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Benucci M, Bardelli M, Cazzato M, Laurino E, Bartoli F, Damiani A, Li Gobbi F, Panaccione A, Di Cato L, Niccoli L, Frediani B, Mosca M, Guiducci S, Cantini F. ReLiFiRa (Real Life Filgotinib in Rheumatoid Arthritis): Retrospective Study of Efficacy and Safety in Common Clinical Practice. J Pers Med 2023; 13:1303. [PMID: 37763071 PMCID: PMC10532886 DOI: 10.3390/jpm13091303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Filgotinib (FIL) is a selective JAK1 inhibitor with an affinity 30-fold higher than JAK2, approved to treat moderate to severe active rheumatoid arthritis (RA), in adults with inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs). METHODS We conducted a retrospective, multicentric study in order to evaluate efficacy and safety of FIL 200 mg daily therapy, after 3 and 6 months, in 120 patients affected by RA, managed in Tuscany and Umbria rheumatological centers. The following clinical records were analyzed: demographical data, smoking status, previous presence of comorbidities (Herpes zoster -HZ- infection, venous thromboembolism -VTE-, major adverse cardiovascular events -MACE-, cancer, diabetes, and hypertension), disease duration, presence of anti-citrullinated protein antibodies (ACPA), rheumatoid factor (RF), number of biological failures, and prior csDMARDs utilized. At baseline, and after 3 (T3) and 6 (T6) months of FIL therapy, we evaluated mean steroid dosage, csDMARDs intake, clinimetric indexes (DAS28, CDAI, HAQ, patient and doctor PGA, VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and body mass index (BMI). RESULTS At baseline, the mean disease duration was 9.4 ± 7.5 years; the prevalence of previous HZ infection, VTE, MACE, and cancer was respectively 4.12%, 0%, 7.21%, and 0.83%, respectively. In total, 76.3% of patients failed one or more biologics (one biological failure, 20.6%; two biological failures, 27.8%; three biological failures, 16.5%; four biological failures, 10.3%; five biological failures, 1.1%). After 3 months of FIL therapy, all clinimetric index results significantly improved from baseline, as well as after 6 months. Also, ESR and CRP significatively decreased at T3 and T6. Two cases of HZ were recorded, while no new MACE, VTE, or cancer were recorded during the observation time. CONCLUSION Despite the limitations of the retrospective study and of the observational period of only 6 months, real-life data on the treatment of RA patients with FIL demonstrate that this Jak inhibitor therapy is safe in terms of CV, VTE events, and occurrence of cancer, and is also effective in a population identified as "difficult to treat" due to failure of previous b-DMARD therapy.
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Affiliation(s)
- Maurizio Benucci
- Rheumatology Unit, San Giovanni di Dio Hospital, 50143 Florence, Italy;
| | - Marco Bardelli
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (M.B.); (B.F.)
| | - Massimiliano Cazzato
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy; (M.C.); (E.L.); (M.M.)
| | - Elenia Laurino
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy; (M.C.); (E.L.); (M.M.)
| | - Francesca Bartoli
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (F.B.); (A.D.); (S.G.)
| | - Arianna Damiani
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (F.B.); (A.D.); (S.G.)
| | | | - Anna Panaccione
- Internal Medicine and Rheumatology Unit, Santa Maria General Hospital, 05100 Terni, Italy; (A.P.); (L.D.C.)
| | - Luca Di Cato
- Internal Medicine and Rheumatology Unit, Santa Maria General Hospital, 05100 Terni, Italy; (A.P.); (L.D.C.)
| | - Laura Niccoli
- Division of Rheumatology, Prato Hospital, 59100 Prato, Italy; (L.N.); (F.C.)
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (M.B.); (B.F.)
| | - Marta Mosca
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy; (M.C.); (E.L.); (M.M.)
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, University of Florence, 50134 Florence, Italy; (F.B.); (A.D.); (S.G.)
| | - Fabrizio Cantini
- Division of Rheumatology, Prato Hospital, 59100 Prato, Italy; (L.N.); (F.C.)
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Damiani A, Bartoli F, Pacini G, Carboni D, Bellando Randone S, Fiori G, Matucci-Cerinic M, Guiducci S. Persistence of remission after lengthening of golimumab in inflammatory joint diseases. Clin Exp Rheumatol 2023; 41:1088-1095. [PMID: 36622116 DOI: 10.55563/clinexprheumatol/k76z51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/02/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES In refractory inflammatory joint diseases (IJDs) biological disease-modifying anti-rheumatic drugs (bDMARDs) may achieve remission. EULAR recommends bDMARD tapering when remission persists. However, guidelines on tapering modalities and criteria for patient selection are lacking. We aimed to evaluate remission persistency after lengthening the time between injections of golimumab in patients affected by IJD and to identify any patient or disease characteristics associated to flare after lengthening. METHODS Patients affected by rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and juvenile idiopathic arthritis (JIA) treated with golimumab were enrolled in a retrospective observational study. Demographic data, ESR, cRP, DAS28/ BASDAI, were collected at baseline and during the follow-up (T1- defined as a medical check-up after 1 year of treatment or, for patients with longerg exposure, the first medical check-up in 2016, when at our unit we began to experience drug tapering- and T2- 12 months after the lengthening was started). In 22/80 patients in remission at T1, injection time was lengthened. RESULTS Eighty patients were enrolled, 34 AS, 33 PsA, 9RA and 4 JIA. At baseline, all had an active disease. At T1, 60/80 patients reached remission and 22/60 patients started tapering. At T2, 20/22 pts (91%) were in remission. At T1 BASDAI was higher (2.2, SD 0.28 vs. 0.58, SD 0.47; p<0.001) in patients who lost remission at T2.Patients who flared recovered remission once taken back to a 28-day interval. 4/38 patients maintained at the standard dose flared up and switched/swapped bDMARD. The difference in retention rate toward patients on reduced dose was not significant. CONCLUSIONS Results show that golimumab lengthening is safe and successfully maintains remission. In patients who experienced a flare after lengthening, the standard regimen promptly restored remission.
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Affiliation(s)
- Arianna Damiani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy.
| | - Francesca Bartoli
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Giovanni Pacini
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Davide Carboni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Silvia Bellando Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Ginevra Fiori
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Italy
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Appleton JV, Bekaert S, Hucker J, Zlatkute G, Paavilainen E, Schecke H, Specka M, Scherbaum N, Jouet E, Zabłocka-Żytka L, Woźniak-Prus M, Czabała JC, Kluczyńska S, Bachi B, Bartoli F, Carrà G, Cioni RM, Crocamo C, Rantanen HE, Kaunonen M, Nieminen I, Roe L, Keenan K, Viganò G, Baldacchino A. A Pan-European Review of Good Practices in Early Intervention Safeguarding Practice with Children, Young People and Families: Evidence Gathering to Inform a Multi-disciplinary Training Programme (the ERICA Project) in Preventing Child Abuse and Neglect in Seven European Countries. Int J Child Maltreat 2022; 6:119-130. [PMID: 36405490 PMCID: PMC9665033 DOI: 10.1007/s42448-022-00132-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Child maltreatment has detrimental social and health effects for individuals, families and communities. The ERICA project is a pan-European training programme that equips non-specialist threshold practitioners with knowledge and skills to prevent and detect child maltreatment. This paper describes and presents the findings of a rapid review of good practice examples across seven participating countries including local services, programmes and risk assessment tools used in the detection and prevention of child maltreatment in the family. Learning was applied to the development of the generic training project. A template for mapping the good practice examples was collaboratively developed by the seven participating partner countries. A descriptive data analysis was undertaken organised by an a priori analysis framework. Examples were organised into three areas: programmes tackling child abuse and neglect, local practices in assessment and referral, risk assessment tools. Key findings were identified using a thematic approach. Seventy-two good practice examples were identified and categorised according to area, subcategory and number. A typology was developed as follows: legislative frameworks, child health promotion programmes, national guidance on child maltreatment, local practice guidance, risk assessment tools, local support services, early intervention programmes, telephone or internet-based support services, COVID-19 related good practices. Improved integration of guidance into practice and professional training in child development were highlighted as overarching needs. The impact of COVID-19 on safeguarding issues was apparent. The ERICA training programme formally responded to the learning identified in this international good practice review.
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Affiliation(s)
- J. V. Appleton
- Oxford, UK
- Formerly Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - S. Bekaert
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - J. Hucker
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - G. Zlatkute
- School of Medicine, University of St Andrews, St Andrews, UK
| | - E. Paavilainen
- Faculty of Social Sciences/Health Sciences Unit, Etelä-Pohjanmaa Hospital District, Tampere University, Tampere, Finland
| | - H. Schecke
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - M. Specka
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - N. Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - E. Jouet
- Laboratoire de Recherche en Santé Mentale, Et Sciences Humaines Et Sociales, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences (GHU- PARIS), Paris, France
| | - L. Zabłocka-Żytka
- Department of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - M. Woźniak-Prus
- Department of Psychology, University of Warsaw, Warsaw, Poland
| | - J. Cz. Czabała
- Department of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - S. Kluczyńska
- Department of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - B. Bachi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - F. Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G. Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - R. M. Cioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - C. Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - H. E. Rantanen
- Faculty of Social Sciences/Health Sciences Unit, Etelä-Pohjanmaa Hospital District, Tampere University, Tampere, Finland
| | - M. Kaunonen
- Faculty of Social Sciences/Health Sciences Unit, Etelä-Pohjanmaa Hospital District, Tampere University, Tampere, Finland
- Faculty of Social Sciences/Health Sciences Unit, Pirkanmaa Hospital District, Tampere University, Tampere, Finland
| | - I. Nieminen
- Faculty of Social Sciences/Health Sciences Unit, Etelä-Pohjanmaa Hospital District, Tampere University, Tampere, Finland
| | - L. Roe
- School of Medicine, University of St Andrews, St Andrews, UK
| | - K. Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - G. Viganò
- Synergia S.R.L. and Department of Decision Sciences, Università L. Bocconi, Milan, Italy
| | - A. Baldacchino
- School of Medicine, University of St Andrews, St Andrews, UK
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Melis MR, El Aoufy K, Bruni C, Bartoli F, Fiori G, Guiducci S, Bellando Randone S, Bambi S, Rasero L, Matucci-Cerinic M. AB1540-HPR NURSING INTERVENTIONS FOR RHEUMATIC MUSCULOSKELETAL DISEASES (RMDS) PATIENTS ON BIOLOGIC THERAPY: A SYSTEMATIC LITERATURE REVIEW (SLR). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe support of the Rheumatology nurse to the management of patients who are affected by RMDs, characterized by remission and recrudescence and chronicity, may be strengthened by the investigation of their unmet needs and the identification of the necessary interventions to the continuity and quality of care.ObjectivesThe aim of the present SLR is to identify the main nursing interventions to assure quality care in RMDs patients on biologic therapy.MethodsStudy design: a systematic search was conducted from 1990 to 2020 (01/01/1990- 2020/05/07). Inclusion criteria consisted of 1) patients with RMDs in accordance with American College of Rheumatology classification criteria and the American College of Rheumatology/European League against Rheumatism (ACR/EULAR); 2) in therapy with bDMARDS; 3) adult population > 18 years; 4) primary research only; 6) English language; 7) abstract available; and 8) relative quantitative studies; 9) nursing interventions and/or outcomes. Data sources: Medline, CINAHL, PsycINFO and EMBASE databases were used to search for relevant studies. Review methods: using the predetermined inclusion/exclusion criteria, two independent reviewers (MRM, KEA) screened records selected for eligibility based on titles and abstracts. Records meeting the inclusion criteria were retrieved and full texts were further assessed. Critical Appraisal Skills Program (CASP) tools were used to evaluate the quality of the included studies. Data from 8 studies were extracted independently by the reviewers.Results1805 articles were retrieved: after the review process, 8 articles met the inclusion criteria resulting in 1 randomized trial, 1 quasi-experimental study and 6 observational studies. The RMDs patient needs emerged concerning the psychosocial domain, the relationship with healthcare facilities and disease follow up to monitor symptoms. Moreover, three major nursing interventions related to these areas were identified: education, patient-centered care and data assessment.ConclusionRheumatology nurses are part of a multidisciplinary team caring for patients on biologic therapy. Starting with accurate initial and ongoing data collection, rheumatology nurses can plan their interventions focusing primarily on patient education and tailored care based on actual needs. Further studies are necessary for research on aspects of patient-centered nursing care, including tele-nursing and Nursing Sensitive Outcomes in RMDs.References[1]EULAR, van Eijk-Hustings Y, van Tubergen A, Boström C, Braychenko E, Buss B, Felix J, Firth J, Hammond A, Harston B, Hernandez C, Huzjak M, Korandová J, Kukkurainen ML, Landewé R, Mezieres M, Milincovic M, Moretti A, Oliver S, Primdahl J, Scholte- Voshaar M, de la Torre-Aboki J, Waite-Jones J, Westhovens R, Zangi HA, Heiberg T, Hill J; “Recommendations for the role of the nurse in the management of chronic inflammatory arthritis”, Ann Rheum Dis. 2012 Jan;71(1):13-9. doi: 10.1136/annrheumdis-2011-200185. Epub 2011 Oct 28.[2]Larsson I. et al,“Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy”Journal of Advanced Nursing 70(1), 164–175., 2013[3]Betegnie,A.L. et al, “Why Do Patients with Chronic Inflammatory Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients’ Adherence Using a Self-report Questionnaire” The Journal of Rheumatology, 2016;43;724-730[4]Giacomelli R. et al, “Quality of life and unmet needs in patients with inflammatory arthropathies: results from the multicentre, observational RAPSODIA study.” Rheumatology (Oxford) 54(5): 792-797, 2015[5]Ozkaraman A. et al, “Effect of education and telephone counselling on adherence to treatment and challenges experienced in anti TNF-alfa treatment: a pilot study” Contemporary Nurse, ISSN: 1037-6178 (Print) 1839-3535 (Online), 2019Disclosure of InterestsNone declared
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Bruni C, Cigolini C, Tesei G, Cometi L, Bartoli F, Fiori G, Nacci F, Bellando-Randone S, Guiducci S, Matucci-Cerinic M. Combination of denosumab and biologic DMARDs in inflammatory muscle-skeletal diseases and connective tissue diseases. Eur J Rheumatol 2022; 8:190-195. [PMID: 35110179 PMCID: PMC10176229 DOI: 10.5152/eurjrheum.2020.21162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Osteoporosis (OP) can complicate the course of rheumatic musculoskeletal diseases (RMDs) and connective tissue diseases (CTDs). Denosumab, a monoclonal antibody against RANK-L, showed beneficial effect in rheumatoid arthritis in inhibiting radiographic progression and erosive burden. We tested the efficacy, safety, and persistence on the treatment of the combination of biologic disease-modifying antirheumatic drugs (bDMARDs)/denosumab versus bDMARD in patients with RMD and CTD. METHODS This is a retrospective evaluation of a single center, including patients with RMD/CTD (including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, and overlap syndromes) treatment with bDMARD/denosumab, compared to age, gender, disease, bDMARD, and conventional synthetic disease-modifying antirheumatic drugs-matched controls. RESULTS Twenty-eight bDMARD/denosumab patients and 49 bDMARD patients were eligible. Despite a statistically significant difference during the first-year efficacy (due to the different baseline timepoint), there was no difference in the efficacy profile in the second year of treatment and in the safety profile (including local, systemic, and serious adverse events). Moreover, no statistically significant difference in the persistence of bDMARD treatment over 2 years of evaluation was found. The combination of bDMARD and denosumab was not an independent predictor of disease flare or bDMARD treatment withdrawal. CONCLUSION The combination of bDMARD and denosumab does not alter the efficacy and the safety profile of the bDMARD in patients with RMD/CTD. Future studies verifying the radiological disease inhibition could support denosumab use in RMD/CTD other than rheumatoid arthritis, when complicated by OP.
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Affiliation(s)
- Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Cosimo Cigolini
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Giulia Tesei
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Laura Cometi
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Francesca Bartoli
- Division of Rheumatology, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Division of Rheumatology, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Francesca Nacci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy;Division of Rheumatology, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy;Division of Rheumatology, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy;Division of Rheumatology, Department of Geriatric Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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Crotti C, Bartoli F, Coletto LA, Manara M, Marini E, Daolio PA, Parafioriti A, Armiraglio E, Zucchi F, Sinigaglia L, Caporali R, Varenna M. Tumor induced osteomalacia: A single center experience on 17 patients. Bone 2021; 152:116077. [PMID: 34175499 DOI: 10.1016/j.bone.2021.116077] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/21/2021] [Accepted: 06/16/2021] [Indexed: 01/02/2023]
Abstract
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome due to a phosphaturic tumor, which overproduces Fibroblast Growth Factor 23 (FGF-23), causing hyperphosphaturia, hypophosphatemia, low 1,25(OH)2D and osteomalacia. Tumor localization is critical, diagnostic delay ranges from 2.5 to 28 years and to date surgical removal is considered effective treatment. We retrospectively evaluated patients with definite diagnosis of TIO referred to a tertiary Rheumatology Center between September 2000 and May 2020, investigating clinical management and disease outcome. We included 17 patients: 10 (58.8%) were females, mean age at diagnosis was 55.3 ± 13.9 years (mean ± standard deviation), with a diagnostic delay from symptoms onset to tumor detection of 6.6 ± 6.25 years. Biochemical data were: serum phosphorus 1.3 ± 0.4 mg/dL (Reference Range: 2.5-4.6), serum 1,25(OH)2D 31.8 ± 22.9 ng/mL (RR: 25-86), intact FGF-23, 358.9 ± 677 pg/mL (RR: 25-45); 24 h-Urine Phosphorus was increased in only 2 patients, while tubular reabsorption of phosphate (TRP) was decreased in all patients confirming a renal phosphate wasting. In 2013 68Ga- DOTA-based PET/CT was introduced in routinely practice and diagnostic delay was consistently reduced (from 8.6 ± 7.9 to 4.3 ± 2.4 years). Thirteen patients underwent surgery, one patient underwent radiofrequency ablation; 3 patients, not eligible for surgery, were treated only with supplements of phosphorus and calcitriol. One was started on Burosumab after several unsuccessful surgical attempts. After surgery or ablation, 8 patients had complete remission, 3 TIO persistence, and 3 had overtime relapse. Relapses were observed only in patients who previously underwent closed biopsy. To our knowledge, this is the widest European cohort of TIO patients in the last two decades. We confirm a usual diagnostic delay and recommend a stepwise diagnostic approach. Tumor biopsy is not recommended due to the potential cell spilling. Surgery is generally considered a definitive treatment, even though other approaches have been successful in curing TIO. Active surveillance on possible recurrence is always needed. Burosumab appears a promising therapy.
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Affiliation(s)
- C Crotti
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - F Bartoli
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - L A Coletto
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - M Manara
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - E Marini
- Oncologic Orthopedic Surgery, Gaetano Pini Institute, Milan, Italy
| | - P A Daolio
- Oncologic Orthopedic Surgery, Gaetano Pini Institute, Milan, Italy
| | | | - E Armiraglio
- UOC Pathology, Gaetano Pini Institute, Milan, Italy
| | - F Zucchi
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - L Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | - R Caporali
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - M Varenna
- Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.
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Agostini E, De Luca G, Bruni C, Bartoli F, Tofani L, Campochiaro C, Pacini G, Moggi-Pignone A, Guiducci S, Bellando-Randone S, Shoenfeld Y, Dagna L, Matucci-Cerinic M. Intravenous immunoglobulins reduce skin thickness in systemic sclerosis: evidence from Systematic Literature Review and from real life experience. Autoimmun Rev 2021; 20:102981. [PMID: 34718166 DOI: 10.1016/j.autrev.2021.102981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intravenous immunoglobulins (IVIG) are a new therapeutic approach in systemic sclerosis SSc. An immunomodulatory and antifibrotic activity has been postulated. IVIG are generally well tolerated and have only rare side effects. Our retrospective study focused its attention on SSc, an autoimmune connective tissue disease, characterized by several complications which has a significant impact on patient's quality of life. The pathophysiology comprises fibrotic, vascular and immunological aspects. AIM The aim of this study was to verify the effectiveness of IVIG on SSc skin involvement. Moreover, a systematic review of the literature (SLR) of the results obtained to date on the use of Intravenous immunoglobulin (IVIG) in SSc has been also performed. PATIENTS AND METHODS The data of 24 patients (21 women, 3 male) with refractory diffuse SSc skin involvement were evaluated (mean age was 52.13 years). IVIG infusion at a dosage of 2 g/Kg body weight for 4 consecutive days/month, was started between 2002 and 2019. Skin involvement was evaluated with the modified Rodnan Skin Score (mRSS) before therapy and then again after 6 and 12 months. To perform the SLR, the PubMed, Medline, Embase, and Web of Science database were searched from 1990 to 2020 (keywords: IVIG, systemic sclerosis). Three assessors (E.A., C.B. & M.M.C) identified the criteria to scan all papers. RESULTS From the total SLR (106 results), 17 papers were identified after the separation of the clinical cases from the studies (total number of treated patients 183). The studies were classified according to the organ involvement considered in each study, as well as the prescribed dose (high or low doses), and the therapeutic regimens. In the selected papers, the organs mainly involved were the skin, the gastrointestinal, the joint and the cardiovascular systems. Only in one case, plasmapheresis was associated to IVIG. All papers reported significant reduction of the skin involvement, although generally the strength of the works was limited the lack of control cases or by the low number of patients involved. From the real life experience, a statistically significant reduction of mRSS was obtained at 6 months follow-up (average value of -6.61 ± 5.2, p < 0.001), and it was further maintained with a significant stabilization after 12-months (-11.45 ± 9.63, p < 0.002). DISCUSSION This SLR and the data of the retrospective study suggest that IVIG may improve skin involvement reducing mRSS in particular in those patients that were refractory to other standard of care therapies and represents a therapeutic option in patients with concomitant myositis. The literature review revealed encouraging perspectives on the use of this therapy, given the effectiveness found in the selected works.
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Affiliation(s)
- Elana Agostini
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Cosimo Bruni
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Francesca Bartoli
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Lorenzo Tofani
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giovanni Pacini
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Alberto Moggi-Pignone
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Internal Medicine, AOUC, Florence, Italy
| | - Serena Guiducci
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Silvia Bellando-Randone
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Division of Rheumatology, AOUC, Florence, Italy
| | - Yehuda Shoenfeld
- Ariel University, Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Saint Petersburg State University, Saint-Petersburg, Russia
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marco Matucci-Cerinic
- Dept. Experimental and Clinical Medicine, University of Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy; Division of Rheumatology, AOUC, Florence, Italy.
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Ferrari M, Palleschi A, Bartoli F, Polli F, Armiraglio E, Parafioriti A, Croci GA, Tosi D. Management of intrathoracic phosphaturic mesenchymal tumor by nonintubated uniportal video-assisted thoracic surgery in a fragile patient. Cancer Rep (Hoboken) 2021; 5:e1500. [PMID: 34350733 PMCID: PMC9124498 DOI: 10.1002/cnr2.1500] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Phosphaturic mesenchymal tumors are rare neoplasms, frequently presenting with osteomalacia. These neoplasms usually grow at a slow rate and are associated with unspecific symptoms. Case In this study, we present the case of a 70‐year‐old woman who had been suffering from musculoskeletal pain, hypophosphatemia, and spontaneous fractures. Positron emission tomography with Gallium showed increase uptake in a subpleural lesion. Conclusion The patient underwent surgical excision of the subpleural lesion with a non‐intubated uniportal video‐assisted thoracoscopic surgery approach.
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Affiliation(s)
- Michele Ferrari
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federico Polli
- Department of Anaesthesia, Critical Care and Emergency Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Armiraglio
- Department of Pathology, ASST-PINI-CTO Centro Specialistico Ortopedico Traumatologico Gaetano Pini, Milan, Italy
| | - Antonina Parafioriti
- Department of Pathology, ASST-PINI-CTO Centro Specialistico Ortopedico Traumatologico Gaetano Pini, Milan, Italy
| | - Giorgio A Croci
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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Bruni C, Gentileschi S, Pacini G, Bardelli M, Tofani L, Bartoli F, Baldi C, Cometi L, Fiori G, Nacci F, Cantarini L, Guiducci S, Moggi-Pignone A, Frediani B, Matucci-Cerinic M. Switching from originator adalimumab to biosimilar SB5 in a rheumatology cohort: persistence on treatment, predictors of drug interruption and safety analysis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211033679. [PMID: 35116080 PMCID: PMC8804457 DOI: 10.1177/1759720x211033679] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/29/2021] [Indexed: 12/11/2022] Open
Abstract
Aims: Medical and non-medical switching strategies have been adopted in Europe in
the last few years. We aimed to investigate persistence on treatment with a
SB5 Adalimumab (SB5) biosimilar after switching from Adalimumab (ADA)
originator among patients with inflammatory rheumatic musculoskeletal
diseases (iRMD), identifying possible predictors of drug interruption and
describing adverse events. Method: iRMD patients previously switched to SB5 after at least 6 months of ADA were
enrolled. Data on concomitant medications, disease flares, and persistence
on SB5 up to the last available follow up were collected retrospectively.
Kaplan–Meier and Cox regression models were used. Result: A total of 172 patients (106 females, ADA duration 5.8 ± 3.8 years) were
enrolled, including 34 rheumatoid arthritis, 59 psoriatic arthritis, and 61
axial spondyloarthritis patients. In a 10 ± 3 months follow up, 65 (37.8%)
patients presented with adverse events, with 46 (26.7%) showing a clinically
defined disease flare (no disease activity and patient reported outcomes
assessment were available); 24 patients interrupted SB5 permanently (among
them, 11 back-switched to ADA and 8 were prescribed a different biological
therapy). Probability of persistence on SB5 was 94.7% at 6 months and 85.1%
at 12 months. Baseline corticosteroid [hazard ratio (HR) 3.209, 95%
confidence interval (CI) 1.193–8.635, p = 0.021] and
therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) (HR 2.876, 95% CI
1.229–6.727, p = 0.015), as well as the baseline
corticosteroid dose (HR 1.200, 95%CI 1.026–1.403,
p = 0.022) were predictors of drug interruption. Conclusion: Our data on persistence of treatment and adverse events are in line with
previous reports. Further large cohort studies may confirm baseline
corticosteroid and NSAIDs use as predictors of SB5 interruption, helping to
identify patients at higher risk of failure after switching.
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Affiliation(s)
- Cosimo Bruni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, Florence, 50141, Italy
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Giovanni Pacini
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Bardelli
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Lorenzo Tofani
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Caterina Baldi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Laura Cometi
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Ginevra Fiori
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Serena Guiducci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Zanca R, Bartoli F, Lazzeri E, Sollini M, Slart RHJA, Erba PA. [18F]FDG hypermetabolisms of the spleen and/or bone marrow: indirect signs of bacteremia. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aim
Recently hypermetabolisms of the spleen and/or bone marrow has been proposed as an indirect sign of infective endocarditis (IE), useful to reinforce the suspicion of IE in the absence of any other infectious, inflammatory, or malignant disease. The purpose of this study is to determine whether hypermetabolisms of the spleen and/or bone marrow are indirect signs of bacteremia rather than of IE, specifically.
Materials and Method
In this work we retrospectively evaluated a series 240 patients who performed between January 2015 to December 2020 [18F]FDG PET/CT (Discovery 710 GE) for suspected infection. In particular, 80 pts had infections from different origin and a positive blood culture (PBC), 80 pts presented localized infection, but negative blood culture (IDBCN) and 80 pts were classified as definite IE (IED) according to the 2015 ESCcriteria. [18F]FDG SUVmax SUVmean in bone marrow, spleen and liver were measured drawind a 14 cm3 regions of interest (ROIs) positioned close to the centers of the spleen and of the right liver lobe, but excluding abscess and/or ischemic lesions., as previously described (Caroline Boursier et al. ; Jordy P.Pijl et al.). BM SUVmax and SUVmean was obtained from ROIs placed on the bodies of each of the five lumbar vertebrae, excluding any damaged vertebra. BM to liver SUV ratios (BLR) and spleen to liver SUV ratios (SLR) were calculated. Kruskal-Wallis tests and the Dunn’s test procedure for multiple comparison were performed using JMP Statistical Discoverytm.
Results
No significant difference among the three groups of SUVmax/mean or in SLR were found. Nevertheless, by grouping patients for the presence of positive blood culture (142 pts) or negative blood culture (98 pts), irrespectively from the final diagnosis a significant associations of SLR was found (p = 0.0070). No significant associations were found with BLR.
Conclusions
Based on our data SLR in seems to represent an indirect signs of bacteremia, rather than IE.
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Affiliation(s)
- R Zanca
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - F Bartoli
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - E Lazzeri
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - M Sollini
- Humanitas Clinical and Research Center, Nuclear Medicine, Humanitas Clinical and Research,Department of Biomedical Sciences, Milan, Italy
| | - RHJA Slart
- University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, Netherlands (The)
| | - PA Erba
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
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11
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Ingegnoli F, Herrick AL, Schioppo T, Bartoli F, Ughi N, Pauling JD, Sulli A, Cutolo M, Smith V. Reporting items for capillaroscopy in clinical research on musculoskeletal diseases: a systematic review and international Delphi consensus. Rheumatology (Oxford) 2021; 60:1410-1418. [PMID: 32984894 DOI: 10.1093/rheumatology/keaa457] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 04/18/2020] [Revised: 07/01/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The level of detail included when describing nailfold videocapillaroscopy (NVC) methods varies among research studies, making interpretation and comparison of results challenging. The overarching objective of the present study was to seek consensus on the reporting standards in NVC methodology for clinical research in rheumatic diseases and to propose a pragmatic reporting checklist. METHODS Based on the items derived from a systematic review focused on this topic, a three-step web-based Delphi consensus on minimum reporting standards in NVC was performed among members of the European League against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium. RESULTS A total of 319 articles were selected by the systematic review, and 46 items were proposed in the Delphi process. This Delphi exercise was completed by 80 participants from 31 countries, including Australia and countries within Asia, Europe, North America and South America. Agreement was reached on items covering three main areas: patient preparation before NVC (15 items), device description (5 items) and examination details (13 items). CONCLUSION Based on the available evidence, the description of NVC methods was highly heterogeneous in the identified studies and differed markedly on several items. A reporting checklist of 33 items, based on practical suggestions made (using a Delphi process) by international participants, has been developed to provide guidance to improve and standardize the NVC methodology to be applied in future clinical research studies.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tommaso Schioppo
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Francesca Bartoli
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Nicola Ughi
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS FT, Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
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12
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Pregnolato F, Gerosa M, Raimondo MG, Comerio C, Bartoli F, Lonati PA, Borghi MO, Acaia B, Ossola MW, Ferrazzi E, Trespidi L, Meroni PL, Chighizola CB. EUREKA algorithm predicts obstetric risk and response to treatment in women with different subsets of anti-phospholipid antibodies. Rheumatology (Oxford) 2021; 60:1114-1124. [PMID: 32441742 DOI: 10.1093/rheumatology/keaa203] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 02/03/2020] [Revised: 03/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES aPL, the serum biomarkers of APS, are the most common acquired causes of pregnancy morbidity (PM). This study investigates the impact of aPL positivity fulfilling classification criteria ('criteria aPL') and at titres lower than thresholds considered by classification criteria ('low-titre aPL') on PM and assesses the effectiveness of low-dose aspirin (LDASA), low molecular weight heparin (LMWH) and HCQ in reducing the probability of PM (PPM). METHODS Longitudinal data on 847 pregnancies in 155 women with persistent aPL at any titre and 226 women with autoimmune diseases and negative aPL were retrospectively collected. A generalized estimating equations model for repeated measures was applied to quantify PPM under different clinical situations. RESULTS EUREKA is a novel algorithm that accurately predicts the risk of aPL-associated PM by considering aPL titres and profiles. aPL significantly impact PPM when at low titres and when fulfilling classification criteria. PPM was further stratified upon the aPL tests: aCL IgG/IgM and anti-β2-glycoprotein I (β2GPI) IgM, alone or combined, do not affect the basal risks of PPM, an increase occurs in case of positive LA or anti-β2GPI IgG. LDASA significantly affects PPM exclusively in women with low-titre aPL without anti-β2GPI IgG. The LDASA + LMWH combination significantly reduces PPM in all women with low-titre aPL and women with criteria aPL, except those carrying LA and anti-β2GPI IgG. In this group, the addition of HCQ further reduces PPM, although not significantly. CONCLUSION EUREKA allows a tailored therapeutic approach, impacting everyday clinical management of aPL-positive pregnant women.
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Affiliation(s)
- Francesca Pregnolato
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy
| | - Maria Gabriella Raimondo
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy
| | - Chiara Comerio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Bartoli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy
| | - Paola A Lonati
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy
| | - Maria Orietta Borghi
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Barbara Acaia
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Cecilia B Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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13
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Cometi L, Bruni C, Tofani L, Tesei G, Nacci F, Fiori G, Bartoli F, Matucci-Cerinic M. AB0256 BARICITINIB (BARI) VERSUS BIOLOGICS IMPACT ON STEROID TAPERING IN RHEUMATOID ARTHRITIS (RA). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Biologic and target synthetic disease modifying anti-rheumatic drugs (bDMARDs and tcDMARDs) are recommended to control RA disease activity, pain and steroid use. Following randomized clinical trials (RCTs) and their post-hoc analyses, the Janus Kinase Inhibitor tsDMARDs BARI was superior to reference bDMARD Adalimumab in reducing disease activity, pain and functional disability. In addition, BARI monotherapy also determined more significant pain reduction and functional improvement when compared to Tocilizumab monotherapy (3).Objectives:to confirm RCT results in a real-life clinical setting, with focus on disease activity, pain, functional disability and steroid tapering, when comparing BARI to bDMARDs for the treatment of active RA.Methods:RA patients starting BARI or a bDMARD for active RA were retrospectively evaluated from June 2019 to June 2020. Disease activity (DAS28CRP, SDAI, CDAI), pain visual analogic scale (pain_VAS), functional disability (HAQ) assessments and mean prednisone dosage (pred_dose) were collected at baseline (BL), 3 months (3M) and 6 months (6M) after BARI/bDMARD initiation. The changes of the outcome measures were evaluated between BL-3M, 3M-6M and BL-6M, as well as between BARI and bDMARDs groups. Finally, we assessed the variables associated with prednisone tapering in the whole population.Results:90 out of 100 RA patients evaluated (baseline: age 57±12 years, disease duration 131±100 months, DAS28PCR 4.8±1.0, pain_VAS 61±23 mm, prednisone dose 5.5±5.3 mg) were eligible for the study; 49 received BARI and 41 bDMARDs (17 abatacept, 12 TNF inhibitors, 11 tocilizumab, 1 rituximab). At BL, the two groups did not differ statistically in terms of age, sex, disease duration, disease activity, pain_VAS, previous bDMARD failure or ts/bDMARD naive, concomitant conventional synthetic DMARDs treatment, pred_dose. Both BARI and bDMARDs determined a significant reduction in activity scales and HAQ when comparing BL-3M and BL-6M, with only pain_VAS and pred_dose showing a significant decrease in the 3M-6M interval. When comparing the two groups, BARI showed a significantly higher reduction of pred_dose (-3.2±5.1 vs -1.7±3.7 mg at BL-3M, and -4.1±5.3 vs -1.9±4.6 mg at BL-6M), which was not significant after adjusting for BL pred_dose. No other difference was seen when the two groups, including the numerically higher reduction of pain_VAS in the BARI group (-29±28 vs -20±27 mm at BL-3M and -35±25 vs -30±28 mm at BL-6M comparison). The analysis of the predictors for steroid tapering (Δmean_pred) in the two intervals, showed that BL DAS28PCR, DAS28PCR BL-3M change and BL pred_dose were associated with BL-3M Δmean_pred, while 3M pain_VAS and 3M pred_dose were associated with 3M-6M Δmean_pred.Conclusion:Although limited by the small samples and the retrospective nature, our real-life comparison shows similar efficacy of BARI and bDMARDs in terms of disease activity control, functional disability and pain. In addition, the treatment with BARI or bDMARD did not influence the steroid tapering, which was driven mostly by its initial dose, disease activity and pain. Larger real-life multi-center studies are warranted to confirm our results.References:[1]Taylor PC et al. Baricitinib versus Placebo or Adalimumab in Rheumatoid Arthritis. N Engl J Med. 2017 Feb 16;376(7):652-662.[2]Fautrel B et al. Effect of Baricitinib and Adalimumab in Reducing Pain and Improving Function in Patients with Rheumatoid Arthritis in Low Disease Activity: Exploratory Analyses from RA-BEAM. J Clin Med. 2019 Sep 5;8(9):1394.[3]Fautrel B et al. Comparative effectiveness of improvement in pain and physical function for baricitinib versus adalimumab, tocilizumab and tofacitinib monotherapies in rheumatoid arthritis patients who are naïve to treatment withDisclosure of Interests:Laura Cometi: None declared, Cosimo Bruni Speakers bureau: Actelion, Consultant of: Eli Lilly, Grant/research support from: Fondazione Italiana Ricerca sull’Artrite (FIRA), Gruppo Italiano lotta alla Sclerodermia (GILS), New Horizon Fellowship, European Scleroderma Trials and Research (EUSTAR) group, Foundation for Research in Rheumatology (FOREUM)., Lorenzo Tofani: None declared, Giulia Tesei: None declared, Francesca Nacci: None declared, Ginevra Fiori: None declared, Francesca Bartoli: None declared, Marco Matucci-Cerinic Speakers bureau: Biogen Italia, Actelion, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly, Consultant of: Biogen Italia, Actelion, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly, Grant/research support from: Biogen Italia, Actelion, Bayer, Boehringer Ingelheim, CSL Behring, Eli-Lilly,
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El Aoufy K, Melis MR, Bellando Randone S, Blagojevic J, Bartoli F, Fiori G, Nacci F, Conforti ML, Cometi L, Bruni C, Moggi Pignone A, Rasero L, Guiducci S, Matucci-Cerinic M. POS1495-HPR THE EXPERIENCE OF A RHEUMATOLOGY UNIT DURING THE COVID19 LOCKDOWN: TELEMEDICINE ALLOWS A SAFE FOLLOW UP OF PATIENTS WITH RHEUMATIC DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In March this year, most of the routine activities were cancelled during the streaming of the pandemic in Italy. This prompted a pragmatic reorganization of the traditional care model of nursing and medicine, to quickly give an efficient clinical response. During the first phase of the pandemic, outpatient visits dropped by more than 60%, forcefully shifting to telemedicine to assure continuity of care despite the lockdown.Objectives:The aim of the present work was to describe the strategy adopted during and immediately after the lockdown to assure the follow up of patients and the maintenance of their treatment in an outpatient “virtual” telemedicine clinic dedicated to RDs.Methods:the patient flow to a rheumatology division during the lockdown was evaluated retrospectively from March to September 2020 in accordance with local restrictions, and three periods are described.Results:653/913 (71.5%), 542/542 (100%) and 1.048/1.048 (100%) infusion activities scheduled were performed at the centre for daily infusion and pre-infusion assessment, respectively during the 1st, 2nd and 3rd period. In the outpatient clinic during the 1st period, 96.96% of the cases was shifted to Telemedicine, which decreased to 52.45% in the 2nd period; while in the 3rd period, 97.6% of the performances were carried out at the clinic. Diagnostic procedures, such as ultrasound, capillaroscopy, and joint injection were generally postponed during the 1st period, reduced drastically during the 2nd and performed regularly during 3rd period. Ulcer treatment and the Clinical Trial Unit never stopped their activity. The flow of the activity of the outpatient clinic and the day hospital is represented as monthly trends in graph 1 (See Graph 1).Conclusion:Our data show the feasibility of Telemedicine in a lockdown condition. Shifting stable patients to Telemedicine has the potentiality to minimize the risk of contagion and allow continuity of care. In the future, the use of Telemedicine for specific clinical uses might assure patient assistance also in non-pandemic conditions.References:[1]Rawaf S, Allen LN, Stigler FL et al. Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide. Eur J Gen Pract. 2020 Dec;26(1):129-133. doi: 10.1080/13814788.2020.1820479. PMID: 32985278.[2]McDougall JA, Ferucci ED, Glover J, et al. Telerheumatology: A Systematic Review. Arthritis Care Res (Hoboken). 2017 Oct;69(10):1546-1557. doi: 10.1002/acr.23153. Epub 2017 Aug 22. PMID: 27863164; PMCID: PMC5436947.[3]Romão VC, Cordeiro I, Macieira C, Oliveira-Ramos F, Romeu JC, Rosa CM, Saavedra MJ, Saraiva F, Vieira-Sousa E, Fonseca JE. Rheumatology practice amidst the COVID-19 pandemic: a pragmatic view. RMD Open. 2020 Jun;6(2):e001314. doi: 10.1136/rmdopen-2020-001314. PMID: 32584782; PMCID: PMC7425193.Characters from table content including title and footnotes:Graph 1.Monthly trend for telemedicine and visits during the SARS Cov2 emergencyAcknowledgements:The project (Telereuma) has been supported by an unrestricted grant of Biogen, BMS, and Novartis.Disclosure of Interests:None declared
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Damiani A, Bartoli F, Gori V, Bellando-Randone S, Fiori G, Matucci-Cerinic M, Guiducci S. POS0618 PERSISTENCE OF REMISSION AFTER TAPERING OF GOLIMUMAB IN INFLAMMATORY JOINT DISEASE (IJD). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In refractory IJD, remission may be obtained with antiTNFa drugs and other biological disease modifying anti-rheumatic drugs (bDMARDs). The last EULAR recommendations suggest tapering of bDMARD when remission persists1. However, best timing and modality of tapering are uncertain and specific knowledge on patients’ characteristics associated to a better outcome is still lacking.Objectives:To evaluate the persistency of remission after increasing the interval between injections of Golimumab in a group of patients affected by rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and juvenile idiopathic arthritis (JIA) and to identify any variables associated to disease flare after tapering.Methods:Between 2011 and July 2020, 80 patients affected by RA, PsA, AS and JIA treated with Golimumab were enrolled. Their demographic and clinical data, including inflammation (ESR and cRP) and clinimetric indices (DAS28 or BASDAI), were collected at baseline and during the follow up visit (T1). In 22/80 patients that reached clinical remission at T1, the time between Golimumab injections has been prolonged (mean time between injection: 43.7 days); ESR and cRP, DAS28/BASDAI, and time since the start of the tapering (weeks) were evaluated in the next control visit (T2).Results:80 patients were enrolled (32 male, mean age 50.6 years +/- 13.91), 34 AS, 33 PsA, 9 RA and 4 JIA. At baseline they have an active disease with a DAS 28 of 4.74+/-0.85 and a BASDAI of 5.23+/- 1.31. At T1, 60/80 patients were in remission (75%), with a mean DAS 28 of 1.84+/- 0.6 and an average BASDAI of 1.32+/-0.6, and 22/60 patients started drug tapering. At T2, 20/22 patients (91%) were in remission, (DAS 28 1.9+/-0.49, BASDAI of 0.8+/- 0, 67). A significantly higher BASDAI was observed at T1, even though in the range of absence of disease activity (2.2, +/- 0.28 vs 0.58, +/- 0.47; p <0.001) in patients who, after extending the therapeutic interval (T1) were no longer in remission at T2. Patients with a flare of disease activity (2/22) were taken back to the 28 days window of Golimumab with a prompt recovery of disease remission. Out of the 38 patients maintained at the standard dose, 4 experienced a disease flare with necessity to switch or swope bDMARD, with a retention rate in this group of 90%. Difference of retention rate between patients on standard vs reduced dose was not statistically significative.Conclusion:Tapering of Golimumab was successful in 91% of the cases without flare. Moreover, the prolongation of the increase of the treatment window provided the same result as that obtained in patients that continued in the standard time window. This evidence suggests that the extension of the gap between Golimumab administrations may be feasible and safely applied in practice.References:[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update Annals of the Rheumatic Diseases 2020;79:685-699.Disclosure of Interests:None declared
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Tesei G, Cometi L, Nacci F, Terenzi R, Tofani L, Capassoni M, Bartoli F, Fiori G, Matucci-Cerinic M, Bruni C. Baricitinib in the treatment of rheumatoid arthritis: clinical and ultrasound evaluation of a real-life single-centre experience. Ther Adv Musculoskelet Dis 2021; 13:1759720X211014019. [PMID: 34025783 PMCID: PMC8120535 DOI: 10.1177/1759720x211014019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Ultrasound (US) is useful in monitoring RA patients, with the US7 score allowing grey-scale and power-Doppler (PD) semi-quantitative evaluation of synovitis and teno-synovitis. We evaluated real-life efficacy and safety of Baricitinib, an oral selective JAK1-2 inhibitor, in RA patients using clinical, clinimetric, and US assessments. Methods: Disease activity score in 28 joints calculated with C-reactive protein (DAS28-CRP), disease activity score in 28 joints calculated with erythrocyte sedimentation rate (DAS28-ESR), clinical disease activity index (CDAI), simplified disease activity index (SDAI), visual analogue scale (VAS)-pain, health assessment questionnaire (HAQ), COCHIN scale, adverse events (AE), concomitant medications, laboratory parameters, and US7 were performed/recorded at baseline, 1, 3, and 6 months in RA patients starting Baricitinib. Responder/non-responder status was determined according to the EULAR Response Criteria at 3 months. SDAI clinical remission or low disease activity (LDA) were calculated at 3 and 6 months. Results: In 43 enrolled patients, a significant improvement in disease activity and US7 components (except tendon PD) and a reduction of steroid dosage were observed. Responders at 3 months showed a significantly higher reduction of CDAI, SDAI, COCHIN scale, VAS-pain, and US7 synovialPD, compared with non-responders. At 3 and 6 months, remission/LDA was achieved by 12.8/53.8% and 21.6/51.3% patients, respectively. The csDMARD co-treatment was independently associated with remission/LDA at 3 months. Safety-related drop-outs were in line with literature data. The steroid dosage was associated with AE development at 6 months. Conclusion: The real-life data, also obtained with US evaluation, confirmed the Baricitinib efficacy in RA disease control, as well as the utility of assessment during the follow up of disease activity.
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Affiliation(s)
- Giulia Tesei
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, ItalyOspedale Infermi, Medicina e Reumatologia, Rimini, Italia
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via delle Oblate 4, Firenze, 50141, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Lorenzo Tofani
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Capassoni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Francesca Bartoli
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Cosimo Bruni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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Cometi L, Bruni C, Passavanti S, Tofani L, Bartoli F, Fiori G, Nacci F, Lepri G, Orlandi M, Melchiorre D, Antonuzzo L, Matucci-Cerinic M, Moggi-Pignone A. Risk of Malignancy and Biologic Therapy in Rheumatic Inflammatory Diseases: A Single-center Experience. Rheumatol Immunol Res 2020; 1:39-45. [PMID: 36465081 PMCID: PMC9524767 DOI: 10.2478/rir-2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Biologic disease modifying anti-rheumatic drugs (bDMARDs) have significantly improved the care of patients with rheumatic muscle-skeletal disorders (RMDs). Considering their immunosuppressive action, a theoretical increase of malignancy risk has been a major concern in the last few decades. The objective of this study is to analyze the incidence of malignancies in a cohort of patients affected by rheumatoid arthritis (RA), psoriathic arthritis (PsA), and ankylosing spondylitis (AS) treated with bDMARDs. METHODS The charts of bDMARD-treated RMD patients were reviewed, and data about bDMARD exposure and malignant cancers (excluding non-melanoma skin cancer) were collected. RESULTS 921 patients were included (median age: 50.59 years, 66.67% females); 1374 bDMARD treatments were administered, 87.12% were tumor necrosis factor inhibitors. A total of 21 malignant neoplasms were detected in 21 patients (61.90% females, median age at cancer diagnosis: 64.99 years), 66.67% in RA patients, 19.05% in PsA, and 14.28% in AS. Among them, 10 patients (47.62%) were treated with etanercept, 6 patients (28.57%) with adalimumab, and 1 case each with tocilizumab, certolizumab, golimumab, infliximab, and abatacept. The most common malignancies that we found were lung cancers, ductal mammary carcinomas, melanomas, and lymphomas. The incidence rate (IR) of malignancies in our cohort was 3.47 per 1000 person-years (p-y); the higher IRs were in RA patients (5.13 per 1000 p-y), in males (4.21 per 1000 p-y), and in patients aged >70 years (10.14 per 1000 p-y). CONCLUSIONS The results of our study showed IR of malignancies in RMD patients treated with bDMARDs that is in agreement with literature data.
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Affiliation(s)
- Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Saverio Passavanti
- Department of Internal Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo Tofani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Ginevra Fiori
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Francesca Nacci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Internal Medicine, Division of Internal Medicine Unit III, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Bruni C, Gentileschi S, Pacini G, Baldi C, Capassoni M, Tofani L, Bardelli M, Cometi L, Cantarini L, Nacci F, Vietri M, Bartoli F, Fiori G, Frediani B, Matucci-Cerinic M. The switch from etanercept originator to SB4: data from a real-life experience on tolerability and persistence on treatment in joint inflammatory diseases. Ther Adv Musculoskelet Dis 2020; 12:1759720X20964031. [PMID: 33133246 PMCID: PMC7576915 DOI: 10.1177/1759720x20964031] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Aims: Switching from originator to biosimilar is part of current practice in inflammatory rheumatic musculoskeletal diseases (iRMDs) such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA), with evidences derived from both etanercept (ETN) to SB4-switching randomized controlled trials and real-life registries. We investigated the safety and treatment persistence of ETN/SB4 in a multi-iRMD cohort derived from two rheumatology departments in our region. Methods: Adult patients with iRMDs, treated with ETN for at least 6 months and switched to SB4 in stable clinical condition, were eligible for this retrospective evaluation. Retrospective data on adverse events, loss of efficacy and persistence on treatment were collected until latest available follow-up. Results: A total of 220 patients (85 RA, 81 PsA, 33 axSpA, 14 juvenile idiopathic arthritis and seven other conditions; 142 females, mean age 58 ± 7 years, disease duration 12 ± 4 years, ETN duration 7 ± 4 years) were enrolled, with median follow-up of 12.1 (9.7–15.8) months. A total of 50 patients (22.7%) presented with at least one adverse event, with 36 (16.4%) disease flares and 30 (13.6%: 11 for safety and 19 loss of efficacy) SB4 withdrawals. Cumulative SB4 treatment persistence was 99.1%, 88.6% and 64.6% at 6, 12 and 18 months respectively. Back-switch to ETN was performed in 17/30 cases, the remaining cases were managed with change of biologic disease modifying or conventional synthetic anti-rheumatic drug. Age was the only significant predictor of SB4 interruption at 6 months. Conclusion: Our real-life data confirm the safety profile of switching from ETN to SB4, with slightly higher treatment persistence rates compared with other real-life registries.
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Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, Via delle Oblate 4, 50141, Firenze, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Giovanni Pacini
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Caterina Baldi
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Capassoni
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Lorenzo Tofani
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Marco Bardelli
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Laura Cometi
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Michele Vietri
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Department Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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Bartoli F, Bailey M, Rode B, Mateo P, Antigny F, Bedouet K, Rucker-Martin C, Beech D, Foster R, Benitah J, Sabourin J. Orai1 channel inhibition preserves left ventricular systolic function and normal Ca2+ handling after pressure overload. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bruni C, Gentileschi S, Capassoni M, Pacini G, Bardelli M, Baldi C, Tofani L, Cometi L, Nacci F, Bartoli F, Fiori G, Cantarini L, Guiducci S, Frediani B, Matucci-Cerinic M. AB0281 SAFETY AND RETENTION RATE AFTER SWITCHING FROM ETANERCEPT ORIGINATOR (ETN) TO ETANERCEPT BIOSIMILAR (SB4) IN INFLAMMATORY JOINT DISEASES: DATA FROM REAL LIFE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:SB4 in now commonly used in the treatment of inflammatory joint diseases, with evidence of efficacy and persistence up to 12 months from switching in both randomized controlled trials in Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS).Objectives:we investigated the safety and retention rate of SB4 at 6, 12 and 18 months after switching from ETN in two rheumatology departments in our region.Methods:adult patients with RA, PsA, AS, Juvenile Idiopathic Arthritis (JIA) and other rheumatic diseases treated with ETN for at least 6 months, switched to SB4 in stable clinical conditions, were eligible for this retrospective evaluation. Data on adverse events (in particular infectious events), loss of efficacy (articular, cutaneous, ocular or intestinal disease re-activation) and persistence on treatment were collected since latest available follow-up. Retention rate, reason for discontinuation and subsequent management data were collected at 6, 12, 18 months.Results:220 patients (142 females, mean age 58+-7 years, disease duration 12+-4 years, ETN duration 7+-4 years) were enrolled, with median follow up of 12.1 (9.7-15.8) months duration; ETN was used in different biologic DMARDs treatment lines (first 76.8%, second 17.7%, third 3.2 %, fourth 2.3%). Study population was composed of 85 RA, 81 PsA, 33 AS, 14 JIA and 7 other conditions (mostly scleroderma). In the follow-up, 50 patients (22.7%) presented with at least one non-serious adverse event, with 36 (16,4%) disease re-activation (mostly articular) and 30 (13,6% - 11 for safety and 19 loss of efficacy) SB4 interruptions. Retention rates were 99.1 (210/212) at 6, 90.9% (150/165) at 12 and 81.5% (53/65) at 18 months respectively. Back-switch to ETN was performed in 17/30 cases, the remaining cases were managed with change of bDMARD or csDMARD). Age was the only significant predictor of SB4 interruption at 6 months (OR 1.058, 95%CI 1.007-1.112, p=0.026), while disease, bDMARD line, csDMARD combination, gender, disease duration or ETN duration did not influence retention rates at 6, 12 or 18 months.Conclusion:our real-life data confirm the safety profile of switching from ETN to SB4. In our patients, the data show a higher retention rate, when compared to other-real life registries data (1,2)References:[1]Ebbers HC et al. Real-World evidence on Etanercept Biosimilar SB4 in Etanercept-Naïve or Switching Patients: A Systematic Review. Rheumatol Ther. 2019 Sep;6(3):317-338.Disclosure of Interests:Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Stefano Gentileschi: None declared, Marco Capassoni: None declared, Giovanni Pacini: None declared, Marco Bardelli: None declared, Caterina Baldi: None declared, Lorenzo Tofani: None declared, Laura Cometi: None declared, Francesca Nacci: None declared, Francesca Bartoli: None declared, Ginevra Fiori: None declared, Luca Cantarini: None declared, Serena Guiducci: None declared, Bruno Frediani: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim
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Ingegnoli F, Schioppo T, Herrick A, Sulli A, Bartoli F, Ughi N, Pauling J, Cutolo M, Smith V. THU0528 NAILFOLD VIDEOCAPILLAROSCOPY REPORTING IN CLINICAL RESEARCH: INTERNATIONAL DELPHI BASED CONSENSUS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Nailfold capillaroscopy (NVC), a non-invasive technique to assess microcirculation, is increasingly being incorporated into rheumatology routine clinical practice. Currently, the degree of description of NVC methods varies amongst research studies, making interpretation and comparison between studies challenging. In this field, an unmet need is the standardization of items to be reported in research studies using NVC.Objectives:To perform a Delphi consensus on minimum reporting standards in methodology for clinical research, based on the items derived from a systematic review focused on this topic.Methods:The systematic review of the literature on NVC methodology relating to rheumatic diseases was performed according to PRISMA guidelines (PROSPERO CRD42018104660) to July 22nd2018 using MEDLINE, Embase, Scopus. Then, a three-step web-based Delphi consensus was performed in between members of the EULAR study group on microcirculation in rheumatic diseases and the Scleroderma Clinical Trials Consortium. Participants were asked to rate each item from 1 (not appropriate) to 9 (completely appropriate).Results:In total, 3491 references were retrieved in the initial search strategy, 2862 were excluded as duplicates or after title/abstract screening. 632 articles were retrieved for full paper review of which 319 fulfilled the inclusion criteria. Regarding patient preparation before the exam, data were scarce: 38% reported acclimatization, 5% to avoid caffeine and smoking, 3% to wash hands and 2% to avoid manicure. Concerning the device description: 90% reported type of instrument, 77% brand/model, 72% magnification, 46% oil use, 40% room temperature and 35% software for image analysis. As regards to examination details: 76% which fingers examined, 75% number of fingers examined, 15% operator experience, 13% reason for finger exclusion, 9% number of images, 8% quality check of the images and 3% time spent for the exam. Then, a three-round Delphi consensus on the selected items was completed by 80 participants internationally, from 31 countries located in Australia, Asia, Europe, North and South America. Some items reached the agreement at the second round (85 participants), and other items were suggested as important to consider in a future research agenda (e.g. temperature for acclimatization, the impact of smoking, allergies at the application of the oil to the nailbed, significance of pericapillary edema, methods of reporting hemorrhages, ramified and giant capillaries). The final agreement results are reported below:Conclusion:On the basis of the available literature the description of NVC methods was highly heterogeneous and individual published studies differed markedly. These practical suggestions developed using a Delphi process among international participants provide a guidance to improve and to standardize the NVC methodology in future clinical research studies.Disclosure of Interests:Francesca Ingegnoli: None declared, Tommaso Schioppo: None declared, Ariane Herrick: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Francesca Bartoli: None declared, Nicola Ughi: None declared, John Pauling: None declared, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl
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Crotti C, Bartoli F, Manara M, Daolio PA, Zucchi F, Caporali R, Sinigaglia L, Varenna M. THU0421 TUMOR-INDUCED OSTEOMALACIA: DATA FROM A MONOCENTRIC EXPERIENCE ON 16 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome due to a phosphaturic tumor, which overproduces fibroblast growth factor-23 (FGF-23), causing hyperphosphaturia, hypophosphoremia, low 1,25(OH)2VitD3and osteomalacia. Locating the tumor is critical, because lesions are typically small, benign mesenchymal tumors, anywhere in the body; the delay between onset of symptoms and diagnosis ranges from 2.5–28 years. Surgical removal is the only effective therapeutic approach.Objectives:To retrospectively evaluate patients affected by TIO, investigating clinical management and disease outcome.Methods:We retrospectively collected data of patients affected by TIO referred to a tertiary Rheumatology Center between Sep 2000 and Jan 2020.Results:We included 16 patients with a definite diagnosis of TIO, mean age±standard deviation 62.4±14.6 yrs, 56.2% females, mean age at symptoms onset 48.0±14.3 yrs (53.8±13.1 at diagnosis). Mean diagnostic delay between symptoms onset and tumor detection was 6.8±6.4 yrs. All patients complained bone pain, muscle weakness, and fractures before diagnosis of TIO. Biochemical findings were: mean serum Phosphorus (PS) 1.4±0.4 mg/dL (reference range (RR) 2.5-4.6), mean serum Calcium 9.4±0.7 mg/dL (RR 8.4-10.2), mean serum 1,25(OH)2VitD330.5±23.4 ng/L (RR 25-86). Intact-FGF-23 was dosed in 9 patients, always resulting elevated: mean 396.6±707.3 pg/mL (RR 25-45). PTH was increased in 30% of cases, while serum alkaline phosphatase was increased in 87.5%. 24h-Urine Phosphorus (PU) was increased in only 13% of patients, but, when renal phosphate wasting by tubular reabsorption of phosphate (TRP) was calculated, PU resulted increased in all.Tumor was localized in all cases (Fig.1) and were localized in bone and soft tissue, by using functional imaging, followed by anatomical techniques. Before the introduction in routinely practice of68Ga-DOTATATE-PET-CT in 2013, Octreoscan-SPECT/CT and18F FDG-PET were used as imaging modalities. Since 2013, diagnostic delay consistently reduced, from 8.6±8.3 yrs (7 patients) to 4.5±2.6 yrs (9 patients), confirming higher diagnostic accuracy of68Ga-DOTATATE-PET-CT.Figure 1.13 patients underwent surgery; in two cases surgery was not possible due to tumor location, so pharmacological support with phosphate supplements and calcitriol was started; a patient underwent to TC-guided radiofrequency ablation. After surgery, 7 patients experienced a complete remission, 3 had a persistence of the disease, and 3 an overtime relapse, even after a longstanding normalization of PS (6 years). After surgical tumor removal, PS significantly increased in few days (from 1.36±0.39 to 2.9±1.1, p=0.0001), while iFGF-23 levels tended to rapidly decreased (from 396.6±707.3 to 62.8±78.4). Before the introduction of68Ga-DOTATATE-PET-CT, 6 patients underwent to imaging-guided closed biopsy to confirm tumor localization; by using68Ga-DOTATATE-PET-CT only 2 subjects had closed biopsy. Furthermore, in our population only patients who had biopsy to detect the lesion (7 patients) had relapses compared to patients who did not.Conclusion:To our knowledge, this is the widest European cohort of patients affected by TIO reported in the last two decades. We confirm an important delay between symptoms onset and diagnosis. To locate tumor, a stepwise approach is recommended, starting with a thorough medical history and physical examination, followed by functional imaging, preferring68Ga-DOTATATE-PET-CT. Tumor biopsy is not recommended due to the potential cell spilling. Surgery is considered the only definitive treatment, aiming to a wider excision. Active surveillance is always needed, due to the possible relapses, even after a long period of complete clinical and biochemical remission.Disclosure of Interests: :Chiara Crotti: None declared, Francesca Bartoli: None declared, Maria Manara Consultant of: Consultant and/or speaker for Eli-Lilly, MSD, Sanofi-Genzyme, Novartis, Alfa Wasserman and Cellgene, Speakers bureau: Consultant and/or speaker for Eli-Lilly, MSD, Sanofi-Genzyme, Novartis, Alfa Wasserman and Cellgene, Primo Andrea Daolio: None declared, Francesca Zucchi: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Luigi Sinigaglia: None declared, Massimo Varenna: None declared
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Passalacqua M, Foggi C, Mauro N, Tofani L, Guiducci S, Bruni C, Lepri G, Blagojevic J, El Aoufy K, Fiori G, Bartoli F, Maddali Bongi S, Mitola M, Gizduloch M, Matucci-Cerinic M, Bellando Randone S. THU0360 EFFICACY OF A SELF-TREATMENT PROTOCOL FOR FACE AND TEMPOROMANDIBULAR JOINTS REHABILITATION IN SYSTEMIC SCLEROSIS (SSC). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In SSc, skin involvement of the face is frequent and extremely disabling, resulting in limited mouth opening, an altered dentition, difficulty in teeth care, as well as having a strong impact on the emotional and psychological well-being, thus impairing quality of life.Objectives:to evaluate the efficacy of a self-treatment protocol (created by AMURR A Multidisciplinary Association of Rheumatological Rehabilitation) for face and tempomandibular joints (TMJs) rehabilitation with two devices used in the dental field.Methods:40 SSc patients (37 female and 3 male) with a mouth opening ≤ 40 mm, were recruited and randomized in two groups of treatment: Group 1 (20 patients: mean age 50,650 yrs ± 13,937 SD, mean disease duraton 10,45 yrs ± 7,877 SD, opening mouth 32,250 mm ± 5,590 SD) treated with a home self-treatment protocol consisting of 23 exercises carried out at home in front of a mirror, 22/23 exercises were performed once a day, one of these using a device to obtain uniform stretching of the buccal rhyme, another one usingused three times a day to reduce tension of muscles of the TMJs, facilitating the mouth opening; group 2 (20 patients: mean age 58,05 yrs ± 18,103 SD, mean disease duration 17,4 yrs ± 15,017 SD, opening mouth 34,950 mm ± 5,753) without physical rehabilitation, only drugs as treatments of SSc and its complications. All patients underwent a baseline (T0) and 45 days (T1) clinimetric assessment by self-assessment of quality of life with SF-36 (Short-Form 36 Health Survey), of the degree of disability of the mouth with MHISS (of the Mouth Handicap in Systemic Sclerosis scale), Muscle pain evaluated by numerical rating scale (NRS) of the temporomandibular joint with TMD (Temporo mandibular Disorders), evaluation of mouth opening and ROM of the cervical spine. Statistical analysis was performed using the t-test or the Mann-Whitney test for assessing changes in all measurement scales between treatment groups.Results:The protocol of home physiotherapy exercises resulted in a statistically significant improvement in the treated group compared to group 2 both for mouth opening (T0: 32,250 ± 5,590, T1: 35,650 ± 6,046) vs (T0: 34,950 ± 5,753 T1: 34,300 ± 6,001) (p<0.001), cervical flexion (T0: 2,950 ± 1,939 T1: 1.700 ± 1,525) vs (T0: 4,450 ± 2,282 T1:4,075 ± 2,238) (p<0.01), cervical extension (T0: 17,025 ± 1,895 T1: 17,625 ± 1,605) vs (T0: 17,050 ± 2,089 T1: 16,525 ± 3,110) (p<0.05), cervical right lateral flexion (T0: 14,075 ± 2,386 T1:13,400 ± 2,431) vs (T0: 14,200 ± 1,765 T1: 14,425 ± 1,742) (p<0.01), cervical right rotation (T0: 14,200 ± 3,416 T1:13,750 ± 3,206) vs (T0: 14,900 ± 1,683 T1: 15,550 ± 2,188) (p<0.01), cervical left rotation (T0: 14,725 ±3,640 T1:14,450 ± 3,710) vs (T0: 15,900 ± 2,614 T1: 16,450 ± 2,964) (p<0.05), mouth disability at MHISS (T0: 19,100 ± 10,356 T1: 16,000 ± 9,989) vs (T0: 20,950 ± 9,950, T1: 21,100 ± 10,775) (p<0.01).Conclusion:The use of the home exercises protocol associated with the two devices has shown a significant improvement of the disability linked to skin involvement of the face. This highlights the fundamental role that home rehabilitation self therapy has in practice. These data will need to be confirmed in a larger cohort of patientsDisclosure of Interests:Mauro Passalacqua: None declared, Cristian Foggi: None declared, Nicola Mauro: None declared, Lorenzo Tofani: None declared, Serena Guiducci: None declared, Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Gemma Lepri: None declared, Jelena Blagojevic: None declared, Khadija El Aoufy: None declared, Ginevra Fiori: None declared, Francesca Bartoli: None declared, Susanna Maddali Bongi: None declared, Marco Mitola: None declared, Marco Gizduloch: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Silvia Bellando Randone: None declared
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Cometi L, Bruni C, Chiti N, Tofani L, Nacci F, Bartoli F, Bellando Randone S, Fiori G, Guiducci S, Matucci-Cerinic M. AB0239 EFFECTS OF DYSMETABOLISMS AND COMORBIDITIES ON THE EFFICACY, SAFETY AND RETENTION RATE OF BIOLOGICAL DMARDS (bDMARD) IN INFLAMMATORY JOINT DISEASES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:bDMARDs have an effect on glucose homeostasis (1), lipoproteins profile (2; 3) and blood pressure (4). However, with the exception of obesity (5; 6), there are no clear data on how bDMARDs work in patients who already have or develop metabolic comorbidities and whether these conditions can impact on their efficacy and safety profile.Objectives:to evaluate, in chronic inflammatory joint diseases, the effect of arterial hypertension (AH), dyslipidemia (DYS) and diabetes mellitus (DM) on efficacy, safety and retention rate of first-line bDMARDs therapy.Methods:a retrospective observational study on the clinical charts of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS), treated with first on-label bDMARD was performed. Data on adverse events, efficacy and comorbidities at the baseline visit in which the bDMARD was prescribed (BL), the visit performed after 6 months of therapy (6M), and the last visit on treatment (LoT) were collected.Results:383 patients (41,8% RA, 33,4% PsA and 24,8% AS) were included in the study, with the predominance of females (F: 67,36%, M: 32,64%; mean age 51,67 ± 15,11 years). Our data show that the presence of comorbidities had no influence on efficacy of bDMARD, while patients who had DYS at BL manifested a higher rate of systemic adverse events either in the first 6 months of therapy (58,9% vs 43,7%, p=0,040) and also later on (80,36% vs. 66,67%, p=0,046). In addition, patients who developed DYS and AH after the 6M visit reported a higher rate of systemic adverse events at LoT visit, compared to others (DYS: 97,8% vs 66,7%, p<0,001; AH: 86,9% vs 65,2%, p=0,031). For what concerns the retention rate, patients who developed DYS or AH during bDMARD treatment continued the drug for a longer period of time (DYS 95,5 vs 19,6 months, p<0,001; AH 72,1 vs 23,4 months, p<0,001). In particular, patients with AH who concomitantly carried out therapy with ACE-inhibitors (ACEi) and/or angiotensin II receptor blockers (ARB) continued bDMARDs for nearly 20 more months than patients who were not exposed to these drugs (40,5 vs 23,4 months, p=0,001) and more frequently maintained the bDMARDS at LoT (59,42% vs. 47,53%). In case of withdrawal in the ACEi/ARB exposed cohort, this was due to well-being and disease remission rather than inefficacy or adverse reaction (p=0,025). In dyslipidemic patients treated with statins, data showed that bDMARDs were continued for a longer time than in DYS patients treated with other anti dyslipidemic therapies (41,09 vs. 26,50 months, p=0,042).Conclusion:our data suggest that AH and DYS may be associated with higher frequency of adverse events but a better drug retention. The combination of bDMARD and ACEi/ARB may determine a better control of the inflammatory process by inhibition of angiotensin II, favouring the achievement of remission. In AH patients on bDMARDs, ACEi and ARB could therefore represent an useful anti-hypertensive drug choice. Similarly, statins could be the treatment of choice in DYS patients.References:[1]Gonzalez-Gay MA, et al. Clin Exp Rheumatol. 2006.[2]Pollono EN, et al. Clin Rheumatol. 2010[3]van Sijl AM, et al. Semin Arthritis Rheum. 2011.[4]Yoshida S, et al. J Hum Hypertens. 2014.[5]Gremese E, et al. Arthritis Care Res (Hoboken). 2013.[6]Heimans L, et al. Arthritis Care Res (Hoboken). 2013.Disclosure of Interests:Laura Cometi: None declared, Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Nicolò Chiti: None declared, Lorenzo Tofani: None declared, Francesca Nacci: None declared, Francesca Bartoli: None declared, Silvia Bellando Randone: None declared, Ginevra Fiori: None declared, Serena Guiducci: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim
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Tesei G, Bruni C, Cometi L, Nacci F, Capassoni M, Terenzi R, Tofani L, Bartoli F, Fiori G, Matucci-Cerinic M. AB0361 EFFICACY AND SAFETY OF BARICITINIB (BARI) IN RHEUMATOID ARTHRITIS(RA): CLINICAL AND ULTRASOUND EVALUATION IN REAL LIFE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Remission or low disease activity (LDA) are the ultimate goals of both conventional synthetic (csDMARD), target synthetic and biologic disease-modifying anti-rheumatic drugs (bDMARD) in treating RA. Janus Kinase (JAK) inhibitors are nowadays part of tsDMARDs, with BARI as an oral selective JAK1-2 inhibitor. Ultrasound (US) is a valuable imaging tool for detecting inflammatory joint changes and monitoring RA patients. The US7 score (US7) is a semiquantitative score including grayscale (GS) and power Doppler (PD) measurements of synovitis and tenosynovitis in 7 joints of the clinically dominant hand and foot.Objectives:to evaluate real life efficacy and safety of BARI 4 mg in RA patients using clinical, clinimetric and US evaluation.Methods:adult RA patients starting BARI were eligible. DAS28ESR, CDAI, SDAI, painVAS, HAQ, COCHIN, laboratory parameters and US7 were performed/collected at baseline (BL) and after 3 and 6 months. Adverse events (AE) and concomitant medications were recorded. Responder/non responder status was determined using DAS28ESR improvement according to the EULAR Response Criteria at 3 months. Moreover, SDAI clinical remission or LDA (remission: SDAI≤3,3; LDA:3,3<SDAI≤11) were calculated at 3 and 6 months.Results:43 patients (12 csDMARD and 31 bDMARD failure) were enrolled, with 30 patients starting BARI in combination with a csDMARDs. BL painVAS was 68±23mm and disease activity was moderate to severe according to DAS28VES, CDAI and SDAI. BARI determined a significant improvement of every disease activity composite score and US7 components, except tendon PD; steroid daily dosage was significantly reduced.28 patients were considered Responders at 3 months: responders used to have higher disease activity levels and synovitis scores at baseline.Table 1.Comparisons demographics and renal pathologies of responder and non-responder groupsBL3Mp value6Mp valueRNRRNRRNRpainVAS67,88±23,3758,18±22,7230,19±23,5245,64±25,48p=0.004030,19±20,4229,73±22,15p=0.2105Daily prednisone equivalent5,97±5,575,45±4,302,96±3,023,95±3,63p=0.22481,63±2,103,03±3,59p=0.1247GSS8,50±5,257,00±3,813,69±3,632,33±2,45p=0.93343,56±3,014,22±2,64p=0.2452GST2,88±2,333,11±2,090,88±0,891,56±1,59p=0.65011,00±1,372,78±1,72p=0.0831PDS8,00±7,113,33±3,463,00±3,482,44±3,36p=0.00663,25±3,135,00±4,56p=0,0006PDT2,81±2,462,44±3,360,88±1,541,33±1,50p=0.449901,06±1,533,78±3,19p=0.0156Erosions1,25±2,050,44±0,731,50±2,030,44±0,73p=0.07361,31±2,091,11±1,27p=0.0902Interestingly, painVAS and steroid dosage significantly decreased both in responders and non-responders, achieving similar value at 6 months. Non-responders showed both synovial and tendon involvement relapse at 6 months, with significantly higher PD score compared to responders. Remission was reached by 12,8% patients at 3 months and 21,6% at 6 months, while LDA patients were respectively 53,8% and 51,3%; combination with csDMARD was the only factor positively associated with remission/LDA at 3 months.The percentage of dropped-out patients due to AE was aligned with literature data (5% in 6 months) whereas the percentage of Herpes Zoster Virus (HZV) infections was higher (4,6% in 6 months in our population vs 4,3% in 1 year in RCTs). Corticosteroid dosage was directly associated with AE development at 6 months.Conclusion:Real life data confirmed BARI RCTs efficacy and safety data. Non responders showed both synovial and tendon PD disease relapse, despite painVAS and steroid reduction were comparable to responders. In our population, HZV infection prevalence was higher than in RCTs and corticosteroid dosage was positively associated with AE development at 6 months.Disclosure of Interests:Giulia Tesei: None declared, Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Laura Cometi: None declared, Francesca Nacci: None declared, Marco Capassoni: None declared, Riccardo Terenzi: None declared, Lorenzo Tofani: None declared, Francesca Bartoli: None declared, Ginevra Fiori: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim
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Cometi L, Bruni C, Chiti N, Tofani L, Nacci F, Bartoli F, Bellando-Randone S, Melchiorre D, Fiori G, Guiducci S, Matucci-Cerinic M. Effect of Dysmetabolisms and Comorbidities on the Efficacy and Safety of Biological Therapy in Chronic Inflammatory Joint Diseases. J Clin Med 2020; 9:jcm9051310. [PMID: 32370139 PMCID: PMC7290363 DOI: 10.3390/jcm9051310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/21/2022] Open
Abstract
In the present study we evaluated how systemic arterial hypertension (SAH), dyslipidemia and diabetes mellitus influence the efficacy, safety and retention rate of biological disease-modifying anti-rheumatic drug (bDMARD) treatment in rheumatic musculoskeletal disorders (RMDs). The charts of RMD patients treated with the first-line bDMARD were reviewed, collecting data on safety, efficacy and comorbidities at prescription (baseline, BL), after 6 months (6M) and at last observation on bDMARD (last observation time, LoT). In 383 RMD patients, a higher rate of adverse events at 6M (p = 0.0402) and at LoT (p = 0.0462) was present in dyslipidemic patients. Patients who developed dyslipidemia or SAH during bDMARD treatment had similar results (dyslipidemia p = 0.0007; SAH p = 0.0319) with a longer bDMARD retention as well (dyslipidemia p < 0.0001; SAH p < 0.0001). SAH patients on angiotensin converting enzyme inhibitors (ACEis) or angiotensin-II receptor blockers (ARBs) continued bDMARDs for longer than non-exposed patients (p = 0.001), with higher frequency of drug interruption for long-standing remission rather than inefficacy or adverse reactions (p = 0.0258). Similarly, dyslipidemic patients on statins had a better bDMARD retention than not-exposed patients (p = 0.0420). In conclusion, SAH and dyslipidemia may be associated with higher frequency of adverse events but a better drug retention of first-line bDMARD in RMDs, suggesting an additional effect of ACEis/ARBs or statins on the inflammatory process and supporting their use in RMD bDMARD patients with SAH/dyslipidemia.
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Affiliation(s)
- Laura Cometi
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
- Correspondence:
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
| | - Nicolò Chiti
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
| | - Francesca Nacci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
| | - Francesca Bartoli
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy;
| | - Daniela Melchiorre
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy;
| | - Ginevra Fiori
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy;
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy;
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Via delle Oblate 4, 50141 Florence, Italy; (C.B.); (N.C.); (L.T.); (F.N.); (F.B.); (S.B.-R.); (D.M.); (S.G.); (M.M.-C.)
- Department of Geriatric Medicine, Division of Rheumatology Azienda Ospedaliera Universitaria Careggi, 50141 Florence, Italy;
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Zanca R, Marciano A, Bartoli F, Doria R, Conti U, Lazzeri E, Slart RHJA, Erba PA. P148Advance texture analysis: a new step in imaging of IE? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Zanca
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - A Marciano
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - F Bartoli
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - R Doria
- Azienda Ospedaliero-Universitaria Pisana, Unit of Infectious Diseases, Pisa, Italy
| | - U Conti
- Azienda Ospedaliero-Universitaria Pisana, Division of Cardiology, Pisa, Italy
| | - E Lazzeri
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - RHJA Slart
- University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, Netherlands (The)
| | - P A Erba
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
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Zanca R, Marciano A, Bartoli F, Mari M, Mocellin DM, Ferrari M, Berchiolli R, Erba PA. P149Comparative assessment of [18F] FDG, [18F]NaF and 68Ga-DOTATATE imaging in patients with symptomatic carotid stenosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Zanca
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - A Marciano
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - F Bartoli
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
| | - M Mari
- Azienda Ospedaliero-Universitaria Pisana, Vascular Surgery Unit Department of Translational Research and New Technologies in Medicine,, Pisa, Italy
| | - D M Mocellin
- Azienda Ospedaliero-Universitaria Pisana, Vascular Surgery Unit Department of Translational Research and New Technologies in Medicine,, Pisa, Italy
| | - M Ferrari
- Azienda Ospedaliero-Universitaria Pisana, Vascular Surgery Unit Department of Translational Research and New Technologies in Medicine,, Pisa, Italy
| | - R Berchiolli
- Azienda Ospedaliero-Universitaria Pisana, Vascular Surgery Unit Department of Translational Research and New Technologies in Medicine,, Pisa, Italy
| | - P A Erba
- Azienda Ospedaliero-Universitaria Pisana, Regional Center of Nuclear Medicine, Pisa, Italy
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Campani C, Guido M, Colagrande S, Bartoli F, Arena U, Marra F. A Large Rheumatoid Nodule Mimicking Hepatic Malignancy. Hepatology 2019; 69:1345-1348. [PMID: 30194686 DOI: 10.1002/hep.30261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/04/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Claudia Campani
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Maria Guido
- Dipartimento di Medicina, University of Padua, Padua, Italy
| | - Stefano Colagrande
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Umberto Arena
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Fabio Marra
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.,Research Center DENOTHE, University of Florence, Florence, Italy
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Bartoli F, Bae S, Cometi L, Matucci Cerinic M, Furst DE. Sirukumab for the treatment of rheumatoid arthritis: update on sirukumab, 2018. Expert Rev Clin Immunol 2018; 14:539-547. [PMID: 29925278 DOI: 10.1080/1744666x.2018.1487291] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Interleukin-6 (IL-6) is well-known for its pro-inflammatory properties, has been proven to target a wide range of cells in the joint, and has been implicated in extra-articular and articular manifestations in rheumatoid arthritis (RA). Tocilizumab (TCZ) is now widely used in patients with active RA and a number of additional agents that target the IL-6 pathways are under development, including sirukumab (SRK). Areas covered: SRK is an IgG1κ human anti-IL-6 monoclonal antibody which binds to IL-6 and prevents IL-6-mediated downstream effects. Initial trial results in phase-III studies in patients with RA seemed promising, showing improved results in patients with moderate-to-severe RA. Data derive from the phase-II study and the various SIRROUND studies (phase III). Expert commentary: The available data show that SRK50 mg every 4 weeks or 100 mg every 2 weeks will be effective in treating the RA population, with clinical improvements as early as week 2 and sustained over time. The adverse-event profile seems to be similar to TCZ, except for an increased mortality post open-label studies due to infections and cardiovascular events, our knowledge of which will be deepened with post-marketing surveillance and registry data.
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Affiliation(s)
- Francesca Bartoli
- a Department of Experimental and Clinical Medicine , University of Florence & Department of Geriatric Medicine, Division of Rheumatology, AOUC , Florence , Italy
| | - Sangmee Bae
- b Division of Rheumatology Fellow , Geffen School of Medicine at the University of California in Los Angeles , Los Angeles , California, USA
| | - Laura Cometi
- a Department of Experimental and Clinical Medicine , University of Florence & Department of Geriatric Medicine, Division of Rheumatology, AOUC , Florence , Italy
| | - Marco Matucci Cerinic
- a Department of Experimental and Clinical Medicine , University of Florence & Department of Geriatric Medicine, Division of Rheumatology, AOUC , Florence , Italy
| | - Daniel E Furst
- c Geffen School of Medicine at the University of California in Los Angeles (Emeritus), California, USA.,d Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.,e University of Washington , Seattle , Washington DC , USA.,f Pacific Arthritis , Los Angeles , California , USA.,g Seattle Rheumatology Associates , Seattle , Washington, DC, USA
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Bartoli F, Bailey M, Rode B, Mateo P, Gosain R, Plante J, Norman K, Gomez S, Lefebvre F, Rucker-Martin C, Gomez A, Beech D, Foster R, Benitah J, Sabourin J. Orai1 channels inhibition protects the heart from pressure overload-induced ventricular dysfunction. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Fiori G, Marzi T, Bartoli F, Bruni C, Ciceroni C, Palomba M, Zolferino M, Corsi E, Galimberti M, Moggi Pignone A, Viggiano MP, Guiducci S, Calamai M, Matucci-Cerinic M. The challenge of pet therapy in systemic sclerosis: evidence for an impact on pain, anxiety, neuroticism and social interaction. Clin Exp Rheumatol 2018; 36 Suppl 113:135-141. [PMID: 30277859] [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: 02/26/2017] [Accepted: 01/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of our study was to evaluate the effect of animal-assisted intervention (AAI), a complementary support to traditional therapies focused on the interaction between animals and human beings, in improving psychological trait, anxiety and pain in a cohort of systemic sclerosis (SSc) patients. METHODS 42 SSc patients, undergoing iloprost intravenous infusion, were divided in three groups: 1) 14 patients submitted to 20 AAI sessions; 2) 14 patients engaged in alternative social activity (control group 1 - C1); and 3) 14 patients without any alternative activity (control group 2 - C2). All patients underwent Visual Analog Scale (VAS), the State-anxiety (STAI-S) and emotional faces at the beginning (s0) and at the end (s1) of each single session, while General Anxiety State-Trait Anxiety Inventory (STAI-T), Beck Depression Inventory (BDI), Social Interaction Anxiety Scale (SIAS), Eysenck Personality Questionnaire-Revised (EPQ-R), the Social Phobia Scale (SPS), the Toronto Alexythymia Scale (TAS-20), the Thought Control Questionnaire (TCQ) were administered at baseline (t0) and at the end of the project (t1). RESULTS AAI group showed a significant decrease of the anxiety state level in respect to the two control groups (p<0.001). VAS scale resulted lower both in AAI (p < 0.001) and C1 group (p<0.01). Moreover, STAI-T and TAS scores were significantly reduced in AAI group (p<0.001). TCQ scale showed that patients treated with AAI, compared to control group C2, had greater capacity to avoid unpleasant and unwanted thoughts (p<0.05). In AAI group, the EPQ-R test revealed an enhancement of extroversion trait compared to both control groups (p<0.05). CONCLUSIONS Our data show that AAI significantly reduces pain perception, anxiety, neuroticism and ameliorates patients' social interaction, therefore it may be a useful to allow a better compliance to traditional therapies.
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Affiliation(s)
- Ginevra Fiori
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
| | - Tessa Marzi
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Italy
| | - Francesca Bartoli
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Ciceroni
- Veterinary Service of Azienda Sanitaria Locale 10, Florence, Italy
| | - Michela Palomba
- Italian Association "Utilizzo Cani D'Assistenza" (AIUCA society), Italy
| | - Michela Zolferino
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elena Corsi
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Alberto Moggi Pignone
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Emergency Medicine, Division of Medicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Pia Viggiano
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Monica Calamai
- General Director of the Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology & Scleroderma Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Bellando-Randone S, Bruni C, Lepri G, Fiori G, Bartoli F, Conforti ML, Moggi-Pignone A, Guiducci S, Giuggioli D, Colaci M, Spinella A, Ferri C, Matucci-Cerinic M. The safety of iloprost in systemic sclerosis in a real-life experience. Clin Rheumatol 2018; 37:1249-1255. [DOI: 10.1007/s10067-018-4043-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 02/02/2023]
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Affiliation(s)
- F Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - M Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - C Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - G Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,Division of Psychiatry, University College London, London, UK
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Corbo M, Acciavatti T, Fiori F, Santacroce R, Aguglia A, Bartoli F, Calò S, Ribolsi M, Barone Y, Pinna F, Stilo M, Staffa P, Caroleo M, Ruberto S, Signorelli M, Suraniti F, Quattrone D, Reggianini C, Carra E, Gazzoletti E, Campese O, Castellazzi M, Ostuzzi G, Bighelli I, Nosè M, Barbui C, Martinotti G. Role of Co-occurring Alcohol and Substances Abuse on QTc Interval Prolongation Among Psychiatric Patients: A Cross-sectional National Survey. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionQTc interval prolongation is considered a risk factor for fatal polymorphic ventricular tachycardia, which can result in sudden cardiac death. Most psychotropic drugs have a dose-dependent potential to prolong the QTc interval. However, other factors require appropriate consideration, including: age; gender; other medications; electrolyte abnormalities; severe comorbid conditions, such as co-occurring alcohol or substances abuse/dependence.ObjectivesThe objective was to study the potential mediating roles of alcohol/substances abuse on QTc prolongation.AimsThe Italian research group STAR Network, in collaboration with the Young Italian Psychiatrists Association, aimed to evaluate the frequency of QTc interval prolongation in a sample of patients under treatment with psychotropic drugs through a cross-sectional national survey.MethodsA sample of 2411 unselected patients were enrolled after performing an ECG during the recruitment period. Sociodemographic and clinical characteristics were collected from medical records. Collected data underwent statistical analysis.ResultsA total of 11.2% of patients reported alcohol abuse, and only 8.9% psychotropic substances. According to the threshold, less than 20% of patients had a borderline value of QTc, and 1% a pathological value. Patients with co-occurring alcohol misuse and drug abuse were more likely to have longer QTc interval.ConclusionsThe present study describes the frequency of QTc prolongation in real-world clinical practice. Before prescribing a psychotropic drug, the physician should carefully assess its risks and benefits to avoid this type of adverse reaction, particularly when additional risk factors are present. The potential role of alcohol and substances on QTc length could be particularly useful in emergency settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Fredi M, Bartoli F, Cavazzana I, Ceribelli A, Carabellese N, Tincani A, Satoh M, Franceschini F. Calcinosis in poly-dermatomyositis: clinical and laboratory predictors and treatment options. Clin Exp Rheumatol 2017; 35:303-308. [PMID: 27908312] [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: 06/13/2016] [Accepted: 09/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES We aimed to identify the possible clinical and laboratory predictors of calcinosis in a cohort of patients with a diagnosis of polymyositis (PM) and dermatomyositis (DM). METHODS We carried out a retrospective analysis of a cohort of myositis patients attending our clinic between January 2013 and May 2014. RESULTS 74 patients (58 females, 16 males) with PM (30 cases), DM (30 cases), overlap syndrome (13 cases) and inclusion body myositis (1 case) were enrolled. Sixteen patients (21.6%) had calcinosis that occurred a mean of 43.7 months after diagnosis of PDM. At multivariate analysis, patients with calcinosis experienced longer follow-up duration (p=0.006), anti-PM/Scl (p=0.033) and anti-NXP2 (p=0.024) positivity compared to patients without calcinosis. Furthermore, anti-NXP-2 positive C+ showed a diffuse form of calcinosis from the beginning and lower frequency of respiratory tract involvement. No single drug or associations of drugs was found effective in the treatment of calcinosis. CONCLUSIONS A longer follow-up period of time, DM diagnosis and positivity for PM/Scl and NXP-2 could all be considered risk factors which foresee the development of calcinosis. Moreover, the positivity for antibodies to NXP-2 depicts a distinct phenotype of calcinosis with an early onset and quick widespread dissemination.
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Affiliation(s)
- Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Rheumatology Chair, Spedali Civili, Brescia, Italy
| | - Francesca Bartoli
- Rheumatology and Clinical Immunology Unit, Rheumatology Chair, Spedali Civili, Brescia; and Università degli Studi di Brescia, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, Rheumatology Chair, Spedali Civili Brescia, Italy.
| | - Angela Ceribelli
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano (Milan); and BIOMETRA Department, University of Milan, Italy
| | - Nice Carabellese
- Rheumatology and Clinical Immunology Unit, Rheumatology Chair, Spedali Civili, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Rheumatology Chair, Spedali Civili, Brescia; and Università degli Studi di Brescia, Italy
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Rheumatology Chair, Spedali Civili, Brescia, Italy
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Braschi F, Bartoli F, Bruni C, Fiori G, Fantauzzo C, Paganelli L, De Paulis A, Rasero L, Matucci-Cerinic M. Lidocaine controls pain and allows safe wound bed preparation and debridement of digital ulcers in systemic sclerosis: a retrospective study. Clin Rheumatol 2016; 36:209-212. [PMID: 27686661 DOI: 10.1007/s10067-016-3414-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/18/2016] [Revised: 08/25/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022]
Abstract
In Systemic Sclerosis (SSc), digital ulcers (DU) are painful, difficult to heal, and frequently infected. To reduce the risk of bacterial infection and to prevent chronicity, it is essential to carefully remove necrotic tissue from DU, with maximum patient comfort. Debridement, although very efficacious, is invasive and causes local pain: lidocaine is a local anesthetic commonly used as to fight pain during debridement procedures. The aim of the study was to evaluate the efficacy of lidocaine 4 % in pain control during debridement procedure of DU in SSc. One hundred eight DU characterized by pain Numeric Rating Scale (NRS) >3/10 before starting the procedure were treated with lidocaine 4 % (lidocaine cloridrate 200 mg in 5 ml of injecting solution). Pain was measured with NRS (0-10) before starting debridement, after 15 min of lidocaine application and at the end of the procedure. In DU, in respect to baseline (mean NRS 6.74 ± 2.96), pain after application of lidocaine 4 % for 15 min was significantly lower (mean NRS 2.83 ± 2.73) (p < 0.001). At the end of the procedure, pain control was still maintained and significantly lower (mean NRS 2.88 ± 2.65) in respect to baseline (p < 0.001). No systemic adverse event due to topical lidocaine were observed. In SSc, topical application of lidocaine 4 % significantly reduces pain, allowing a safe debridement procedure, thus improving the management of DU.
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Affiliation(s)
- Francesca Braschi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. .,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy.
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Ginevra Fiori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Claudia Fantauzzo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Lucia Paganelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Laura Rasero
- Department of Public Health AOUC, University of Florence, Florence, Italy
| | - M Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine Division of Rheumatology AOUC, University of Florence, Florence, Italy
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Guiducci S, Bellando-Randone S, Bruni C, Giuggioli D, Colaci M, Lumetti F, Lepri G, Fiori G, Bartoli F, Ferri C, Matucci-Cerinic M. AB0637 Iloprost (ILO) in Systemic Sclerosis (SSC): The Safety Experience of Two Italian Centres. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bartoli F, Bruni C, Tesei G, Denaro V, Nacci F, Antonuzzo L, Di Costanzo F, Matucci-Cerinic M, Fiori G. SAT0582 Incidence of Malignancies in Patients with Inflammatory Rheumatic Diseases and Biological Drugs: Experience from One Center in Italy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fiori G, Bartoli F, Marzi T, Bruni C, Lepri G, Bellando-Randone S, Guiducci S, Denaro V, Tesei G, Matucci-Cerinic M. THU0641-HPR The Challenge of Pet Therapy in Rheumatology: Evidence for The Improvement of Patients Compliance in Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bartoli F, Fiori G, Braschi F, Amanzi L, Bruni C, Blagojevic J, Bellando-Randone S, Cometi L, de Souza Mueller C, Guiducci S, Rasero L, Epifani F, Furst DE, Matucci-Cerinic M. Calcinosis in systemic sclerosis: subsets, distribution and complications. Rheumatology (Oxford) 2016; 55:1610-4. [PMID: 27241706 DOI: 10.1093/rheumatology/kew193] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 07/23/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To retrospectively analyse the features of calcinosis in a cohort of SSc patients. METHODS Charts of SSc patients attending the Ulcer Unit of the Rheumatology Department, University of Florence and presenting a clinical suspicion of calcinosis were considered in the study. Data on clinical history, including recent skin changes, and clinical examination of all areas with suspected calcinosis, radiological imaging of the calcinotic area, demographics and SSc-related organ involvement and pain measured by a visual analogue scale were recorded. RESULTS In 52 of 112 SSc patients, a total of 316 calcinoses were recorded and were divided into visible and palpable {154 [47.4%], clustered according to their macroscopic features as mousse [49 (31.8%)] and stone [: 105 (68.2%)]} and non-visible but palpable {: 162 [52.6%]: net [5 (3%)], plate [22 (13.8%)] and stone [135 (83.2%)]}. The X-ray-based classification of all calcinoses, both visible and non-visible, was as follows: stone, 289 (91.4%); net, 12 (3.8%) and plate, 15 (4.8%). Skin ulcers complicated 154 of 316 calcinoses (48.7%). Mousse calcinosis was associated with pulmonary arterial hypertension, the stone subset was suggestive of pulmonary involvement and justified further investigation and the net subset was the slowest to heal. CONCLUSION Our data indicate that calcinosis may be classified in SSc as mousse, stone, net and plate according to its clinical and X-ray features. This classification awaits validation for a possible use in clinical practice and to support early treatment and prevention of complications.
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Affiliation(s)
- Francesca Bartoli
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Ginevra Fiori
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Francesca Braschi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Amanzi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Jelena Blagojevic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Carolina de Souza Mueller
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy Serviço de Reumatologia, University Hospital of Curitiba, Paraná, Brazil
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | | | - Francesco Epifani
- Interinstitutional Department of Didactic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Daniel E Furst
- Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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Blagojevic J, Piemonte G, Benelli L, Braschi F, Fiori G, Bartoli F, Guiducci S, Bellando Randone S, Galluccio F, Cometi L, Castellani S, Boddi M, Moggi Pignone A, Rasero L, Epifani F, Matucci-Cerinic M. Assessment, Definition, and Classification of Lower Limb Ulcers in Systemic Sclerosis: A Challenge for the Rheumatologist. J Rheumatol 2016; 43:592-8. [PMID: 26834223 DOI: 10.3899/jrheum.150035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate pathogenesis and clinical features of lower limb ulcers in systemic sclerosis (SSc) and to propose a classification that could be used in clinical practice. METHODS Charts of 60 patients with SSc who had lower limb cutaneous lesions were reviewed. All patients had videocapillaroscopy and arterial and venous lower limb color Doppler ultrasonography (US). Arteriography was performed if occlusive peripheral arterial disease was suspected. RESULTS The 554 lesions were classified as hyperkeratosis, ulcers, and gangrenes. There were 341 (61.6%) hyperkeratoses, 208 (37.5%) ulcers, and 5 (0.9%) gangrenes. Ulcers were divided into pure ulcers, ulcers associated with hyperkeratosis, and ulcers secondary to calcinosis. Involvement of arterial and venous macrocirculation as determined by color Doppler US was observed in 17 (18.3%) and 18 (30%) patients, respectively. Seventeen out of 37 patients with pure ulcers (45.9%) presented neither venous insufficiency nor hemodynamically significant macrovascular arterial disease. In these patients, pure ulcers were most likely caused by isolated SSc-related microvascular involvement (pure microvascular ulcers). The only significant risk factor for development of pure microvascular ulcers in the multivariate analysis was the history of lower limb ulcers (OR 26.67, 95% CI 2.75-259.28; p < 0.001). CONCLUSION Results of our study indicate that lower limb ulcers in SSc often have a multifactorial pathogenesis that may be difficult to manage. Further studies are needed to validate the proposed classification and to assess the most appropriate management of lower limb ulcers in SSc.
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Affiliation(s)
- Jelena Blagojevic
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Guya Piemonte
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Laura Benelli
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Francesca Braschi
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Ginevra Fiori
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Francesca Bartoli
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Serena Guiducci
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Silvia Bellando Randone
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Felice Galluccio
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Laura Cometi
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Sergio Castellani
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Maria Boddi
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Alberto Moggi Pignone
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Laura Rasero
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Francesco Epifani
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
| | - Marco Matucci-Cerinic
- From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
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Schivalocchi A, Carretta D, Bartoli F, Crocamo C, Carrà G. E-health app to reduce binge drinking among adolescents and young adults: the D-ARIANNA Project. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pini Prato A, Carlucci M, Bagolan P, Gamba PG, Bernardi M, Leva E, Paradies G, Manzoni C, Noccioli B, Tramontano A, Jasonni V, Vaccarella F, De Pascale S, Alberti D, Riccipetitoni G, Falchetti D, Caccia F, Pelizzo G, Schleef J, Lima M, Andriolo P, Franchella A, Cacciari A, Caravaggi F, Federici S, Andermarcher M, Perrino G, Codrich D, Camoglio FS, Chiarenza FS, Martino A, Appignani A, Briganti V, Caterino S, Cozzi D, Messina M, Rizzo A, Liotta L, Salerno D, Aceti MGR, Bartoli F, Romeo C, Esposito C, Lelli Chiesa PL, Clemente E, Mascia L, Cacciaguerra S, Di Benedetto V, Licciardi S, De Grazia E, Ubertazzi M, Piazza G, Mattioli G, Rossi F, Nobili M. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50:1441-56. [PMID: 25783403 DOI: 10.1016/j.jpedsurg.2015.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.
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Affiliation(s)
| | - M Carlucci
- Istituto Giannina Gaslini, Genova, Italy
| | - P Bagolan
- Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - P G Gamba
- Azienda Ospedaliero-Universitaria, Padova, Italy
| | - M Bernardi
- Azienda Ospedaliera della Provincia di Lecco, Merate, Italy
| | - E Leva
- Ospedale Maggiore Policlinico Magiagalli, Milano, Italy
| | | | | | - B Noccioli
- Ospedale Pediatrico Meyer, Firenze, Italy
| | - A Tramontano
- Azienda Ospedaliera Pediatrica Santobono Pausilipon, Napoli, Italy
| | - V Jasonni
- Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - F Vaccarella
- ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | | | | | - F Caccia
- Ospedale San Carlo Borromeo, Milano
| | | | - J Schleef
- Ospedale Infantile Regina Margherita, Torino
| | - M Lima
- Ospedale Sant'Orsola Malpighi, Bologna
| | | | | | | | | | | | | | | | - D Codrich
- Ospedale Infantile Burlo Garofalo, Trieste
| | | | | | | | - A Appignani
- Ospedale Santa Maria della Misericordia, Perugia
| | | | | | | | - M Messina
- Ospedale Policlinico Santa Maria alle Scotte, Siena
| | | | - L Liotta
- Ospedale Francesco Ferrari, Casarano
| | - D Salerno
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | | | - F Bartoli
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
| | - C Romeo
- Azienda Ospedaliero-Universitaria G. Martino, Messina
| | - C Esposito
- Policlinico Universitario Federico II, Napoli
| | | | - E Clemente
- Azienda Ospedaliera Universitaria S. Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | | | | | - E De Grazia
- Azienda Ospedaliero-Universitaria Policlinico P. Giaccone
| | | | - G Piazza
- Ospedale Sant'Antonio Abate, Trapani
| | | | - F Rossi
- Ospedale Maggiore della carità, Novara
| | - M Nobili
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
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Fredi M, Bartoli F, Cavazzana I, Carabellese N, Ceribelli A, Tincani A, Satoh M, Franceschini F. SAT0469 Calcinosis Cutis in Poly-Dermatomyositis: Clinical and Therapeutic Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fiori G, Bartoli F, Marzi T, Galimberti M, Palomba M, Corsi E, Zolferino M, Ciceroni C, Matucci Cerinic M. FRI0465 Animal (PET)-Assisted Therapy Helps in Reducing Pain and Promotes Social-Affective Regulation in Systemic Sclerosis (SSC). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bruni C, Guiducci S, Bellando-Randone S, Lepri G, Braschi F, Fiori G, Bartoli F, Peruzzi F, Blagojevic J, Matucci-Cerinic M. Digital ulcers as a sentinel sign for early internal organ involvement in very early systemic sclerosis. Rheumatology (Oxford) 2014; 54:72-6. [PMID: 25065009 DOI: 10.1093/rheumatology/keu296] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the presence of digital lesions in very early diagnosis of SSc (VEDOSS) patients and its possible association with internal organ involvement. METHODS One hundred and ten VEDOSS patients were investigated for the presence of digital ulcers (DUs), digital pitting scars, calcinosis, necrosis or gangrene, nailfold videocapillaroscopic abnormalities, disease-specific autoantibodies (ACA and anti-topo I) and internal organ involvement. RESULTS Four patients reported a history of digital pitting scars, while 25 patients presented an active DU or reported a history of DUs. In particular, 16 patients presented with active DUs (14/16 also reporting a history of previous DUs), while the other 9 patients reported a history of DUs only. A statistically significant association between DUs and oesophageal manometry alteration was found in the whole DU population, as well as in the history of DU and the presence of active DU with/without a history of DU subgroups (P < 0.01, P = 0.01 and P < 0.05, respectively). DUs were observed in VEDOSS patients with internal organ involvement but not in those without organ involvement. CONCLUSION DUs are already present in VEDOSS patients characterized by internal organ involvement, significantly correlating and associating with gastrointestinal involvement. DUs may be a sentinel sign for early organ involvement in VEDOSS patients.
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Affiliation(s)
- Cosimo Bruni
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Francesca Braschi
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Ginevra Fiori
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Francesca Bartoli
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Francesca Peruzzi
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Jelena Blagojevic
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
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Abstract
PURPOSE To retrospectively analyze the feasibility, safety and complication rate of laparoscopic inguinal herniorraphy in babies weighing 5 kg or less. METHODS Thirty infants weighing 5 kg or less underwent laparoscopic inguinal hernia repair during a 3-year period. Twenty-eight infants were born preterm and the mean body weight at surgery was 3,800 kg. Internal inguinal ring was closed with a non-absorbable purse-string suture. Contralateral processus vaginalis was closed if patent. Feeding was started on the same day and the patient discharged the following day. Follow-up consisted of physical examination at 1 week, 6 and 12 months post-operatively. RESULTS Of the 30 patients (27 males, 3 females), 11 had bilateral and 19 monolateral hernia (16 right, 3 left). At laparoscopy, 23 infants needed to have bilateral herniorraphies. The mean corrected gestational age at surgery was 49.1 weeks. The mean operative time for repair was 30 min for unilateral and 41 min for bilateral hernia. There were not intra- or post-operative complications as well as conversions or recurrences. CONCLUSIONS Laparoscopic inguinal hernia repair in newborns and in ex-preterm infants is a safe and effective procedure to perform and, perhaps, even less technically demanding than open herniotomy.
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Affiliation(s)
- V Pastore
- Pediatric Surgery Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122, Foggia, Italy,
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Bartoli F, Fiori G, Peruzzi F, Guidi G, Pfanner S, Ceruso M, Matucci Cerinic M. SAT0344 Intravenous Bisphosphonate Reduces Rapidly Pain in Complex Regional Pain Syndrome (CRPS). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Peruzzi F, Bartalesi F, Attala L, Cavallo A, Fiori G, Maddali-Bongi S, Bruni C, Nacci F, Bartoli F, Cappelli S, Denaro V, Bartoloni A, Matucci-Cerinic M. AB0466 Quantiferon (QFT) identifies latent tuberculosis (LTB) but does not help the evaluation of the efficacy of prophylaxis in inflammatory arthritides. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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