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Muley M, Finamore P, Pedone C, Margiotta DPE, Gilardi E, Sambuco F, De Vincentis A, Vespasiani-Gentilucci U, Travaglino F, Incalzi RA. The authors reply. Crit Care Med 2023; 51:e138-e139. [PMID: 37199561 DOI: 10.1097/ccm.0000000000005882] [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: 05/19/2023]
Affiliation(s)
- Moises Muley
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Panaiotis Finamore
- Geriatrics Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Claudio Pedone
- Geriatrics Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | | | - Emanuele Gilardi
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Federica Sambuco
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Antonio De Vincentis
- Internal Medicine Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | | | - Francesco Travaglino
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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Ruscitti P, Cipriani P, Liakouli V, Iacono D, Pantano I, Margiotta DPE, Navarini L, Destro Castaniti GM, Maruotti N, Di Scala G, Caso F, Bongiovanni S, Grembiale RD, Atzeni F, Scarpa R, Perosa F, Emmi G, Cantatore FP, Guggino G, Afeltra A, Ciccia F, Giacomelli R. Occurrence and predictive factors of high blood pressure, type 2 diabetes, and metabolic syndrome in rheumatoid arthritis: findings from a 3-year, multicentre, prospective, observational study. Clin Exp Rheumatol 2021; 39:995-1002. [DOI: 10.55563/clinexprheumatol/5r53em] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Italy.
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Italy
| | - Vasiliki Liakouli
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Daniela Iacono
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ilenia Pantano
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Luca Navarini
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Italy
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Italy
| | - Nicola Maruotti
- Department of Medical and Surgery Sciences, Rheumatology Unit, University of Foggia, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Rheumatologic and Systemic Autoimmune Diseases Unit, University of Bari Medical School, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Giuliana Guggino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Italy
| | - Antonella Afeltra
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Italy
| | - Francesco Ciccia
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Italy
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Sperti M, Malavolta M, Ciniero G, Borrelli S, Cavaglià M, Muscat S, Tuszynski JA, Afeltra A, Margiotta DPE, Navarini L. JAK inhibitors in immune-mediated rheumatic diseases: From a molecular perspective to clinical studies. J Mol Graph Model 2021; 104:107789. [DOI: 10.1016/j.jmgm.2020.107789] [Citation(s) in RCA: 2] [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: 04/06/2020] [Revised: 09/21/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022]
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Gigante A, Iannazzo F, Navarini L, Sgariglia MC, Margiotta DPE, Vaiarello V, Foti F, Afeltra A, Cianci R, Rosato E. Metabolic syndrome and adipokine levels in systemic lupus erythematosus and systemic sclerosis. Clin Rheumatol 2021; 40:4253-4258. [PMID: 33839992 PMCID: PMC8463337 DOI: 10.1007/s10067-021-05731-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 03/09/2021] [Accepted: 04/04/2021] [Indexed: 11/27/2022]
Abstract
Introduction Aims of study were to evaluate the prevalence of metabolic syndrome (MetS) in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) patients and to evaluate serum level of adipokines in SLE and SSc patients with and without MetS. Methods Fifty SLE patients and 85 SSc patients were enrolled. The diagnosis of MetS was made according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. Clinical assessment and serum levels of adiponectin and resistin were evaluate in SLE and SSc patients. Results Prevalence of MetS was significantly (p<0.0001) higher in SLE patients than SSc patients (36% vs 10.6%). Median values of resistin were significantly (p<0.001) higher in SLE patients with MetS than SLE patients without MetS [4.01 ng/mL (2.7–4.5) vs 1.92 ng/mL (1.2–3)]. Median values of adiponectin were significantly (p<0.05) lower in SLE patients with MetS than SLE patients without MetS [5.64 ng/mL (4.96–8) vs 8.38 ng/mL (6.54–11.01)]. Systemic Lupus Erythematosus Activity Index [8 (6–12) vs 10 (6–13), p<0.01] and Systemic Damage Index [2 (1–3) vs 2 (0–3), p<0.001] were significantly higher in MetS patients than in patients without MetS. In SSc, the median value of disease severity scale was significantly higher (p<0.05) in MetS patients than in patients without MetS [7 (5–7) vs 5 (3–6)]. Conclusion Prevalence of MetS is higher in SLE patients. In SLE patients, MetS showed an association with adipokine levels and inflammation/activity disease scores. In SSc patients, MetS was associated with severity of disease.
Key Points • Prevalence of metabolic syndrome is higher in SLE patients than SSc patients. • Resistin is higher in SLE patients with metabolic syndrome. • Adineponectin is lower in SLE patients with metabolic syndrome. • Disease severity scale is higher in SSc patients with metabolic syndrome. |
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Iannazzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Maria Chiara Sgariglia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Valentina Vaiarello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Foti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Saccon F, Zen M, Gatto M, Margiotta DPE, Afeltra A, Ceccarelli F, Conti F, Bortoluzzi A, Govoni M, Frontini G, Moroni G, Dall'Ara F, Tincani A, Signorini V, Mosca M, Frigo AC, Iaccarino L, Doria A. Remission in systemic lupus erythematosus: testing different definitions in a large multicentre cohort. Ann Rheum Dis 2020; 79:943-950. [DOI: 10.1136/annrheumdis-2020-217070] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 04/01/2020] [Indexed: 11/03/2022]
Abstract
ObjectivesRemission in systemic lupus erythematosus (SLE) is defined through a combination of ‘clinical SLE Disease Activity Index (cSLEDAI)=0’, ‘physician's global assessment (PGA) <0.5’ and ‘prednisone (PDN) ≤5 mg/day’. We investigated the performance of these items, alone or in combination, in defining remission and in predicting SLICC/ACR Damage Index.MethodsWe tested seven potential definitions of remission in SLE patients followed-up for ≥5 years: PDN ≤5 mg/day; PGA <0.5; cSLEDAI=0; PGA <0.5 plus PDN ≤5 mg/day; cSLEDAI=0 plus PGA <0.5; cSLEDAI=0 plus PDN ≤5 mg/day; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5. The effect of these definitions on damage was evaluated by Poisson regression analysis; the best performance was identified as the lowest Akaike and Bayesian information criterion (AIC and BIC). Positive and negative predictive values in identifying no damage increase were calculated.ResultsWe included 646 patients (mean±SD disease duration 9.2±6.9 years). At multivariate analysis, ≥2 consecutive year remission according to all definitions protected against damage (OR, 95% CI: PGA <0.5 0.631, 0.444 to 0.896; cSLEDAI=0 0.531, 0.371 to 0.759; PGA <0.5 plus PDN ≤5 mg/day 0.554, 0.381 to 0.805; cSLEDAI=0 plus PGA <0.5 0.574, 0.400 to 0.826; cSLEDAI=0 plus PDN ≤5 mg/day 0.543, 0.376 to 0.785; cSLEDAI=0 plus PDN ≤5 mg/day plus PGA <0.5 0.532, 0.363 to 0.781, p<0.01 for all), except PDN ≤5 mg/day, which required four consecutive years (OR 0.534, 95% CI 0.325 to 0.877, p=0.013). Positive and negative predictive values were similar; however, cSLEDAI=0 showed the best performance (AIC 1082.90, BIC 1109.72, p<0.0001). Adding PGA <0.5 and/or PDN ≤5 mg/day to cSLEDAI=0 decreased remission duration (−1.8 and −1.5 year/patient, respectively) without increasing cSLEDAI=0 performance in predicting damage accrual.ConclusionscSLEDAI=0 is the most attainable definition of remission, while displaying the best performance in predicting damage progression in the short-to-mid-term follow-up.
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Navarini L, Costa L, Tasso M, Chimenti MS, Currado D, Fonti GL, Ciccozzi M, Margiotta DPE, Benigno C, De Martino E, Perricone R, Afeltra A, Scarpa R, Caso F. Retention rates and identification of factors associated with anti-TNFα, anti-IL17, and anti-IL12/23R agents discontinuation in psoriatic arthritis patients: results from a real-world clinical setting. Clin Rheumatol 2020; 39:2663-2670. [PMID: 32189149 DOI: 10.1007/s10067-020-05027-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 09/02/2019] [Revised: 02/12/2020] [Accepted: 03/05/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Biologic disease-modifying antirheumatic drugs (bDMARDs) play a pivotal role in the treatment of psoriatic arthritis (PsA). Despite this, their discontinuation due to inefficacy or adverse events is often observed. The aims of this study are to describe retention rates and treatment trends of anti-TNFα, anti-IL17, and anti-IL12/23R agents in patients with PsA and to identify factors associated with bDMARDs discontinuation in a real-world clinical setting. METHODS A retrospective cohort study based on the analysis of the three Italian prescription cohorts of patients with PsA has been performed. Survival analysis was performed using Kaplan-Meier curves and Cox proportional-hazards model. RESULTS During the follow up, which lasted 25.5 (12-60) months, 68 patients discontinued a bDMARD: 13 for primary failure, 12 for secondary failure, 15 for adverse events, 5 for remission, 12 because of lost at follow-up, and 11 for other causes. Cox proportional-hazards demonstrated that a shorter disease duration (HR 0.994991, 95% CI 0.9910336-0.9989647, p = 0.014) and first-line bDMARD (HR 0.5090986, 95% CI 0.3073519-0.8432722, p = 0.009) have a protective role on bDMARD retention rate, while the multivariable analysis failed in demonstrating an independent protective role of male sex on drug retention rate (p = 0.083). No significant differences in retention rate have been found regarding biologic drugs, combination therapy or monotherapy, and class of bDMARD (anti-TNFα or anti-pIL12/23R and anti-IL-17). CONCLUSIONS This study shows that a shorter disease duration and treatment with a first-line bDMARD are predictors of bDMARDs retention rate, further highlighting the importance of early diagnosis of PsA. Key Points • No significant difference in retention among patients treated with anti-IL17A, anti-IL12/23R, and anti-TNFα agents has been demonstrated. • A shorter disease duration and first-line bDMARD treatment are associated with persistence in biologic treatment.
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Affiliation(s)
- Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Damiano Currado
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulia Lavinia Fonti
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Carolina Benigno
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Erica De Martino
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
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Navarini L, Sperti M, Currado D, Costa L, Deriu MA, Margiotta DPE, Tasso M, Scarpa R, Afeltra A, Caso F. A machine-learning approach to cardiovascular risk prediction in psoriatic arthritis. Rheumatology (Oxford) 2020; 59:1767-1769. [DOI: 10.1093/rheumatology/kez677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Luca Navarini
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma
| | - Michela Sperti
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Damiano Currado
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Marco A Deriu
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | | | - Marco Tasso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Antonella Afeltra
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Roma
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University Federico II of Naples, Naples, Italy
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Laudisio A, Giovannini S, Finamore P, Navarini L, Margiotta DPE, Vannetti F, Macchi C, Coraci D, Imbimbo I, Molino-Lova R, Loreti C, Antonelli Incalzi R, Zuccalà G, Padua L. Metabolic syndrome is associated with better quality of sleep in the oldest old: results from the "Mugello Study". Diabetol Metab Syndr 2020; 12:46. [PMID: 32742311 PMCID: PMC7386243 DOI: 10.1186/s13098-020-00554-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Reduced sleep quality is common in advanced age. Poor sleep quality is associated with adverse outcomes, chiefly cardiovascular, in young and middle-aged subjects, possibly because of its association with metabolic syndrome (MetS). However, the correlates of sleep quality in oldest populations are unknown. We evaluated the association of sleep quality with MetS in a cohort of subjects aged 90+. METHODS AND RESULTS We analysed data of 343 subjects aged 90+ living in the Mugello area (Tuscany, Italy). Quality of sleep was assessed using the Pittsburgh Sleep Quality Assessment Index (PSQI). Good quality of sleep was defined by a PSQI score < 5. MetS was diagnosed according to the National Cholesterol Education Program's ATP-III criteria; 83 (24%) participants reported good quality of sleep. MetS was diagnosed in 110 (24%) participants. In linear and logistic models, MetS was inversely associated with PSQI score ((B = - 1.04; 95% CI - 2.06 to - .03; P = .044), with increased probability of good sleep quality (OR = 2.52; 95% CI 1.26-5.02; P = .009), and with a PSQI below the median (OR = 2.11; 95% CI 1.11-3.40, P = .022), after adjusting. None of the single components of MetS were associated with PSQI (all P values > .050). However, an increasing number of MetS components was associated with increasing probability of good quality of sleep (P for trend = .002), and of PSQI below the median (P for trend = .007). Generalized Additive Model analysis documented no smoothing function suggestive of nonlinear association between PSQI and MetS. CONCLUSION Our results confirm a high prevalence of poor sleep quality in oldest age; however, in these subjects, MetS seems to be associated with better sleep quality. Additional larger, dedicated studies are required to confirm our results, and, if so, to identify the subsystems involved and the potential therapeutic implications of such an association.
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Affiliation(s)
- Alice Laudisio
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Panaiotis Finamore
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico di Roma University, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | | | - Daniele Coraci
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Claudia Loreti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giuseppe Zuccalà
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Basta F, Margiotta DPE, Vadacca M, Vernuccio A, Mazzuca C, Picchianti Diamanti A, Afeltra A. Is fatigue a cause of work disability in systemic lupus erythematosus? Results from a systematic literature review. Eur Rev Med Pharmacol Sci 2019; 22:4589-4597. [PMID: 30058699 DOI: 10.26355/eurrev_201807_15516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Fatigue affects the almost totality of Systemic Lupus Erythematous (SLE) patients impairing physical function and leading to a strong reduction of health-related quality of life (HRQoL). Similarly, SLE patients have an increased rate of work loss and work limitations. The aim of our paper was to systematically assess the relationship between fatigue and work disability in SLE. MATERIALS AND METHODS We performed a systematic review using the terms "fatigue" and "employment", "work disability", "work impairment", "presenteeism" and "absenteeism." RESULTS 19 studies were identified. Fatigue was involved in the development of work loss. In employed patients, fatigue led to impairment of work productivity and presenteeism with a parallel increase of both direct and indirect health costs. Fatigue also affected parenting and household productivity. CONCLUSIONS An adequate control of fatigue could improve physical and work performance in SLE patients thus reducing rates of work loss.
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Affiliation(s)
- F Basta
- ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy.
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Margiotta DPE, Fasano S, Basta F, Pierro L, Riccardi A, Navarini L, Valentini G, Afeltra A. The association between duration of remission, fatigue, depression and health-related quality of life in Italian patients with systemic lupus erythematosus. Lupus 2019; 28:1705-1711. [PMID: 31707917 DOI: 10.1177/0961203319884651] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the impact of duration of remission on the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE). METHODS We conducted a 5-year retrospective study on two Italian cohorts. Remission was defined as a continuative period of no clinical disease activity, according to the Systemic Lupus Erythematosus Disease Activity Index 2 K, and a permitted maximum prednisone dose of 5 mg/day. HRQoL was measured using the 36-Item Short-Form Health Survey (SF36) during the last visit. RESULTS We enrolled 136 female SLE patients. During observation, 15 (11%) patients had been in remission for ≥1 and <2 years, 15 (11%) for ≥2 and <3 years, 19 (14%) for ≥3 and <4 years, 9 (7%) for ≥4 and <5 years, and 53 (39%) had been in prolonged remission for ≥5 years. In the multivariate model, considering depression and fatigue as covariates, patients in prolonged remission showed significantly better scores in the physical functioning (p = 0.039), role physical (p = 0.029), bodily pain (p = 0.0057), general health (p = 0.0033) and social functioning (p = 0.0085) components of the SF36, compared with those in remission <5 years or unremitted. Subsequent mediation analyses found that these effects were partly influenced by depression. CONCLUSION Lupus remission could improve the HRQoL of SLE patients, particularly when associated with appropriate management of depression and fatigue.
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Affiliation(s)
- D P E Margiotta
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - S Fasano
- Division of Rheumatology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F Basta
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.,Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - L Pierro
- Division of Rheumatology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A Riccardi
- Division of Rheumatology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - G Valentini
- Division of Rheumatology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
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Ruscitti P, Cipriani P, Liakouli V, Iacono D, Pantano I, Margiotta DPE, Navarini L, Destro Castaniti GM, Maruotti N, Di Scala G, Picciariello L, Caso F, Bongiovanni S, Grembiale RD, Atzeni F, Scarpa R, Perosa F, Emmi G, Cantatore FP, Guggino G, Afeltra A, Ciccia F, Giacomelli R. Subclinical and clinical atherosclerosis in rheumatoid arthritis: results from the 3-year, multicentre, prospective, observational GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Arthritis Res Ther 2019; 21:204. [PMID: 31481105 PMCID: PMC6724256 DOI: 10.1186/s13075-019-1975-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 04/30/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is associated with an increased risk of morbidity and mortality, when compared with general population, largely due to enhanced atherosclerotic disease. In this work, we aimed at assessing both occurrence and predictive factors of subclinical and clinical atherosclerosis in RA. Methods From January 1, 2015, to December 31, 2015, consecutive participants with RA, admitted to Italian Rheumatology Units, were assessed in the GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) cohort. After that, those participants were followed up in a 3-year, prospective, observational study, assessing the occurrence of subclinical and clinical atherosclerosis and possible predictive factors. McNemar test was employed to assess the changes in subclinical and clinical atherosclerosis, and regression analyses exploited the ORs for the occurrence of those comorbidities. Results We analysed 841 participants, mostly female (82.2%) and with median age of 60 years (range 21–90). The remission was achieved and maintained by 41.8% of participants during the follow-up. We observed an increased rate of subclinical atherosclerosis at the end of follow-up (139 vs 203 participants, p < 0.0001), particularly in participants with a disease duration less than 5 years at baseline (70 participants vs 133 participants, p < 0.0001). Type 2 diabetes (T2D) (OR 4.50, 95%CI 1.74–11.62, p = 0.002), high blood pressure (OR 2.03, 95%CI 1.04–4.14, p = 0.042), ACPA (OR 2.36, 95%CI 1.19–4.69, p = 0.014) and mean values of CRP during the follow-up (OR 1.07, 95%CI 1.03–1.14, p = 0.040) were significantly associated with higher risk of subclinical atherosclerosis. We observed an increased rate of clinical atherosclerosis at the end of follow-up (48 vs 76 participants, p < 0.0001). T2D (OR 6.21, 95%CI 2.19–17.71, p = 0.001) was associated with a significant risk of clinical atherosclerosis. The achievement and the maintenance of remission reduced the risk of subclinical (OR 0.25, 95%CI 0.11–0.56, p = 0.001) and clinical atherosclerosis (OR 0.20, 95%CI 0.09–0.95, p = 0.041). Conclusions We reported an increased prevalence and incidence of both subclinical and clinical atherosclerosis in 3-year prospectively followed participants, mainly in the subset with a duration of disease less than 5 years. The achievement and the maintenance of remission are associated with a reduction of the risk of subclinical and clinical atherosclerosis. Among “traditional” cardiovascular risk factors, participants with T2D showed a higher risk of clinical and subclinical atherosclerosis. Electronic supplementary material The online version of this article (10.1186/s13075-019-1975-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, delta 6 building, PO box 67100, L'Aquila, Italy.
| | - Paola Cipriani
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, delta 6 building, PO box 67100, L'Aquila, Italy
| | - Vasiliki Liakouli
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, delta 6 building, PO box 67100, L'Aquila, Italy
| | - Daniela Iacono
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ilenia Pantano
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Luca Navarini
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Nicola Maruotti
- Department of Medical and Surgery Sciences, Rheumatology Unit, University of Foggia, Foggia, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Licia Picciariello
- Department of Biomedical Sciences and Human Oncology (DIMO), Rheumatologic and Systemic Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Rheumatologic and Systemic Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Giuliana Guggino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonella Afeltra
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Ciccia
- Department of Clinical and Experimental Medicine, Rheumatology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Giacomelli
- Rheumatology Unit; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, delta 6 building, PO box 67100, L'Aquila, Italy
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12
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Barbati C, Stefanini L, Colasanti T, Cipriano E, Celia A, Gabriele G, Vomero M, Ceccarelli F, Spinelli FR, Finucci A, Speziali M, Orso G, Margiotta DPE, Conti F, Violi F, Afeltra A, Valesini G, Alessandri C. Anti-D4GDI antibodies activate platelets in vitro: a possible link with thrombocytopenia in primary antiphospholipid syndrome. Arthritis Res Ther 2019; 21:161. [PMID: 31262358 PMCID: PMC6604387 DOI: 10.1186/s13075-019-1947-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/03/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background Thrombocytopenia is a manifestation associated with primary antiphospholipid syndrome (PAPS), and many studies have stressed the leading role played by platelets in the pathogenesis of antiphospholipid syndrome (APS). Platelets are highly specialized cells, and their activation involves a series of rapid rearrangements of the actin cytoskeleton. Recently, we described the presence of autoantibodies against D4GDI (Rho GDP dissociation inhibitor beta, ARHGDIB) in the serum of a large subset of SLE patients, and we observed that anti-D4GDI antibodies activated the cytoskeleton remodeling of lymphocytes by inhibiting D4GDI and allowing the upregulation of Rho GTPases, such as Rac1. Proteomic and transcriptomic studies indicate that D4GDI is very abundant in platelets, and small GTPases of the RHO family are critical regulators of actin dynamics in platelets. Methods We enrolled 38 PAPS patients, 15 patients carrying only antiphospholipid antibodies without clinical criteria of APS (aPL carriers) and 20 normal healthy subjects. Sera were stored at − 20 °C to perform an ELISA test to evaluate the presence of anti-D4GDI antibodies. Then, we purified autoantibodies anti-D4GDI from patient sera. These antibodies were used to conduct in vitro studies on platelet activation. Results We identified anti-D4GDI antibodies in sera from 18/38 (47%) patients with PAPS, in sera from 2/15(13%) aPL carriers, but in no sera from normal healthy subjects. Our in vitro results showed a significant 30% increase in the activation of integrin αIIbβ3 upon stimulation of platelets from healthy donors preincubated with the antibody anti-D4GDI purified from the serum of APS patients. Conclusions In conclusion, we show here that antibodies anti-D4GDI are present in the sera of PAPS patients and can prime platelet activation, explaining, at least in part, the pro-thrombotic state and the thrombocytopenia of PAPS patients. These findings may lead to improved diagnosis and treatment of APS.
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Affiliation(s)
- C Barbati
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy.
| | - L Stefanini
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - T Colasanti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - E Cipriano
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - A Celia
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - G Gabriele
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - M Vomero
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - F Ceccarelli
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - F R Spinelli
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - A Finucci
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - M Speziali
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - G Orso
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - D P E Margiotta
- Department of Immuno-Rheumatology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - F Conti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - F Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - A Afeltra
- Department of Immuno-Rheumatology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - G Valesini
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
| | - C Alessandri
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico, 155, Rome, Italy
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Margiotta DPE, Fasano S, Basta F, Pierro L, Riccardi A, Navarini L, Valentini G, Afeltra A. Clinical features of patients with systemic lupus erythematosus according to health-related quality of life, entity of pain, fatigue and depression: a cluster analysis. Clin Exp Rheumatol 2019; 37:535-539. [PMID: 31140392] [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] [Received: 02/02/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify the distribution of patients with systemic lupus erythematosus (SLE) in clusters according to the levels of health-related quality of life (HRQoL), entity of pain, fatigue and depression. METHODS We performed a hierarchical cluster analysis. The following measures were used as clustering variables, after canonical transformation: the SF36 physical and mental component summary (PCS and MCS), the Beck Depression Inventory II (entity of depression), the Facit-Fatigue, all assessed during the last visit. Consecutive SLE patients were enrolled from two Italian cohorts. Lupus remission was retrospectively assessed over a period of 5 years before the last visit and was defined as a continuative period of no clinical disease activity according to SLEDAI2K and the maximum dose of prednisone allowed of 5 mg/day. RESULTS We enrolled 130 female SLE patients. We identified three clusters. The first cluster (43 patients) was characterised by the highest levels of MCS and PCS and the lowest entity of pain, fatigue and depression. Cluster 2 (35 patients) was defined by a reduction of MCS and increase of pain, fatigue and depression; conversely, PCS levels were similar to cluster 1. In cluster 3 (52 patients) we found a reduction of MCS and increase of depression and fatigue (similar to cluster 2) but also a decrease in PCS levels and Bodily Pain (meaning increase in pain). In cluster 3 we found a decreased prevalence of remission ≥5 years. CONCLUSIONS Identification of clusters of patients according to HRQoL levels could be useful to improve SLE management, aiming at personalised medicine.
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Affiliation(s)
| | - Serena Fasano
- Division of Rheumatology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Fabio Basta
- Unit of Allergology, Clinical Immunology and Rheumatology, Campus Bio-Medico University of Rome, and Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Luciana Pierro
- Division of Rheumatology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Antonella Riccardi
- Division of Rheumatology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Campus Bio-Medico University of Rome, Italy.
| | - Gabriele Valentini
- Division of Rheumatology, Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Campus Bio-Medico University of Rome, Italy
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Margiotta DPE, Laudisio A, Navarini L, Basta F, Mazzuca C, Angeletti S, Ciccozzi M, Incalzi RA, Afeltra A. Pattern of sleep dysfunction in systemic lupus erythematosus: a cluster analysis. Clin Rheumatol 2019; 38:1561-1570. [PMID: 30693395 DOI: 10.1007/s10067-018-04410-3] [Citation(s) in RCA: 5] [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: 08/28/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate how the different components of sleep dysfunction described in SLE patients combine together in sleep clusters. METHODS We conducted a cross-sectional study on a perspective cohort of 79 SLE patients (mean age 8.2 ± 14.3 years). Sleep was evaluated using Pittsburgh Sleep Quality Index (PSQI). Clusters were defined using the single components of PSQI in a hierarchical clustering model. We used Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Medical Outcomes Study Short Form 36 (SF36) to measure depressive symptoms, anxiety, and quality of life, respectively. RESULTS Three sleep clusters were identified. The cluster 1 (N = 47) is characterized by the lowest values of PSQI total score. The cluster 2 (N = 21) presents higher values of sleep latency, but sleep duration similar to cluster 1. In cluster 3 (N = 11), we found sleep latency increased as in cluster 2, but the highest values of PSQI total score and reduced sleep duration. Scores of anxiety and sedentary time were higher in clusters 2 and 3 than in cluster 1. Cluster 3 presented the highest scores of depression and reduced mental and physical components of SF36. CONCLUSIONS The combination of different sleep components in SLE patients allowed us to identify three patterns of dysfunction: a first cluster with better sleep latency and duration, a second with increased sleep latency but conserved duration, and a third with impairment of both latency and duration. The stratification of sleep disorders in clusters might be useful for the personalization of therapy in relation to sleep cluster membership.
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Affiliation(s)
- Domenico Paolo Emanuele Margiotta
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Alice Laudisio
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Luca Navarini
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Fabio Basta
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Carmen Mazzuca
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | | | - Antonella Afeltra
- Unit of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128, Rome, Italy
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15
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Navarini L, Margiotta DPE, Costa L, Currado D, Tasso M, Angeletti S, Ciccozzi M, Scarpa R, Afeltra A, Caso F. Performance and calibration of the algorithm ASSIGN in predicting cardiovascular disease in Italian patients with psoriatic arthritis. Clin Rheumatol 2019; 38:971-976. [DOI: 10.1007/s10067-019-04442-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 12/18/2022]
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Giacomelli R, Afeltra A, Alunno A, Bartoloni-Bocci E, Berardicurti O, Bombardieri M, Bortoluzzi A, Caporali R, Caso F, Cervera R, Chimenti MS, Cipriani P, Coloma E, Conti F, D'Angelo S, De Vita S, Di Bartolomeo S, Distler O, Doria A, Feist E, Fisher BA, Gerosa M, Gilio M, Guggino G, Liakouli V, Margiotta DPE, Meroni P, Moroncini G, Perosa F, Prete M, Priori R, Rebuffi C, Ruscitti P, Scarpa R, Shoenfeld Y, Todoerti M, Ursini F, Valesini G, Vettori S, Vitali C, Tzioufas AG. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev 2019; 18:93-106. [PMID: 30408582 DOI: 10.1016/j.autrev.2018.08.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [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: 08/06/2018] [Accepted: 08/11/2018] [Indexed: 12/21/2022]
Abstract
Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care. The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments.
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Affiliation(s)
- Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy.
| | - Antonella Afeltra
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Onorina Berardicurti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandra Bortoluzzi
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Roberto Caporali
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria Sole Chimenti
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Emmanuel Coloma
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Salvatore D'Angelo
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Azienda Ospedaliero Universitaria S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Salvatore Di Bartolomeo
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology of the Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK; Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Maria Gerosa
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Michele Gilio
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica, Rheumatology section, University of Palermo, Italy
| | - Vasiliki Liakouli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Domenico Paolo Emanuele Margiotta
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pierluigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Chiara Rebuffi
- Grant Office and Scientific Documentation Center, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Yehuda Shoenfeld
- Zabludowitz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Monica Todoerti
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Serena Vettori
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Athanasios G Tzioufas
- Pathophysiology Department, General Hospital of Athens "Laiko", Medical School, National and Kapodistrian University of Athens, Greece
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Basta F, Margiotta DPE, Mazzuca C, Batani V, Dolcini G, Moras P, Vadacca M, Afeltra A. Factors related to alexithymia in patients with systemic sclerosis: a tight relationship with facial image dissatisfaction. Rheumatol Int 2018; 39:461-467. [PMID: 30498976 DOI: 10.1007/s00296-018-4214-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
Abstract
To assess clinical and psychosocial factors related to alexithymia in systemic sclerosis (SSc). We enrolled 40 consecutive SSc patients in a cross-sectional study evaluating alexithymia with Toronto Alexithymia scale (TAS-20). We measured Beck Depression inventory (BDI), Hamilton Anxiety rating scale (HAM-H), 36-Items Short-Form Healthy Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Visual Analog Scale (VAS) pain, Pittsburgh Sleep Quality Index (PSQI), Satisfaction with Appearance Scale (SWAP), and Mouth Handicap in Systemic Sclerosis (MHISS). The prevalence of alexithymia was 42%. Alexithymic patients presented increased depressive (p = ≤ 0.001) and anxiety symptoms (p = ≤ 0.001), sleep disorders (p = 0.03), pain (p = 0.02), esthetic concerns (p = 0.03), disability in activities (p = 0.03) and reduced scores of SF-36 in mental components summary (MCS) (p = ≤ 0.001) and physical components summary (PCS) (p = 0.01). We found significant correlations with sleep disorders (r = 0.41, p = ≤ 0.001), BID (r = 0.35, p = 0.04), facial image dissatisfaction (r = 0.35, p = 0.04), mouth disability (r = 0.51, p = 0.005), depressive (r = 0.6, p = ≤ 0.001), and anxiety symptoms (r = 0.48, p = ≤ 0.001), fatigue (r = - 0.45 p = 0.005), SF-36 PCS (r = - 0.51, p = ≤ 0.001) and MCS (r = - 0.65, p = ≤ 0.001). In multiple linear regression analysis, SWAP facial was the only variable associated with TAS-20 [0.99 (0.48) p = 0.05]. Alexithymia correlates with several psychosocial factors but seems strongly related to facial image dissatisfaction.
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Affiliation(s)
- Fabio Basta
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Carmen Mazzuca
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Veronica Batani
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Giulio Dolcini
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Patrizio Moras
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marta Vadacca
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Picchianti Diamanti A, Navarini L, Messina F, Markovic M, Arcarese L, Basta F, Meneguzzi G, Margiotta DPE, Laganà B, Afeltra A, D'Amelio R, Iagnocco A. Ultrasound detection of subclinical synovitis in rheumatoid arthritis patients in clinical remission: a new reduced-joint assessment in 3 target joints. Clin Exp Rheumatol 2018; 36:984-989. [PMID: 29998842] [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] [Received: 11/13/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The ability of ultrasound (US) to identify subclinical joint inflammation in rheumatoid arthritis (RA) patients in remission has been already reported. Nonetheless, current studies present a lack of homogeneity in patient's characteristics and number of joints assessed by US. The aim of this study was to identify a reduced set of target joints to be scanned in RA patients in clinical remission in order to detect subclinical synovitis. METHODS Forty RA patients in clinical remission (DAS28 ≤2.6) for at least 3 months underwent an US examination of 18 joints: wrist, II-III-IV-V metacarpophalangeal (MCP) and II-III-IV-V metatarsophalangeal joints bilaterally. The presence of synovial hypertrophy (SH) and power-Doppler (PD) signal was registered following the OMERACT definitions and was graded according to a 4-point scale (0-3). Then, by applying a process of data reduction based on the frequency of joint involvement, a reduced assessment was obtained. RESULTS Twenty (50%) subjects had at least one joint affected by active synovitis; 17.5% presented grade 1 PD and 32.5% grade 2 PD. The joints most frequently affected by active synovitis were the wrists (75%) and the II MCP joints (55%). After data reduction, the evaluation of 3 joints (both wrists and the II MCP of the dominant hand) obtained a sensitivity of 90% for the detection of subclinical synovitis. CONCLUSIONS The US scan of 3 target joints showed a high sensitivity in detecting subclinical active synovitis in RA patients in clinical remission and can be feasible in the routine assessment of these patients.
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Affiliation(s)
- Andrea Picchianti Diamanti
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Luca Navarini
- ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Filippo Messina
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Milica Markovic
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Luisa Arcarese
- ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Fabio Basta
- ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Giorgia Meneguzzi
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | | | - Bruno Laganà
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Antonella Afeltra
- ImmunoRheumatology Unit, Policlinico Universitario Campus Biomedico, Rome, Italy
| | - Raffaele D'Amelio
- Department of Clinical and Molecular Medicine, S. Andrea University Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Annamaria Iagnocco
- Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Italy.
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Fasano S, Margiotta DPE, Pierro L, Navarini L, Riccardi A, Afeltra A, Valentini G. Prolonged remission is associated with a reduced risk of cardiovascular disease in patients with systemic lupus erythematosus: a GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Clin Rheumatol 2018; 38:457-463. [PMID: 30194649 DOI: 10.1007/s10067-018-4286-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 07/18/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 01/18/2023]
Abstract
Prolonged remission (PR), defined as a 5-year consecutive period of no disease activity based on SLEDAI-2K, has been reported to be associated with a lower damage accrual over time in patients with systemic lupus erythematosus (SLE), as the consequence of a lower activity burden. Since disease activity is considered to play a role in the incidence of cardiovascular disease (CVD), we investigated the relationship, if any, between PR and the occurrence of a subsequent first CV event in patients with SLE. Out of 488 patients consecutively admitted to two tertiary Italian centers from November 1, 2000, to December 31, 2016, the 294 patients, who had been followed at least for 5 years, had not experienced any CV event at admission, and had been visited biannually during follow-up, were considered for the present study. The incidence of a first CV in patients who had achieved PR was compared with that registered in those who had not. Moreover, it was compared among PR patients subdivided into three groups: complete remission, clinical off-corticosteroids (offCR), and clinical on-corticosteroids remission (onCR). Kaplan-Meier curves and the log-rank test were used to analyze differences in event-free survival among groups. Cox regression was used to investigate disease and therapeutic features associated with the development of a first CV event. During 9 years median follow-up time, 24 (8.1%) CV events occurred. Out of the 294 patients, 126 (42.8%) had achieved PR. Kaplan-Meier analysis revealed a greater overall CV event-free rate in these patients as compared to both those with a shorter lasting remission and those who had never remitted (log-rank test χ2 = 14.43; p = 0.0001). In addition, CV outcome did not differ among PR patients, irrespectively the type of remission achieved (p > 0.05). At multivariate analysis, hydroxychloroquine therapy and PR resulted to be protective (HR 0.19; HR 0.18), while arterial hypertension and antiphospholipid positivity increased the risk of a first CV event (HR 2.61; HR 2.47). The PR, whichever the subtype, is associated with a better CV outcome and should be considered as a treat-to-target goal in the CV risk management of the lupus patient.
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Affiliation(s)
- Serena Fasano
- Division of Rheumatology, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | | | - Luciana Pierro
- Division of Rheumatology, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Navarini
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonella Riccardi
- Division of Rheumatology, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonella Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gabriele Valentini
- Division of Rheumatology, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Basta F, Afeltra A, Margiotta DPE. Fatigue in systemic sclerosis: a systematic review. Clin Exp Rheumatol 2018; 36 Suppl 113:150-160. [PMID: 29303706] [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] [Received: 07/10/2017] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To systematically review fatigue in systemic sclerosis (SSc) in terms of prevalence, features, correlates, predictors and management. METHODS We performed a literature search in PubMed (Medline), EBSCO and COCHRANE databases up to June 2017 selecting articles regarding fatigue in SSc. The articles finally selected fulfilled the following eligibility criteria: written in English, referred to fatigue in SSc, reporting original data, including validated questionnaires measuring fatigue. RESULTS A total of 43 records were included. Fatigue in SSc has a prevalence similar to that of other rheumatic diseases and is one of the most prevalent and debilitating symptom experienced by SSc patients. Fatigue leads to a significant impairment of quality of life, parenting, household and work ability. Fatigue is associated with psychosocial factors (depression, pain and sleep disorders), sociodemographic factors and clinical manifestations of the disease (pulmonary and gastrointestinal involvement). Indeed, the relationship with scores of disease activity is uncertain. Pharmacological therapeutic approaches were broadly ineffective in reducing fatigue. More encouraging results concern physical activity, complementary and alternative medicine. CONCLUSIONS Adequate management of fatigue could lead to a marked improvement of the patient's quality of life, also contributing to reduction in SSc indirect costs.
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Affiliation(s)
- Fabio Basta
- Department of Clinical Medicine and Rheumatology, Campus Bio-Medico, University of Rome, Italy.
| | - Antonella Afeltra
- Department of Clinical Medicine and Rheumatology, Campus Bio-Medico, University of Rome, Italy
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Laudisio A, Navarini L, Margiotta DPE, Gemma A, Giovannini S, Saviano A, Bernabei R, Afeltra A, Zuccalà G, Antonelli Incalzi R. Inflammation as a mediator of the association between osteoporosis and hearing loss in older subjects: a population-based study. Eur Rev Med Pharmacol Sci 2018; 22:1451-1456. [PMID: 29565506 DOI: 10.26355/eurrev_201803_14492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Due to the aging of populations, the prevalence of hearing loss and osteoporosis is increasing. Previous studies have found an association between these conditions. Nevertheless, the pathophysiologic pathway of such an association has not yet been established. The present study aimed at evaluating the association, if any, of hearing loss with osteoporosis in an older unselected population, and whether this association varied according to inflammatory status. PATIENTS AND METHODS We assessed the association of osteoporosis with a self-reported hearing loss in all 310 subjects aged 75+ living in Tuscania (Italy), without exclusion criteria. Bone density was assessed by calcaneal quantitative ultrasound; osteoporosis was defined as a T-score ≤ -2.5 Standard Deviation. RESULTS Hearing loss was associated with osteoporosis (OR = 1.84, 95% CI = 1.03-3.28; p = 0.40) in multivariable logistic regression analysis, after adjusting for potential confounders. Analysis of the interaction term indicated that this association varied according to the erythrocyte sedimentation rate, ERS (p = 0.030), and high-sensitivity C reactive protein, hs-CRP (p = 0.017) but not sex (p = 0.832). Of notice, this association was significant only for higher levels of inflammatory parameters (OR = 2.82; 95% CI = 1.15-6.90; p = 0.023 for the higher ERS tertile; and OR = 3.81; 95% CI = 1.36-10.63; p = 0.011 for the higher hs-CRP tertile vs. lower tertiles). CONCLUSIONS Hearing loss is associated with osteoporosis in community dwelling elderly. Such an association seems to depend upon higher inflammation levels.
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Affiliation(s)
- A Laudisio
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.
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Navarini L, Margiotta DPE, Vadacca M, Afeltra A. Leptin in autoimmune mechanisms of systemic rheumatic diseases. Cancer Lett 2018; 423:139-146. [PMID: 29548819 DOI: 10.1016/j.canlet.2018.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 10/20/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 12/28/2022]
Abstract
In the last two decades, white adipose tissue (WAT) has been recognized as a key actor of many physiological and pathological conditions. WAT is able to produce mediators, named "adipokines", which may affect systemic homeostasis. In particular, leptin is not only involved in appetite and energy metabolism, but also in immune system. Increasing evidence established that leptin can regulate both innate and adaptive immunity mainly with pro-inflammatory effects but also, to a lesser extent, with anti-inflammatory features. In autoimmune diseases, a failure or breakdown of the mechanisms of self-tolerance is observed. Leptin, which plays an important role in the control of immune balance, has been involved in autoimmunity generation and maintenance. In this review, it has been provided an up-to-date report about the role of leptin in systemic autoimmune diseases, with particular reference to connective tissue diseases, inflammatory arthritis, and vasculitis.
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Affiliation(s)
- Luca Navarini
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Marta Vadacca
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
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Margiotta DPE, Basta F, Batani V, Afeltra A. Belimumab and low-doses of mycophenolate mofetil as induction therapy of class IV lupus nephritis: case series and literature review. BMC Nephrol 2018. [PMID: 29514612 PMCID: PMC5842533 DOI: 10.1186/s12882-018-0847-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Indexed: 01/06/2023] Open
Abstract
Background The treatment of Lupus Nephritis (LN) is an unmet need in the management of patients with Systemic Lupus Erythematosus (SLE). Case presentation We report two cases of women affected by Lupus Nephritis (LN) ISN/RNP Class IV with serological active disease, high disease activity and marked fatigue. In both cases, Mycophenolate mofetil (MMF), as induction therapy, was poorly tolerated because of gastrointestinal toxicity. Belimumab, together with low-doses of MMF, was effective as induction treatment leading to early achievement of complete renal response in these two selected cases of LN. Conclusions We also report a literature review concerning the efficacy and safety of Belimumab in Lupus Nephritis. Further studies are needed to evaluate the use of Belimumab to manage the renal involvement in patients with Systemic Lupus Erythematosus, waiting for the results of ongoing randomized clinical trials.
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Affiliation(s)
- Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Fabio Basta
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Veronica Batani
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy
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Margiotta DPE, Basta F, Dolcini G, Batani V, Lo Vullo M, Vernuccio A, Navarini L, Afeltra A. Physical activity and sedentary behavior in patients with Systemic Lupus Erythematosus. PLoS One 2018; 13:e0193728. [PMID: 29505598 PMCID: PMC5837187 DOI: 10.1371/journal.pone.0193728] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction The aim of this study was to evaluate the proportion of patients with Systemic Lupus Erythematosus (SLE) who did not met the WHO recommendations for physical activity and to evaluate the amount of time spent in sedentary behavior. Methods SLE patients were consecutively enrolled in a cross sectional study. The type and the time spent in physical activity and sedentary behavior were evaluated using the IPAQ short form questionnaire. The adequate physical activity was defined according to the 2010 WHO recommendations for health and the sedentary behavior according to the 2017 SBRN consensus. We also assessed quality of life using SF-36, mood disorders using BDI and HAM-H, fatigue using Facit-Fatigue and sleep disorders using PSQI scores. Results Physical activity was not sufficient to meet WHO recommendations in 56 of 93 SLE patients (60%). SLE patients spent a median (95% range) of 180 (0–600) minutes everyday in sedentary activities. The length of daily sedentary time was more than 6 hours in 25% of SLE patients. In multivariable analysis, the factors associated to the probability of not meeting WHO criteria was only the time of exposure to antimalarials (OR 0.88, p 0.03) and the factors related to the probability of being in the upper tertile of sedentary time (more than 270 minutes) were age (OR 1.04, p 0.02), disease activity expressed by SELENA-SLEDAI score (OR 1.2, p 0.01) and Facit-fatigue score (OR 0.94, p 0.04). Conclusion A relevant proportion of SLE patients were inadequately physically active. It is essential to improve the awareness of the importance of increase physical activity and reduce sedentary time. A better control of disease activity and fatigue and a prolonged use of antimalarials could help to reach this notable goal.
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Affiliation(s)
| | - Fabio Basta
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giulio Dolcini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Veronica Batani
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marina Lo Vullo
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Alessia Vernuccio
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
- * E-mail:
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
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Margiotta DPE, Basta F, Dolcini G, Batani V, Navarini L, Afeltra A. The relation between, metabolic syndrome and quality of life in patients with Systemic Lupus Erythematosus. PLoS One 2017; 12:e0187645. [PMID: 29112985 PMCID: PMC5675433 DOI: 10.1371/journal.pone.0187645] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 10/23/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Systemic Lupus Erythematosus (SLE) is associated to an increased prevalence of Metabolic Syndrome (MeS) and to a reduction of Quality of Life (QoL). The aim of this study is to evaluate the association between MeS and QoL in SLE. Methods SLE patients were consecutively enrolled in a cross sectional study. MeS was defined according to IFD definition. Therapy with glucocorticoids (GC) and antimalarial was analyzed as cumulative years of exposure. We used a cut off of 7.5 mg of prednisone to define high daily dose of GC. QoL was quantified using SF-36. We used BDI and HAM-H to assess symptoms of mood disorders. Fatigue was evaluated using Facit-Fatigue, physical activity using IPAQ, sleep quality using PSQI and alexithymia using TAS-20. Results We enrolled 100 SLE patients. MeS prevalence was 34%. Patients with MeS presented reduced scores in SF-36 MCS and PCS compared to patients without MeS (p 0.03 and p 0.004). BDI and HAM-H score were significantly higher in patients meeting MeS criteria compared to subjects without MeS (p 0.004, p 0.02). These results were confirmed after adjustment for confounders. Compared to patients without MeS, those with MeS presented higher age, lower education level, higher recent SELENA-SLEDAI, higher number of flares, increased SDI, longer cumulative exposure to high dose GC and shorter duration of antimalarial therapy. In the multiple logistic regression model, the variable associated to the Odds Ratio of having MeS were: the average of recent SELENA-SLEDAI (OR 1.15 p 0.04), the years of exposure to high dose of GC (OR 1.18 p 0.004), the years of exposure to antimalarials (OR 0.82 p 0.03) and the BDI score (OR 1.1 p 0.005). Conclusion A modern management of SLE should not miss to take all the possible measures to ensure an adequate QoL to SLE patients, with particular attention to those affected by MeS.
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Affiliation(s)
| | - Fabio Basta
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giulio Dolcini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Veronica Batani
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
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Navarini L, Afeltra A, Gallo Afflitto G, Margiotta DPE. Polyunsaturated fatty acids: any role in rheumatoid arthritis? Lipids Health Dis 2017; 16:197. [PMID: 29017507 PMCID: PMC5634864 DOI: 10.1186/s12944-017-0586-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022] Open
Abstract
Background Polyunsaturated fatty acids (PUFAs) are members of the family of fatty acids and are included in the diet. Particularly, western diet is usually low in n-3 PUFAs and high in n-6 PUFAs. PUFAs play a central role in the homeostasis of immune system: n-6 PUFAs have predominantly pro-inflammatory features, while n-3 PUFAs seem to exert anti-inflammatory and pro-resolving properties. Rheumatoid arthritis (RA) is a chronic inflammatory arthritis in which many inflammatory pathways contribute to joint and systemic inflammation, disease activity, and structural damage. Research on PUFAs could represent an important opportunity to better understand the pathogenesis and to improve the management of RA patients. Methods We searched PubMed, Embase, EBSCO-Medline, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI and Wanfang to identify primary research reporting the role of n-3 PUFAs in rheumatoid arthritis both in humans and in animal models up to the end of March 2017. Results Data from animal models allows to hypothesize that n-3 PUFAs supplementation may represent an interesting perspective in future research as much in prevention as in treating RA. In humans, several case-control and prospective cohort studies suggest that a high content of n-3 PUFAs in the diet could have a protective role for incident RA in subjects at risk. Moreover, n-3 PUFAs supplementation has been assessed as a valuable therapeutic option also for patients with RA, particularly in order to improve the pain symptoms, the tender joint count, the duration of morning stiffness and the frequency of NSAIDs assumption. Conclusions n-3 PUFAs supplementation could represent a promising therapeutic option to better control many features of RA. The impact of n-3 PUFAs on radiographic progression and synovial histopathology has not been yet evaluated, as well as their role in early arthritis and the combination with biologics.
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Affiliation(s)
- Luca Navarini
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Antonella Afeltra
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Gabriele Gallo Afflitto
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Immunology, Rheumatology, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128, Rome, Italy
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Ruscitti P, Margiotta DPE, Macaluso F, Iacono D, D’Onofrio F, Emmi G, Atzeni F, Prete M, Perosa F, Sarzi-Puttini P, Emmi L, Cantatore FP, Triolo G, Afeltra A, Giacomelli R, Valentini G. Subclinical atherosclerosis and history of cardiovascular events in Italian patients with rheumatoid arthritis: Results from a cross-sectional, multicenter GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Medicine (Baltimore) 2017; 96:e8180. [PMID: 29049200 PMCID: PMC5662366 DOI: 10.1097/md.0000000000008180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Several studies have pointed out a significant association between rheumatoid arthritis (RA) and accelerated atherosclerosis. At the best of our knowledge, no such study has been carried out in a large Italian series and, in this study, we aimed to investigate the prevalence of both subclinical atherosclerosis and history of cardiovascular events (CVEs), in patients consecutively admitted from January 1, 2015 to December 31, 2015 to Rheumatology Units throughout the whole Italy.Centers members of GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) were invited to enrol patients consecutively admitted from January 1, 2015 to December 31, 2015 and satisfying American College of Rheumatology/ European League Against Rheumatism criteria for RA and to investigate each of them for: traditional cardiovascular risk factors: sex, age, smoking habit, total cholesterol, triglycerides, glycaemia, high blood pressure, metabolic syndrome (MS), type 2 diabetes (T2D); RA features: disease duration as assessed from the first symptom, disease activity as evaluated by DAS28, radiographic damage as assessed by hands and feet x-ray, and previous joint surgery; prevalence of both subclinical atherosclerosis and history of CVEs.Eight centers participated to the study. From January 1, 2015 to December 31, 2015, the 1176 patients, who had been investigated for all the items, were enrolled in the study. They were mostly women (80.52%), with a median age of 60 years (range, 18-91 years), a median disease duration of 12 years (range, 0.8-25 years), seropositive in 69.21%. Nineteen percent were in remission; 17.51% presented low disease activity; 39.45% moderate disease activity; 22.61% high disease activity.Eighty-two patients (6.9%) had a history for CVEs (58 myocardial infarction, 38 heart failure, 10 ischemic transitory attack, and 7 stroke). This figure appears to be lower than that reported worldwide (8.5%). After excluding the 82 patients with a history of CV events, subclinical atherosclerosis was detected in 16% of our patients, (176 patients), a figure lower than that reported worldwide (32.7%) and in previous Italian studies.This is the first Italian multicenter study on subclinical and clinical atherosclerosis in patients with RA. We pointed out a low prevalence of both subclinical atherosclerosis and history of CV events.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila
| | | | - Federica Macaluso
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo
| | - Daniela Iacono
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples
| | - Francesca D’Onofrio
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Fabiola Atzeni
- Rheumatology Section, L. Sacco University Hospital, Milan
| | - Marcella Prete
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Federico Perosa
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | | | - Lorenzo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence
| | - Francesco Paolo Cantatore
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia
| | - Giovanni Triolo
- Rheumatology Section, Department of Internal Medicine, University of Palermo, Palermo
| | - Antonella Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome
| | - Roberto Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila
| | - Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples
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Giacomelli R, Afeltra A, Alunno A, Baldini C, Bartoloni-Bocci E, Berardicurti O, Carubbi F, Cauli A, Cervera R, Ciccia F, Cipriani P, Conti F, De Vita S, Di Benedetto P, Doria A, Drosos AA, Favalli EG, Gandolfo S, Gatto M, Grembiale RD, Liakouli V, Lories R, Lubrano E, Lunardi C, Margiotta DPE, Massaro L, Meroni P, Minniti A, Navarini L, Pendolino M, Perosa F, Pers JO, Prete M, Priori R, Puppo F, Quartuccio L, Ruffatti A, Ruscitti P, Russo B, Sarzi-Puttini P, Shoenfeld Y, Somarakis GA, Spinelli FR, Tinazzi E, Triolo G, Ursini F, Valentini G, Valesini G, Vettori S, Vitali C, Tzioufas AG. International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)? Autoimmun Rev 2017; 16:911-924. [DOI: 10.1016/j.autrev.2017.07.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 02/06/2023]
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Margiotta DPE, Navarini L, Vadacca M, Lo Vullo M, Pignataro F, Basta F, Afeltra A. The IL33/ST2 axis in Sjogren syndrome in relation to disease activity. Eur Rev Med Pharmacol Sci 2016; 20:1295-1299. [PMID: 27097949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Primary Sjogren's Syndrome (pSS) is a systemic autoimmune disorder characterized by infiltration of the exocrine glands leading to secretory insufficiency. Despite the progress made in understanding the pathogenesis of the SS, many aspects remain to be clarified. Interleukin-33 (IL33) is a recently discovered cytokine, belonging to IL-1 superfamily. IL33 and its soluble receptor ST2 were implied in a number of immune and in autoimmune diseases pathogenesis. In this work ,we analyzed expression of IL33 and ST2 in Sjogren's syndrome. PATIENTS AND METHODS Serum IL-33 and soluble ST2 were analyzed using commercial ELISA kit in 15 pSS, 9 patients with Systemic Lupus Erythematosus and 9 controls. RESULTS We found significant hyperexpression of sST2 in sera of SS patients and SLE patients compared to healthy subjects (p = 0.04 and p = 0.07, respectively). In pSS, sST2 levels in pSS positively correlated with activity index SSDAI (r = 0.662, p = 0.007). In SLE, we found positive correlation between ST2 and SLEDAI 2K (r = 0.685, p = 0.04). Circulating levels of IL-33 were detectable in 2 of 15 SS patients, in 2 SLE patients and in 1 of control subjects. CONCLUSIONS We found an hyperexpression of sST2 in pSS and SLE patients with a possible immune modulatory role, because of a substantial suppression of circulating IL33. In our pSS and SLE cohort, sST2 levels were in correlation with disease activity indices.
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Affiliation(s)
- D P E Margiotta
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico University of Rome, Rome, Italy.
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Afeltra A, Gigante A, Margiotta DPE, Taffon C, Cianci R, Barbano B, Liberatori M, Amoroso A, Rossi Fanelli F. The involvement of T regulatory lymphocytes in a cohort of lupus nephritis patients: a pilot study. Intern Emerg Med 2015; 10:677-83. [PMID: 25720575 DOI: 10.1007/s11739-015-1212-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/30/2015] [Indexed: 12/22/2022]
Abstract
T regulator lymphocytes (Tregs) play a key role in the maintenance of immune tolerance and in the development of autoimmune diseases. Expression of Foxp3 is specific for Tregs, and can be used for the identification of these cells. This study investigated the variations of Tregs Foxp3+ in the kidney biopsies inflammatory infiltrate of different lupus nephritis classes compared to that of ANCA glomerulonephritis, acute tubulointerstitial nephritis and nephroangiosclerosis. Sections of paraffin-embedded tissue have been stained by immunohistochemistry with anti-CD3 and anti-FoxP3 antibodies. We find that the ratio of FoxP3+/CD3+ cells is significantly lower in patients with lupus nephritis class IV and in patients with vasculitides than in the course of nephroangiosclerosis, tubulointerstitial nephritis and lupus nephritis class V. The data presented herein demonstrate a decrease of FoxP3+ Treg cells in the inflammatory infiltrate of lupus nephritis, particularly during the most active phases of lupus nephritis, as observed in the course of a IV class nephritis.
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Affiliation(s)
- Antonella Afeltra
- Clinical Medicine and Rheumatology, Integrated Research Center, Campus Bio-Medico University, Rome, Italy
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Zardi EM, Sambataro G, Basta F, Margiotta DPE, Afeltra AMV. Subclinical carotid atherosclerosis in elderly patients with primary Sjögren syndrome: a duplex Doppler sonographic study. Int J Immunopathol Pharmacol 2015; 27:645-51. [PMID: 25572746 DOI: 10.1177/039463201402700422] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A growing body of evidence presents a link between chronic inflammatory rheumatic diseases and atherosclerosis. To evaluate subclinical carotid atherosclerosis in an elderly group of patients with primary Sjögren syndrome compared with a control group matched for age, sex, ethnicity and cardiovascular risk factors, we enrolled 18 patients with Primary Sjögren Syndrome (mean age 65 ± 5.93 SD) and 18 mild Ostheoarthritic patients (mean age 66 ± 5.94 SD) from the outpatient department of Rheumatology, University Campus Bio-Medico, Rome, Italy, matched for age, sex, ethnicity and cardiovascular risk factors. A duplex Doppler sonographic study of carotids was performed in order to evaluate intima-media thickness (IMT), stiffness and haemodynamic parameters [resistivity and pulsatility indices (RI and PI, respectively)]. No significant difference was found between primary Sjögren syndrome and control patients in IMT, stiffness and haemodynamic parameters. The lack of significant difference in subclinical atherosclerosis between elderly primary Sjögren syndrome and control matched patients, indicates that traditional cardiovascular risk factors, immunologic alterations and chronic inflammation do not influence the progression of vascular damage in the carotid circulation of patients with median disease duration of 6.5 years.
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Affiliation(s)
- E M Zardi
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Rome, Italy
| | - G Sambataro
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Rome, Italy
| | - F Basta
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Rome, Italy
| | - D P E Margiotta
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Rome, Italy
| | - A M V Afeltra
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Rome, Italy
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