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Di Matteo A, Smerilli G, Di Donato S, Liu AR, Becciolini A, Camarda F, Cazenave T, Cipolletta E, Corradini D, de Agustín JJ, Destro Castaniti GM, Di Donato E, Di Geso L, Duran E, Farisogullari B, Fornaro M, Francioso F, Giorgis P, Granel A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Karadag O, Li L, Marin J, Martire MV, Michelena X, Moscioni E, Muntean L, Piga M, Rosemffet M, Rovisco J, Sahin D, Salaffi F, Saraiva L, Scioscia C, Tamas MM, Tanimura S, Venetsanopoulou A, Ventura-Rios L, Villota O, Villota-Eraso C, Voulgari PV, Vukatana G, Zacariaz Hereter J, Marzo-Ortega H, Grassi W, Filippucci E. Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study. Ann Rheum Dis 2024:ard-2023-225443. [PMID: 38443140 DOI: 10.1136/ard-2023-225443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. METHODS In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). RESULTS In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. CONCLUSIONS This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.
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Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Di Donato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - An Ran Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Federica Camarda
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Tomas Cazenave
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Provincial Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Emine Duran
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bayram Farisogullari
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Marco Fornaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Rheumatology Unit, University of Bari, Bari, Italy
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Pamela Giorgis
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Amelia Granel
- Rheumatology, Hospital San Roque de Gonnet, La Plata, Buenos Aires, Argentina
| | | | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Praha, Czech Republic
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Praha, Czech Republic
| | - Diogo Jesus
- Rheumatology Department, Leiria Hospital Centre, Pousos, Portugal
- Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - Omer Karadag
- Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ling Li
- Department of Rheumatology and Immunology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Josefina Marin
- Rheumatology Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Xabier Michelena
- Rheumatology Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Laura Muntean
- Department of Rheumatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Matteo Piga
- Rheumatology Unit, University of Cagliari, Cagliari, Italy
| | - Marcos Rosemffet
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Didem Sahin
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Liliana Saraiva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Crescenzio Scioscia
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Rheumatology Unit, University of Bari, Bari, Italy
| | - Maria-Magdalena Tamas
- Department of Rheumatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, The Hokkaido Medical Center, Sapporo, Japan
| | - Aliki Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Lucio Ventura-Rios
- Division of Rheumatology, National Institute of Rehabilitation Luis Guillermo Ibarra, Ciudad de Mexico, Mexico
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, San Juan de Pasto, Colombia
- Department of Rheumatology, Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Catalina Villota-Eraso
- Department of Rheumatology, Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy
| | - Johana Zacariaz Hereter
- Rheumatology Unit, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy
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Paroli M, Becciolini A, Bravi E, Andracco R, Nucera V, Parisi S, Ometto F, Lumetti F, Farina A, Del Medico P, Colina M, Lo Gullo A, Ravagnani V, Scolieri P, Larosa M, Priora M, Visalli E, Addimanda O, Vitetta R, Volpe A, Bezzi A, Girelli F, Molica Colella AB, Caccavale R, Di Donato E, Adorni G, Santilli D, Lucchini G, Arrigoni E, Platè I, Mansueto N, Ianniello A, Fusaro E, Ditto MC, Bruzzese V, Camellino D, Bianchi G, Serale F, Foti R, Amato G, De Lucia F, Dal Bosco Y, Foti R, Reta M, Fiorenza A, Rovera G, Marchetta A, Focherini MC, Mascella F, Bernardi S, Sandri G, Giuggioli D, Salvarani C, Franchina V, Molica Colella F, Ferrero G, Ariani A. Long-Term Retention Rate of Tofacitinib in Rheumatoid Arthritis: An Italian Multicenter Retrospective Cohort Study. Medicina (Kaunas) 2023; 59:1480. [PMID: 37629770 PMCID: PMC10456797 DOI: 10.3390/medicina59081480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
Background: Tofacitinib (TOFA) was the first Janus kinase inhibitor (JAKi) to be approved for the treatment of rheumatoid arthritis (RA). However, data on the retention rate of TOFA therapy are still far from definitive. Objective: The goal of this study is to add new real-world data on the TOFA retention rate in a cohort of RA patients followed for a long period of time. Methods: A multicenter retrospective study of RA subjects treated with TOFA as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was conducted in 23 Italian tertiary rheumatology centers. The study considered a treatment period of up to 48 months for all included patients. The TOFA retention rate was assessed with the Kaplan-Meier method. Hazard ratios (HRs) for TOFA discontinuation were obtained using Cox regression analysis. Results: We enrolled a total of 213 patients. Data analysis revealed that the TOFA retention rate was 86.5% (95% CI: 81.8-91.5%) at month 12, 78.8% (95% CI: 78.8-85.2%) at month 24, 63.8% (95% CI: 55.1-73.8%) at month 36, and 59.9% (95% CI: 55.1-73.8%) at month 48 after starting treatment. None of the factors analyzed, including the number of previous treatments received, disease activity or duration, presence of rheumatoid factor and/or anti-citrullinated protein antibody, and presence of comorbidities, were predictive of the TOFA retention rate. Safety data were comparable to those reported in the registration studies. Conclusions: TOFA demonstrated a long retention rate in RA in a real-world setting. This result, together with the safety data obtained, underscores that TOFA is a viable alternative for patients who have failed treatment with csDMARD and/or biologic DMARDs (bDMARDs). Further large, long-term observational studies are urgently needed to confirm these results.
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Affiliation(s)
- Marino Paroli
- Department of Clinical, Internist, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Elena Bravi
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Romina Andracco
- Internal Medicine Unit, Imperia Hospital, 18100 Imperia, Italy; (R.A.); (N.M.)
| | - Valeria Nucera
- Rheumatology Unit, ASL Novara, 28100 Novara, Italy; (V.N.); (A.I.)
| | - Simone Parisi
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | | | - Federica Lumetti
- Rheumatology Unit, Azienda USL of Modena and AOU Policlinico of Modena, 41100 Modena, Italy;
| | - Antonella Farina
- Internal Medicine Unit, Augusto Murri Hospital, 63900 Fermo, Italy;
| | - Patrizia Del Medico
- Internal Medicine Unit, Civitanova Marche Hospital, 62012 Civitanova Marche, Italy;
| | - Matteo Colina
- Rheumatology Unit, Internal Medicine Division, Department of Medicine and Oncology, Santa Maria della Scaletta Hospital, 40026 Imola, Italy;
- Rheumatology Unit, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy
| | | | - Viviana Ravagnani
- Rheumatology Unit, Santa Chiara Hospital APSS—Trento, 38122 Trento, Italy;
| | - Palma Scolieri
- Rheumatology Unit, Nuovo Regina Margherita Hospital, 00154 Roma, Italy; (P.S.); (V.B.)
| | - Maddalena Larosa
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | - Marta Priora
- Rheumatology Unit, ASL CN1, 12100 Cuneo, Italy; (M.P.); (F.S.)
| | - Elisa Visalli
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Olga Addimanda
- Rheumatology Unit, AUSL of Bologna—Policlinico Sant’Orsola—AOU—IRCCS of Bologna, 40138 Bologna, Italy; (O.A.); (M.R.)
| | - Rosetta Vitetta
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Alessandro Volpe
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (A.V.); (A.M.)
| | - Alessandra Bezzi
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Francesco Girelli
- Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy; (F.G.); (S.B.)
| | | | - Rosalba Caccavale
- Department of Clinical, Internist, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Giuditta Adorni
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Daniele Santilli
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Gianluca Lucchini
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
| | - Eugenio Arrigoni
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Ilaria Platè
- Rheumatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (E.B.); (E.A.); (I.P.)
| | - Natalia Mansueto
- Internal Medicine Unit, Imperia Hospital, 18100 Imperia, Italy; (R.A.); (N.M.)
| | - Aurora Ianniello
- Rheumatology Unit, ASL Novara, 28100 Novara, Italy; (V.N.); (A.I.)
| | - Enrico Fusaro
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | - Maria Chiara Ditto
- Rheumatology Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (S.P.); (E.F.); (M.C.D.)
| | - Vincenzo Bruzzese
- Rheumatology Unit, Nuovo Regina Margherita Hospital, 00154 Roma, Italy; (P.S.); (V.B.)
| | - Dario Camellino
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | - Gerolamo Bianchi
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, 16132 Genova, Italy; (M.L.); (D.C.); (G.B.)
| | | | - Rosario Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Giorgio Amato
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Francesco De Lucia
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Ylenia Dal Bosco
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Roberta Foti
- Rheumatology Unit, Policlinico San Marco Hospital, 95121 Catania, Italy; (E.V.); (R.F.); (G.A.); (F.D.L.); (Y.D.B.); (R.F.)
| | - Massimo Reta
- Rheumatology Unit, AUSL of Bologna—Policlinico Sant’Orsola—AOU—IRCCS of Bologna, 40138 Bologna, Italy; (O.A.); (M.R.)
| | - Alessia Fiorenza
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Guido Rovera
- Unit of Rheumatology, ASL VC Sant’ Andrea Hospital, 13100 Vercelli, Italy; (R.V.); (A.F.)
| | - Antonio Marchetta
- Unit of Rheumatology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (A.V.); (A.M.)
| | - Maria Cristina Focherini
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Fabio Mascella
- Internal Medicine and Rheumatology Unit, AUSL della Romagna—Rimini, 47924 Rimini, Italy; (A.B.); (M.C.F.); (F.M.)
| | - Simone Bernardi
- Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, 47121 Forlì, Italy; (F.G.); (S.B.)
| | - Gilda Sandri
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy; (G.S.); (D.G.); (C.S.)
| | - Veronica Franchina
- Medical Oncology Unit, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | | | - Giulio Ferrero
- Unit of Diagnostic and Interventional Radiology, Santa Corona Hospital, 17027 Pietra Ligure, Italy;
| | - Alarico Ariani
- Internal Medicine and Rheumatology Unit, University Hospital of Parma, 43126 Parma, Italy; (A.B.); (E.D.D.); (G.A.); (D.S.); (G.L.); (A.A.)
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Lo Gullo A, Becciolini A, Parisi S, Del Medico P, Farina A, Visalli E, Dal Bosco Y, Molica Colella AB, Lumetti F, Caccavale R, Scolieri P, Andracco R, Girelli F, Bravi E, Colina M, Volpe A, Ianniello A, Ditto MC, Nucera V, Franchina V, Platé I, Di Donato E, Amato G, Salvarani C, Bernardi S, Lucchini G, De Lucia F, Molica Colella F, Santilli D, Mansueto N, Ferrero G, Marchetta A, Arrigoni E, Foti R, Sandri G, Bruzzese V, Paroli M, Fusaro E, Ariani A. Therapeutic Effects of Apremilast on Enthesitis and Dactylitis in Real Clinical Setting: An Italian Multicenter Study. J Clin Med 2023; 12:3892. [PMID: 37373587 DOI: 10.3390/jcm12123892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Enthesitis and dactylitis are difficult-to-treat features of psoriatic arthritis (PsA), leading to disability and affecting quality of life. OBJECTIVE The aim of this study is to evaluate enthesitis (using the Leed enthesitis index (LEI)) and dactylitis at 6 and 12 months in patients treated with apremilast. METHODS Patients affected by PsA from fifteen Italian rheumatological referral centers were screened. The inclusion criteria were: (a) enthesitis or dactylitisphenotype; (b) treatment with apremilast 30 mg bid. Clinical and treatment history, including PsA disease activity, were recorded. Mann-Whitney and chi-squared tests were used to assess the differences between independent groups, and Wilcoxon matched pairs signed-rank test assessed the differences between dependent samples. A p-value of <0.05 was considered statistically significant. RESULTS The Eph cohort consisted of 118 patients (median LEI 3); the Dph cohort included 96 patients with a median dactylitis of 1 (IQR 1-2). According to an intention to treat analysis, 25% and 34% of patients with enthesitis achieved remission (i.e., LEI = 0) in T1 and T2. The remission of dactylitis was 47% in T1 and 44% in T2. The per protocol analysis (patients observed for at least 12 months) showed that both dactylitis and LEI significantly improved in T1 (median LEI 1 (IQR 1-3)) and T2 (median LEI 0 (IQR 1-2)). CONCLUSION Eph and Dph PsA patients treated with apremilast experienced a significant improvement in enthesitis and dactylitis activity. After 1 year, enthesitis and dactylitis remission was achieved in more than one-third of patients.
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Affiliation(s)
- Alberto Lo Gullo
- Unit of Rheumatology, Department of Medicine, ARNAS "Garibaldi", 95124 Catania, Italy
| | - Andrea Becciolini
- Internal Medicine and Rheumatology, Department of Medicine, Azienda Ospedaliera Di Parma, 43126 Parma, Italy
| | - Simone Parisi
- Department of General and Specialistic Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Patrizia Del Medico
- Internal Medicine Unit, Civitanova Marche Hospital, 62012 Civitanova Marche, Italy
| | - Antonella Farina
- Internal Medicine Unit, Ospedale Augusto Murri-Fermo, 63900 Fermo, Italy
| | - Elisa Visalli
- Unit of Rheumatology, Ospedale San Marco, 95121 Catania, Italy
| | | | | | - Federica Lumetti
- Unit of Rheumatology, Azienda Unità Sanitaria Locale di Modena, 41121 Modena, Italy
| | - Rosalba Caccavale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy
| | - Palma Scolieri
- Unit of Internal Medicine and Rheumatology, ASL Roma 1-Presidio Nuovo Regina Margherita, 00153 Roma, Italy
| | | | - Francesco Girelli
- Internal Medicine Unit, Ospedale "Morgagni-Pierantoni" di Forlì, 47121 Forlì, Italy
| | - Elena Bravi
- Department of Rheumatology, Ospedale "Guglielmo da Saliceto", 29121 Piacenza, Italy
| | - Matteo Colina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-Università di Bologna, 40136 Bologna, Italy
| | - Alessandro Volpe
- Rheumatology Unit, Ospedale Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | | | - Maria Chiara Ditto
- Department of General and Specialistic Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | | | | | - Ilaria Platé
- Department of Rheumatology, Ospedale "Guglielmo da Saliceto", 29121 Piacenza, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology, Department of Medicine, Azienda Ospedaliera Di Parma, 43126 Parma, Italy
| | - Giorgio Amato
- Unit of Rheumatology, Ospedale San Marco, 95121 Catania, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Simone Bernardi
- Internal Medicine Unit, Ospedale "Morgagni-Pierantoni" di Forlì, 47121 Forlì, Italy
| | - Gianluca Lucchini
- Internal Medicine and Rheumatology, Department of Medicine, Azienda Ospedaliera Di Parma, 43126 Parma, Italy
| | | | | | - Daniele Santilli
- Internal Medicine and Rheumatology, Department of Medicine, Azienda Ospedaliera Di Parma, 43126 Parma, Italy
| | | | | | - Antonio Marchetta
- Rheumatology Unit, Ospedale Sacro Cuore Don Calabria, 37024 Negrar di Valpolicella, Italy
| | - Eugenio Arrigoni
- Department of Rheumatology, Ospedale "Guglielmo da Saliceto", 29121 Piacenza, Italy
| | - Rosario Foti
- Unit of Rheumatology, Ospedale San Marco, 95121 Catania, Italy
| | - Gilda Sandri
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Vincenzo Bruzzese
- Unit of Internal Medicine and Rheumatology, ASL Roma 1-Presidio Nuovo Regina Margherita, 00153 Roma, Italy
| | - Marino Paroli
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00185 Roma, Italy
| | - Enrico Fusaro
- Department of General and Specialistic Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Alarico Ariani
- Internal Medicine and Rheumatology, Department of Medicine, Azienda Ospedaliera Di Parma, 43126 Parma, Italy
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4
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Salaffi F, Di Carlo M, Di Franco M, Bianchi G, Bazzichi L, Tirri R, Guiducci S, Gorla R, Atzeni F, Giacomelli R, Di Donato E, Guggino G, Fischetti F, Tirri E, Biasi G, Foti R, Dagna L, Carubbi F, Gremese E, Govoni M, Cutolo M, Iannone F, Lippolis I, Conti F, Tramontano G, Marino V, Farah S, Sarzi-Puttini P. Determining the PASS cut-off points for the FIQR, FASmod and PSD in patients with fibromyalgia: a registry-based study. Clin Exp Rheumatol 2023:19514. [PMID: 37140611 DOI: 10.55563/clinexprheumatol/on8j9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/09/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To determine the cut-off values of Patient Acceptable Symptom State (PASS) for the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Scale (FASmod), and the Polysymptomatic Distress scale (PSD) and to determine the predictors of PASS in patients with fibromyalgia (FM). METHODS FM patients belonging to the Italian Fibromyalgia Registry (IFR) completed the FIQR, the FASmod and the PSD. The PASS was assessed using a dichotomous answer. The cut-off values were obtained through the receiver operating characteristic curve (ROC) analyses. A multivariate logistic regression analysis was performed to determine predictors of achieving the PASS. RESULTS 5545 women (93.7%) and 369 males (6.3%) were included in the study. The 27.8% of patients reported an acceptable symptom state. Patients in PASS differed in all patient-reported outcome measures (p <0.001). The FIQR PASS threshold was ≤58 (area under the ROC curve [AUC] = 0.819). The FASmod PASS threshold was ≤23 (AUC = 0.805) and the PSD PASS threshold was ≤16 (AUC = 0.773). In the pairwise AUC comparison, the discriminatory power of the FIQR PASS outperforms both FASmod PASS (p = 0.0124) and PSD PASS (p <0.0001). Multivariate logistic analysis showed that FIQR items related to memory and pain were the only predictors of PASS. CONCLUSIONS The FIQR, FASmod, and PSD PASS cut-off points for FM patients have never been determined before. This study provides additional information to facilitate interpretation of the severity assessment scales in daily practice and clinical research related to FM patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy.
| | - Manuela Di Franco
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | - Gerolamo Bianchi
- Department of Medical Specialties, Division of Rheumatology Asl 3, Genova, Italy
| | | | - Rosella Tirri
- Rheumatology Unit, Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
| | - Roberto Gorla
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Italy
| | - Roberto Giacomelli
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Italy
| | - Giuliana Guggino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Fabio Fischetti
- Department of Medical Sciences, University of Trieste, UCO Medicina Clinica (SSD Reumatologia), Trieste, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - Giovanni Biasi
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria Senese and University of Siena, Italy
| | - Rosario Foti
- Rheumatology Unit, AOU Policlinico San Marco, Catania, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute & Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Carubbi
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Elisa Gremese
- UOC Reumatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University of Genova, IRCCS San Martino Polyclinic, Genova, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica- DiMePRe-J, University of Bari, Italy
| | - Irma Lippolis
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Fabrizio Conti
- Department of Clinical Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Rheumatology Unit, Policlinico Umberto I, Sapienza University of Rome, Italy
| | | | - Valentina Marino
- Rheumatology Unit, Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Sonia Farah
- Rheumatology Clinic, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, ASST, Milan State University School of Medicine, Milan, Italy
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5
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Becciolini A, Parisi S, Del Medico P, Farina A, Visalli E, Molica Colella AB, Lumetti F, Caccavale R, Scolieri P, Andracco R, Girelli F, Bravi E, Colina M, Volpe A, Ianniello A, Ditto MC, Nucera V, Franchina V, Platè I, Donato ED, Amato G, Salvarani C, Bernardi S, Lucchini G, De Lucia F, Molica Colella F, Santilli D, Mansueto N, Ferrero G, Marchetta A, Arrigoni E, Foti R, Sandri G, Bruzzese V, Paroli M, Fusaro E, Ariani A. Predictors of DAPSA Response in Psoriatic Arthritis Patients Treated with Apremilast in a Retrospective Observational Multi-Centric Study. Biomedicines 2023; 11:biomedicines11020433. [PMID: 36830969 PMCID: PMC9953385 DOI: 10.3390/biomedicines11020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To date, only a few real-world-setting studies evaluated apremilast effectiveness in psoriatic arthritis (PsA). The aims of this retrospective observational study are to report long-term Disease Activity Index for Psoriatic Arthritis (DAPSA) response of apremilast in PsA patients and to analyze the predictors of clinical response. METHODS All PsA consecutive patients treated with apremilast in fifteen Italian rheumatological referral centers were enrolled. Anamnestic data, treatment history, and PsA disease activity (DAPSA) at baseline, 6 months, and 12 months were recorded. The Mann-Whitney test and chi-squared tests assessed the differences between independent groups, whereas the Wilcoxon matched pairs signed-rank test assessed the differences between dependent samples. Logistic regressions verified if there were factors associated with achievement of DAPSA low disease activity or remission at 6 and 12 months. RESULTS DAPSA low disease activity or remission rates at 6 and 12 months were observed, respectively, in 42.7% (n = 125) and 54.9% (n = 161) patients. Baseline DAPSA was inversely associated with the odds of achieving low disease activity or remission at 6 months (odds ratio (OR) 0.841, 95% confidence interval (CI) 0.804-0.879; p < 0.01) and at 12 months (OR 0.911, 95% CI 0.883-0.939; p < 0.01). CONCLUSIONS Almost half of the PsA patients receiving apremilast achieved DAPSA low disease activity or remission at 6 and 12 months. The only factor associated with achievement of low disease activity or remission at both 6 and 12 months was baseline DAPSA.
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Affiliation(s)
- Andrea Becciolini
- Internal Medicine and Rheumatology Unit, Department of Medicine, University Hospital of Parma, 43121 Parma, Italy
| | - Simone Parisi
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, 10121 Turin, Italy
| | - Patrizia Del Medico
- Rheumatology Outpatient Clinic, Internal Medicine Unit, Civitanova Marche Hospital, 62012 Civitanova Marche, Italy
| | - Antonella Farina
- Internal Medicine Unit, Rheumatology Outpatient Clinic, Ospedale “A. Murri”, 63900 Fermo, Italy
| | - Elisa Visalli
- Rheumatology Unit, Policlinico San Marco University Hospital of Catania, 95121 Catania, Italy
| | | | - Federica Lumetti
- Rheumatology Unit, Azienda USL of Modena and AOU Policlinico of Modena, 41100 Modena, Italy
| | - Rosalba Caccavale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Palma Scolieri
- Unit of Internal Medicine and Rheumatology, “Nuovo Regina Margherita/S. Spirito” Hospital, ASL Roma 1, 00153 Rome, Italy
| | - Romina Andracco
- Distretto Socio Sanitario ASL 1 Imperiese, 18100 Imperia, Italy
| | - Francesco Girelli
- Rheumatology Service, Internal Medicine Unit, GB Morgagni Hospital, 47121 Forli, Italy
| | - Elena Bravi
- Rheumatology Unit, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy
| | - Matteo Colina
- Rheumatology Service, Section of Internal Medicine, Department of Medicine and Oncology, Ospedale Santa Maria della Scaletta, 40026 Imola, Italy
- Alma Mater Studiorum, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Alessandro Volpe
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Bologna, Italy
| | | | - Maria Chiara Ditto
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, 10121 Turin, Italy
| | - Valeria Nucera
- Rheumatology Outpatient Unit, ASL Novara, 28100 Novara, Italy
| | | | - Ilaria Platè
- Rheumatology Unit, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Department of Medicine, University Hospital of Parma, 43121 Parma, Italy
| | - Giorgio Amato
- Rheumatology Unit, Policlinico San Marco University Hospital of Catania, 95121 Catania, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Simone Bernardi
- Rheumatology Service, Internal Medicine Unit, GB Morgagni Hospital, 47121 Forli, Italy
| | - Gianluca Lucchini
- Internal Medicine and Rheumatology Unit, Department of Medicine, University Hospital of Parma, 43121 Parma, Italy
| | - Francesco De Lucia
- Rheumatology Unit, Policlinico San Marco University Hospital of Catania, 95121 Catania, Italy
| | | | - Daniele Santilli
- Internal Medicine and Rheumatology Unit, Department of Medicine, University Hospital of Parma, 43121 Parma, Italy
| | | | - Giulio Ferrero
- Unit of Diagnostic and Interventional Radiology, Santa Corona Hospital, 17027 Pietra Ligure, Italy
| | - Antonio Marchetta
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, 37024 Bologna, Italy
| | - Eugenio Arrigoni
- Rheumatology Unit, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy
| | - Rosario Foti
- Rheumatology Unit, Policlinico San Marco University Hospital of Catania, 95121 Catania, Italy
| | - Gilda Sandri
- Rheumatology Unit, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Vincenzo Bruzzese
- Unit of Internal Medicine and Rheumatology, “Nuovo Regina Margherita/S. Spirito” Hospital, ASL Roma 1, 00153 Rome, Italy
| | - Marino Paroli
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Department of General and Specialistic Medicine, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, 10121 Turin, Italy
| | - Alarico Ariani
- Internal Medicine and Rheumatology Unit, Department of Medicine, University Hospital of Parma, 43121 Parma, Italy
- Correspondence: ; Tel.: +39-05-2170-4798
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Di Matteo A, Moscioni E, Lommano MG, Cipolletta E, Smerilli G, Farah S, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Carotti M, Carrara G, Cazenave T, Corradini D, Cosatti MA, de Agustin JJ, Destro Castaniti GM, Di Carlo M, Di Donato E, Di Geso L, Elliott A, Fodor D, Francioso F, Gabba A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Marin J, Martire MV, Mashadi Mirza R, Massarotti M, Musca AA, Nair J, Okano T, Papalopoulos I, Rosa J, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Scioscia C, Scirè CA, Tamas MM, Tanimura S, Ventura-Rios L, Villota-Eraso C, Villota O, Voulgari PV, Vreju FA, Vukatana G, Hereter JZ, Zanetti A, Grassi W, Filippucci E. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study. Front Med (Lausanne) 2023; 9:1090468. [PMID: 36733934 PMCID: PMC9886677 DOI: 10.3389/fmed.2022.1090468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. Results The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.
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Affiliation(s)
- Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom,*Correspondence: Andrea Di Matteo,
| | - Erica Moscioni
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Maria Giovanna Lommano
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Carla Airoldi
- Hospital Provincial, Rheumatology, Rosario, Argentina
| | - Sibel Zehra Aydin
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Becciolini
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Davide Corradini
- Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, CA, Italy
| | - Micaela Ana Cosatti
- CEMIC, Centro de Educación Médica e Investigaciones Médicas “Norberto Quirno”, Buenos Aires, Argentina
| | - Juan Josè de Agustin
- Rheumatology Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Internal Medicine and Rheumatology Unit, Department of Medicine, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Daniela Fodor
- 2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Gabba
- Local Health Unit (ASL), Samugheo, OR, Italy,Local Health Unit (ASL), Orosei, NU, Italy
| | - Cristina Hernández-Díaz
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Rudolf Horvath
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czechia
| | - Diogo Jesus
- Department of Rheumatology, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Josefina Marin
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, United Kingdom
| | | | - Jagdish Nair
- Department of Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Heraklion, Greece
| | - Javier Rosa
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Crescenzio Scioscia
- Rheumatology Unit, Department of Emergency and Organ Transplants (DETO), University of Bari, Bari, Italy
| | | | - Maria-Magdalena Tamas
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Department of Rheumatology, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- División de Reumatología, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Mexico City, Mexico
| | - Catalina Villota-Eraso
- IPS Servicio Integral de Reumatología e Inmunología Doctor Orlando Villota, Pasto, Colombia
| | - Orlando Villota
- Division of Rheumatology, Fundación Hospital San Pedro, Pasto, Colombia
| | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gentiana Vukatana
- Rheumatology Unit, IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, “Carlo Urbani” Hospital, Polytechnic University of Marche, Ancona, Italy
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7
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Di Matteo A, Cipolletta E, Destro Castaniti GM, Smerilli G, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Bruns A, Carrara G, Cazenave T, Ciapetti A, Cosatti MA, de Agustín JJ, Di Carlo M, Di Donato E, Di Geso L, Duran E, Elliott A, Estrach C, Farisogulları B, Fiorenza A, Fodor D, Gabba A, Hernández-Díaz C, Huang F, Hurnakova J, Li L, Jesus D, Karadag O, Martire MV, Massarotti M, Michelena X, Musca AA, Nair J, Okano T, Papalopoulos I, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Satulu I, Scioscia C, Scirè CA, Sun F, Tamas MM, Tanimura S, Ventura-Rios L, Voulgari PV, Vreju FA, Vukatana G, Wong E, Yang J, Zacariaz Hereter J, Zanetti A, Grassi W, Filippucci E. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study. Rheumatology (Oxford) 2022; 61:4863-4874. [PMID: 35293988 DOI: 10.1093/rheumatology/keac162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. METHODS In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. RESULTS Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. CONCLUSIONS The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.
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Affiliation(s)
- Andrea Di Matteo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Edoardo Cipolletta
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Giulia Maria Destro Castaniti
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology section, University of Palermo, Palermo, Italy
| | - Gianluca Smerilli
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Carla Airoldi
- Rheumatology, Hospital Provincial, Rosario, Argentina
| | - Sibel Zehra Aydin
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Karina Bonfiglioli
- Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Alessandro Ciapetti
- Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK
| | - Micaela Ana Cosatti
- CEMIC, Centro de investigaciones médicas Norberto Quirno, Buenos Aires, Argentina
| | - Juan José de Agustín
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marco Di Carlo
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Luca Di Geso
- Department of Internal Medicine, Ospedale Madonna del Soccorso, San Benedetto del Tronto, Marche, Italy
| | - Emine Duran
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ashley Elliott
- Centre for Experimental Medicine, Queen's University, Belfast
| | - Cristina Estrach
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Bayram Farisogulları
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alessia Fiorenza
- SSD Reumatologia, Ospedale Sant'Andrea di Vercelli, Vercelli, Italy
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Gabba
- Rheumatology Clinic, ATS Sardegna, Medicina Specialistica Ambulatoriale, Oristano, Nuoro
| | - Cristina Hernández-Díaz
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Feng Huang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jana Hurnakova
- Department of Paediatric and Adult Rheumatology, University Hospital Motol, Prague, Czech Republic
| | - Ling Li
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Diogo Jesus
- Rheumatology Department, Centro Hospitalar de Leiria, Leiria.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Marco Massarotti
- Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch Hospital, Christchurch, UK
| | - Xabier Michelena
- Rheumatology Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alice Andreea Musca
- Internal Medicine and Rheumatology Department, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Jagdish Nair
- Rheumatology, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Tadashi Okano
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ioannis Papalopoulos
- Department of Rheumatology, Clinical Immunology and Allergy, University Hospital of Heraklion, Greece
| | - Marcos Rosemffet
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - João Rovisco
- Faculdade de Medicina, Coimbra University, Coimbra, Portugal
| | - Davide Rozza
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy
| | - Fausto Salaffi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Iulia Satulu
- Rheumatology Department, Internal Medicine Clinic, Kalmar County Hospital, Kalmar, Sweden
| | - Crescenzio Scioscia
- Department of Emergency and Organ Transplants (DETO), Rheumatology Unit, Bari
| | | | - Fei Sun
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Maria-Magdalena Tamas
- Department of Rheumatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Shun Tanimura
- Rheumatology Department, Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | - Lucio Ventura-Rios
- Division de Reumatologia, Instituto Nacional de Rehabilitacion "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Paraksevi V Voulgari
- Department of Rheumatology, School of Health Science, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Ernest Wong
- Rheumatology Department, Queen Alexandra Hospital, Portsmouth, UK
| | - Jinshui Yang
- Department of Rheumatology and Immunology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Walter Grassi
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
| | - Emilio Filippucci
- Department of Clinical and Molecular Sciences, Rheumatology Unit, "Carlo Urbani" Hospital, Polytechnic University of Marche, Jesi, Ancona
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8
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Faverzani S, Nocera F, Crisafulli E, Marvisi M, Becciolini A, Mosetti F, Di Donato E, Mozzani F, Santilli D, Scopelliti G, Ariani A. Home-based unsupervised pulmonary rehabilitation program improves the respiratory disability in systemic sclerosis patients with dyspnea: an observational prospective study. Monaldi Arch Chest Dis 2021; 92. [PMID: 34964573 DOI: 10.4081/monaldi.2021.1984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
Dyspnea is a common symptom in Systemic Sclerosis (SSc) that considerably decreases patients' quality of life (QoL). Pulmonary Rehabilitation (PR) mitigates dyspnea impact on daily activities. The aim of this study is to evaluate the effect on respiratory disability of home-based PR in SSc patients with dyspnea. In this observational prospective monocentric study, we screened all dyspneic SSc consecutive patients attending the Rheumatological day hospital in the University hospital of Parma from January 2019 and June 2019. The aim of our study was to understand if a PR unsupervised home-based program could improve respiratory disability in this specific population. Dyspnea was evaluated with the self-administered questionnaires modified Medical Research Council (mMRC) and Saint George's Respiratory Questionnaire (SGRQ).Patients also filled in Short Form 36 (SF36) and the Modified-Health Assessment Questionnaire for SSc (HAQ-MOD). Health Professionals assessed and trained the patients and collected data before PR and at the end of the program. PR consisted in 5 weekly unsupervised sessions for 8 weeks. Wilcoxon test for paired data evaluated the changes after PR. p<0.05 was considered statistically significant. 46 SSc patients were included (43 female). Only 31 (29 female) performed PR as planned (Adherent Group-AG) while the others gave up within the first week (Non-Adherent Group-NAG). All SGRQ domains (Symptoms: from 30 to 18; p=0.0055; Activity: from 47 to 35, p=0.23; Impact from 29 to 25, p=0.044) and SGRQ total score (from 35 to 29; p=0.022) improved in AG. SGRQ scores did not change in NAG as well as SF36 and HAQ-MOD in both groups. The home-based PR program dramatically decreased the effect, frequency and severity of respiratory symptoms. Conversely, it slightly changed the activities causing breathlessness and dyspnea-related social functioning disturbances. PR appears to be a useful tool in treatment strategies aiming to achieve a QoL improvement in SSc patients.
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Affiliation(s)
| | - Filippo Nocera
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma.
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona.
| | - Maurizio Marvisi
- Internal Medicine Unit, Figlie di San Camillo Hospital, Cremona.
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma.
| | | | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma.
| | - Flavio Mozzani
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma.
| | - Daniele Santilli
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma.
| | | | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma.
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9
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Cipolletta E, Filippucci E, Incorvaia A, Schettino M, Smerilli G, Di Battista J, Tesei G, Cosatti MA, Di Donato E, Tardella M, Di Matteo A, Di Carlo M, Grassi W. Ultrasound-Guided Procedures in Rheumatology Daily Practice: Feasibility, Accuracy, and Safety Issues. J Clin Rheumatol 2021; 27:226-231. [PMID: 32000229 DOI: 10.1097/rhu.0000000000001298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The aims of this study were to describe in detail the ultrasound (US)-guided procedures in our daily rheumatology practice, to evaluate the feasibility and accuracy of US-guided procedures, and to test the efficacy of our disinfection protocol in preventing infectious complications. METHODS This was a cross-sectional and monocentric study. Information regarding patients' age, sex, body mass index, rheumatic disease, US pathological findings, aspirated and/or injected anatomical site, US equipment (ie, probe type and frequency), and needle type was consecutively collected for each US-guided procedure in a third-level rheumatology center. RESULTS A total of 643 US-guided procedures were performed, with a mean of 5.2 procedures per working-day. In 94.2% of the patients, only one procedure was carried out, whereas in 5.8%, more than one. The mean time was 7 ± 2.5 minutes. Ultrasound-guided procedures were highly accurate (accuracy rate higher than 95%) and safe (adverse events were reported in 0.8%). Our disinfection protocol was effective in preventing infectious complications. Probes with frequency values between 8 to 13 MHz and 20-, 21-, and 22-gauge needles were the most frequently used at shoulder, knee, wrist, elbow, and ankle level. High-frequency linear probes (ranging between 18 and 22 MHz) and 23- and 25-gauge needles were used for injecting small joints of the hands and feet. Convex low-frequency probe (2-7 MHz) and 18- and 20-gauge needles were the most used for performing hip joint aspirations and/or injections. CONCLUSIONS This study reports useful information for setting up a service providing US-guided procedures in rheumatology and supports the feasibility, accuracy, and safety of US-guided procedures.
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Affiliation(s)
- Edoardo Cipolletta
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Emilio Filippucci
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Antonella Incorvaia
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Martina Schettino
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Gianluca Smerilli
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Jacopo Di Battista
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Giulia Tesei
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Micaela Ana Cosatti
- Rheumatology and Immunology Unit, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina
| | - Eleonora Di Donato
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Marika Tardella
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | | | - Marco Di Carlo
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
| | - Walter Grassi
- From the Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital Jesi, Ancona
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10
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Mozzani F, Marino NG, Becciolini A, Di Donato E, Ariani A, Santilli D. A Parsonage-Turner Syndrome secondary to Parvovirus B19 infection. Acta Biomed 2021; 92:e2021129. [PMID: 33944819 PMCID: PMC8142777 DOI: 10.23750/abm.v92is1.10702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022]
Abstract
Parvovirus B19 (PVB19) is a small DNA virus that causes the fifth disease in children; however it can also affect adults. The infection can be asymptomatic in about a quarter of healthy subjects. Typical clinical manifestations are: short lived fever accompanied by asthenia, myalgias and pharyngodynia; symmetrical acute polyarthritis; megalo-erytema in child; maculopulotic rash and/or fleeting purpuric at the extremities in adult; adenopathies in the cervical area. Atypical manifestions can affect neurological system (both central and peripheral), hearth and kidney. We describe a 37-year-old man with neuralgic amyotrophy (Parsonage-Turner syndrome) caused by Parvovirus B19 infection.
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11
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Ariani A, Santilli D, Mozzani F, Lumetti F, Lucchini G, Di Donato E, Giordano S, Riva M, Becciolini A. Cycling or swap biologics and small molecules in psoriatic arthritis: Observations from a real-life single center cohort. Medicine (Baltimore) 2021; 100:e25300. [PMID: 33879661 PMCID: PMC8078287 DOI: 10.1097/md.0000000000025300] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/13/2020] [Accepted: 03/07/2021] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT During the last years there has been an increasing availability of drugs (biologics and small molecules) with different mechanisms of action (MoA) in psoriatic arthritis (PsA). New issues about treatment strategies have arisen. The main aim of this study is to verify if there is a difference in terms of clinical efficacy (i.e. retention rate) between cycling (i.e. treating patients with the same MoA after the failure of the previous one) or swap (i.e choosing drugs with a MoA different from the failed previous one) strategies in PsA.In this mono-centric medical records review study, PsA patients treated with biologics, apremilast or tofacitinib were enrolled. Every prescription was clustered in three groups: cycling (CG), swap (SG) or first line group (1LG). Kaplan-Meier analysis and Cox test estimated and compared drugs' retention rate in CG, SG and 1LG. P < .05 was considered statistically significant.One hundred eighty-three PsA patients were enrolled (9967 patient-months). In CG and 1LG the more prescribed drugs were tumor necrosis factor inhibitor (respectively 99% and 89%), in SG interleukin 17 inhibitor (60%). There were no differences in terms of sex, age, disease duration, and retention rate between CG and SG. The 18-months retention rate of 1LG, SG and CG was 77%, 60%, and 51% respectively. The CG retention rate was lower than in 1LG (P = .03).The findings of this study suggest that in PsA the swap strategy gives no remarkable advantage compared to cycling. However, patients undergoing swap strategy may experience the same failure rate observed in naives.
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Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Daniele Santilli
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Flavio Mozzani
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Federica Lumetti
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
- Rheumatology Unit - Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio Emilia, Italy
| | - Gianluca Lucchini
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Salvatore Giordano
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Michele Riva
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria di Parma
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12
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Becciolini A, Lumetti F, Di Donato E, Giordano S, Santilli D, Mozzani F, Riva M, Lucchini G, Ariani A. bDMARDs retention rate in the biosimilar era: A real-life monocentric study. Eur J Rheumatol 2021; 8:109-110. [PMID: 32910769 PMCID: PMC8133886 DOI: 10.5152/eurjrheum.2020.20080] [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: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Andrea Becciolini
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Federica Lumetti
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Unit of Rheumatology, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Eleonora Di Donato
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Salvatore Giordano
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Daniele Santilli
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Flavio Mozzani
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Michele Riva
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Gianluca Lucchini
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alarico Ariani
- Department of Medicine, Unit of Internal Medicine and Rheumatology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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13
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Faverzani S, Becciolini A, Di Donato E, Santilli D, Mozzani F, Monica L, Barone L, Barbieri A, Riva M, Ariani A. Comment on: Lower urinary tract symptoms in systemic sclerosis: a detailed investigation. Rheumatology (Oxford) 2020; 59:1455-1456. [PMID: 31958136 DOI: 10.1093/rheumatology/kez678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Silvia Faverzani
- Department of Geriatric and Rehabilitation, Rehabilitation Unit-Respiratory Rehabilitation, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Becciolini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Eleonora Di Donato
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Daniele Santilli
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Flavio Mozzani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Lorenza Monica
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Lissette Barone
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Annalisa Barbieri
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Michele Riva
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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14
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Hurnakova J, Filippucci E, Cipolletta E, Di Matteo A, Salaffi F, Carotti M, Draghessi A, Di Donato E, Di Carlo M, Lato V, Horvath R, Komarc M, Pavelka K, Grassi W. Prevalence and distribution of cartilage damage at the metacarpal head level in rheumatoid arthritis and osteoarthritis: an ultrasound study. Rheumatology (Oxford) 2020; 58:1206-1213. [PMID: 30690561 DOI: 10.1093/rheumatology/key443] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/03/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the prevalence and distribution of US-detected qualitative cartilage damage at metacarpal heads of patients with RA and hand OA. METHODS Fifty-two RA patients and 34 patients with hand OA were enrolled. US examination of the metacarpal head cartilage from the II to V finger of both hands was performed. A total of 414 MCP joints in RA and 266 MCP joints in OA patients were scanned with a linear probe up to 22 MHz. Qualitative assessments using a previously described scoring system for cartilage damage were performed. The prevalence and distribution of cartilage damage were analysed. Multivariate regression analysis was used to determine the predictive value of age, gender, BMI, disease duration and the presence of RF and anti-CCP antibodies for US-detected cartilage damage. RESULTS The metacarpal head cartilage was positive for cartilage damage in 35.7% (148/414) of MCP joints in RA and in 43.6% (116/266) of MCP joints in OA patients. In RA, the hyaline cartilage of the II and III metacarpal heads (bilaterally) was the most frequently affected. In OA, cartilage damage was more homogeneously distributed in all MCP joints. Multivariate regression analysis showed that age and disease duration, but not gender, BMI or autoantibody status, were independent predictors of US-detected cartilage damage in RA. CONCLUSION Cartilage damage was found in more than one-third of the MCP joints in both RA and OA patients, and in RA patients, the II and III MCP joints were the most damaged.
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Affiliation(s)
- Jana Hurnakova
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy.,Department of Rheumatology, Institute of Rheumatology, First Faculty of Medicine, Charles University.,Department of Pediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Emilio Filippucci
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Andrea Di Matteo
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Fausto Salaffi
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Marina Carotti
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy
| | - Antonella Draghessi
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Eleonora Di Donato
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Valentina Lato
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
| | - Rudolf Horvath
- Department of Pediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Department of Rheumatology, Institute of Rheumatology, First Faculty of Medicine, Charles University
| | - Walter Grassi
- Rheumatology Department, Università Politecnica delle Marche, C. Urbani Hospital, Jesi, Ancona, Italy
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Salaffi F, Di Carlo M, Luchetti MM, Di Donato E, Campanati A, Benfaremo D, Nicolini M, Carotti M, Giacchetti A, Ganzetti G, Bugatti L, Gabrielli A, Offidani AM. A validation study of the Simple Psoriatic Arthritis Screening (SiPAS) questionnaire to screen psoriasis patients for psoriatic arthritis. Clin Exp Rheumatol 2018; 36:127-135. [PMID: 29148421] [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: 05/05/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To validate in a multicentric cohort of patients a self-administered PsA screening tool, called Simple Psoriatic Arthritis Screening (SiPAS) questionnaire, to screen psoriasis patients for signs and symptoms of PsA. METHODS The SiPAS questionnaire was validated in a multicentric Italian cohort of psoriasis patients referred to two rheumatological centres. RESULTS A total of 202 psoriasis patients were screened with SiPAS in the validation study. Sixty-two psoriasis patients (30.7%) were diagnosed with PsA. The five screening questions (1. Have you ever had a finger or a toe and/or another joint swollen and painful without any apparent reason?; 2. Occasionally, has an entire finger or toe become swollen, making it look like a 'sausage'?; 3. Do you wake up at night because of low back pain?; 4. Have you had pain in your heels?; 5. Has a doctor ever diagnosed you with psoriatic arthritis?) with a dichotomous response, demonstrated high sensitivity and specificity for predicting PsA. Likelihood ratios for individual parameters varied between 2.06 and 4.75. Using the Bayesian Analysis, the presence of three of five items answered as "yes" showed respectively a sensibility and a specificity of 79% and 87%, with a positive likelihood ratio of 6.14. CONCLUSIONS The SiPAS questionnaire is able to quickly screen psoriasis patients for PsA. A SiPAS score ≥3 is an indication for referral to a rheumatologist. The SiPAS needs further validation.
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Affiliation(s)
- Fausto Salaffi
- Rheumatological Clinic, Università Politecnica delle Marche, Ancona, Italy.
| | - Marco Di Carlo
- Rheumatological Clinic, Università Politecnica delle Marche, Ancona, Italy
| | | | - Eleonora Di Donato
- Rheumatological Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Anna Campanati
- Dermatological Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Devis Benfaremo
- Medical Clinic, Università Politecnica delle Marche, Ancona, Italy
| | | | - Marina Carotti
- Radiology Department, Università Politecnica delle Marche, Ancona, Italy
| | - Alfredo Giacchetti
- Dermatology Unit, 'Istitituto Nazionale di Riposo e Cura per Anziani - INRCA' Hospital, Ancona, Italy
| | - Giulia Ganzetti
- Dermatological Clinic, Università Politecnica delle Marche, Ancona, Italy
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Di Matteo A, Filippucci E, Salaffi F, Carotti M, Carboni D, Di Donato E, Grassi W. Diagnostic accuracy of musculoskeletal ultrasound and conventional radiography in the assessment of the wrist triangular fibrocartilage complex in patients with definite diagnosis of calcium pyrophosphate dihydrate deposition disease. Clin Exp Rheumatol 2017; 35:647-652. [PMID: 28339356] [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: 10/10/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the diagnostic accuracy of musculoskeletal ultrasound (MSUS) and x-ray in evaluating wrist triangular fibrocartilage complex (TFCC) in patients with calcium pyrophosphate dihydrate deposition disease (CPPD) and to investigate the agreement between the extent of the calcium pyrophosphate dihydrate (CPP) crystal deposits assessed by MSUS and the radiographic findings. METHODS We enrolled 84 patients: 36 patients with "definite" CPPD and 48 controls. The Ryan and McCarty diagnostic criteria were used. A rheumatologist performed bilateral MSUS examinations of the TFCC in all patients, assessing both the presence and absence of CCP crystals deposits and their extent (0-3; 0: absent; 1: 1-2 spots; 2: more than two spots covering <50% of the volume of the structure; 3: deposits covering >50% of the volume of the structure). A radiologist evaluated the presence/absence of x-ray calcifications at TFCC level in both groups. RESULTS MSUS and x-ray sensitivity was 77.8% and 76.4%, respectively, whereas MSUS and x-ray specificity was 90.6% and 96.9%, respectively. Total agreement between MSUS and radiographic findings indicative of calcifications at TFCC level was 88.7%. CONCLUSIONS This study supports the diagnostic accuracy of MSUS and x-ray in evaluating TFCC crystal deposits in patients with CPPD. Sensitivity and specificity of MSUS and x-ray resulted comparable. The highest MSUS score of the extent of the deposits correlated better with x-ray findings.
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Affiliation(s)
- Andrea Di Matteo
- Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy.
| | - Emilio Filippucci
- Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Fausto Salaffi
- Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Marina Carotti
- Clinica di Radiologia, "Ospedali Riuniti", Università Politecnica delle Marche, Ancona, Italy
| | - Davide Carboni
- Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Eleonora Di Donato
- Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Walter Grassi
- Clinica Reumatologica, "C. Urbani" Hospital, Università Politecnica delle Marche, Jesi, Ancona, Italy
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Salaffi F, Carotti M, Di Donato E, Di Carlo M, Ceccarelli L, Giuseppetti G. Computer-Aided Tomographic Analysis of Interstitial Lung Disease (ILD) in Patients with Systemic Sclerosis (SSc). Correlation with Pulmonary Physiologic Tests and Patient-Centred Measures of Perceived Dyspnea and Functional Disability. PLoS One 2016; 11:e0149240. [PMID: 26930658 PMCID: PMC4773230 DOI: 10.1371/journal.pone.0149240] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 01/17/2023] Open
Abstract
Objectives This study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),—related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement. Methods 126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson’s correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis. Results Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods. Conclusions Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy.
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Affiliation(s)
- Fausto Salaffi
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
- * E-mail:
| | - Marina Carotti
- Department of Radiology, Polythecnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
| | - Luca Ceccarelli
- Department of Radiology, Polythecnic University of Marche, Ancona, Italy
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