, Infantino M, Amedei A. Different Biomarkers of Response to Treatment with Selective Jak-1 Inhibitors in Rheumatoid Arthritis. FRONT BIOSCI-LANDMRK 2023; 28:176. [PMID: 37664943 DOI: 10.31083/j.fbl2808176] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes progressive joint damage. The Janus kinase (JAK) inhibitors (JAK-I) represent a new therapeutic option for RA patients, blocking the intracellular JAK-STAT pathway. Today, no studies have been conducted to determine whether new biomarkers could better reflect disease activity in patients treated with JAK-I than traditional disease activity indicators. Thus, the aim of our study was to determine additional disease activity biomarkers in RA patients receiving selective JAK-1 inhibitors. METHODS we enrolled 57 patients with RA: 34 patients were treated with Upadacitinib (UPA) and 23 patients with Filgotinib (FIL). All patients were evaluated for clinimetry with DAS28 and Crohn's Disease Activity Index (CDAI), number of tender and swollen joints, Visual Analogic Scale (VAS), Physician Global Assessment (PhGA), and Health Assessment Questionnaire (HAQ), at baseline and at the 12th week of treatment. Lymphocyte subpopulations, complete blood count, erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), anti-cyclic citrullinated peptide antibodies (APCA), rheumatoid factor (RF) IgM, interleukin 6 (IL-6), circulating calprotectin (cCLP), tumor necrosis factor α (TNFα), soluble urokinase Plasminogen Activator Receptor (suPAR), complement functional activity were measured at baseline and after the 12th week of treatment. RESULTS in both groups of patients, we documented a significant reduction in the clinimetric parameters DAS28, CDAI, number of tender joints, number of swollen joints, VAS, PhGA, and HAQ. Moreover, significant differences were reported for laboratory parameters of ESR, CRP, IL-6, suPAR, cCLP, and PLT/L ratio in both groups. However, no difference was demonstrated between the two groups for changes in renal, hepatic, and lipid parameters. CONCLUSIONS the suPAR and cCLP levels may lead towards a different therapeutic choice between UPA and FIL, with the expression of two different RA pathophenotypes directing FIL towards a lymphocyte-poor form and UPA towards a myeloid form of RA.
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Affiliation(s)
- Maurizio Benucci
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50068 Florence, Italy
| | - Francesca Li Gobbi
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50068 Florence, Italy
| | - Paola Fusi
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50068 Florence, Italy
| | - Arianna Damiani
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, 50068 Florence, Italy
| | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, 50068 Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, 50068 Florence, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy
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Lepri G, Orlandi M, Bellando-Randone S, Matucci-Cerinic M, Guiducci S. The COVID-19 pandemic highlights the need for a psychological support in systemic sclerosis patients. Clin Exp Rheumatol 2023:20164. [PMID: 37497726 DOI: 10.55563/clinexprheumatol/hgkk7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, Section of Rheumatology, AOU Careggi, Florence, Italy.
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, Section of Rheumatology, AOU Careggi, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Section of Rheumatology, AOU Careggi, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Section of Rheumatology, AOU Careggi, Florence, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Section of Rheumatology, AOU Careggi, Florence, Italy
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21
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Gaggiano C, Del Bianco A, Sota J, Gentileschi S, Ruscitti P, Giacomelli R, Piga M, Crisafulli F, Monti S, Emmi G, De Paulis A, Vitale A, Tarsia M, Caggiano V, Nuzzolese R, Parretti V, Fabiani C, Lopalco G, Maier A, Cattalini M, Rigante D, Govoni M, Li Gobbi F, Guiducci S, Parronchi P, Marino A, Ciccia F, Maggio MC, Aragona E, Bartoloni E, Iagnocco A, Viapiana O, Sebastiani GD, Guerriero S, Insalaco A, Del Giudice E, Conti G, Barone P, Olivieri AN, Brucato A, Carubbi F, Triggianese P, Mauro A, Tosi GM, Fonollosa A, Giardini HAM, Ragab G, Tharwat S, Hernández-Rodríguez J, Sfikakis PP, Laskari K, Karamanakos A, Espinosa G, Shahram F, Direskeneli H, Hinojosa-Azaola A, Opris-Belinski D, AlMaghlouth IA, Hatemi G, Eksin MA, Önen F, Więsik-Szewczyk E, Akkoç N, Tufan A, Şahin A, Erten Ş, Ozen S, Batu ED, Frediani B, Balistreri A, Cantarini L. A patient-driven registry on Behçet's disease: the AIDA for patients pilot project. Front Med (Lausanne) 2023; 10:1188021. [PMID: 37396916 PMCID: PMC10313381 DOI: 10.3389/fmed.2023.1188021] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction This paper describes the creation and preliminary results of a patient-driven registry for the collection of patient-reported outcomes (PROs) and patient-reported experiences (PREs) in Behçet's disease (BD). Methods The project was coordinated by the University of Siena and the Italian patient advocacy organization SIMBA (Associazione Italiana Sindrome e Malattia di Behçet), in the context of the AIDA (AutoInflammatory Diseases Alliance) Network programme. Quality of life, fatigue, socioeconomic impact of the disease and therapeutic adherence were selected as core domains to include in the registry. Results Respondents were reached via SIMBA communication channels in 167 cases (83.5%) and the AIDA Network affiliated clinical centers in 33 cases (16.5%). The median value of the Behçet's Disease Quality of Life (BDQoL) score was 14 (IQR 11, range 0-30), indicating a medium quality of life, and the median Global Fatigue Index (GFI) was 38.7 (IQR 10.9, range 1-50), expressing a significant level of fatigue. The mean Beliefs about Medicines Questionnaire (BMQ) necessity-concern differential was 0.9 ± 1.1 (range - 1.8-4), showing that the registry participants prioritized necessity belief over concerns to a limited extent. As for the socioeconomic impact of BD, in 104 out of 187 cases (55.6%), patients had to pay from their own pocket for medical exams required to reach the diagnosis. The low family socioeconomic status (p < 0.001), the presence of any major organ involvement (p < 0.031), the presence of gastro-intestinal (p < 0.001), neurological (p = 0.012) and musculoskeletal (p = 0.022) symptoms, recurrent fever (p = 0.002), and headache (p < 0.001) were associated to a higher number of accesses to the healthcare system. Multiple linear regression showed that the BDQoL score could significantly predict the global socioeconomic impact of BD (F = 14.519, OR 1.162 [CI 0.557-1.766], p < 0.001). Discussion Preliminary results from the AIDA for Patients BD registry were consistent with data available in the literature, confirming that PROs and PREs could be easily provided by the patient remotely to integrate physician-driven registries with complementary and reliable information.
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Affiliation(s)
- Carla Gaggiano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | | | - Jurgen Sota
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Roberto Giacomelli
- Rheumatology and Immunology Unit, Department of Medicine, University of Rome “Campus Biomedico”, Rome, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia and Spedali Civili [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Sara Monti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC, Australia
| | - Amato De Paulis
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Maria Tarsia
- Clinical Paediatrics, Department of Molecular Medicine and Development, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Valeria Caggiano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Rossana Nuzzolese
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Veronica Parretti
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Armin Maier
- Rheumatology Unit, Department of Medicine, Central Hospital of Bolzano, Bolzano, Italy
| | - Marco Cattalini
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Brescia, Italy
| | - Donato Rigante
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Rare Diseases and Periodic Fevers Research Centre, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Ferrara, Italy
| | - Francesca Li Gobbi
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cellular Therapies Unit, University Hospital Careggi, Florence, Italy
| | - Achille Marino
- Unit of Pediatric Rheumatology, Azienda Socio-Sanitaria Territoriale (ASST) Gaetano Pini-Centro Specialistico Ortopedico Traumatologico (CTO), Milan, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Cristina Maggio
- University Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Emma Aragona
- Division of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Center, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | | | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Antonella Insalaco
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Rome, Italy
| | - Emanuela Del Giudice
- Pediatric and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Latina, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliero Universitaria (AOU) G Martino, Messina, Italy
| | - Patrizia Barone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alma Nunzia Olivieri
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences and Internal Medicine and Nephrology Unit, Department of Medicine, University of L’Aquila and ASL Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, L’Aquila, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Angela Mauro
- Pediatric Rheumatology Unit, Department of Childhood and Developmental Medicine, Fatebenefratelli-Sacco Hospital, Milan, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
- Faculty of Medicine, New Giza University, Giza, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University, Mansoura, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain
| | - Petros P. Sfikakis
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Laskari
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gerard Espinosa
- Department of Autoimmune Diseases, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain
| | - Farhad Shahram
- Behcet’s Disease Unit, Rheumatology Research Center, Shariati Hospital Tehran University of Medical Sciences, Tehran, Iran
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Andrea Hinojosa-Azaola
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Daniela Opris-Belinski
- Rheumatology and Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ibrahim A. AlMaghlouth
- Rheumatology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- College of Medicine Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gülen Hatemi
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
- Behçet’s Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Fatos Önen
- Department of Internal Medicine Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Nurullah Akkoç
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine Gazi University, Ankara, Turkey
| | - Ali Şahin
- Division of Rheumatology, Department of Internal Medicine, Sivas Cumhuriyet University Medical Faculty, Sivas, Turkey
| | - Şükran Erten
- Rheumatology Clinic, Ankara City Hospital, Ankara, Turkey
| | - Seza Ozen
- Pediatric Rheumatology Unit, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Pediatric Rheumatology Unit, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Alberto Balistreri
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy
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22
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Salaffi F, Di Carlo M, Farah S, Di Franco M, Bazzichi L, Bianchi G, Tirri R, Atzeni F, Guiducci S, Guggino G, Gorla R, Fischetti F, Mozzani F, Biasi G, Gremese E, Dagna L, Govoni M, Giacomelli R, Gerli R, Iannone F, Cutolo M, Wolfe F, Sarzi-Puttini P. The measurement of fibromyalgia severity: converting scores between the FIQR, the PSD and the FASmod. Clin Exp Rheumatol 2023; 41:1225-1229. [PMID: 36067219 DOI: 10.55563/clinexprheumatol/31gsnd] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The revised Fibromyalgia Impact Questionnaire (FIQR) is a widely used fibromyalgia severity assessment tool that was introduced in 2009 prior to the publication of the American College of Rheumatology (ACR) preliminary fibromyalgia criteria in 2010 and its revision in 2016. In 2020, the modified Fibromyalgia Assessment Scale (FASmod) was published. The Polysymptomatic Distress scale (PSD) of the fibromyalgia criteria and FASmod include assessments of pain location severity and can be used for diagnosis as well as in non-fibromyalgia patients. The aim of this study is to provide equations for the conversion of the FIQR scores to PSD and FASmod as an aid to understanding and sharing fibromyalgia severity information. METHODS 3089 patients with fibromyalgia, diagnosed according to the ACR 2010/2011 criteria and belonging to the Italian Fibromyalgia Registry completed FIQR, FASmod and PSD questionnaires. Pearson's correlation coefficient was used to test the correlations between indices. The least square regression approach was used to produce predictive equations for each scale based on the remaining scales. RESULTS FIQR was correlated with PSD (r=0.714) and FASmod (r=0.801); PSD and FASmod showed the highest correlation (r=0.897), expected since they assess the same constructs. Predictive equations showing a linear model were effective in producing mean cohort values, but individual predictions deviated substantially, precluding prediction in the individual patient. CONCLUSIONS Conversion equations that allow for interconversion of multiple scales fibromyalgia severity assessment scales are produced. These can be useful in obtaining mean values for cohorts but are not accurate enough for use in individual patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi, Ancona, Italy.
| | - Sonia Farah
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Manuela Di Franco
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | | | - Gerolamo Bianchi
- Department of Medical Specialties, Division of Rheumatology Asl 3, Genova, Italy
| | - Rosella Tirri
- Rheumatology Unit, Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
| | - Giuliana Guggino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Fabio Fischetti
- Department of Medical Sciences, University of Trieste, UCO Medicina Clinica (SSD Reumatologia), Trieste, Italy
| | - Flavio Mozzani
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Giovanni Biasi
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria Senese and University of Siena, Italy
| | - Elisa Gremese
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute & Vita-Salute San Raffaele University, Milan, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genova, IRCCS San Martino Polyclinic, Genova, Italy
| | - Frederick Wolfe
- National Data Bank for Rheumatic Diseases Wichita, Kansas, USA
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23
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Di Battista M, Lepri G, Codullo V, Da Rio M, Fiorentini E, Della Rossa A, Guiducci S. Systemic sclerosis: one year in review 2023. Clin Exp Rheumatol 2023:19876. [PMID: 37199215 DOI: 10.55563/clinexprheumatol/ki76s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
Systemic sclerosis is a rare and chronic connective tissue disease resulting from an intricate pathogenesis and which is expressed in very heterogeneous clinical manifestations. Several studies try every year to unravel and shed a novel insight into the pathogenesis, organ involvement and treatment of this complex and severe disease. We herein provide an overview of the most relevant studies published in the literature in 2022.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Veronica Codullo
- Rheumatology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mattia Da Rio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elisa Fiorentini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
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Carrasco-Vega E, Martínez-Moya M, Barni L, Guiducci S, Nacci F, Gonzalez-Sanchez M. Questionnaires for the subjective evaluation of patients with fibromyalgia: a systematic review. Eur J Phys Rehabil Med 2023:S1973-9087.23.07762-6. [PMID: 37184415 DOI: 10.23736/s1973-9087.23.07762-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION The objective of this study was to identify and review the subjective assessment tools validated in patients with fibromyalgia, identifying their most significant structural characteristics, as well as the psychometric characteristics analyzed in each of the identified instruments. EVIDENCE ACQUISITION This systematic review was registered in PROSPERO with the following reference: CRD42022306878. It analyzed documents published until June 30, 2022, through the Medline, Pedro and Scopus, Dialnet, Cinahl and Latin Index databases. The keywords used were: 1) fibromyalgia; 2) assessment; 3) questionnaire; 4) reliability; 5) validity; 6) scale; and 7) validation study. Combined using the Boolean operators "AND" and "OR." The included articles were analyzed to extract: data on the structural characteristics of the questionnaires (including acronym, year of publication, number of items, sub-categories, time to complete the questionnaire, measurement range, cutoff score and cost) and psychometric characteristics of the selected questionnaires, including data on reliability (Cronbach's alpha and test-retest) and data on the validity of the questionnaires (content, construct and criterion validity). EVIDENCE SYNTHESIS Twenty-two studies containing 16 questionnaires were analyzed. The quality and risk of bias assessment was performed following the COSMIN checklist. In general, the quality of the subjective assessment studies validated in the population with fibromyalgia was good, with the exception of 5 studies, which did not exceed 5 points out of 10. The first questionnaire analyzed was published in 1991, and the last in 2020; the number of items ranged from 3 to 60. The most measured subcategories are function, overall impact and symptoms; other studies also include sleep and cognition disturbances. Only 6 studies described the time to complete them. The most analyzed psychometric characteristics were reliability (analyzed by 13 questionnaires), validity (analyzed by 7) and error measures (provided by only 3 of them). CONCLUSIONS There is a wide range of questionnaires specifically designed for patients with fibromyalgia that present good and/or excellent basic psychometric characteristics. The structural characteristics of the identified instruments were very heterogeneous, which makes it possible to select those that best adapt to the clinical/investigator scenario where the tool will be used.
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Affiliation(s)
- Elio Carrasco-Vega
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Marta Martínez-Moya
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Luca Barni
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain -
- Terme Redi, Montecatini Terme, Pistoia, Italy
| | - Serena Guiducci
- Divisions of Internal Medicine and Rheumatology AOUC Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Nacci
- Divisions of Internal Medicine and Rheumatology AOUC Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuel Gonzalez-Sanchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Salaffi F, Di Carlo M, Di Franco M, Bianchi G, Bazzichi L, Tirri R, Guiducci S, Gorla R, Atzeni F, Giacomelli R, Di Donato E, Guggino G, Fischetti F, Tirri E, Biasi G, Foti R, Dagna L, Carubbi F, Gremese E, Govoni M, Cutolo M, Iannone F, Lippolis I, Conti F, Tramontano G, Marino V, Farah S, Sarzi-Puttini P. Determining the PASS cut-off points for the FIQR, FASmod and PSD in patients with fibromyalgia: a registry-based study. Clin Exp Rheumatol 2023:19514. [PMID: 37140611 DOI: 10.55563/clinexprheumatol/on8j9a] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/09/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To determine the cut-off values of Patient Acceptable Symptom State (PASS) for the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Scale (FASmod), and the Polysymptomatic Distress scale (PSD) and to determine the predictors of PASS in patients with fibromyalgia (FM). METHODS FM patients belonging to the Italian Fibromyalgia Registry (IFR) completed the FIQR, the FASmod and the PSD. The PASS was assessed using a dichotomous answer. The cut-off values were obtained through the receiver operating characteristic curve (ROC) analyses. A multivariate logistic regression analysis was performed to determine predictors of achieving the PASS. RESULTS 5545 women (93.7%) and 369 males (6.3%) were included in the study. The 27.8% of patients reported an acceptable symptom state. Patients in PASS differed in all patient-reported outcome measures (p <0.001). The FIQR PASS threshold was ≤58 (area under the ROC curve [AUC] = 0.819). The FASmod PASS threshold was ≤23 (AUC = 0.805) and the PSD PASS threshold was ≤16 (AUC = 0.773). In the pairwise AUC comparison, the discriminatory power of the FIQR PASS outperforms both FASmod PASS (p = 0.0124) and PSD PASS (p <0.0001). Multivariate logistic analysis showed that FIQR items related to memory and pain were the only predictors of PASS. CONCLUSIONS The FIQR, FASmod, and PSD PASS cut-off points for FM patients have never been determined before. This study provides additional information to facilitate interpretation of the severity assessment scales in daily practice and clinical research related to FM patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy.
| | - Manuela Di Franco
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Gerolamo Bianchi
- Department of Medical Specialties, Division of Rheumatology Asl 3, Genova, Italy
| | | | - Rosella Tirri
- Rheumatology Unit, Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Giuliana Guggino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Fabio Fischetti
- Department of Medical Sciences, University of Trieste, UCO Medicina Clinica (SSD Reumatologia), Trieste, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - Giovanni Biasi
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria Senese and University of Siena, Italy
| | - Rosario Foti
- Rheumatology Unit, AOU Policlinico San Marco, Catania, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute & Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Carubbi
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Elisa Gremese
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genova, IRCCS San Martino Polyclinic, Genova, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica- DiMePRe-J, University of Bari, Italy
| | - Irma Lippolis
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Fabrizio Conti
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | | | - Valentina Marino
- Rheumatology Unit, Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Sonia Farah
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, ASST, Milan State University School of Medicine, Milan, Italy
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Damiani A, Bartoli F, Pacini G, Carboni D, Bellando Randone S, Fiori G, Matucci-Cerinic M, Guiducci S. Persistence of remission after lengthening of golimumab in inflammatory joint diseases. Clin Exp Rheumatol 2023; 41:1088-1095. [PMID: 36622116 DOI: 10.55563/clinexprheumatol/k76z51] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/02/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In refractory inflammatory joint diseases (IJDs) biological disease-modifying anti-rheumatic drugs (bDMARDs) may achieve remission. EULAR recommends bDMARD tapering when remission persists. However, guidelines on tapering modalities and criteria for patient selection are lacking. We aimed to evaluate remission persistency after lengthening the time between injections of golimumab in patients affected by IJD and to identify any patient or disease characteristics associated to flare after lengthening. METHODS Patients affected by rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and juvenile idiopathic arthritis (JIA) treated with golimumab were enrolled in a retrospective observational study. Demographic data, ESR, cRP, DAS28/ BASDAI, were collected at baseline and during the follow-up (T1- defined as a medical check-up after 1 year of treatment or, for patients with longerg exposure, the first medical check-up in 2016, when at our unit we began to experience drug tapering- and T2- 12 months after the lengthening was started). In 22/80 patients in remission at T1, injection time was lengthened. RESULTS Eighty patients were enrolled, 34 AS, 33 PsA, 9RA and 4 JIA. At baseline, all had an active disease. At T1, 60/80 patients reached remission and 22/60 patients started tapering. At T2, 20/22 pts (91%) were in remission. At T1 BASDAI was higher (2.2, SD 0.28 vs. 0.58, SD 0.47; p<0.001) in patients who lost remission at T2.Patients who flared recovered remission once taken back to a 28-day interval. 4/38 patients maintained at the standard dose flared up and switched/swapped bDMARD. The difference in retention rate toward patients on reduced dose was not significant. CONCLUSIONS Results show that golimumab lengthening is safe and successfully maintains remission. In patients who experienced a flare after lengthening, the standard regimen promptly restored remission.
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Affiliation(s)
- Arianna Damiani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Francesca Bartoli
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Giovanni Pacini
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Davide Carboni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Silvia Bellando Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Ginevra Fiori
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
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Manfredi M, Van Hoovels L, Benucci M, De Luca R, Coccia C, Bernardini P, Russo E, Amedei A, Guiducci S, Grossi V, Bossuyt X, Perricone C, Infantino M. Soluble Urokinase Plasminogen Activator Receptor (suPAR) in Autoimmune Rheumatic and Non Rheumatic Diseases. J Pers Med 2023; 13:jpm13040688. [PMID: 37109074 PMCID: PMC10140982 DOI: 10.3390/jpm13040688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
The soluble urokinase plasminogen activator receptor (suPAR) is the bioactive form of uPAR, a membrane-bound glycoprotein, and it is primarily expressed on the surface of immunologically active cells. Mirroring local inflammation and immune activation, suPAR has gained interest as a potential prognostic biomarker in several inflammatory diseases. Indeed, in many diseases, including cancer, diabetes, cardiovascular diseases, kidney diseases, and inflammatory disorders, higher suPAR concentrations have been associated with disease severity, disease relapse, and mortality. Our review describes and discusses the supporting literature concerning the promising role of suPAR as a biomarker in different autoimmune rheumatic and non-rheumatic diseases.
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Affiliation(s)
- Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, 50143 Florence, Italy
| | - Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, University of Leuven, 3000 Leuven, Belgium
- Department of Laboratory Medicine, OLV Hospital, 9300 Aalst, Belgium
| | - Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, 50143 Florence, Italy
| | - Riccardo De Luca
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Carmela Coccia
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Pamela Bernardini
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Edda Russo
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, 50143 Florence, Italy
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, University of Leuven, 3000 Leuven, Belgium
- Department of Laboratory Medicine, University Hospital Leuven, 3000 Leuven, Belgium
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, 06122 Perugia, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, 50143 Florence, Italy
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28
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Benucci M, Bernardini P, Coccia C, De Luca R, Levani J, Economou A, Damiani A, Russo E, Amedei A, Guiducci S, Bartoloni E, Manfredi M, Grossi V, Infantino M, Perricone C. JAK inhibitors and autoimmune rheumatic diseases. Autoimmun Rev 2023; 22:103276. [PMID: 36649877 DOI: 10.1016/j.autrev.2023.103276] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
The four Janus kinase (JAK) proteins and the seven Signal Transducers of Activated Transcription (STAT) mediate intracellular signal transduction downstream of cytokine receptors, which are involved in the pathology of allergic, autoimmune, and inflammatory diseases. The development of targeted small-molecule treatments with diverse selective inhibitory profiles, such as JAK inhibitors (JAKi), has supported an important change in the treatment of multiple disorders. Indeed, JAKi inhibit intracellular signalling controlled by numerous cytokines implicated in the disease process of rheumatoid arthritis and several other inflammatory and immune diseases. Therefore, JAKi have the capacity to target multiple pathways of those diseases. Other autoimmune diseases treated with JAKi include systemic sclerosis, systemic lupus erythematosus, dermatomyositis, primary Sjogren's syndrome, and vasculitis. In all of these cases, innate immunity stimulation activates adaptive immunity, resulting in the production of autoreactive T cells as well as the stimulation and differentiation of B cells. Mechanism-based treatments that target JAK-STAT pathways have the possibility of improving outcomes by reducing the consumption of glucocorticoids and/or non-specific immunosuppressive drugs in the management of systemic immune-mediated inflammatory diseases.
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Affiliation(s)
- Maurizio Benucci
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, Florence, Italy
| | - Pamela Bernardini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Carmela Coccia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Riccardo De Luca
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Juela Levani
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessio Economou
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Arianna Damiani
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Edda Russo
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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Melis MR, El Aoufy K, Bambi S, Bruni C, Guiducci S, Bellando-Randone S, Matucci-Cerinic M, Rasero L. Correction to: Nursing interventions for patients with rheumatic and musculoskeletal diseases on biological therapies: a systematic literature review. Clin Rheumatol 2023; 42:1731. [PMID: 36933073 DOI: 10.1007/s10067-023-06580-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Maria Ramona Melis
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. .,Department of Geriatric Medicine, Division of Rheumatology, AOUC, Viale Largo Brambilla, 3, 50134, Florence, Italy.
| | - Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Bambi
- Department of Public Health AOUC, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology, AOUC, Viale Largo Brambilla, 3, 50134, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology, AOUC, Viale Largo Brambilla, 3, 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Laura Rasero
- Department of Public Health AOUC, University of Florence, Florence, Italy
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Barni L, Carrasco-Vega E, Olivieri M, Galán-Mercant A, Guiducci S, Picariello F, González-Sánchez M. Does Physical Exercise Enhance the Immune Response after Vaccination? A Systematic Review for Clinical Indications of COVID-19 Vaccine. Int J Environ Res Public Health 2023; 20:5183. [PMID: 36982095 PMCID: PMC10049110 DOI: 10.3390/ijerph20065183] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Stimulating protective immunity with vaccines appears to be the most promising option for providing widespread moderate to high protection against COVID-19 in people over the age of 18. Regular exercise improves the immune response, transmitting possible benefits against virus infections. The aim of this review is to study the effects of physical activity on vaccine injections, helping to develop new recommendations for COVID-19 vaccination campaigns. METHODS A comprehensive review of the existing literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The internal quality of the studies was assessed according to the Physiotherapy Evidence Database (PEDro) scale. The outcomes analyzed were antibody titer, the level of lymphocytes CD4, CD8, InterLeukin 6 (IL6), leukocytes level, the visual analogue scale (VAS) for overall pain rating, arm and forearm circumferences and volume of oxygen (VO2) peak. RESULTS Fourteen articles were selected for the analysis. The majority of studies were randomized controlled trials (RCT) (n = 8) and controlled trials (CT) (n = 6). According to PEDro, the 'fair' category (n = 7) was the most represented, followed by 'good' (n = 6) and 'excellent' (n = 1). Physical training showed a positive effect on antibody titers of the vaccine; yet, different variables seem to influence antibody titers: higher new vs. old antigen in the vaccine, higher in younger vs. older individuals, and higher in females vs. males. After exercise, when analyzing variables of direct response to the vaccine, such as the amount of CD4, IL-6 and leukocytes, higher levels were observed in the patients who performed physical exercise compared to the control group. In the same way, better results were observed in physiological variables such as VO2 and limb circumferences, or subjective variables such as pain, which showed better results than the control group. CONCLUSIONS The immune response (antibody titers) depends on age, gender and the intensity of physical activity: long-term protocols at moderate intensity are the most recommended. All of these aspects also have to be carefully considered for the COVID-19 vaccination.
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Affiliation(s)
- Luca Barni
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.B.); (E.C.-V.); (M.G.-S.)
| | - Elio Carrasco-Vega
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.B.); (E.C.-V.); (M.G.-S.)
| | | | - Alejandro Galán-Mercant
- Institute of Biomedicine of Cádiz (INIBICA), 11009 Cádiz, Spain
- MOVE-IT Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Cádiz, 11009 Cádiz, Spain
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology AOUC, University of Florence, 50134 Florence, Italy;
| | - Felice Picariello
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Manuel González-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain; (L.B.); (E.C.-V.); (M.G.-S.)
- Institute of Biomedicine of Málaga (IBIMA), 29010 Málaga, Spain
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31
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Hoffmann-Vold AM, Brunborg C, Airò P, Ananyeva LP, Czirják L, Guiducci S, Hachulla E, Li M, Mihai C, Riemekasten G, Sfikakis PP, Valentini G, Kowal-Bielecka O, Allanore Y, Distler O. Cohort Enrichment Strategies for Progressive Interstitial Lung Disease in Systemic Sclerosis From European Scleroderma Trials and Research. Chest 2023; 163:586-598. [PMID: 36244404 DOI: 10.1016/j.chest.2022.09.044] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Enrichment strategies from clinical trials for progressive systemic sclerosis-associated interstitial lung disease (SSc-ILD) have not been tested in a real-life cohort. RESEARCH QUESTION Do enrichment strategies for progressive ILD impact efficacy, representativeness, and feasibility in patients with SSc-ILD from the European Scleroderma Trials and Research (EUSTAR) database? STUDY DESIGN AND METHODS We applied the inclusion criteria of major recent SSc-ILD trials (Study of the Efficacy and Safety of Tocilizumab in Participants With Systemic Sclerosis [focuSSced], Scleroderma Lung Study II [SLS II], and Safety and Efficacy of Nintedanib in Systemic Sclerosis [SENSCIS]) and assessed progressive ILD, which was defined as absolute change in FVC and as significant progression (FVC decline ≥10%). Data were compared with all patients and with patients who did not fulfill any inclusion criteria. RESULTS In total, 2,258 patients with SSc-ILD were included: 31.2% of the patients met SENSCIS criteria; 5.8% of the patients met SLS II criteria; 1.6% of the patients met focuSSced criteria, and 67.7% (1,529) of the patients did not meet any criteria. In the first 12 ± 3 months, the absolute FVC decline in all patients and in patients who fulfilled criteria from SENSCIS was -0.1%, in patients who fulfilled criteria from focuSSced was -3.7%, and in patients who fulfilled criteria from SLS II was 2.3%, with accompanying more progressors in focuSSced. The patient populations that fulfilled the different study inclusion criteria significantly differed in various clinical parameters. In the second 12-month period, SENSCIS-enriched patients had a further absolute FVC% decline as described for the total cohort. In contrast, patients who fulfilled the focuSSced and SLS II criteria showed numeric improvement of lung function. There were no significant associations of enrichment criteria and ILD progression. INTERPRETATION The application of enrichment criteria from previous clinical trials showed enrichment for progression with variable success, which led to selected patient populations reducing feasibility of recruitment. These findings are important for future clinical trial design and interpretation of the results of published trials.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway; Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Paolo Airò
- UO Reumatologia e Immunologia Clinica, Spedali Civili di Brescia, Brescia, Italy
| | - Lidia P Ananyeva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - László Czirják
- Department of Rheumatology and Immunology, Medical school of Pécs, Pécs, Hungary
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, University of Lille, Lille, France
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital (West Campus), Beijing, China
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Medical Center Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Petros P Sfikakis
- Joint Rheumatology Programme, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gabriele Valentini
- Dipartimento di Medicina di Precisione, Università della Campania "Luigi Vanvitelli," Napoli, Italy
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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De Angelis R, Ferri C, Giuggioli D, Bajocchi G, Dagna L, Bellando-Randone S, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Lepri G, Girelli F, Riccieri V, Zanatta E, Bosello SL, Cavazzana I, Ingegnoli F, De Santis M, Murdaca G, Abignano G, Romeo N, Della Rossa A, Caminiti M, Iuliano AM, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Cipolletta E, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Di Vico C, Gigante A, Pellagrino G, Pigatto E, Lazzaroni MG, Franceschini F, Generali E, Mennillo G, Barsotti S, Mariano GP, Furini F, Vultaggio L, Parisi S, Peroni CL, Rozza D, Zanetti A, Carrara G, Landolfi G, Scirè CA, Bianchi G, Fusaro E, Sebastiani GD, Govoni M, D'Angelo S, Cozzi F, Guiducci S, Doria A, Salvarani C, Iannone F, Matucci-Cerinic M. Systemic sclerosis sine scleroderma: clinical and serological features and relationship with other cutaneous subsets in a large series of patients from the national registry 'SPRING' of the Italian Society for Rheumatology. RMD Open 2023; 9:rmdopen-2022-002890. [PMID: 36868782 PMCID: PMC9990652 DOI: 10.1136/rmdopen-2022-002890] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/08/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVE To describe demographic, clinical and laboratory features of systemic sclerosis sine scleroderma (ssSSc) in a large multicentre systemic sclerosis (SSc) cohort. METHODS Data involving 1808 SSc patients from Italian Systemic sclerosis PRogression INvestiGation registry were collected. The ssSSc was defined by the absence of any cutaneous sclerosis and/or puffy fingers. Clinical and serological features of ssSSc were compared with limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets. RESULTS Among patients with SSc, only 61 (3.4%) were classified as having ssSSc (F/M=19/1). Time from Raynaud's phenomenon (RP) onset to diagnosis was longer in ssSSc (3 years, IQR 1-16.5) than lcSSc (2 years, IQR 0-7), and dcSSc (1 year, IQR 0-3) (p<0.001). Clinical ssSSc phenotype was comparable to lcSSc, except for digital pitting scars (DPS) (19.7% vs 42%, p=0.01), but significantly milder than dcSSc, particularly for digital ulcers (DU) (6.6% vs 35.7%, p<0.001), oesophagus (46.2% vs 63.5%, p=0.009), lung (mean diffusion capacity for carbon monoxide 72.2±19.6 vs 62.4±22.8, p=0.009; mean forced vital capacity 105.6±21.7 vs 89.2±20.9, p<0.001) and major videocapillaroscopic alterations (late pattern 8.6% vs 47.6%, p<0.001). Moreover, in ssSSc the percentages of anticentromere and antitopoisomerase were comparable to lcSSc (40% and 18.3% vs 36.7% and 26.6%), but divergent respect to dcSSc (8.6% and 67.4%, p<0.001). CONCLUSION The ssSSc is a quite rare disease variant characterised by clinico-serological features comparable to lcSSc, but significantly different from dcSSc. Overall, longer RP duration, low percentages of DPS and peripheral microvascular abnormalities, and increased anti-centromere seropositivity distinguish ssSSc. Further investigations based on national registries might provide useful insights on the actual relevance of the ssSSc within the scleroderma spectrum.
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Affiliation(s)
- Rossella De Angelis
- Rheumatology Unit - Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy, Reggio Emilia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | | | - Rosario Foti
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy, Catania, Italy
| | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine - University of Campania "Luigi Vanvitelli", Naples, Italy, Caserta, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy, Parma, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy, Roma, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Francesco Girelli
- Department of Medicine, Rheumatology Unit, Ospedale GB Morgagni - L Pierantoni, Forlì, Italy, Forlì, Italy
| | - Valeria Riccieri
- Department of Rheumatology, Sapienza University of Rome, Rome, Italy, Rome, Italy
| | | | - Silvia Laura Bosello
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy, Rome, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Brescia, Italy
| | - Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini, Dept. of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milan, Italy, Milano, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, and Humanitas University, Pieve Emanuele, Milan, Italy, Rozzano, Italy
| | - Giuseppe Murdaca
- Research Hospital San Martino, University of Genoa, Genoa, Italy, Genova, Italy
| | - Giuseppina Abignano
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy, Potenza, Italy
| | | | | | - Maurizio Caminiti
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy, Italy
| | | | - Giovanni Ciano
- Hospital of Ariano Irpino, Local Health Department, Ariano Irpino, Avellino, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ennio Lubrano
- Department of Rheumatology, University of Molise, Campobasso, Italy
| | - Ilenia De Andres
- Rheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale ed Alta Specializzazione "Garibaldi", Catania, Italy
| | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Marta Saracco
- Rheumatology Unit, Mauriziano-Umberto I Hospital, Torino, Italy
| | | | - Edoardo Cipolletta
- Rheumatology Unit - Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Federica Lumetti
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Amelia Spinella
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Luca Magnani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy, Reggio Emilia, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Veronica Codullo
- Department of Rheumatology, Policlinico San Matteo, Pavia, Italy, Pavia, Italy
| | - Elisa Visalli
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy, Catania, Italy
| | - Claudio Di Vico
- Department of Precision Medicine - University of Campania "Luigi Vanvitelli", Naples, Italy, Caserta, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy, Roma, Italy
| | - Greta Pellagrino
- Department of Rheumatology, Sapienza University of Rome, Rome, Italy, Rome, Italy
| | - Erika Pigatto
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Maria-Grazia Lazzaroni
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Brescia, Italy
| | - Elena Generali
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, and Humanitas University, Pieve Emanuele, Milan, Italy, Rozzano, Italy
| | - Gianna Mennillo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy, Potenza, Italy
| | - Simone Barsotti
- Department of Rheumatology, University of Pisa, Pisa, Italy, Italy
| | - Giuseppa Pagano Mariano
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy, Italy
| | - Federica Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Licia Vultaggio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Simone Parisi
- Rheumatology Unit, Città della Salute e della Scienza, Turin, Italy
| | | | - Davide Rozza
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | | | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Gerolamo Bianchi
- Rheumatology Unit, Department of Musculoskeletal Sciences, Local Health Trust 3, La Colletta Hospital, Genoa, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Città della Salute e della Scienza, Turin, Italy
| | | | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Salvatore D'Angelo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy, Potenza, Italy
| | - Franco Cozzi
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Andrea Doria
- Department of Rheumatology, University of Padua, Padua, Italy
| | - Carlo Salvarani
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy.,Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
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El Aoufy K, Pezzutto A, Pollina A, Rasero L, Bambi S, Bellando-Randone S, Guiducci S, Maddali-Bongi S, Matucci Cerinic M. Systemic Sclerosis Patients Experiencing Mindfulness-Based Stress Reduction Program: The Beneficial Effect on Their Psychological Status and Quality of Life. Int J Environ Res Public Health 2023; 20:2512. [PMID: 36767877 PMCID: PMC9915443 DOI: 10.3390/ijerph20032512] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Psychological concerns in Systemic Sclerosis (SSc) patients represent an important issue and should be addressed through non-pharmacological treatments. Thus, the aim of the present study was to assess the effects of the Mindfulness-Based Stress Reduction (MBSR) program on psychological variables and the perspectives and experiences of patients with an SSc diagnosis. Notably, 32 SSc patients were enrolled and assigned to either the intervention (MBSR) group or the waitlist group. Inclusion criteria were (i) age ≥ 18 years, SSc diagnosis according to EULAR/ACR diagnostic criteria and informed consent. Exclusion criteria were previous participation in any Mind-Body Therapy or psychiatric diagnosis. Quantitative and qualitative outcomes were investigated through clinometric questionnaires and individual interviews. MBSR did not significantly impact outcomes such as physical functionality, anxiety, hopelessness, depression, physical health status, perceived stress, mindfulness and mental health status. For the anger evaluation, statistically significant differences are found for both controlling and expressing anger, indicating that the MBSR program had a favorable impact. As for qualitative results, more awareness of daily activities, stress reduction in terms of recognizing the causes and implementing self-strategies to prevent them, adherence to therapy, and recognition of the effect of medication on their bodies were reported. In conclusion, it is important to highlight the absence of negative or side effects of the MBSR program and the positive impact on patients' experience and perspective; thus, we suggest this approach should be taken into account for SSc patients.
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Affiliation(s)
- Khadija El Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, Viale largo Brambilla 3, 50134 Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology AOUC, 50134 Florence, Italy
| | | | - Alessandra Pollina
- Center for Mindfulness Certified MBSR, University of Massachusetts, Worcester, MA 01605, USA
| | - Laura Rasero
- Department of Health Science, University of Florence, 50134 Florence, Italy
| | - Stefano Bambi
- Department of Health Science, University of Florence, 50134 Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Viale largo Brambilla 3, 50134 Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology AOUC, 50134 Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, Viale largo Brambilla 3, 50134 Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology AOUC, 50134 Florence, Italy
| | - Susanna Maddali-Bongi
- Department of Experimental and Clinical Medicine, University of Florence, Viale largo Brambilla 3, 50134 Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Viale largo Brambilla 3, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
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34
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Ingegnoli F, Cornalba M, De Angelis R, Guiducci S, Giuggioli D, Pizzorni C, Riccieri V, Sebastiani M, Sulli A, Cutolo M. Nailfold capillaroscopy in the rheumatological current clinical practice in Italy: results of a national survey. Reumatismo 2022; 74. [PMID: 36580065 DOI: 10.4081/reumatismo.2022.1508] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022] Open
Abstract
This cross-sectional online study was designed by the study group on Capillaroscopy and Microcirculation in Rheumatic Diseases (CAP) of the Italian Society of Rheumatology (SIR) to provide an overview of the management of nailfold capillaroscopy in Italian rheumatology centers. Therefore, SIR distributed the survey to its members in July 2021, and each center's physician with the most expertise in capillaroscopy completed the questionnaire. The survey was completed by 102 centers, with at least one representative from each Italian region. Ninety-three centers perform capillaroscopy, and 52 (56) conduct more than 200 investigations annually. Seventy-eight (84%) of respondents have more than five years of experience with the technique, and 75 centers (80.6%) have received certification from specific national or international training courses. In 85 centers, a videocapillaroscope with 200x magnification is employed (91.4%). The average waiting period for the examination is 2.4 months, and less than 3 months in 64 of the locations (68.8%). The study demonstrates that capillaroscopy is an integral part of both the diagnostic phase of Raynaud's phenomenon and the monitoring of autoimmune connective tissue diseases (CTDs). However, the reporting methods and timing of patient followup are heterogeneous.
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Affiliation(s)
- F Ingegnoli
- Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Department of Clinical and Community Sciences, University of Milano, Milano.
| | - M Cornalba
- Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Department of Clinical and Community Sciences, University of Milano, Milano.
| | - R De Angelis
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (AN).
| | - S Guiducci
- Department of Clinical and Molecular Sciences, Division of Rheumatology, University of Firenze.
| | - D Giuggioli
- Rheumatology Unit, Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena.
| | - C Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCSS Polyclinic San Martino, Genoa.
| | - V Riccieri
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, La Sapienza University, Roma.
| | - M Sebastiani
- Rheumatology Unit, Hospital of Modena, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena.
| | - A Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCSS Polyclinic San Martino, Genoa.
| | - M Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCSS Polyclinic San Martino, Genoa.
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Peretti S, Torracchi S, Russo E, Bonomi F, Fiorentini E, Aoufy KE, Bruni C, Lepri G, Orlandi M, Chimenti MS, Guiducci S, Amedei A, Matucci-Cerinic M, Bellando Randone S. The Yin-Yang Pharmacomicrobiomics on Treatment Response in Inflammatory Arthritides: A Narrative Review. Genes (Basel) 2022; 14:89. [PMID: 36672830 PMCID: PMC9859330 DOI: 10.3390/genes14010089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
(1) Background: Gut microbiota (GM) is the set of microorganisms inhabiting the gastroenteric tract that seems to have a role in the pathogenesis of rheumatic diseases. Recently, many authors proved that GM may influence pharmacodynamics and pharmacokinetics of several drugs with complex interactions that are studied by the growing field of pharmacomicrobiomics. The aim of this review is to highlight current evidence on pharmacomicrobiomics applied to the main treatments of Rheumatoid Arthritis and Spondyloarthritis in order to maximize therapeutic success, in the framework of Personalized Medicine. (2) Methods: We performed a narrative review concerning pharmacomicrobiomics in inflammatory arthritides. We evaluated the influence of gut microbiota on treatment response of conventional Disease Modifying Anti-Rheumatic drugs (cDMARDs) (Methotrexate and Leflunomide) and biological Disease Modifying Anti-Rheumatic drugs (bDMARDs) (Tumor necrosis factor inhibitors, Interleukin-17 inhibitors, Interleukin 12/23 inhibitors, Abatacept, Janus Kinase inhibitors and Rituximab). (3) Results: We found a great amount of studies concerning Methotrexate and Tumor Necrosis Inhibitors (TNFi). Conversely, fewer data were available about Interleukin-17 inhibitors (IL-17i) and Interleukin 12/23 inhibitors (IL-12/23i), while none was identified for Janus Kinase Inhibitors (JAKi), Tocilizumab, Abatacept and Rituximab. We observed that microbiota and drugs are influenced in a mutual and reciprocal way. Indeed, microbiota seems to influence therapeutic response and efficacy, whereas in the other hand, drugs may restore healthy microbiota. (4) Conclusions: Future improvement in pharmacomicrobiomics could help to detect an effective biomarker able to guide treatment choice and optimize management of inflammatory arthritides.
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Affiliation(s)
- Silvia Peretti
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Sara Torracchi
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Edda Russo
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesco Bonomi
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Elisa Fiorentini
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Khadija El Aoufy
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
- Department of Rheumatology, University Hospital of Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Martina Orlandi
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Medicina dei Sistemi, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Silvia Bellando Randone
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Salaffi F, Siragusano C, Alciati A, Cassone G, D’Angelo S, Guiducci S, Favalli EG, Conti F, Gremese E, Iannone F, Caporali R, Sebastiani M, Ferraccioli GF, Lapadula G, Atzeni F. Axial Spondyloarthritis: Reshape the Future-From the "2022 GISEA International Symposium". J Clin Med 2022; 11:jcm11247537. [PMID: 36556152 PMCID: PMC9780899 DOI: 10.3390/jcm11247537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The term "axial spondyloarthritis" (axSpA) refers to a group of chronic rheumatic diseases that predominantly involve the axial skeleton and consist of ankylosing spondylitis, reactive arthritis, arthritis/spondylitis associated with psoriasis (PsA) and arthritis/spondylitis associated with inflammatory bowel diseases (IBD). Moreover, pain is an important and common symptom of axSpA. It may progress to chronic pain, a more complicated bio-psychosocial phenomena, leading to a significant worsening of quality of life. The development of the axSpA inflammatory process is grounded in the complex interaction between genetic (such as HLA B27), epigenetic, and environmental factors associated with a dysregulated immune response. Considering the pivotal contribution of IL-23 and IL-17 in axSpA inflammation, the inhibition of these cytokines has been evaluated as a potential therapeutic strategy. With this context, here we discuss the main pathogenetic mechanisms, therapeutic approaches and the role of pain in axSpA from the 2022 International GISEA/OEG Symposium.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Ospedale Carlo Urbani, Università Politecnica delle Marche, 60035 Jesi, Italy
| | - Cesare Siragusano
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98125 Messina, Italy
| | - Alessandra Alciati
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, Como, and Humanitas Clinical and Research Centre, Rozzano, 20089 Milan, Italy
| | - Giulia Cassone
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Salvatore D’Angelo
- Rheumatology Institute of Lucania and Rheumatology Department of Lucania, San Carlo Hospital of Potenza, 85100 Potenza, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Ennio Giulio Favalli
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, 20122 Milan, Italy
| | - Fabrizio Conti
- Lupus Clinic, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, 00161 Rome, Italy
| | - Elisa Gremese
- Rheumatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency Surgery and Organ Transplantations, University of Bari, 70121 Bari, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, 20122 Milan, Italy
| | - Marco Sebastiani
- Rheumatology Unit, Azienda Ospedaliera Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence:
| | | | - Giovanni Lapadula
- Rheumatology Unit, Department of Emergency Surgery and Organ Transplantations, University of Bari, 70121 Bari, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, 98125 Messina, Italy
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Orlandi M, Meliante LA, Damiani A, Tofani L, Bruni C, Guiducci S, Matucci-Cerinic M, Bellando-Randone S, Tomassetti S. The Role of Bronchoalveolar Lavage in Systemic Sclerosis Interstitial Lung Disease: A Systematic Literature Review. Pharmaceuticals (Basel) 2022; 15:ph15121584. [PMID: 36559035 PMCID: PMC9781787 DOI: 10.3390/ph15121584] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than in the health control and, in some cases, they were related to more severe pulmonary disease. There was no consensus regarding the role of BAL cellularity as a predictor of mortality.
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Affiliation(s)
- Martina Orlandi
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Laura Antonia Meliante
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Arianna Damiani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Lorenzo Tofani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Cosimo Bruni
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Serena Guiducci
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-055-794-7066
| | - Marco Matucci-Cerinic
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Silvia Bellando-Randone
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, and Division of Interventional Pulmonology, Careggi University Hospital, 50134 Florence, Italy
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Fiorentini E, Bonomi F, Peretti S, Orlandi M, Lepri G, Matucci Cerinic M, Bellando Randone S, Guiducci S. Potential Role of JAK Inhibitors in the Treatment of Systemic Sclerosis-Associated Interstitial Lung Disease: A Narrative Review from Pathogenesis to Real-Life Data. Life (Basel) 2022; 12:life12122101. [PMID: 36556466 PMCID: PMC9785277 DOI: 10.3390/life12122101] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is one of the most relevant complications of SSc and the major cause of death. The pathogenesis of SSc-ILD involves a complex interplay of multiple cell types and different molecular pathways, with both inflammation and fibrosis as pathological hallmarks. To date, there are no treatments able to target both components of the disease. Janus kinase inhibitors (JAKinibs) represent an interesting therapeutic option because they exert both anti-inflammatory and anti-fibrotic properties. METHODS Here, we performed a narrative review concerning the potential role of JAKinibs in SSc-ILD to define the state of art and to evaluate the pathogenetic rationale behind this type of treatment. RESULTS Currently, few studies investigated SSc-ILD response to JAKinibs treatment. Data were analyzed from three clinical studies and four case reports and progression of SSc-ILD was not evident in 93.5% of patients treated with JAKinibs. CONCLUSIONS Available evidence of efficacy of JAKinibs in SSc-ILD is sparse but promising. JAKinibs could be an interesting treatment in SSc-ILD because of their potential inhibition of the fibrotic processes combined with their anti-inflammatory action. Moreover, JAKinibs were also shown in some studies to have a potential effect on pulmonary arterial hypertension (PAH), another threatening complication in SSc. More data are necessary to define JAKinibs role in SSc-ILD treatment.
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Affiliation(s)
- Elisa Fiorentini
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Bonomi
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
- Correspondence:
| | - Silvia Peretti
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Martina Orlandi
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Marco Matucci Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Silvia Bellando Randone
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
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Benucci M, Damiani A, Russo E, Guiducci S, Li Gobbi F, Fusi P, Grossi V, Amedei A, Manfredi M, Infantino M. The Association of uPA, uPAR, and suPAR System with Inflammation and Joint Damage in Rheumatoid Arthritis: suPAR as a Biomarker in the Light of a Personalized Medicine Perspective. J Pers Med 2022; 12:jpm12121984. [PMID: 36556207 PMCID: PMC9788564 DOI: 10.3390/jpm12121984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In recent years, the involvement of the soluble urokinase Plasminogen Activator Receptor (suPAR) in the pathophysiological modulation of Rheumatoid Arthritis (RA) has been documented, resulting in the activation of several intracellular inflammatory pathways. METHODS We investigated the correlation of urokinase Plasminogen Activator (uPA)/urokinase Plasminogen Activator Receptor (uPAR) expression and suPAR with inflammation and joint damage in RA, evaluating their potential role in a precision medicine context. RESULTS Currently, suPAR has been shown to be a potential biomarker for the monitoring of Systemic Chronic Inflammation (SCI) and COVID-19. However, the effects due to suPAR interaction in immune cells are also involved in both RA onset and progression. To date, the literature data on suPAR in RA endorse its potential application as a biomarker of inflammation and subsequent joint damage. CONCLUSION Available evidence about suPAR utility in the RA field is promising, and future research should further investigate its use in clinical practice, resulting in a big step forward for precision medicine. As it is elevated in different types of inflammation, suPAR could potentially work as an adjunctive tool for the screening of RA patients. In addition, a suPAR system has been shown to be involved in RA pathogenesis, so new data about the therapeutic response to Jak inhibitors can represent a possible way to develop further studies.
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Affiliation(s)
- Maurizio Benucci
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50143 Florence, Italy
- Correspondence: ; Tel.: +39-055-6932636; Fax: +39-055-6932099
| | - Arianna Damiani
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Edda Russo
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Francesca Li Gobbi
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50143 Florence, Italy
| | - Paola Fusi
- Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50143 Florence, Italy
| | - Valentina Grossi
- Immunology and Allergology Laboratory, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50143 Florence, Italy
| | - Amedeo Amedei
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50143 Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, 50143 Florence, Italy
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Mariotti EB, Corrà A, Lemmi E, Laschi L, Aimo C, Quintarelli L, Volpi W, Nacci F, Verdelli A, Ruffo di Calabria V, Guiducci S, Caproni M. Multicentric Reticulohistiocytosis Associated with an Early Form of Systemic Lupus Erythematosus: A Case Report of a Rare Disease, with Mini Review of the Literature. J Clin Med 2022; 11:6529. [PMID: 36362761 PMCID: PMC9658768 DOI: 10.3390/jcm11216529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 11/01/2022] [Indexed: 08/10/2023] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is the most frequently described form of reticulohistiocytosis (RH), and it is classified as a class IIb non-Langerhans cell histiocytosis. It has been designated as multicentric, being characterized by multisystemic involvement. In fact, although mainly involving the skin, along with the joints, it is a systemic inflammatory condition potentially involving every internal organ. As MRH-related skin findings can mimic rheumatoid nodules or Gottron papules, the histopathology of the cutaneous lesions is often necessary for the correct diagnosis. Approximately one-third of MRH patients have confirmed concomitant autoimmune disorders. A wide variety of autoimmune disorders associated with the disease have been reported in the literature, suggesting immune dysfunction as a factor in the pathophysiology of MRH. A case of MRH associated with autoimmune manifestation is reported in the context of a mini review of the literature, with a focus on clinical presentation, treatments, and treatment outcomes. Moreover, eight cases of MRH associated with autoimmune diseases are briefly discussed.
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Affiliation(s)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Elisa Lemmi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Lucrezia Laschi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Lavinia Quintarelli
- Rare Disease Skin Unit, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Walter Volpi
- Section of Dermatology, Azienda USL Toscana Centro, 50125 Florence, Italy
| | - Francesca Nacci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, 50125 Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Azienda USL Toscana Centro, 50125 Florence, Italy
| | | | - Serena Guiducci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, 50125 Florence, Italy
| | - Marzia Caproni
- Rare Disease Skin Unit, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
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Lepri G, Catalano M, Bellando-Randone S, Pillozzi S, Giommoni E, Giorgione R, Botteri C, Matucci-Cerinic M, Antonuzzo L, Guiducci S. Systemic Sclerosis Association with Malignancy. Clin Rev Allergy Immunol 2022; 63:398-416. [PMID: 36121543 DOI: 10.1007/s12016-022-08930-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 12/17/2022]
Abstract
The association of systemic sclerosis (SSc) and cancer is well known from several decades suggesting common genetic and environmental risk factors involved in the development of both diseases. Immunosuppressive drugs widely used in SSc may increase the risk of cancer occurrence and different SSc clinical and serological features identify patients at major risk to develop malignancy. In this context, among serological features, presence of anti-RNA polymerase III and anti-topoisomerase I autoantibodies seems to increase cancer frequency in SSc patients (particularly lung and breast cancers). Lung fibrosis and a long standing SSc pulmonary involvement have been largely proposed as lung cancer risk factors, and the exposure to cyclophosphamide and an upper gastrointestinal involvement have been traditionally linked to bladder and oesophagus cancers, respectively. Furthermore, immune checkpoint inhibitors used for cancer therapy can induce immune-related adverse events, which are more frequent and severe in patients with pre-existing autoimmune diseases such as SSc. The strong association between SSc and cancer occurrence steers clinicians to carefully survey SSc patients performing periodical malignancy screening. In the present review, the most relevant bilateral relationships between SSc and cancer will be addressed.
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Affiliation(s)
- Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy.
| | - Martina Catalano
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy
| | - Serena Pillozzi
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Elisa Giommoni
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | | | - Cristina Botteri
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology, AOUC & Scleroderma Unit, Florence, Italy
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Tenti S, Mondanelli N, Bernetti A, Mangone M, Agostini F, Capassoni M, Cheleschi S, De Chiara R, Farì G, Frizziero A, Giannotti S, Guiducci S, Masiero S, Megna M, Messina C, Moretti L, Tognolo L, Gigliucci G, Santilli V, Migliore A, Fioravanti A. Impact of Covid-19 pandemic on injection-based practice: report from an Italian multicenter and multidisciplinary survey. Ann Ig 2022; 34:501-514. [PMID: 35861721 DOI: 10.7416/ai.2022.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND There are no papers exploring the impact of COVID-19 pandemic on the injection-based practice in patients affected by different rheumatic diseases, including osteoarthritis. The aim was to investigate the impact of COVID-19 pandemic on injection-based practice trough the Italian country. STUDY DESIGN A survey-based retrospective cross-sectional study. METHODS An Italian-language questionnaire was developed by a group of senior researchers and distributed by e-mail to some Rheumatology, Orthopedic and Rehabilitation Units from different geographic areas of Italy. The survey included information about the number of injections performed during COVID-19 pandemic (stratified by injected agents and injected joint), in comparison to the pre-pandemic period, and the possible reasons behind an eventual reduction. Responses were collected and descriptive analysis calculated. RESULTS Eleven centers of the National Health Service completed the survey. The activities of the injections services significantly decreased across the country with a percentage of reduction of 60% compared to the pre-pandemic period. A significant reduction of both intra-articular and peri-articular injections was registered. Among intra-articular. treatments, the most affected ones were the hyaluronic acid injections, when compared to corticosteroids. A significant decrease of the total amount of peri-articular injections was observed. The strict government restrictions and the fear of patients to become infected represented the most limiting factors. CONCLUSIONS The reported decrease of the injection-based practice in our country during the COVID-19 pandemic highlights the detrimental effects of the COVID-19 pandemic on the management of chronic musculoskeletal diseases with possible negative consequences in terms of disability and quality of life.
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Affiliation(s)
- S Tenti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - N Mondanelli
- Orthopedics and Traumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - A Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - M Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - F Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - M Capassoni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - S Cheleschi
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - R De Chiara
- Rehabilitation Unit, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - G Farì
- Physical Medicine and Rehabilitation, Unipolar Spinal Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro University of Bari, Italy
| | - A Frizziero
- Outpatient and Orthogeriatric Rehabilitation Unit, Department of Medicine and Surgery, University of Parma, Italy
| | - S Giannotti
- Orthopedics and Traumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - S Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - S Masiero
- Physical Medicine and Rehabilitation Unit, Department of Neuroscience, University of Padua, Italy
| | - M Megna
- Physical Medicine and Rehabilitation, Unipolar Spinal Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro University of Bari, Italy
| | - C Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - L Moretti
- Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Aldo Moro Uni-versity of Bari, Italy
| | - L Tognolo
- Physical Medicine and Rehabilitation Unit, Department of Neuroscience, University of Padua, Italy
| | - G Gigliucci
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - V Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - A Migliore
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - A Fioravanti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
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Pagliai G, Colombini B, Bellando Randone S, Amedei A, Guiducci S, Sofi F. Nutrients, foods and dietary patterns in the management of autoimmune rheumatic diseases. Clinical Nutrition Open Science 2022. [DOI: 10.1016/j.nutos.2022.06.002] [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: 11/25/2022] Open
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Ferri C, De Angelis R, Giuggioli D, Bajocchi G, Dagna L, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Guiducci S, Girelli F, Riccieri V, Zanatta E, Bosello S, Cavazzana I, Ingegnoli F, De Santis M, Murdaca G, Abignano G, Romeo N, Rossa AD, Caminiti M, Iuliano A, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Masini F, Gigante A, Bellando-Randone S, Pellegrino G, Pigatto E, Lazzaroni MG, Franceschini F, Generali E, Mennillo G, Barsotti S, Mariano GP, Calabrese F, Furini F, Vultaggio L, Parisi S, Peroni CL, Rozza D, Zanetti A, Carrara G, Landolfi G, Scirè CA, Bianchi G, Fusaro E, Sebastiani GD, Govoni M, D'Angelo S, Cozzi F, Doria A, Iannone F, Salvarani C, Matucci-Cerinic M. Geographical heterogeneity of clinical and serological phenotypes of systemic sclerosis observed at tertiary referral centres. The experience of the Italian SIR-SPRING registry and review of the world literature. Autoimmun Rev 2022; 21:103159. [DOI: 10.1016/j.autrev.2022.103159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 12/18/2022]
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Lepri G, Orlandi M, Di Battista M, De Mattia G, Da Rio M, Codullo V, Guiducci S, Della Rossa A. Systemic sclerosis: one year in review 2022. Clin Exp Rheumatol 2022; 40:1911-1920. [DOI: 10.55563/clinexprheumatol/3401fl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies,
University of Siena, Italy
| | - Gianmarco De Mattia
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Mattia Da Rio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Veronica Codullo
- Rheumatology Unit, Fondazione IRCS Policlinico San Matteo, Pavia, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Ferri C, Raimondo V, Gragnani L, Giuggioli D, Dagna L, Tavoni A, Ursini F, L'Andolina M, Caso F, Ruscitti P, Caminiti M, Foti R, Riccieri V, Guiducci S, Pellegrini R, Zanatta E, Varcasia G, Olivo D, Gigliotti P, Cuomo G, Murdaca G, Cecchetti R, De Angelis R, Romeo N, Ingegnoli F, Cozzi F, Codullo V, Cavazzana I, Colaci M, Abignano G, De Santis M, Lubrano E, Fusaro E, Spinella A, Lumetti F, De Luca G, Bellando-Randone S, Visalli E, Bosco YD, Amato G, Giannini D, Bilia S, Masini F, Pellegrino G, Pigatto E, Generali E, Mariano GP, Pettiti G, Zanframundo G, Brittelli R, Aiello V, Caminiti R, Scorpiniti D, Ferrari T, Campochiaro C, Brusi V, Fredi M, Moschetti L, Cacciapaglia F, Paparo SR, Ragusa F, Mazzi V, Elia G, Ferrari SM, Di Cola I, Vadacca M, Lorusso S, Monti M, Lorini S, Aprile ML, Tasso M, Miccoli M, Bosello S, D'Angelo S, Doria A, Franceschini F, Meliconi R, Matucci-Cerinic M, Iannone F, Giacomelli R, Salvarani C, Zignego AL, Fallahi P, Antonelli A. Prevalence and death rate of COVID-19 in systemic autoimmune diseases in the first three pandemic waves. Relationship to disease subgroups and ongoing therapies. Curr Pharm Des 2022; 28:2022-2028. [PMID: 35726427 DOI: 10.2174/1381612828666220614151732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Autoimmune systemic diseases (ASD) represent a predisposing condition to COVID-19. Our prospective, observational multicenter telephone survey study aimed to investigate the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients. METHOD The study included 3,918 ASD pts (815 M, 3103 F; mean age 59±12SD years) consecutively recruited between March 2020 and May 2021 at the 36 referral centers of COVID-19 & ASD Italian Study Group. The possible development of COVID-19 was recorded by means of a telephone survey using a standardized symptom assessment questionnaire. RESULTS ASD patients showed a significantly higher prevalence of COVID-19 (8.37% vs 6.49%; p<0.0001) but a death rate statistically comparable to the Italian general population (3.65% vs 2.95%). Among the 328 ASD patients developing COVID-19, 17% needed hospitalization, while mild-moderate manifestations were observed in 83% of cases. Moreover, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular events; systemic sclerosis (SSc) patients showed a significantly higher COVID-19-related death rate compared to the general population (6.29% vs 2.95%; p=0.018). Major adverse prognostic factors to develop COVID-19 were: older age, male gender, SSc, pre-existing ASD-related interstitial lung involvement, and long-term steroid treatment. Of note, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%; p=0.000), as well as the SSc patients treated with low dose aspirin (with 5.57% vs without 27.84%; p=0.000). CONCLUSION During the first three pandemic waves, ASD patients showed a death rate comparable to the general population despite the significantly higher prevalence of COVID-19. A significantly increased COVID-19-related mortality was recorded in only SSc patients' subgroup, possibly favored by preexisting lung fibrosis. Moreover, ongoing long-term treatment with csDMARDs in ASD might usefully contribute to the generally positive outcomes of this frail patients' population.
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Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy.,Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Laura Gragnani
- Department of Clinical Experimental Medicine, Interdepartmental Hepatology Center MASVE, University of Florence, Firenze, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | | | | | - Francesco Ursini
- University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, Italy
| | - Massimo L'Andolina
- Rheumatology Outpatient Clinic, ASP- Vibo Valentia-Tropea Hospital, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L\'Aquila, L\'Aquila, Italy
| | - Maurizio Caminiti
- UOD Reumatologia- Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Rosario Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | | | | | - Domenico Olivo
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
| | | | | | - Giuseppe Murdaca
- Ospedale Policlinico S. Martino-University of Genova, Genova, Italy
| | | | - Rossella De Angelis
- Rheumatology Clinic, Department of Clinical & Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | | | | | | | | | - Ennio Lubrano
- Rheumatology, Università del Molise, Campobasso, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Amelia Spinella
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Federica Lumetti
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | | | | | | | | | | | | | - Silvia Bilia
- Clinical Immunology, University of Pisa, Pisa, Italy
| | | | | | | | - Elena Generali
- Humanitas Clinical and Research Center IRCCS, Milano, Italy
| | | | | | | | | | - Vincenzo Aiello
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Rodolfo Caminiti
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | | | | | | | - Veronica Brusi
- University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, Italy
| | - Micaela Fredi
- Rheumatology, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Sabrina Rosaria Paparo
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L\'Aquila, L\'Aquila, Italy
| | - Marta Vadacca
- Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | - Sebastiano Lorusso
- Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | | | | | | | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Silvia Bosello
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, and Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Andrea Doria
- Rheumatology, University of Padova, Padova, Italy
| | | | - Riccardo Meliconi
- University of Bologna, Rizzoli Orthopaedic Institute Bologna, Bologna, Italy
| | | | | | - Roberto Giacomelli
- Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio-Medico di Roma, Roma, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Anna Linda Zignego
- Department of Clinical Experimental Medicine, Interdepartmental Hepatology Center MASVE, University of Florence, Firenze, Italy
| | - Poupak Fallahi
- Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa, School of Medicine, Pisa, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
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Russo E, Carboni D, Baldi S, Fioretto B, Romano E, El Aoufy K, Ramazzotti M, Rosa I, Lepri G, DI Gloria L, Bruni C, Melchiorre D, Guiducci S, Manetti M, Matucci-Cerinic M, Amedei A, Bellando Randone S. POS0487 THE CROSSTALK OF THE SKIN-ORAL-GUT MICROBIOME AXIS IN LIMITED AND DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4630] [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
BackgroundSystemic sclerosis (SSc) is a complex and still unclear rare disease. Microbiota has recently emerged as an important environmental factor in SSc pathogenesis, either at gut, oral and skin level.ObjectivesTo investigate the role of microbiota in SSc subsets, focusing on the skin-oral-gut microbiota axis and serum and fecal free fatty acids (FFA) profile.MethodsTwenty-six consecutive SSc patients (22 females) (mean disease duration (SD): 13 ± 6.91 yrs), classified according to the ACR/EULAR2013 criteria, were enrolled. Demographic, clinical and laboratory data were recorded. Gastrointestinal symptoms were investigated with UCLA GIT-2.0-questionnaire. Fecal, unstimulated saliva and superficial epidermal samples were collected. Microbiota was assessed through 16S ribosomal RNA Next Generation gene-sequencing analysis. Gas Cromatography-Mass Spettroscopy was used to measure FFAs in serum and fecal samples.ResultsThirteen patients had limited cutaneous SSc (lcSSc), 13 diffuse cutaneous (dcSSc). The two subsets displayed a different cutaneous and fecal microbiota profile. In detail, the class of cutaneous Sphingobacteria was significantly higher in lcSSc (p<0.05), while the phylum of Lentisphaerae, the family of Victivallaceae and the genus of Victivallis were significantly higher in fecal samples of lcSSc (all p<0.05). A significant increase of fecal propionic acid was observed in lcSSc patients (p<0.05). Moreover, all fecal medium-chain FAs and hexanoic acids were significantly higher in lcSSc (p<0.05 and p<0.001, respectively). The analysis of serum FFAs levels showed an increase of valeric and octanoic acids in lcSSc (both p<0.05). A negative correlation between UCLA-GIT-2.0 total score and fecal octanoic acid (rho=-0.61; p=0.03), and a positive correlation with serum propionic acid (rho=0.55; p=0.05) was found in lcSSc.ConclusionOur findings show a different microbiota signature in the skin and gut, and a different FFAs profile in lcSSc and dcSSc. Such a differential regulation of microbiota composition and bacterial metabolite production suggests different dynamics of skin-oral-gut microbiota axis in SSc subsets. This data could be useful to develop personalized therapies targeting gastrointestinal and skin involvement.Disclosure of InterestsNone declared.
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Palermo A, Bettiol A, Urban ML, Barilaro A, Danieli MG, Capassoni M, Guiducci S, Campochiaro C, Dagna L, Canti V, Rovere-Querini P, Cardelli C, Mosca M, Emmi G. POS0922 RECOMBINANT HUMAN HYALURONIDASE-FACILITATED SUBCUTANEOUS IMMUNOGLOBULIN FOR IDIOPATHIC INFLAMMATORY MYOSITIS: A MULTICENTER OBSERVATIONAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4827] [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
BackgroundThe spectrum of idiopathic inflammatory myositis (IIM) includes a heterogeneous group of diseases characterized by chronic inflammation of skeletal muscle, often associated with skin, joints, lungs, esophageal, gastrointestinal and cardiac involvement. Conventional treatment for IIM is based on glucocorticoids and immunosuppressants. Moreover, intravenous immunoglobulin (IVIg) has emerged as a promising steroid- and DMARD-sparing treatment for myositis [1]. However, the long-term use of IVIg is complicated by the fact that the intravenous route requires in-hospital drug administration, which not only influences patients’ quality of life, but is also associated with an increased risk of systemic adverse effects, difficulties in venous access over time, and high costs [2]. On these bases, administration of subcutaneous Ig (SCIg) by a programmable pump has been considered as a possible alternative to IVIg.Recombinant human hyaluronidase-facilitated (hf)-SCIg is currently approved for the use in patients with primary immunodeficiency disorders, while its efficacy and safety in myositis disorders is limited [3].ObjectivesThis multicenter retrospective observational study is sought to evaluate the effectiveness and safety of recombinant human hf-SCIg in patients with IIM treated at different referral centers.MethodsA multicenter, retrospective, cohort study was conducted on adult patients diagnosed with IIM according to the EULAR/ACR classification criteria [4] treated with recombinant human hf-SCIg according to routine clinical practice. The effectiveness of this treatment was assessed in terms of variations in the Medical Research Council (MRC) score, creatine kinase values, inflammatory parameters, and daily prednisolone dosage. Safety data were also collected.ResultsTwenty-three patients with IIM treated with hf-SCIg were included (16/23 females, 70%; median age at diagnosis of 61 years (IQR 43-65)).In most patients (22/23, 96%), IIM had been initially treated with high-dose corticosteroids (+/- synthetic or biologic DMARDs), and 20/23 patients (87%) had received previous IVIg treatment (in 12 for remission induction and in 8 for maintenance).Hf-SCIg were introduced after a median time of 2 years (1-4) from the diagnosis of IIM, mostly for remission maintenance (18/23). Hf-SCIg was started in combination with oral corticosteroids in 19/23 [83%, at a median dose of 5 mg/day (4-12.5)] and/or with traditional or biologic DMARDs (18/23, 78%).At time of hf-SCIg introduction, the median MRC score was 4 (3-4) and the median creatine kinase level was of 134 U/L (44-243). After 6 months of treatment, the median MRC score was 4 (3-5); no patient discontinued hf-SCIg, and only one experience a mild adverse event.ConclusionHf-SCIg seems effective to maintain remission in a high proportion of IIM patients, while showing a good safety profile in the first 6 months of treatment.References[1]Oddis. Treatment in myositis. Nat Rev Rheumatol 2018[2]Danieli. Subcutaneous IgG in the Myositis Spectrum Disorders. Curr Rheumatol Rev. 2018.[3]Wasserman. Recombinant human hyaluronidase-facilitated subcutaneous infusion of human immunoglobulins for primary immunodeficiency. JACI.2012.[4]Lundberg. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. ARD. 2017Table 1.Effectiveness and safety of hf-ScIG treatment in a cohort of patients with IIMhf-ScIg beginning3 months6 monthsN patients with available follow-up data2320 *19*MRC score §4 (3-4)4 (4-5)4 (3-5)Creatine kinase, U/L §134 (44-243)118 (77-308)130 (84-222)ESR, mm/h §21 (15-28)30 (25-43)31 (23-39)CRP, mg/dl §0.2 (0.1-0.5)0.3 (0.1-0.5)0.3 (0.1-0.3)Prednisolone dosage, mg/day §5 (4-12.5)7.5 (5-10)5 (5-7.5)Adverse events-NA1 ***none discontinued**One infusion site reaction§ median value (IQR)CRP=C reactive protein; ESR=erythrocyte sedimentation rateDisclosure of InterestsNone declared
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Bandini G, Cometi L, Accogli E, Domanico A, Tofani L, Bruni C, Bellando-Randone S, Lepri G, Orlandi M, Guiducci S, El-Aoufy K, Ciuti G, Fabbri A, Matucci-Cerinic M, Moggi-Pignone A. Ultrasound evaluation of bowel vasculopathy in systemic sclerosis. Eur J Intern Med 2022; 100:62-68. [PMID: 35058148 DOI: 10.1016/j.ejim.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) manifestations are frequent in systemic sclerosis (SSc) with an impact on quality of life and morbidity. Bowel vasculopathy is a key pathogenetic factor responsible for GI involvement. OBJECTIVES To compare abdominal ultrasound (US) and Color Doppler Ultrasonography (CDU) features of splanchnic vessels of SSc patients with healthy controls. METHODS The charts of SSc patients who underwent an abdominal US and CDU study were retrospectively analyzed. For Superior Mesenteric Artery (SMA) and Inferior Mesenteric Artery (IMA) caliber, Peak Systolic Velocity (PSV), Reverse Velocity (RV), End-Diastolic Velocity (EDV), Mean Velocity (mV), Blood-flow, Resistive Index (RI) and Pulsatility Index (PI) were recorded. RESULTS 28 SSc patients and 28 controls were enrolled. In SSc, caliber of SMA was significantly smaller than in controls (5.75 ± 0.62 mm vs. 6.45 ± 0.60 mm, p < 0.0001 - p adj =0.0002). The flow study of SMA and IMA showed a significant reduction of RV (SMA: 7.25 ± 6.37 cm/s vs. 18.52 ± 6.16 cm/s, p < 0.0001 - p adj <0.0001; IMA: 2.69 ± 6.10 cm/s vs. 17.06 ± 5.75 cm/s, p < 0.0001 - p adj <0.0001) and PI (SMA: 3.33 ± 0.75 vs. 4.53 ± 1.03, p < 0.0001 - p adj =0.0002; IMA: 3.54 ± 0.95 vs. 6.08 ± 1.53, p < 0.0001 - p adj <0.0001) in SSc patients than controls. CONCLUSION involvement of splanchnic vessels in SSc may be non-invasively investigated with abdominal US and CDU. Morphological and functional changes of Doppler parameters observed in SMA and IMA clearly demonstrate that these vessels are affected by SSc vasculopathy.
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Affiliation(s)
- Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy.
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Esterita Accogli
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Andrea Domanico
- Department of Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, Bologna, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Khadija El-Aoufy
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Gabriele Ciuti
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alessia Fabbri
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Internal Medicine AOUC, Viale San Luca, Florence 50134, Italy; Institute of Clinical Physiology, National Research Council, Pisa, Italy; Interventional and Structural Cardiology, Heart, Lung and Vessels Department, AOU Careggi, Italy
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Melis MR, El Aoufy K, Bruni C, Bartoli F, Fiori G, Guiducci S, Bellando Randone S, Bambi S, Rasero L, Matucci-Cerinic M. AB1540-HPR NURSING INTERVENTIONS FOR RHEUMATIC MUSCULOSKELETAL DISEASES (RMDS) PATIENTS ON BIOLOGIC THERAPY: A SYSTEMATIC LITERATURE REVIEW (SLR). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2630] [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
BackgroundThe support of the Rheumatology nurse to the management of patients who are affected by RMDs, characterized by remission and recrudescence and chronicity, may be strengthened by the investigation of their unmet needs and the identification of the necessary interventions to the continuity and quality of care.ObjectivesThe aim of the present SLR is to identify the main nursing interventions to assure quality care in RMDs patients on biologic therapy.MethodsStudy design: a systematic search was conducted from 1990 to 2020 (01/01/1990- 2020/05/07). Inclusion criteria consisted of 1) patients with RMDs in accordance with American College of Rheumatology classification criteria and the American College of Rheumatology/European League against Rheumatism (ACR/EULAR); 2) in therapy with bDMARDS; 3) adult population > 18 years; 4) primary research only; 6) English language; 7) abstract available; and 8) relative quantitative studies; 9) nursing interventions and/or outcomes. Data sources: Medline, CINAHL, PsycINFO and EMBASE databases were used to search for relevant studies. Review methods: using the predetermined inclusion/exclusion criteria, two independent reviewers (MRM, KEA) screened records selected for eligibility based on titles and abstracts. Records meeting the inclusion criteria were retrieved and full texts were further assessed. Critical Appraisal Skills Program (CASP) tools were used to evaluate the quality of the included studies. Data from 8 studies were extracted independently by the reviewers.Results1805 articles were retrieved: after the review process, 8 articles met the inclusion criteria resulting in 1 randomized trial, 1 quasi-experimental study and 6 observational studies. The RMDs patient needs emerged concerning the psychosocial domain, the relationship with healthcare facilities and disease follow up to monitor symptoms. Moreover, three major nursing interventions related to these areas were identified: education, patient-centered care and data assessment.ConclusionRheumatology nurses are part of a multidisciplinary team caring for patients on biologic therapy. Starting with accurate initial and ongoing data collection, rheumatology nurses can plan their interventions focusing primarily on patient education and tailored care based on actual needs. Further studies are necessary for research on aspects of patient-centered nursing care, including tele-nursing and Nursing Sensitive Outcomes in RMDs.References[1]EULAR, van Eijk-Hustings Y, van Tubergen A, Boström C, Braychenko E, Buss B, Felix J, Firth J, Hammond A, Harston B, Hernandez C, Huzjak M, Korandová J, Kukkurainen ML, Landewé R, Mezieres M, Milincovic M, Moretti A, Oliver S, Primdahl J, Scholte- Voshaar M, de la Torre-Aboki J, Waite-Jones J, Westhovens R, Zangi HA, Heiberg T, Hill J; “Recommendations for the role of the nurse in the management of chronic inflammatory arthritis”, Ann Rheum Dis. 2012 Jan;71(1):13-9. doi: 10.1136/annrheumdis-2011-200185. Epub 2011 Oct 28.[2]Larsson I. et al,“Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy”Journal of Advanced Nursing 70(1), 164–175., 2013[3]Betegnie,A.L. et al, “Why Do Patients with Chronic Inflammatory Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients’ Adherence Using a Self-report Questionnaire” The Journal of Rheumatology, 2016;43;724-730[4]Giacomelli R. et al, “Quality of life and unmet needs in patients with inflammatory arthropathies: results from the multicentre, observational RAPSODIA study.” Rheumatology (Oxford) 54(5): 792-797, 2015[5]Ozkaraman A. et al, “Effect of education and telephone counselling on adherence to treatment and challenges experienced in anti TNF-alfa treatment: a pilot study” Contemporary Nurse, ISSN: 1037-6178 (Print) 1839-3535 (Online), 2019Disclosure of InterestsNone declared
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