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Delle Sedie A, Terslev L, Bruyn GAW, Cazenave T, Chrysidis S, Diaz M, Di Carlo M, Frigato M, Gargani L, Gutierrez M, Hocevar A, Iagnocco A, Juche A, Keen H, Mandl P, Naredo E, Mortada M, Pineda C, Karalilova R, Porta F, Ravagnani V, Scirè C, Serban T, Smith K, Stoenoiu MS, Tardella M, Torralba K, Wakefield R, D'Agostino MA. Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group. Semin Arthritis Rheum 2024; 65:152406. [PMID: 38401294 DOI: 10.1016/j.semarthrit.2024.152406] [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: 09/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
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Affiliation(s)
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - George A W Bruyn
- Reumakliniek Lelystad, Lelystad, and Tergooi Hospital, Hilversum, the Netherlands
| | - Tomas Cazenave
- Instituto de Rehabiltacion Psicofisca, Buenos Aires, Argentina
| | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Esbjerg Hospital, Denmark
| | - Mario Diaz
- Fundacion Santa Fe de Bogotá, Bogotà, Colombia
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | - Marilena Frigato
- S.C. Allergologia, Immunologia e Reumatologia, ASST "Carlo Poma" Mantova, Mantova, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche - AO Mauriziano di Torino, Università di Torino, Turin, Italy
| | - Aaron Juche
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Helen Keen
- Department of Medicine and Pharmacology, University of Western Australia, Murdoch, Perth, WA, Australia
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Fundación Jiménez Díaz, Madrid, Spain
| | - Mohamed Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Carlos Pineda
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rositsa Karalilova
- Medical University of Plovdiv, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Santa Maria Maddalena Hospital, Rovigo, Italy
| | | | - Carlo Scirè
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | | | - Kate Smith
- NIHR Leeds Biomedical Research Centre and University of Leeds, UK
| | - Maria S Stoenoiu
- Rheumatology Department, Clinique Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marika Tardella
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | | | | | - Maria Antonietta D'Agostino
- Rheumatology division, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
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Paroli M, Becciolini A, Bravi E, Andracco R, Nucera V, Parisi S, Ometto F, Lumetti F, Farina A, Del Medico P, Colina M, Lo Gullo A, Ravagnani V, Scolieri P, Larosa M, Priora M, Visalli E, Addimanda O, Vitetta R, Volpe A, Bezzi A, Girelli F, Molica Colella AB, Caccavale R, Di Donato E, Adorni G, Santilli D, Lucchini G, Arrigoni E, Platè I, Mansueto N, Ianniello A, Fusaro E, Ditto MC, Bruzzese V, Camellino D, Bianchi G, Serale F, Foti R, Amato G, De Lucia F, Dal Bosco Y, Foti R, Reta M, Fiorenza A, Rovera G, Marchetta A, Focherini MC, Mascella F, Bernardi S, Sandri G, Giuggioli D, Salvarani C, Franchina V, Molica Colella F, Ferrero G, Ariani A. Long-Term Retention Rate of Tofacitinib in Rheumatoid Arthritis: An Italian Multicenter Retrospective Cohort Study. Medicina (Kaunas) 2023; 59:1480. [PMID: 37629770 PMCID: PMC10456797 DOI: 10.3390/medicina59081480] [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] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Background: Tofacitinib (TOFA) was the first Janus kinase inhibitor (JAKi) to be approved for the treatment of rheumatoid arthritis (RA). However, data on the retention rate of TOFA therapy are still far from definitive. Objective: The goal of this study is to add new real-world data on the TOFA retention rate in a cohort of RA patients followed for a long period of time. Methods: A multicenter retrospective study of RA subjects treated with TOFA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was conducted in 23 Italian tertiary rheumatology centers. The study considered a treatment period of up to 48 months for all included patients. The TOFA retention rate was assessed with the Kaplan-Meier method. Hazard ratios (HRs) for TOFA discontinuation were obtained using Cox regression analysis. Results: We enrolled a total of 213 patients. Data analysis revealed that the TOFA retention rate was 86.5% (95% CI: 81.8-91.5%) at month 12, 78.8% (95% CI: 78.8-85.2%) at month 24, 63.8% (95% CI: 55.1-73.8%) at month 36, and 59.9% (95% CI: 55.1-73.8%) at month 48 after starting treatment. None of the factors analyzed, including the number of previous treatments received, disease activity or duration, presence of rheumatoid factor and/or anti-citrullinated protein antibody, and presence of comorbidities, were predictive of the TOFA retention rate. Safety data were comparable to those reported in the registration studies. Conclusions: TOFA demonstrated a long retention rate in RA in a real-world setting. This result, together with the safety data obtained, underscores that TOFA is a viable alternative for patients who have failed treatment with csDMARD and/or biologic DMARDs (bDMARDs). Further large, long-term observational studies are urgently needed to confirm these results.
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Affiliation(s)
- Marino Paroli
- Department of Clinical, Internist, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Elena Bravi
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Romina Andracco
- Internal Medicine Unit, Imperia Hospital, 18100 Imperia, Italy; (R.A.); (N.M.)
| | - Valeria Nucera
- Rheumatology Unit, ASL Novara, 28100 Novara, Italy; (V.N.); (A.I.)
| | - Simone Parisi
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | | | - Federica Lumetti
- Rheumatology Unit, Azienda USL of Modena and AOU Policlinico of Modena, 41100 Modena, Italy;
| | - Antonella Farina
- Internal Medicine Unit, Augusto Murri Hospital, 63900 Fermo, Italy;
| | - Patrizia Del Medico
- Internal Medicine Unit, Civitanova Marche Hospital, 62012 Civitanova Marche, Italy;
| | - Matteo Colina
- Rheumatology Unit, Internal Medicine Division, Department of Medicine and Oncology, Santa Maria della Scaletta Hospital, 40026 Imola, Italy;
- Rheumatology Unit, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy
| | | | - Viviana Ravagnani
- Rheumatology Unit, Santa Chiara Hospital APSS—Trento, 38122 Trento, Italy;
| | - Palma Scolieri
- Rheumatology Unit, Nuovo Regina Margherita Hospital, 00154 Roma, Italy; (P.S.); (V.B.)
| | - Maddalena Larosa
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | - Marta Priora
- Rheumatology Unit, ASL CN1, 12100 Cuneo, Italy; (M.P.); (F.S.)
| | - Elisa Visalli
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Olga Addimanda
- Rheumatology Unit, AUSL of Bologna—Policlinico Sant’Orsola—AOU—IRCCS of Bologna, 40138 Bologna, Italy; (O.A.); (M.R.)
| | - Rosetta Vitetta
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Alessandro Volpe
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (A.V.); (A.M.)
| | - Alessandra Bezzi
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Francesco Girelli
- Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy; (F.G.); (S.B.)
| | | | - Rosalba Caccavale
- Department of Clinical, Internist, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Giuditta Adorni
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Daniele Santilli
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Gianluca Lucchini
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Eugenio Arrigoni
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Ilaria Platè
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Natalia Mansueto
- Internal Medicine Unit, Imperia Hospital, 18100 Imperia, Italy; (R.A.); (N.M.)
| | - Aurora Ianniello
- Rheumatology Unit, ASL Novara, 28100 Novara, Italy; (V.N.); (A.I.)
| | - Enrico Fusaro
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | - Maria Chiara Ditto
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | - Vincenzo Bruzzese
- Rheumatology Unit, Nuovo Regina Margherita Hospital, 00154 Roma, Italy; (P.S.); (V.B.)
| | - Dario Camellino
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | - Gerolamo Bianchi
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | | | - Rosario Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Giorgio Amato
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Francesco De Lucia
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Ylenia Dal Bosco
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Roberta Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Massimo Reta
- Rheumatology Unit, AUSL of Bologna—Policlinico Sant’Orsola—AOU—IRCCS of Bologna, 40138 Bologna, Italy; (O.A.); (M.R.)
| | - Alessia Fiorenza
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Guido Rovera
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Antonio Marchetta
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (A.V.); (A.M.)
| | - Maria Cristina Focherini
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Fabio Mascella
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Simone Bernardi
- Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy; (F.G.); (S.B.)
| | - Gilda Sandri
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Veronica Franchina
- Medical Oncology Unit, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | | | - Giulio Ferrero
- Unit of Diagnostic and Interventional Radiology, Santa Corona Hospital, 17027 Pietra Ligure, Italy;
| | - Alarico Ariani
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
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Rossi-Semerano L, Ravagnani V, Collado P, Vojinovic J, Roth J, Magni-Manzoni S, Naredo E, D'Agostino MA, Jousse-Joulin S. Validity of ultrasonography in detecting enthesitis in children: A systematic literature review. Joint Bone Spine 2023; 90:105538. [PMID: 36754113 DOI: 10.1016/j.jbspin.2023.105538] [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: 11/11/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A systematic review to assess the value of ultrasonography (US) for detecting enthesitis in juvenile idiopathic arthritis (JIA). METHODS PubMed and Embase databases were searched for articles published from January 1966 to May 2021; we selected those meeting the inclusion criteria according to the US definition of enthesitis and metric properties studied. We assessed the clinical features of the population, study design, the type and number of entheses examined, the definition and scoring system of US enthesitis and metric properties according to the OMERACT filter (truth, discrimination and feasibility). The quality of the studies was evaluated with the Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS Five publications met the inclusion criteria (26 to 146 patients and 1 to 10 bilaterally examined entheses). All studies focused on lower-limb entheses. The elementary lesions included in the definition of adult enthesitis were generally assessed. Few studies reported US reliability and none evaluated sensitivity to change of US. US revealed entheseal abnormalities in 9.4 to 53% of JIA patients and 20 to 83% of enthesitis-related arthritis cases. No significant abnormalities were found in healthy children. US findings were poorly correlated with clinical examination. The overall quality of the studies was low, mainly because of the lack of a reference standard. CONCLUSION US is a sensitive tool to detect entheseal abnormalities in JIA. The current evidence highlights that a standardized US definition of enthesitis in children is lacking and US criteria and discriminant validity have not been established.
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Affiliation(s)
- Linda Rossi-Semerano
- Department of Pediatric Rheumatology, National Reference Centre for Auto-inflammatory Diseases and Amyloidosis of Inflammatory origin (CEREMAIA), Bicêtre hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | | | - Paz Collado
- Department of Rheumatology, Hospital Universitario Severo Ochoa, University Alfoso X E1 Sabio, Madrid, Spain
| | - Jelena Vojinovic
- Clinic of Pediatrics, Clinical Center, Faculty of Medicine, University of Nis, Bul dr Zorana Djindjica 48, 18000 Nis, Serbia
| | - Johannes Roth
- Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H8L1, Canada
| | - Silvia Magni-Manzoni
- Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Sandrine Jousse-Joulin
- Department of Rheumatology, La Cavale Blanche University hospital, University Brest, Inserm, LBAI, UMR 1227, Brest, France.
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Batticciotto A, Marotto D, Giorgi V, Balzarini P, Favalli EG, Balduzzi S, Fredi M, Bazzani C, Sartorelli S, Ravagnani V, Tamanini S, Castelnovo L, Lurati AM, Farah S, Bongiovanni S, Caporali R, Dagna L, Faggioli P, Franceschini F, Montecucco CM, Salaffi F, Galli M, Cappelli A, Sarzi-Puttini P. Use of rituximab in a multicentre cohort of patients with rheumatic diseases during the outbreak of novel SARS-COV-2 infection. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/6z3ong] [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] [Indexed: 11/13/2022]
Affiliation(s)
- Alberto Batticciotto
- Rheumatology Unit, Ospedale di Circolo - Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy.
| | - Daniela Marotto
- Rheumatology Unit, ASST-Fatebenefratelli L. Sacco University Hospital, University of Milan, Italy
| | - Valeria Giorgi
- Rheumatology Unit, ASST-Fatebenefratelli L. Sacco University Hospital, University of Milan, Italy
| | - Patrizia Balzarini
- Rheumatology Unit, Ospedale di Circolo - Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | - Ennio Giulio Favalli
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy
| | - Silvia Balduzzi
- Department of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Chiara Bazzani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Laura Castelnovo
- Department of Internal Medicine, ASST Ovest Milanese, Legnano, Italy
| | | | - Sonia Farah
- Rheumatology Clinic, Ospedale Carlo Urbani, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Sara Bongiovanni
- Rheumatology Unit, ASST-Fatebenefratelli L. Sacco University Hospital, University of Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, and Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Faggioli
- Department of Internal Medicine, ASST Ovest Milanese, Legnano, and Department of Rheumatology, ASST Ovest Milanese, Magenta, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Fausto Salaffi
- Rheumatology Clinic, Ospedale Carlo Urbani, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Massimo Galli
- Department of Clinical and Biomedical Sciences, L. Sacco University Hospital, University of Milan; III Division of Infectious Diseases, ASST-Fatebenefratelli Luigi Sacco Hospital, Milan, Italy
| | - Antonella Cappelli
- Rheumatology Unit, Ospedale di Circolo - Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, ASST-Fatebenefratelli L. Sacco University Hospital, University of Milan, Italy
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Salvarani C, Dolci G, Massari M, Merlo DF, Cavuto S, Savoldi L, Bruzzi P, Boni F, Braglia L, Turrà C, Ballerini PF, Sciascia R, Zammarchi L, Para O, Scotton PG, Inojosa WO, Ravagnani V, Salerno ND, Sainaghi PP, Brignone A, Codeluppi M, Teopompi E, Milesi M, Bertomoro P, Claudio N, Salio M, Falcone M, Cenderello G, Donghi L, Del Bono V, Colombelli PL, Angheben A, Passaro A, Secondo G, Pascale R, Piazza I, Facciolongo N, Costantini M. Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:24-31. [PMID: 33080005 PMCID: PMC7577199 DOI: 10.1001/jamainternmed.2020.6615] [Citation(s) in RCA: 489] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic is threatening billions of people worldwide. Tocilizumab has shown promising results in retrospective studies in patients with COVID-19 pneumonia with a good safety profile. OBJECTIVE To evaluate the effect of early tocilizumab administration vs standard therapy in preventing clinical worsening in patients hospitalized with COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS Prospective, open-label, randomized clinical trial that randomized patients hospitalized between March 31 and June 11, 2020, with COVID-19 pneumonia to receive tocilizumab or standard of care in 24 hospitals in Italy. Cases of COVID-19 were confirmed by polymerase chain reaction method with nasopharyngeal swab. Eligibility criteria included COVID-19 pneumonia documented by radiologic imaging, partial pressure of arterial oxygen to fraction of inspired oxygen (Pao2/Fio2) ratio between 200 and 300 mm Hg, and an inflammatory phenotype defined by fever and elevated C-reactive protein. INTERVENTIONS Patients in the experimental arm received intravenous tocilizumab within 8 hours from randomization (8 mg/kg up to a maximum of 800 mg), followed by a second dose after 12 hours. Patients in the control arm received supportive care following the protocols of each clinical center until clinical worsening and then could receive tocilizumab as a rescue therapy. MAIN OUTCOME AND MEASURES The primary composite outcome was defined as entry into the intensive care unit with invasive mechanical ventilation, death from all causes, or clinical aggravation documented by the finding of a Pao2/Fio2 ratio less than 150 mm Hg, whichever came first. RESULTS A total of 126 patients were randomized (60 to the tocilizumab group; 66 to the control group). The median (interquartile range) age was 60.0 (53.0-72.0) years, and the majority of patients were male (77 of 126, 61.1%). Three patients withdrew from the study, leaving 123 patients available for the intention-to-treat analyses. Seventeen patients of 60 (28.3%) in the tocilizumab arm and 17 of 63 (27.0%) in the standard care group showed clinical worsening within 14 days since randomization (rate ratio, 1.05; 95% CI, 0.59-1.86). Two patients in the experimental group and 1 in the control group died before 30 days from randomization, and 6 and 5 patients were intubated in the 2 groups, respectively. The trial was prematurely interrupted after an interim analysis for futility. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of hospitalized adult patients with COVID-19 pneumonia and Pao2/Fio2 ratio between 200 and 300 mm Hg who received tocilizumab, no benefit on disease progression was observed compared with standard care. Further blinded, placebo-controlled randomized clinical trials are needed to confirm the results and to evaluate possible applications of tocilizumab in different stages of the disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04346355; EudraCT Identifier: 2020-001386-37.
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Affiliation(s)
- Carlo Salvarani
- SOC Reumatologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Unità di Reumatologia, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Dolci
- Unità di Malattie Infettive, Università degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Marco Massari
- SOC Malattie Infettive, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luisa Savoldi
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Bruzzi
- SC Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabrizio Boni
- SOC Internistica Multidisciplinare, Ospedale Civile Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- SC Infrastruttura Ricerca e Statistica, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Turrà
- SOC Farmacia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Roberto Sciascia
- UOC Medicina Generale Ospedale di Vittorio Veneto, Treviso, Italy
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, SOD Malattie infettive e tropicali, AOU Careggi, Firenze, Italy
| | - Ombretta Para
- Medicina Interna 1, Dipartimento Emergenza ed Accettazione, AOU Careggi, Firenze, Italy
| | - Pier Giorgio Scotton
- UO di Malattie Infettive, Ospedale Regionale Ca' Foncello di Treviso, Treviso, Italy
| | - Walter Omar Inojosa
- UO di Malattie Infettive, Ospedale Regionale Ca' Foncello di Treviso, Treviso, Italy
| | - Viviana Ravagnani
- SSD Centro DH Allergologia e Immunologia Clinica, ASST-Mantova, Mantva, Italy
| | | | - Pier Paolo Sainaghi
- SS Reumatologia, SC Medicina Interna, DIMET, Università del Piemonte Orientale e AOU Maggiore della Carità di Novara
| | | | | | - Elisabetta Teopompi
- SOC Internistica Multidisciplinare, Ospedale Civile Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Milesi
- Unità di malattie Infettive, ASST di Cremona, Cremona, Italy
| | - Perla Bertomoro
- UOC Medicina Generale, ULSS6 Euganea Ospedali Riuniti Padova Sud, Padova, Italy
| | | | - Mario Salio
- SC Malattie dell'Apparato Respiratorio, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Marco Falcone
- Unità di Malattie Infettive, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | | | - Lorenzo Donghi
- UO Malattie Infettive ed Epatologia, AOU Parma, Parma, Italy
| | - Valerio Del Bono
- Malattie Infettive e Tropicali, AO S. Croce e Carle, Cuneo, Italy
| | | | - Andrea Angheben
- Dipartimento di Malattie Infettive, Tropicali e Microbiologia, IRCCS Ospedale Sacro Cuore-Don Calabria, Negrar di Valpolicella, Verona, Italy
| | | | | | - Renato Pascale
- UO Malattie Infettive, Dipartimento di scienze mediche e chirurgiche, Università di Bologna, Bologna, Italy
| | - Ilaria Piazza
- UOC Medicina Interna, AUSSS3 Serenissima, Dolo, Venezia, Italy
| | - Nicola Facciolongo
- SOC Pneumologia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Treppo E, Infantino M, Benucci M, Ravagnani V, Palterer B, Grandis M, Fabris M, Tomietto P, Manfredi M, Sonaglia A, Giudizi MG, Ligobbi F, Cammelli D, Parronchi P, De Vita S, Quartuccio L. AB0601 RAPID AND SUSTAINED EFFICACY OF AN INDUCTION TREATMENT WITH A TRIPLE THERAPY INCLUDING HIGH-DOSE INTRAVENOUS IMMUNOGLOBULINS, METHOTREXATE AND GLUCOCORTICOIDS IN ANTI-3-HYDROXY-3-METHYLGLUTARYL-COENZYME A REDUCTASE MYOPATHY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Anti-3-hydroxy-3-methylglutaryl-coenzime A reductase (HMGCR) myopathy is a new entity, which has been clearly associated to statin use, even if it can be diagnosed in patients without a history of exposure to statin or even in the childhood (1).Objectives:The aim of the study is to describe the efficacy of a triple therapy regimen consisting in high-doses of intravenous immunoglobulins (IVIG), methotrexate (MTX), and glucocorticoids (GC) in 16 patients with Anti-HMGCR myopathy enrolled in 6 specialized centres.Methods:A total of 16 patients with anti-HMGCR myopathy (7 females; 9 males) were collected. Mean (±standard deviation) age at the onset of disease was 72.4±10.3 years old. All patients were diagnosed having anti-HMGCR myopathy [anti-HMGCR antibodies were measured by chemiluminescence assay (BioFlash, Inova, CA)] (2). Median follow-up was 29.5 months (interquartile range: 15.75-60 months). Anti-HMGCR antibodies were available in the follow-up in 8/16 patients.Results:Thirteen out of 16 patients (81.3%) had been exposed to statin (1/13 to red rice), 3/16 (18.7%) were not exposed. As induction therapy, 11/16 patients have been treated with triple therapy (high-dose IVIG, MTX and GC), 2/16 with double therapy (high-dose IVIG and GC), 2/16 have been treated with GC alone, the patient exposed to red rice resolved only with red rice suspension. Clinical remission and normalization of CPK values within month +24 were obtained in all the patients. All the patients were in remission at the last follow-up. Gradual improvement started soon from the first month, and among the 13 patients treated with an aggressive immunosuppresssive therapy including IVIG (13/13), GC (13/13) and methotrexate (11/13), 9/13 normalized the CPK value within 6 months. Clinical and laboratory response was accompanied by significant decrease or normalization of the anti-HMGCR antibody titer. All the patients were either not taking GC (56.3%), or were taking low doses of GC (43.7%) at the last follow-up. Four patients had stopped GC within 6 months. No serious side effects were recorded. After persistent remission, a maintenance immunosuppressive therapy was then administered. Only 3 relapses in 3 different cases were recorded, all of them during drug-free remission in long-term follow-up. Reinduction was again effective in all.Conclusion:Anti-HMGCR myopathy is a rare and serious myopathy which usually affects older people during statin treatment. After statin suspension, a rapid and sustained remission can be achieved by induction with a triple aggressive therapy consisting in medium-to high doses of GC, high-dose IVIG, and MTX (3). GC should be tapered as soon as possible. Relapse appears infrequent during maintenance treatment. Monitoring anti-HMGCR antibody titer may be clinically relevant.References:[1]AL Mammen et al. N Engl J Med. 2016;374:664-9[2]Musset L et al. Autoimmun Rev. 2016;15:983-93.[3]Aggarwal A et al. Scand J Rheumatol. 2019; 1-7.Acknowledgments:We thank MD Francesca Grosso and MD Valentina Mecheri from the University of Florence, MD Angela Zuppa and MD Chiara De Michelis, from San Martino Hospital, Genova, for their valued collaboration in data collectionDisclosure of Interests:Elena Treppo: None declared, Maria Infantino: None declared, Maurizio Benucci: None declared, Viviana Ravagnani: None declared, Boaz Palterer: None declared, Marina Grandis: None declared, Martina Fabris: None declared, Paola Tomietto: None declared, Mariangela Manfredi: None declared, Arianna Sonaglia: None declared, Maria Grazia Giudizi: None declared, Francesca Ligobbi: None declared, Daniele Cammelli: None declared, Paola Parronchi: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer
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Ravagnani V, Vinco G, Aroldi M, Frigato M, Izzo A, Costantino MT, Lettieri C. THU0601 REFRACTORY ACUTE CORONARY SYNDROME AND CARDIOGENIC SHOCK AS ATYPICAL ONSET OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Eosinophilic Granulomatosis with Polyangiitis (EGPA) is an ANCA-associated vasculitis, characterized by eosinophilic infiltration in tissues, intravascular and extravascular granuloma formation. It is a rare disease, affecting between 0 and 4 per million population per year. The cardiac involvement occurs in 15-60% of EGPA patients (generally ANCA-negative); it is often insidious, underestimated and it has a poor prognosis. The disease usually shows a prodromal phase characterized by asthma and allergic manifestations.Objectives:We report the case of a young patient with acute coronary syndrome (ACS) complicated by cardiogenic shock as the first manifestation of EGPA.Methods:A 36 year old Indian male patient, with a previous history of asthma, rhinitis, Raynaud syndrome and allergy to ketoprofen, presented to the emergency department with a complaint of chest pain and dyspnea. Cardiac troponin was elevated and he was admitted to intensive care unit with a diagnosis of ACS. The patient conditions rapidly deteriorated due to acute cardiogenic shock and an urgent coronary angiogram was performed. An occlusion of the left main coronary artery was treated with angioplasty and two drug-eluting stents. Echocardiography showed severe left ventricular dysfunction requiring inotropic and intra-aortic balloon pump support. A mild dermatitis after salicylic acid administration resolved with intravenous hydrocortisone 1 g. The thrombophilia screening was negative, as well as cardiovascular risk factors. Over the next days, the clinical conditions rapidly improved with recovery of normal ventricular function on discharge. However, two weeks later he was readmitted with recurrent mandibular and chest pain. Troponin levels were elevated and fluctuated, suggesting recurrent ischemic events. Repeated ECG during angina crisis showed ischemic alterations in different coronary territories. The coronary angiogram detected coronary vasospasm of the circumflex artery, reversible after nitroglycerin (Figure 1). Nitroglycerin and calcium channel blockers were initiated, but did not resolve the vasospastic angina crisis, occurring daily. Laboratory tests revealed eosinophilia (4390 cells/mcl), increased C reactive protein (9.4 mg/l) and positive antinuclear antibodies (1:320). The other serological and immunological tests were negative, including MPO-ANCA and PR3-ANCA. An abdomen and chest CT scan was negative.Figure 1.Coronary angiogram showing coronary vasospasm in the left circumflex artery (panel A, yellow arrow), reversible after nytroglicerin infusion (panel B, yellow arrow)Results:The eosinophilia and the history of asthma rose the suspect of EGPA vasculitis. The patient was treated with intravenous methylprednisolone 250 mg once daily for 3 days, followed by oral prednisone 1 mg/kg/day, with rapid and complete resolution of the recurrent angina episodes. Intravenous cyclophosphamide 10 mg/kg was administered every 2 weeks for 2 times, then 12 mg/kg every 4 weeks. Oral corticosteroid was tapered, with the persistence of a complete remission of the symptoms, after 2 months of immunosuppressive therapy.Conclusion:Coronary involvement in EGPA can mimic atherosclerotic artery disease and can be life threatening, if not promptly recognized. An accurate medical history and complete serological and immunological tests are crucial to detect an atypical onset of EGPA, prompting early immunosuppressive therapy which is pivotal for the patient survival.References:[1]MR Hazebroek et al. Prevalence and Prognostic Relevance of Cardiac Involvement in ANCA-associated Vasculitis: Eosinophilic Granulomatosis With Polyangiitis and Granulomatosis With Polyangiitis. Int J Cardiol 2015, 199: 170-9.Disclosure of Interests:None declaredDOI: 10.1136/annrheumdis-2020-eular.6482
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Windschall D, Collado P, Vojinovic J, Magni‐Manzoni S, Balint P, Bruyn GAW, Hernandez‐Diaz C, Nieto JC, Ravagnani V, Tzaribachev N, Iagnocco A, D'Agostino MA, Naredo E. Age‐Related Vascularization and Ossification of Joints in Children: An International Pilot Study to Test Multiobserver Ultrasound Reliability. Arthritis Care Res (Hoboken) 2020; 72:498-506. [DOI: 10.1002/acr.23335] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/01/2017] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Peter Balint
- National Institute of Rheumatology and Physiotherapy Budapest Hungary
| | | | | | - Juan Carlos Nieto
- Hospital General Universitario Gregorio Marañón and Complutense University Madrid Spain
| | | | | | | | - Maria Antonietta D'Agostino
- APHPHôspital Ambroise Paré, 92100 Boulogne‐Billancourt, INSERM U1173, UFR Simone Veil, and Versailles‐Saint‐Quentin University Saint‐Quentin en Yvelines France
| | - Esperanza Naredo
- Hospital General Universitario Gregorio Marañón and Complutense University Madrid Spain
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Quartuccio L, Bond M, Isola M, Monti S, Felicetti M, Furini F, Murgia S, Berti A, Silvestri E, Pazzola G, Bozzolo E, Leccese P, Raffeiner B, Parisi S, Leccese I, Cianci F, Bettio S, Sainaghi P, Ianniello A, Ravagnani V, Bellando Randone S, Faggioli P, Lomater C, Stobbione P, Ferro F, Colaci M, Alfieri G, Carubbi F, Erre GL, Giollo A, Franzolini N, Ditto MC, Balduzzi S, Padoan R, Bortolotti R, Bortoluzzi A, Cariddi A, Padula A, Di Scala G, Gremese E, Conti F, D'Angelo S, Matucci Cerinic M, Dagna L, Emmi G, Salvarani C, Paolazzi G, Roccatello D, Govoni M, Schiavon F, Caporali R, De Vita S. Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors. J Autoimmun 2020; 108:102397. [PMID: 31926833 DOI: 10.1016/j.jaut.2019.102397] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Alveolar haemorrhage (AH) is considered an important cause of morbidity and early mortality in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV). OBJECTIVES The aim of this study was to identify predictors of outcome in patients with AH-AAV and to evaluate outcome and causes of death in this subset. MATERIALS AND METHODS A multicenter retrospective study was conducted in 29 Italian Centers. Clinicians were asked to recruit all patients diagnosed with AAV-associated AH during the last 10 years, from 2007 to 2016. Univariate and multivariable analysis were performed. RESULTS One-hundred and six patients were included (median age at onset of 55 years [IQR 42-67]). The majority were ANCA-positive (PR3 57.1%, MPO 33.7%) and 72.6% had also renal involvement. At presentation, anaemia was shown in 97 (92.4%) patients, hemoptysis in 54 (51.9%), respiratory failure in 68 (66.7%), of whom 48 (70.6%), requiring respiratory support. At the end of the 37 months [IQR 13-77] follow-up, 19/106 (17.9%) patients were dead. The main causes of death were active disease and infections. By stepwise regression analysis, age >65 years (HR 3.66 [95% CI 1.4-9.51], p = 0.008) and the need for respiratory support (HR 4.58 [95% CI 1.51-13.87], p = 0.007) at AH onset were confirmed to be predictive of mortality. CONCLUSIONS Predictors of outcome in AAV-AH were determined. Factors related to the patient's performance status and the severity of the lung involvement strongly influenced the outcome. Balancing harms and benefits for the individual patient in induction and maintenance treatment strategies is crucial.
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Affiliation(s)
- Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy.
| | - Milena Bond
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Miriam Isola
- Institute of Statistics, Department of Medical Area, University of Udine, Udine, Italy
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy; University of Pavia, PhD in Experimental Medicine, Pavia, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Federica Furini
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Stefano Murgia
- CMID-Center of Research of Nephrology, Rheumatology, and Rare Diseases Interregional Coordinating Center of the Network of Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-net Member) G. Bosco Hospital, and University of Turin, Italy
| | - Alvise Berti
- Department of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Italy
| | - Enrica Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Bernd Raffeiner
- Rheumatology Unit, Department of Medicine, Centrale Hospital of Bolzano, Italy
| | - Simone Parisi
- S.C. Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilaria Leccese
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - Francesco Cianci
- Rheumatology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvano Bettio
- Rheumatology Unit, Internal Medicine Department, University Hospital of Cattinara, Trieste, Italy
| | - Pierpaolo Sainaghi
- Rheumatology Unit, CAAD and DiMet, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Aurora Ianniello
- Day Hospital Multidisciplinare, Ospedale di Borgomanero, ASL-NO Novara, Novara, Italy
| | | | - Silvia Bellando Randone
- Department of Experimental and Clinical Medicine University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Paola Faggioli
- ASST Ovest Milanese, UOC Internal Medicine, Legnano, Italy
| | | | | | | | - Michele Colaci
- Dept Clinical and Experimental Medicine University of Catania, Catania, Italy
| | | | | | | | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | | | - Maria Chiara Ditto
- S.C. Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy; University of Padua, PhD Program in Clinical and Experimental Sciences, Padua, Italy
| | - Silvia Balduzzi
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | | | - Alessandra Bortoluzzi
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angela Padula
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisa Gremese
- Rheumatology Institute, Università Cattolica del Sacro Cuore, Rome, Italy; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | | | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Italy
| | | | - Dario Roccatello
- CMID-Center of Research of Nephrology, Rheumatology, and Rare Diseases Interregional Coordinating Center of the Network of Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-net Member) G. Bosco Hospital, and University of Turin, Italy
| | - Marcello Govoni
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Roberto Caporali
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
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Collado P, Windschall D, Vojinovic J, Magni-Manzoni S, Balint P, Bruyn GAW, Hernandez-Diaz C, Nieto JC, Ravagnani V, Tzaribachev N, Iagnocco A, D’Agostino MA, Naredo E. Amendment of the OMERACT ultrasound definitions of joints' features in healthy children when using the DOPPLER technique. Pediatr Rheumatol Online J 2018; 16:23. [PMID: 29631610 PMCID: PMC5892017 DOI: 10.1186/s12969-018-0240-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recently preliminary ultrasonography (US) definitions, in B mode, for normal components of pediatric joints have been developed by the OMERACT US group. The aim of the current study was to include Doppler findings in the evaluation and definition of normal joint features that can be visualized in healthy children at different age groups. METHODS A multistep approach was used. Firstly, new additional definitions of joint components were proposed during an expert meeting. In the second step, these definitions, along with the preliminary B-mode-US definitions, were tested for feasibility in an exercise in healthy children at different age groups. In the last step, a larger panel of US experts were invited to join a web-based consensus process in order to approve the developed definitions using the Delphi methodology. A Likert scale of 1-5 was used to assess agreement. RESULTS Physiological vascularity and fat pad tissue were identified and tested as two additional joint components in healthy children. Since physiological vascularity changes over the time in the growing skeleton, the final definition of Doppler findings comprised separate statements instead of a single full definition. A total of seven statements was developed and included in a written Delphi questionnaire to define and validate the new components. The final definitions for fat pad and physiological vascularity agreed by the group of experts reached 92.9% and 100% agreement respectively in a web survey. CONCLUSION The inclusion of these two additional joints components which are linked to detection of Doppler signal in pediatric healthy joints will improve the identification of abnormalities in children with joint pathologies.
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Affiliation(s)
- P. Collado
- 0000 0001 0635 4617grid.411361.0Hospital Universitario Severo Ochoa., Madrid, Spain
| | - D. Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany
| | - J. Vojinovic
- 0000 0001 0942 1176grid.11374.30Department of Pediatrics, Clinical Center, Faculty of Medicine, University of Nis, Nis, Serbia
| | - S. Magni-Manzoni
- 0000 0001 0727 6809grid.414125.7Rheumatology Division, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - P. Balint
- 0000 0004 0637 0256grid.419642.c3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - G. A. W. Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - C. Hernandez-Diaz
- 0000 0004 0633 2911grid.419223.fInstituto Nacional de Rehabilitación, Mexico City, Mexico
| | - J. C. Nieto
- 0000 0001 0277 7938grid.410526.4Department of Rheumatology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - V. Ravagnani
- 0000 0004 0493 6690grid.413174.4Department of Internal Medicine, ASST Mantova, C. Poma Hospital, Mantova, Italy
| | - N. Tzaribachev
- Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - A. Iagnocco
- grid.7841.aRheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - M. A. D’Agostino
- 0000 0001 2323 0229grid.12832.3aRheumatology Department, Hôspital Ambroise Paré, Boulogne Billancourt; INSERM U1173, Laboratoire d’Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Yvelines, France
| | - E. Naredo
- grid.419651.eDepartment of Rheumatology, Hospital Universitario Fundación Jimenez Díaz and Autonoma University, Madrid, Spain
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De Lucia O, Ravagnani V, Pregnolato F, Hila A, Pontikaki I, Gattinara M, Romano M, Gerloni V, Pieropan S, Murgo A, Rossini M, Cimaz R, Meroni PL. Baseline ultrasound examination as possible predictor of relapse in patients affected by juvenile idiopathic arthritis (JIA). Ann Rheum Dis 2018; 77:1426-1431. [DOI: 10.1136/annrheumdis-2017-211696] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesTo define the correlation between joint ultrasonography and clinical examination in patients with juvenile idiopathic arthritis (JIA) and to assess whether synovitis detected by ultrasonography in clinically inactive patients predicts arthritis flares.Methods88 consecutive patients with JIA—46 (52%) with persistent oligoarthritis, 15 (17%) with extended oligoarthritis, 15 (17%) with rheumatoid factor-negative polyarthritis and 12 (14%) with other forms of JIA, all clinically inactive for a minimum of 3 months—underwent ultrasound (US) assessment of 44 joints. Joints were scanned at study entry for synovial hyperplasia, joint effusion and power Doppler (PD) signal. Patients were followed clinically for 4 years.ResultsUS was abnormal in 20/88 (22.7%) patients and in 38/3872 (0.98%) joints. Extended oligoarthritis and rheumatoid factor-negative polyarthritis were more frequent in US-positive than in US-negative patients (35.0% vs 11.8% and 30.0% vs 13.2%, respectively; P=0.005). During 4 years of follow-up, 41/88 (46.6%) patients displayed a flare; 26/68 (38.2%) were US-negative and 15/20 (75%) were US-positive at baseline. Abnormality on US examination, after correction for therapy modification, significantly increased the risk of flare (OR=3.8, 95% CI 1.2 to 11.5). The combination of grey scale and PD abnormalities displayed a much higher predictive value of relapse (65%, 13/20) than grey scale alone (33%, 6/18).ConclusionsUS abnormalities are a strong predictor of relapse at individual patient level. Irrespective of treatment, the risk of flare in US-positive versus US-negative patients was almost four times higher. In case of US abnormalities, patients should be carefully followed regardless of both the International League of Associations for Rheumatology and Wallace categories.
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Roth J, Ravagnani V, Backhaus M, Balint P, Bruns A, Bruyn GA, Collado P, De la Cruz L, Guillaume-Czitrom S, Herlin T, Hernandez C, Iagnocco A, Jousse-Joulin S, Lanni S, Lilleby V, Malattia C, Magni-Manzoni S, Modesto C, Rodriguez A, Nieto JC, Ohrndorf S, Rossi-Semerano L, Selvaag AM, Swen N, Ting TV, Tzaribachev N, Vega-Fernandez P, Vojinovic J, Windschall D, D'Agostino MA, Naredo E. Preliminary Definitions for the Sonographic Features of Synovitis in Children. Arthritis Care Res (Hoboken) 2017; 69:1217-1223. [PMID: 27748074 DOI: 10.1002/acr.23130] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasonography (US) has the potential to be an important tool in the assessment of disease activity in childhood arthritides. To assess pathology, clear definitions for synovitis need to be developed first. The aim of this study was to develop and validate these definitions through an international consensus process. METHODS The decision on which US techniques to use and the components to be included in the definitions, as well as the final wording, were developed by 31 US experts in a consensus process. A Likert scale of 1-5 (where 1 = complete disagreement and 5 = complete agreement) was used. A minimum of 80% of the experts scoring 4 or 5 was required for final approval. The definitions were then validated on 120 standardized US images of the wrist, metacarpophalangeal joints, and tibiotalar joints, displaying various degrees of synovitis at various ages. RESULTS B-mode and Doppler should be used for assessing synovitis in children. A US definition of the various components (i.e., synovial hypertrophy, effusion, and Doppler signal within the synovium) was developed. The definition was validated on still images with a median of 89% of participants (range 80-100) scoring it as 4 or 5 on a Likert scale. CONCLUSION US definitions of synovitis and its elementary components covering the entire pediatric age range were successfully developed through a Delphi process and validated in a web-based still-images exercise. These results provide the basis for the standardized US assessment of synovitis in clinical practice and research.
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Affiliation(s)
- Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Peter Balint
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Alessandra Bruns
- Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Paz Collado
- Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Lorenia De la Cruz
- Hospital Universitario Universidad Autonoma de Nuevo Leon-Monterrey, Nuevo Leon, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nanno Swen
- Medisch Centrum Alkmaar, Alkmaar, The Netherlands
| | - Tracy V Ting
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | | | | | | | | | - Maria-Antonietta D'Agostino
- Ambroise Paré Hospital, Boulogne-Billancourt and INSERM U1173, Laboratoire d'Excellence INFLAMEX, University Paris Ouest-Versailles St.-Quentin, Saint Quentin en Yvelines, France
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Terslev L, Iagnocco A, Bruyn GA, Naredo E, Vojinovic J, Collado P, Damjanov N, Filer A, Filippou G, Finzel S, Gandjbakhch F, Ikeda K, Keen HI, Kortekaas MC, Magni-Manzoni S, Ohrndorf S, Pineda C, Ravagnani V, Richards B, Sahbudin I, Schmidt WA, Siddle HJ, Stoenoiu MS, Szkudlarek M, Tzaribachev N, D’Agostino MA. The OMERACT Ultrasound Group: A Report from the OMERACT 2016 Meeting and Perspectives. J Rheumatol 2017; 44:1740-1743. [DOI: 10.3899/jrheum.161240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective.To provide an update from the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group on the progress for defining ultrasound (US) minimal disease activity threshold at joint level in rheumatoid arthritis (RA) and for standardization of US application in juvenile idiopathic arthritis (JIA).Methods.For minimal disease activity, healthy controls (HC) and patients with early arthritis (EA) who were naive to disease-modifying antirheumatic drugs were recruited from 2 centers. US was performed of the hands and feet, and scored semiquantitatively (0–3) for synovial hypertrophy (SH) and power Doppler (PD). Synovial effusion (SE) was scored a binary variable. For JIA, a Delphi approach and subsequent validation in static images and patient-based exercises were used to developed preliminary definitions for synovitis and a scoring system.Results.For minimal disease activity, 7% HC had at least 1 joint abnormality versus 30% in the EA group. In HC, the findings of SH and PD were predominantly grade 1 whereas all grades were seen in the EA cohort, but SE was rare. In JIA, synovitis can be diagnosed based on B-mode findings alone because of the presence of physiological vascularization. A semiquantitative scoring system (0–3) for synovitis for both B-mode and Doppler were developed in which the cutoff between Doppler grade 2 and grade 3 was 30%.Conclusion.The first step has been taken to define the threshold for minimal disease activity in RA by US and to define and develop a scoring system for synovitis in JIA. Further steps are planned for the continuous validation of US in these areas.
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Lanni S, De Lucia O, Possemato N, Malattia C, Ravagnani V, Magni-Manzoni S. Musculoskeletal ultrasound in paediatric rheumatology: the Italian perspective. Clin Exp Rheumatol 2016; 34:957-958. [PMID: 27157383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Stefano Lanni
- Pediatria II Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | - Orazio De Lucia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - Niccolò Possemato
- Department of Internal Medicine, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy
| | - Clara Malattia
- Pediatria II Reumatologia, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Silvia Magni-Manzoni
- Paediatric Rheumatology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
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Dal Forno I, Pieropan S, Facci M, Dosso G, Ravagnani V, Caramaschi P, Biasi D, Adami S. AB0982 Juvenile Idiopathic Arthritis: Parental Stress Reaction After Diagnosis of a Chronic Desease of their Sons. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Scambi C, Ugolini S, Jokiranta TS, De Franceschi L, Bortolami O, La Verde V, Guarini P, Caramaschi P, Ravagnani V, Martignoni G, Colato C, Pedron S, Benedetti F, Sorio M, Poli F, Biasi D. The local complement activation on vascular bed of patients with systemic sclerosis: a hypothesis-generating study. PLoS One 2015; 10:e0114856. [PMID: 25658605 PMCID: PMC4319765 DOI: 10.1371/journal.pone.0114856] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/13/2014] [Indexed: 11/26/2022] Open
Abstract
Objective The role of complement system in the pathogenesis of systemic sclerosis (SSc) has been debated during the last decade but an evident implication in this disease has never been found. We carried out an explorative study on SSc patients to evaluate the expression of soluble and local C5b-9 complement complex and its relation with a complement regulator, the Membrane Cofactor Protein (MCP, CD46) on skin vascular bed as target distinctive of SSc disease. We also analyzed two polymorphic variants in the complement activation gene cluster involving the MCP region. Methods C5b-9 plasma levels of SSc patients and healthy subjects were analyzed by ELISA assay. Archival skin biopsies of SSc patients and controls were subjected to immunofluorescence analysis to detect C5b-9 and MCP on vascular endothelial cells. The expression of MCP was validated by immunoblot analysis with specific antibody. Polymorphic variants in the MCP gene promoter were tested by a quantitative PCR technique-based allelic discrimination method. Results Even though circulating levels of C5b-9 did not differ between SSc and controls, C5b-9 deposition was detected in skin biopsies of SSc patients but not in healthy subjects. MCP was significantly lower in skin vessels of SSc patients than in healthy controls and was associated with the over-expression of two polymorphic variants in the MCP gene promoter, which has been related to more aggressive phenotypes in other immune-mediated diseases. Conclusions Our results firsty document the local complement activation with an abnormal expression of MCP in skin vessels of SSc patients, suggesting that a subset of SSc patients might be exposed to more severe organ complications and clinical evolution due to abnormal local complement activation.
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Affiliation(s)
- Cinzia Scambi
- Department of Medicine, University of Verona, Verona, Italy
- * E-mail:
| | - Sara Ugolini
- Department of Medicine, University of Verona, Verona, Italy
| | - T. Sakari Jokiranta
- Department of Bacteriology and Immunology, Haartman Institute and Research Programs Unit, Immunobiology, University of Helsinki, Helsinki, Finland
| | | | - Oscar Bortolami
- Research Support Unit and Biostatistics, Verona University Hospital, Verona, Italy
| | | | | | | | | | - Guido Martignoni
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Chiara Colato
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Serena Pedron
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | | | - Marco Sorio
- Department of Medicine, University of Verona, Verona, Italy
| | - Fabio Poli
- Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Biasi
- Department of Medicine, University of Verona, Verona, Italy
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De Lucia O, Donati C, Ravagnani V, Del Giudice E, Soldi A, Pontikaki I, Gattinara M, Pieropan S, Lodi Rizzini S, Meroni P, Gerloni V. FRI0554 Can Ultrasound BE Useful in Detection of Inactive Disease in Patients Affected by Jia? an Observational Case-Control Study of 128 Subjects. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5618] [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: 11/03/2022]
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Iagnocco A, Porta F, Cuomo G, Delle Sedie A, Filippucci E, Grassi W, Sakellariou G, Epis O, Adinolfi A, Ceccarelli F, De Lucia O, Di Geso L, Di Sabatino V, Gabba A, Gattamelata A, Gutierrez M, Massaro L, Massarotti M, Perricone C, Picerno V, Ravagnani V, Riente L, Scioscia C, Naredo E, Filippou G. The Italian MSUS Study Group recommendations for the format and content of the report and documentation in musculoskeletal ultrasonography in rheumatology. Rheumatology (Oxford) 2013; 53:367-73. [DOI: 10.1093/rheumatology/ket356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Quartuccio L, Fabris M, Pontarini E, Salvin S, Zabotti A, Benucci M, Manfredi M, Biasi D, Ravagnani V, Atzeni F, Sarzi Puttini P, Morassi P, Fischetti F, Tomietto P, Bazzichi L, Saracco M, Pellerito R, Cimmino M, Schiavon F, Carraro V, Semeraro A, Caporali R, Cavagna L, Bortolotti R, Paolazzi G, Govoni M, Bombardieri S, De Vita S. FRI0255 The 158vv fcgamma receptor 3a genotype is associated with response to rituximab in rheumatoid arthritis: results of an italian multicentre study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fabris M, Quartuccio L, Pontarini E, Zabotti A, Benucci M, Manfredi M, Biasi D, Ravagnani V, Atzeni F, Morassi P, Fischetti F, Bazzicchi L, Saracco M, Pellerito R, Cimmino M, Carraro V, Semeraro A, Caporali R, Cavagna L, Bortolotti R, Govoni M, Bombardieri S, De Vita S. AB0311 The 158vv fcgamma receptor iiia genotype predicts a positive response to rituximab in rheumatoid arthritis: Analysis in a large cohort of italian patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pieropan S, Biasi D, Barausse G, Facci M, Tonetta S, Ravagnani V, Carletto A, Boscaini F, Boner A, Sidoti G, Adami S, Zoccante L. AB1196 Paediatric autoimmune neuropsychiatric disorder associated with group a streptococcal infection (PANDAS): Cardiac and articular involvement. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1194] [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: 11/03/2022]
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Ravagnani V, Pieropan S, Barausse G, Sidoti G, Boner A, Volpe A, Caramaschi P, Biasi D, Adami S. THU0339 Power doppler ultrasonograpic findings in healthy pediatric enthesises. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fabris M, Quartuccio L, Vital E, Pontarini E, Salvin S, Fabro C, Zabotti A, Benucci M, Manfredi M, Ravagnani V, Biasi D, Atzeni F, Sarzi-Puttini P, Morassi P, Fischetti F, Bazzicchi L, Saracco M, Pellerito R, Cimmino M, Carraro V, Semeraro A, Schiavon F, Caporali R, Bortolotti R, Govoni M, Fogolari F, Tonutti E, Bombardieri S, Emery P, De Vita S. The TTTT B lymphocyte stimulator promoter haplotype is associated with good response to rituximab therapy in seropositive rheumatoid arthritis resistant to tumor necrosis factor blockers. ACTA ACUST UNITED AC 2013; 65:88-97. [PMID: 23001900 DOI: 10.1002/art.37707] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 09/11/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the polymorphisms in the promoter region of the B lymphocyte stimulator (BLyS) gene as markers of response to rituximab (RTX) in rheumatoid arthritis (RA). METHODS The study was first conducted in 152 Italian RA patients and then replicated in an additional 117 RA patients (73 Italian, 44 British). The European League Against Rheumatism response criteria were used to evaluate the response rate at months 4 and 6 after the first cycle of RTX, by means of the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate; patients were classified according to the best response shown between months 4 and 6. BLyS promoter polymorphisms were analyzed by polymerase chain reaction followed by the analysis of the restriction fragments, BLyS promoter haplotypes were analyzed using the expectation-maximization algorithm, and BLyS serum levels were analyzed using enzyme-linked immunosorbent assay. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). RESULTS The TTTT BLyS promoter haplotype appeared to be significantly associated with response to RTX only in the subset of seropositive patients (those positive for rheumatoid factor and/or anti-cyclic citrullinated peptide). The replication study confirmed that this association was limited to seropositive RA patients in whom treatment with anti-tumor necrosis factor (anti-TNF) agents had previously failed. In the whole series of seropositive patients in whom anti-TNF agents had previously failed, patients carrying the TTTT BLyS promoter haplotype were more prevalent in good responders (18 of 43 [41.9%]) than in moderate responders (20 of 83 [24.1%]) or in nonresponders (1 of 21 [4.8%]) (for good responders versus nonresponders, OR 14.4 [95% CI 1.77-117.39], P=0.0028). Furthermore, multivariate analysis selected the TTTT BLyS promoter haplotype as an independent marker of good response to RTX (for good responders versus nonresponders, OR 16.2 [95% CI 1.7-152.5], P=0.01; for good responders versus moderate responders and nonresponders combined, OR 3.1 [95% CI 1.2-7.8], P=0.02). The relationship between BLyS polymorphisms and BLyS serum levels remained unclear. CONCLUSION BLyS promoter genotyping may be suitable for identifying seropositive RA patients who may have a good response to RTX after anti-TNF agents have failed.
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Affiliation(s)
- Martina Fabris
- DSMB, Azienda Ospedaliero Universitaria of Udine, Udine, Italy
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Quartuccio L, Fabris M, Pontarini E, Salvin S, Zabotti A, Benucci M, Manfredi M, Biasi D, Ravagnani V, Atzeni F, Sarzi-Puttini P, Morassi P, Fischetti F, Tomietto P, Bazzichi L, Saracco M, Pellerito R, Cimmino M, Schiavon F, Carraro V, Semeraro A, Caporali R, Cavagna L, Bortolotti R, Paolazzi G, Govoni M, Bombardieri S, De Vita S. The 158VV Fcgamma receptor 3A genotype is associated with response to rituximab in rheumatoid arthritis: results of an Italian multicentre study. Ann Rheum Dis 2013; 73:716-21. [DOI: 10.1136/annrheumdis-2012-202435] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ferraccioli G, Tolusso B, Bobbio-Pallavicini F, Gremese E, Ravagnani V, Benucci M, Podestà E, Atzeni F, Mannocci A, Biasi D, Manfredi M, Sarzi-Puttini P, Laganà B, Montecucco C. Biomarkers of good EULAR response to the B cell depletion therapy in all seropositive rheumatoid arthritis patients: clues for the pathogenesis. PLoS One 2012; 7:e40362. [PMID: 22859946 PMCID: PMC3408482 DOI: 10.1371/journal.pone.0040362] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/05/2012] [Indexed: 11/19/2022] Open
Abstract
Objective To find out whether a high number of auto-antibodies can increase the probability of a “good-EULAR response” and to identify the possible biomarkers of response in seropositive rheumatoid arthritis (RA) patients undergoing the B cell depletion therapy (BCDT). Patients and Methods One hundred and thirty-eight patients with long standing RA (LSRA), 75% non or poorly responsive to one or more TNFα blockers, all seropositive for at least one autoantibody (AAB) (RF-IgM, RF-IgA, RF-IgG, anti-MCV, ACPA-IgG, ACPA-IgA, ACPA-IgM) received one full course of BCDT. The major outcomes (moderate or good-EULAR response) were assessed after 6 months of therapy. The IL6 and BAFF levels were also determined. Results At a 6-month follow-up, 33 (23.9%) of the RA patients achieved a good EULAR response. Having up to 5-AABs positivity increased the chances for treatment response. After a logistic regression analysis, however, only 4 baseline factors arose as associated with a good-EULAR response: no steroid therapy (OR = 6.25), a lymphocyte count <1875/uL (OR = 10.74), a RF-IgG level >52.1 IU/ml (OR = 8.37) and BAFF levels <1011 pg/ml (OR = 7.38). When all the AABs, except for RF-IgM and ACPA-IgG, were left in the analysis, the two final predictors were no-steroid therapy and low lymphocyte count. Discussion The number of AABs increased the chances of being a “good-EULAR” responder. The only predictors, however, at the baseline of a good response in this seropositive cohort of RA patients were 2 simple variables – no steroids and lymphocyte count – and two laboratory assays – IgG-RF and BAFF.
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Taraborelli M, Ramoni V, Brucato A, Airò P, Bajocchi G, Bellisai F, Biasi D, Blagojevic J, Canti V, Caporali R, Caramaschi P, Chiarolanza I, Codullo V, Cozzi F, Cuomo G, Cutolo M, De Santis M, De Vita S, Di Poi E, Doria A, Faggioli P, Favaro M, Ferraccioli G, Ferri C, Foti R, Gerosa A, Gerosa M, Giacuzzo S, Giani L, Giuggioli D, Imazio M, Iudici M, Iuliano A, Leonardi R, Limonta M, Lojacono A, Lubatti C, Matucci-Cerinic M, Mazzone A, Meroni M, Meroni PL, Mosca M, Motta M, Muscarà M, Nava S, Padovan M, Pagani G, Paolazzi G, Peccatori S, Ravagnani V, Riccieri V, Rosato E, Rovere-Querini P, Salsano F, Santaniello A, Scorza R, Tani C, Valentini G, Valesini G, Vanoli M, Vigone B, Zeni S, Tincani A. Brief Report: Successful pregnancies but a higher risk of preterm births in patients with systemic sclerosis: An Italian multicenter study. ACTA ACUST UNITED AC 2012; 64:1970-7. [DOI: 10.1002/art.34350] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Caramaschi P, Dalla Gassa A, Prati D, Barausse G, Tinazzi I, Ravagnani V, Confente S, Biasi D. Severe vascular complications in patients affected by systemic sclerosis cyclically treated with iloprost. Rheumatol Int 2011; 32:1933-8. [DOI: 10.1007/s00296-011-1878-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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Caramaschi P, Dalla Gassa A, Ruzzenente O, Volpe A, Ravagnani V, Tinazzi I, Barausse G, Bambara LM, Biasi D. Vitamin D and autoimmune rheumatic diseases. Clin Rheumatol 2011; 30:443-4. [DOI: 10.1007/s10067-011-1683-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 01/04/2011] [Indexed: 01/08/2023]
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Caramaschi P, Ravagnani V, Bambara LM, Biasi D. Clinical images: recurrence of sarcoidosis heralded by Bullous reaction within tribal scarification. Arthritis Rheum 2010; 62:2940. [PMID: 20564004 DOI: 10.1002/art.27613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Caramaschi P, Ravagnani V, Bambara LM, Biasi D. Is the family history positive for SLE a predisposing factor for anti-TNFalpha blockers induced lupus? A case report. Joint Bone Spine 2010; 77:484-5. [DOI: 10.1016/j.jbspin.2010.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 02/03/2010] [Indexed: 01/30/2023]
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Caramaschi P, Baglio I, Ravagnani V, Bambara LM, Biasi D. Extensive soft tissue calcifications in systemic sclerosis. Clin Exp Rheumatol 2010; 28:798-799. [PMID: 20659412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 03/22/2010] [Indexed: 05/29/2023]
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Caramaschi P, Dalla Gassa A, Ruzzenente O, Volpe A, Ravagnani V, Tinazzi I, Barausse G, Bambara LM, Biasi D. Very low levels of vitamin D in systemic sclerosis patients. Clin Rheumatol 2010; 29:1419-25. [PMID: 20454816 DOI: 10.1007/s10067-010-1478-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/22/2010] [Accepted: 04/27/2010] [Indexed: 12/22/2022]
Abstract
Vitamin D displays many extraosseous immunomodulatory effects. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis (SSc) and to analyze the associations between the concentration of the vitamin and clinical manifestations. In March-April 2009, 65 consecutive SSc patients underwent evaluation of vitamin D concentrations by the LIAISON immunoassay (normal 30-100 ng/ml). Serum levels between 10 and 30 ng/ml were classified as vitamin D insufficiency, while concentrations <10 ng/ml as vitamin D deficiency. None of the patients were receiving vitamin D supplementation at the time of or during the year prior to study entry. The mean level of vitamin D was 15.8 ± 9.1 ng/ml. Only three cases showed normal values; vitamin D insufficiency and deficiency were found in 43 and 19 cases, respectively. Patients with vitamin D deficiency showed longer disease duration (13.1 ± 6.8 versus 9.4 ± 5.5 years, P = 0.026), lower diffusing lung capacity for carbon monoxide (63.7 ± 12.4 versus 76.4 ± 20.2, P = 0.014), higher estimated pulmonary artery pressure (28.9 ± 9.9 versus 22.8 ± 10.4, P = 0.037) and higher values of ESR (40 ± 25 versus 23 ± 13 mm/h, P = 0.001) and of CRP (7 ± 7 and 4 ± 2 mg/l, P = 0.004) in comparison with patients with vitamin D insufficiency; moreover, late nailfold videocapillaroscopic pattern was more frequently found (52.6% versus 18.6%, P = 0.013). None of the patients showed evidence of overt mal-absorption. Low levels of vitamin D are very frequent in patients with SSc. Intestinal involvement is not likely the cause of vitamin D deficit; other factors such as skin hyperpigmentation and reduced sun exposition for psychological and social reasons may be implicated. Patients with vitamin D deficiency showed more severe disease in comparison with patients with vitamin D insufficiency, above all concerning lung involvement. Further trials are awaited to determine whether vitamin D could represent a modifiable factor able to interfere with SSc evolution.
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Affiliation(s)
- Paola Caramaschi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Verona, Italy.
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Friso S, Pizzolo F, Choi SW, Guarini P, Castagna A, Ravagnani V, Carletto A, Pattini P, Corrocher R, Olivieri O. Epigenetic control of 11 beta-hydroxysteroid dehydrogenase 2 gene promoter is related to human hypertension. Atherosclerosis 2008; 199:323-7. [PMID: 18178212 DOI: 10.1016/j.atherosclerosis.2007.11.029] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/16/2007] [Accepted: 11/21/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lower activity of 11 beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) classically induces hypertension by leading to an altered tetrahydrocortisol- versus tetrahydrocortisone-metabolites (THFs/THE) shuttle. Recent cell culture and animal studies suggest a role for promoter methylation, a major epigenetic feature of DNA, in regulation of HSD11B2 expression. Little is known, however, of human HSD11B2 epigenetic control and its relationship with the onset of hypertension. OBJECTIVE To explore the possible relevance of HSD11B2 promoter methylation, by examining human peripheral blood mononuclear cell (PBMC) DNA and urinary THFs/THE ratio as a biochemical indicator of 11beta-HSD2 activity, in blood pressure control. METHODS Twenty-five essential hypertensives and 32 subjects on prednisone therapy were analyzed, the latter to investigate 11beta-HSD2 function in the development of hypertension. RESULTS Elevated HSD11B2 promoter methylation was associated with hypertension developing in glucocorticoid-treated patients in parallel with a higher urinary THFs/THE ratio. Essential hypertensives with elevated urinary THFs/THE ratio also showed higher HSD11B2 promoter methylation. CONCLUSIONS These results show a clear link between the epigenetic regulation through repression of HSD11B2 in PBMC DNA and hypertension.
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Affiliation(s)
- Simonetta Friso
- Department of Clinical and Experimental Medicine, University of Verona School of Medicine, Verona, Italy.
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Volpe A, Caramaschi P, Thalheimer U, Fava C, Ravagnani V, Bambara LM, Biasi D. Familiar association of Gitelman's syndrome and calcium pyrophosphate dihydrate crystal deposition disease a case report. Rheumatology (Oxford) 2007; 46:1506-8. [PMID: 17666441 DOI: 10.1093/rheumatology/kem184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mattuzzi S, Barbi S, Carletto A, Ravagnani V, Moore PS, Bambara LM, Scarpa A. Association of polymorphisms in the IL1B and IL2 genes with susceptibility and severity of systemic sclerosis. J Rheumatol 2007; 34:997-1004. [PMID: 17444587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To investigate possible associations of 9 single-nucleotide polymorphisms in the IL10, IL1B, IL1A, IL1RN, IL2, LTA, and IL6 genes with susceptibility to systemic sclerosis (SSc), and with clinical subtype of SSc patients. METHODS A total of 78 patients with SSc [diffuse SSc (dcSSc), n = 31; limited SSc, (lcSSc), n = 47] and 692 healthy blood donors were genotyped for the following polymorphisms: IL10 T-3575A, IL10 A-1082G, IL1B C-31T, IL1B C-511T, IL1A C-889T, IL1RN A9589T, IL2 T-384G, LTA T-91G, and IL6 G-174C. RESULTS Alleles in IL1B-31 and IL1B-511 showed a significantly different distribution between cases and controls. Carriers of at least one copy of the IL1B-31-C allele had an increased risk of SSc [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.6-5.2, p < 0.001], while a similar strong association was also evident for IL1B-511-T carriers (OR 3.1, 95% CI 1.7-5.7, p < 0.001). Interestingly, carriers of the IL2-384-G allele were significantly more frequent among patients with lcSSc (80.8%), compared to patients with the diffuse subtype (45.1%) (OR 5.1, 95% CI 1.8-14.3, p = 0.001) and in subjects positive to anticentromere antibodies (OR 4.2, 95% CI 1.5-11.9, p = 0.007). Lastly, the distribution of the IL2-384 genotype showed statistically significant differences between controls and patients with lcSSc (OR 3.5, 95% CI 1.7-7.4, p < 0.001). There were no differences between patients with dcSSc and controls. CONCLUSION IL1B and IL2 gene polymorphisms may be involved in susceptibility to SSc. Moreover, the IL2-384-G allele may be a marker for the limited phenotype of SSc.
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MESH Headings
- Adult
- Arthralgia/complications
- Arthralgia/diagnosis
- Arthralgia/genetics
- Arthritis/complications
- Arthritis/diagnosis
- Arthritis/genetics
- Biomarkers
- Female
- Genetic Predisposition to Disease
- Genotype
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/genetics
- Interleukin-1beta/genetics
- Interleukin-2/genetics
- Male
- Middle Aged
- Odds Ratio
- Polymorphism, Single Nucleotide
- Pulmonary Fibrosis/complications
- Pulmonary Fibrosis/diagnosis
- Pulmonary Fibrosis/genetics
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/diagnosis
- Scleroderma, Diffuse/genetics
- Scleroderma, Limited/complications
- Scleroderma, Limited/diagnosis
- Scleroderma, Limited/genetics
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Affiliation(s)
- Silvia Mattuzzi
- Dipartimento di Patologia, Universita di Verona, Verona, Italy
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