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Miceli MC, Zoli A, Peluso G, Bosello S, Gremese E, Ferraccioli G. Baseline Shoulder Ultrasonography Is Not a Predictive Marker of Response to Glucocorticoids in Patients with Polymyalgia Rheumatica: A 12-month Followup Study. J Rheumatol 2016; 44:241-247. [PMID: 27980012 DOI: 10.3899/jrheum.160090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/22/2022]
Abstract
Objective.In this study, we evaluated whether ultrasound (US) subdeltoid bursitis (SB) and/or biceps tenosynovitis (BT) presence at baseline could represent a predictive marker of response to standard therapy after 12 months of followup, and whether a positive US examination could highlight the need of higher maintenance dosage of glucocorticoids (GC) at 6 and 12 months in patients with polymyalgia rheumatica (PMR).Methods.Sixty-six consecutive patients with PMR underwent bilateral shoulder US evaluations before starting therapy and after 12 months of followup. Absence of girdle pain and morning stiffness (clinical remission) and laboratory variables were evaluated. After diagnosis, all patients were treated with prednisone.Results.At baseline, SB and/or BT were present in 46 patients (70%), of whom 33 (72%) became negative while 13 (28%) remained positive at the 12-month US evaluation. All patients rapidly achieved a clinical remission, and at 6 months 26 (39%) also achieved a laboratory variable normalization. According to US positivity at baseline, no difference was found in remission or relapse rate after 12 months. Thirty patients (46%) at 6 months and 7 (11%) at 12 months were still taking more than 5 mg/day of prednisone. According to the US pattern at baseline, no difference was found in the mean GC dose at 6 and 12 months.Conclusion.In patients with PMR, the presence of SB and/or BT on US at diagnosis is not a predictive marker of GC response or of a higher GC dosage to maintain remission in a 12-month prospective followup study.
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Sellam J, Rivière E, Courties A, Rouzaire PO, Tolusso B, Vital EM, Emery P, Ferraccioli G, Soubrier M, Ly B, Hendel Chavez H, Taoufik Y, Dougados M, Mariette X. Serum IL-33, a new marker predicting response to rituximab in rheumatoid arthritis. Arthritis Res Ther 2016; 18:294. [PMID: 27964756 PMCID: PMC5154136 DOI: 10.1186/s13075-016-1190-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent works have suggested a possible link between interleukin (IL)-33 and B-cell biology. We aimed to study the possible association between serum IL-33 detection and response to rituximab (RTX) in rheumatoid arthritis (RA) patients in different cohorts with an accurate enzyme-linked immunosorbent assay (ELISA). METHODS Serum IL-33, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), and high serum immunoglobulin (Ig)G levels were assessed in 111 RA patients receiving a first course of 2 g RTX (cohort 1) in an observational study and in 74 RA patients treated with the same schedule in routine care (cohort 2). Univariate and multivariate analyses identified factors associated with a European League Against Rheumatism (EULAR) response at 24 weeks. RESULTS At week 24, 84/111 (76%) and 54/74 (73%) patients reached EULAR response in cohorts 1 and 2, respectively. Serum IL-33 was detectable in only 33.5% of the patients. In the combined cohorts, the presence of RF or anti-CCP (odds ratio (OR) 3.27, 95% confidence interval (CI) 1.13-9.46; p = 0.03), high serum IgG (OR 2.32, 95% CI 1.01-5.33; p = 0.048), and detectable serum IL-33 (OR 2.40, 95% CI 1.01-5.72; p = 0.047) were all associated with RTX response in multivariate analysis. The combination of these three factors increased the likelihood of response to RTX. When serum IL-33 detection was added to seropositivity and serum IgG level, 100% of the patients with the three risk factors (corresponding to 9% of the population) responded to RTX (OR versus patients with none of the three risk factors 29.61, 95% CI 1.30-674.79; p = 0.034). CONCLUSION Detectable serum IL-33 may predict clinical response to RTX independently of, and synergistically with, auto-antibodies and serum IgG level. TRIAL REGISTRATION NCT01126541 ; 18 May 2010.
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Carbonella A, Mancano G, Gremese E, Alkuraya FS, Patel N, Gurrieri F, Ferraccioli G. An autosomal recessive DNASE1L3-related autoimmune disease with unusual clinical presentation mimicking systemic lupus erythematosus. Lupus 2016; 26:768-772. [PMID: 27821515 DOI: 10.1177/0961203316676382] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe the third family in the world, after Arabian and Turkish ones, displaying an autosomal recessive autoimmune disease (AID), mimicking systemic lupus erythematosus (SLE), with unusual manifestations due to a homozygous frame-shift variant in DNASE1L3. SLE is a complex AID characterized by multiple organ involvement. Genetic risk variants identified account for only 15% of SLE heritability. Rare Mendelian forms have been reported, including DNASE1L3-related SLE. Through specific genetic tests we identified a homozygous 2 bp-deletion c.289_290delAC (NM_004944.2) in DNASE1L3, predicting frameshift and premature truncation (p.Thr97Ilefs*2). The same mutation was previously reported in three sisters, born from consanguineous parents and affected with hypocomplementemic urticarial vasculitis syndrome (HUVS). As approximately 50% of individuals affected with HUVS develop SLE, it is still unclear whether it is a SLE sub-phenotype or a separate condition.
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Biscetti F, Carbonella A, Parisi F, Bosello SL, Schiavon F, Padoan R, Gremese E, Ferraccioli G. The prognostic significance of the Birmingham Vasculitis Activity Score (BVAS) with systemic vasculitis patients transferred to the intensive care unit (ICU). Medicine (Baltimore) 2016; 95:e5506. [PMID: 27902615 PMCID: PMC5134801 DOI: 10.1097/md.0000000000005506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Systemic vasculitides represent a heterogeneous group of diseases that share clinical features including respiratory distress, renal dysfunction, and neurologic disorders. These diseases may often cause life-threatening complications requiring admission to an intensive care unit (ICU). The aim of the study was to evaluate the validity and responsiveness of Birmingham Vasculitis Activity Score (BVAS) score to predict survival in patients with systemic vasculitides admitted to ICU.A retrospective study was carried out from 2004 to 2014 in 18 patients with systemic vasculitis admitted to 2 different Rheumatology divisions and transferred to ICU due to clinical worsening, with a length of stay beyond 24 hours. We found that ICU mortality was significantly associated with higher BVAS scores performed in the ward (P = 0.01) and at the admission in ICU (P = 0.01), regardless of the value of Acute Physiology And Chronic Health Evaluation (APACHE II) scores (P = 0.50). We used receiver-operator characteristic (ROC) curve analysis to evaluate the possible cutoff value for the BVAS in the ward and in ICU and we found that a BVAS > 8 in the ward and that a BVAS > 10 in ICU might be a useful tool to predict in-ICU mortality.BVAS appears to be an excellent tool for assessing ICU mortality risk of systemic vasculitides patients admitted to specialty departments. Our experience has shown that performing the assessment at admission to the ward is more important than determining the evaluation before the clinical aggravation causing the transfer to ICU.
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Bosello S, Peluso G, Iavarone F, Tolusso B, Messana I, Faa G, Castagnola M, Ferraccioli G. Thymosin β 4 and β 10 in Sjögren's syndrome: saliva proteomics and minor salivary glands expression. Arthritis Res Ther 2016; 18:229. [PMID: 27716395 PMCID: PMC5053072 DOI: 10.1186/s13075-016-1134-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background In the present study, we investigated whether thymosin β (Tβ) in saliva and in minor salivary glands is differentially expressed in patients with primary Sjögren’s syndrome (pSS) and patients with autoimmune diseases (systemic sclerosis [SSc], systemic lupus erythematosus [SLE], and rheumatoid arthritis [RA], with and without sicca syndrome [ss]). Methods Saliva specimens of nine patients with pSS, seven with ss/SSc, seven with ss/SLE, seven with ss/RA, seven with SSc, seven with SLE, and seven with RA, as well as ten healthy subjects, were analyzed using a high-performance liquid chromatograph coupled with a mass spectrometer equipped with an electrospray ionization source to investigate the presence and levels of Tβ4, Tβ4 sulfoxide, and Tβ10. Immunostaining for Tβ4 and Tβ10 was performed on minor salivary glands of patients with pSS and ss. Results Tβ4 levels were statistically higher in patients with pSS with respect to the other subgroups. Tβ10 was detectable in 66.7 % of patients with pSS and in 42.8 % of those with ss/SSc, while Tβ4 sulfoxide was detectable in 44.4 % of patients with pSS and in 42.9 % of those with ss/SSc. Tβ10 and Tβ4 sulfoxide were not detectable in patients without associated ss and in healthy control subjects. Regarding thymosin immunostaining, all patients had immunoreactivity for Tβ10, and a comparable distribution pattern in the four different subgroups of patients was observed. Tβ4 immunoreactivity was present in patients with ss/SSc and those with ss/SLE, while it was completely absent in patients with pSS and those with ss/RA. Conclusions Our data show that higher salivary Tβ expression characterizes patients with pSS, while Tβ4 sulfoxide and Tβ10 salivary expression was selectively present in patients with sicca symptoms. Moreover, at the immunohistochemical level in patients with pSS, minor salivary glands showed a peculiar pattern characterized by immunostaining for Tβ10 in acinar cells in the absence of any reactivity for Tβ4. These findings, taken together, suggest a different role for Tβ4 and Tβ10 in patients with pSS who have ss and other autoimmune disease.
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Alivernini S, Kurowska-Stolarska M, Tolusso B, Benvenuto R, Elmesmari A, Canestri S, Petricca L, Mangoni A, Fedele AL, Di Mario C, Gigante MR, Gremese E, McInnes IB, Ferraccioli G. MicroRNA-155 influences B-cell function through PU.1 in rheumatoid arthritis. Nat Commun 2016; 7:12970. [PMID: 27671860 PMCID: PMC5052655 DOI: 10.1038/ncomms12970] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022] Open
Abstract
MicroRNA-155 (miR-155) is an important regulator of B cells in mice. B cells have a critical role in the pathogenesis of rheumatoid arthritis (RA). Here we show that miR-155 is highly expressed in peripheral blood B cells from RA patients compared with healthy individuals, particularly in the IgD-CD27- memory B-cell population in ACPA+ RA. MiR-155 is highly expressed in RA B cells from patients with synovial tissue containing ectopic germinal centres compared with diffuse synovial tissue. MiR-155 expression is associated reciprocally with lower expression of PU.1 at B-cell level in the synovial compartment. Stimulation of healthy donor B cells with CD40L, anti-IgM, IL-21, CpG, IFN-α, IL-6 or BAFF induces miR-155 and decreases PU.1 expression. Finally, inhibition of endogenous miR-155 in B cells of RA patients restores PU.1 and reduces production of antibodies. Our data suggest that miR-155 is an important regulator of B-cell activation in RA. MiR-155 is thought to inhibit PU.1 and thereby drive antigen-induced B-cell maturation. Here the authors show that patients with rheumatoid arthritis have high B-cell miR-155 expression and that an antagomir can rescue PU.1 expression, suggesting potential therapeutic avenues to treat rheumatoid arthritis.
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Iannone F, Sinigaglia L, Favalli EG, Sarzi-Puttini P, Atzeni F, Caporali R, Codullo V, Ferraccioli G, Gremese E, Carletto A, Giollo A, Govoni M, Bergossi F, Galeazzi M, Cantarini L, Salaffi F, Di Carlo M, Bazzani C, Pellerito R, Sebastiani M, Ramonda R, Lapadula G. Drug survival of adalimumab in patients with rheumatoid arthritis over 10 years in the real-world settings: high rate remission together with normal function ability. Clin Rheumatol 2016; 35:2649-2656. [PMID: 27418051 DOI: 10.1007/s10067-016-3349-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 01/06/2023]
Abstract
The purpose of the study was to estimate the clinical profile of naïve biological patients with rheumatoid arthritis (RA) starting adalimumab through 3-year calendar periods and their clinical outcomes such as drug survival and global clinical disease control (GCDC). RA patients starting adalimumab as first biological drug between 2003 and 2012 were subdivided in 3-year calendar periods. Survival on therapy was estimated using the Kaplan-Meier analysis. One and 2-year clinical response was assessed by calculating percentage of patients attaining GCDC (28-joint Disease Activity Score (DAS28) ≤ 2.6 + Health Assessment Questionnaire (HAQ) ≤ 0.5), low disease activity (DAS28 ≤ 3.2), remission (DAS28 ≤ 2.6) and good European League Against Rheumatism (EULAR) response. Multivariate regression models were used to assess baseline predictors of drug discontinuation or achievement of clinical remission. We recruited 1695 RA patients. Overall drug persistence at 3 years was 40.6 %, while the global rate of nonswitching patients was 54.7 %. Compared to 2003-2005, initiators in more recent years had a significantly lower 3-year crude drug retention rate (log rank, p < 0.0001) and a significantly higher rate of switching to alternative biologics (log rank, p < 0.0001). No difference in adverse events or effectiveness rate among the calendar periods was found. A substantial proportion of patients (up to 27 %) achieved GCDC at 2 years, regardless of the calendar period. In real-life setting, RA patients starting adalimumab in more recent years had a higher rate of drug discontinuation not related to ineffectiveness or side effects but to switching, probably due to a wider availability of biologics. A meaningful proportion of patients attained GCDC without any difference across calendar periods.
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Quartuccio L, Sacco S, Franzolini N, Perin A, Ferraccioli G, De Vita S. Efficacy of cyclosporin-A in the long-term management of thrombocytopenia associated with systemic lupus erythematosus. Lupus 2016; 15:76-9. [PMID: 16539277 DOI: 10.1191/0961203306lu2266oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thrombocytopenia frequently complicates systemic lupus erythematosus (SLE), and its long-term management may be problematic. Intravenous immunoglobulins and high doses of steroids are often effective as induction therapy, but thrombocytopenia frequently relapses during steroid tapering. Several immunosuppressive agents have been evaluated as induction or maintenance therapy in small series or in case reports. We describe six consecutive unselected SLE patients where cyclosporin-A (CyA) was effective and safe in the long-term management of thrombocytopenia and allowed steroid tapering. One relapse occurred during CyA reduction and responded to CyA dose adjustment. Steroids could be stopped in three out of six patients, and were maintained at very low doses in the remaining patients. CyA was stopped in one patient after one year of treatment, without relapse at month 11+ from discontinuation. No severe side effects were documented. Overall, these data suggest that CyA may prove to be an effective and safe therapeutic option for SLE-related thrombocytopenia.
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Ferraccioli G, Tolusso B, Gremese E. Could we use a lower dose of rituximab to treat rheumatoid arthritis in clinical practice: pros and cons? Arthritis Res Ther 2016; 18:126. [PMID: 27255529 PMCID: PMC4890326 DOI: 10.1186/s13075-016-1022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The CERERRA database provides evidence that low-dose rituximab performs as well as the conventional dose in the real world, thus highlighting the possible pharmacoeconomic impact. In clinical trials, it has been shown that rituximab 500 mg twice, performs as well as 1 g twice, 2 weeks apart, in terms of the American College of Rheumatology (ACR)20 and ACR50, but not the ACR70. The choice should always be made after considering that the IMAGE trial has demonstrated similar radiographic progression after the first 6 months, but with less control, with low-dose rituximab in the first 6 months. A possible alternative can be hypothesized.
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Biscetti F, Carbonella A, Parisi F, Cianci F, Bosello S, Tolusso B, Gremese E, Ferraccioli G. AB0541 The Prognostic Significance of The Birmingham Vasculitis Activity Score (BVAS) in Patients with Systemic Vasculitis Transferred To The Intensive Care Unit (ICU). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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111
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Ramiro S, Landewé R, van der Heijde D, FitzGerald O, Østergaard M, Homik J, Elkayam O, Thorne J, Larche M, Ferraccioli G, Backhaus M, Boire G, Combe B, Schaeverbeke T, Saraux A, Dougados M, Adami S, Govoni M, Sinigaglia L, Cantagrel A, Allaart C, Barnabe C, Bingham C, Tak P, van Schaardenburg D, Hammer H, Dadashova R, Hutchings E, Paschke J, Maksymowych W. THU0067 Is Treat-To-Target Really Working? A Longitudinal Analysis in Biodam. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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112
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Bosello S, Tolusso B, Berardi G, Canestri S, Parisi F, Di Mario C, Canestrari G, Rucco M, Ferraccioli G. SAT0248 B Cell Characterization in Systemic Sclerosis: CD19 Correlates Inversely with Disease Activity and Plasmablasts Directly with Diffuse Disease and Lung Involvement. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Galeazzi M, Voll R, Sebastiani G, Bazzichi L, Viapiana O, Dudler J, Sarzi-Puttini P, Selvi E, Iuliano A, Pedretti M, Giovannoni L, Bindi I, Bettini C, Ravenni N, Wilton J, Zufferey P, Ferraccioli G, Caporali R, Specker C, Wollenhaupt J, Neri D. AB0364 A Novel Approach for Rheumatoid Arthritis: Results of The Ongoing Clinical Trials with The Fully Human Immunocytokine Dekavil (F8-IL10). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Biscetti F, Angelini F, Gobessi S, Gremese E, Tolusso B, Efremov D, Ferraccioli G. AB0088 Transgenic ZAP-70+ B Cells Mice Show A More Severe Collagen Antibody Induced Arthritis (CAIA) than Wild Type. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bosello S, Basile U, De Lorenzis E, Canestrari G, Parisi F, Rucco M, Birra D, Gulli F, Napodano C, Pocino K, Forni F, Tolusso B, Ferraccioli G. FRI0238 Increased Serum Free Light Chains of Immunoglobulins in Systemic Sclerosis Patients: Correlation with Lung Involvement and Inflammatory Milieu. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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116
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Fedele A, Tolusso B, Canestri S, Gremese E, Di Mario C, Di Sante G, Alivernini S, Ferraccioli G. SAT0155 Signature of Inflammatory Genes in B-Cells and Double Negative Memory Phenotype as Biomarkers of Response To Tocilizumab. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Di Sante G, Tolusso B, Fedele A, Canestri S, Petricca L, Alivernini S, Di Mario C, Gremese E, Ferraccioli G. OP0245 HS1,2A Enhancer Polymorphism in Rheumatoid Arthritis Determines High Disease Activity, High NF-KB Activity in B Cells and Leads To A Differential Response To Therapy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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118
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Di Mario C, Petricca L, Gigante M, Marino G, Varriano V, Barini A, Canestri S, Barini A, Tolusso B, Ferraccioli G, Gremese E. FRI0306 Serum Anti-Müllerian Hormone Levels in SLE Patients: Influence of Disease Severity and Therapy on The Ovarian Reserve. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alivernini S, Tolusso B, Petricca L, Kurowska-Stolarska M, Fedele A, Gremese E, Di Sante G, McInnes I, Ferraccioli G. AB0244 MIR-155 Expression in B Cells of Rheumatoid Arthritis Patients Is Related To Follicular Synovitis and Mirrors B Cell Subpopulations Changes after IL-6R Inhibitor Treatment. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gvozdenović E, Allaart CF, van der Heijde D, Ferraccioli G, Smolen JS, Huizinga TWJ, Landewé R. When rheumatologists report that they agree with a guideline, does this mean that they practise the guideline in clinical practice? Results of the International Recommendation Implementation Study (IRIS). RMD Open 2016; 2:e000221. [PMID: 27175294 PMCID: PMC4860861 DOI: 10.1136/rmdopen-2015-000221] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/01/2016] [Accepted: 04/06/2016] [Indexed: 12/31/2022] Open
Abstract
Introduction The European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) and the treat-to-target (T2T) principles have been developed in order to improve the treatment outcome of patients with RA, and have received broad attention. It is not clear, though, whether these recommendations are indeed followed up in clinical practice. Objective To investigate if rheumatologists that report to agree with existing guidelines indeed follow them up in clinical practice. Methods The International Recommendation Implementation Study (IRIS) included 132 participating rheumatologists from 14 countries. Participating rheumatologists received a questionnaire measuring their awareness/commitment with the EULAR/T2T recommendations and followed a dedicated educational programme. Subsequently, they were asked to enrol 5–10 patients with new-onset RA in the online IRIS database and monitor disease activity and treatment for a period of 1–2 years. Four recommendations (3 from the EULAR recommendations and one from the T2T recommendations) were selected on the basis of testability, and analysed with regard to compliance by participating rheumatologists. Results In total, 72 of the 132 participating rheumatologists contributed 378 patients to the database. Of these participants, 70 (98%) agreed upfront with the recommendation that disease-modifying antirheumatic drug (DMARD) therapy should be started as soon as possible after diagnosis in every patient; 69 (96%) of the rheumatologists agreed with the recommendation that methotrexate (MTX) should be part of the first treatment strategy. When measuring the actual performance, it was found that the recommendation on early DMARD start was met in 253 (67%) of the recorded patients, and the recommendation on MTX in 225 (60%) of the recorded patients. Of the participants, 60 (83%) agreed that composite measures should be recorded regularly, but only in 134(54%) of the patients were composite scores actually recorded in ≥50% of patient visits. Conclusion Reporting to be compliant with EULAR recommendations and T2T principles, even after dedicated education does not mean they actually comply with it in clinical practice.
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De Luca G, Bosello S, Leone AM, Gabrielli F, Pelargonio G, Inzani F, Crea F, Ferraccioli G. Life-threatening arrhythmias in a scleroderma patient: the role of myocardial inflammation in arrhythmic outburst. Scand J Rheumatol 2016; 46:78-80. [PMID: 27098649 DOI: 10.3109/03009742.2016.1157626] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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De Luca G, Bosello SL, Gabrielli FA, Berardi G, Parisi F, Rucco M, Canestrari G, Loperfido F, Galiuto L, Crea F, Ferraccioli G. Prognostic Role of Ventricular Ectopic Beats in Systemic Sclerosis: A Prospective Cohort Study Shows ECG Indexes Predicting the Worse Outcome. PLoS One 2016; 11:e0153012. [PMID: 27101136 PMCID: PMC4839708 DOI: 10.1371/journal.pone.0153012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/22/2016] [Indexed: 01/29/2023] Open
Abstract
Background Arrhythmias are frequent in Systemic Sclerosis (SSc) and portend a bad prognosis, accounting alone for 6% of total deaths. Many of these patients die suddenly, thus prevention and intensified risk-stratification represent unmet medical needs. The major goal of this study was the definition of ECG indexes of poor prognosis. Methods We performed a prospective cohort study to define the role of 24h-ECG-Holter as an additional risk-stratification technique in the identification of SSc-patients at high risk of life-threatening arrhythmias and sudden cardiac death (SCD). One-hundred SSc-patients with symptoms and/or signs suggestive of cardiac involvement underwent 24h-ECG-Holter. The primary end-point was a composite of SCD or need for implantable cardioverter defibrillator (ICD). Results Fifty-six patients (56%) had 24h-ECG-Holter abnormalities and 24(24%) presented frequent ventricular ectopic beats (VEBs). The number of VEBs correlated with high-sensitive cardiac troponin T (hs-cTnT) levels and inversely correlated with left-ventricular ejection fraction (LV-EF) on echocardiography. During a mean follow-up of 23.1±16.0 months, 5 patients died suddenly and two required ICD-implantation. The 7 patients who met the composite end-point had a higher number of VEBs, higher levels of hs-cTnT and NT-proBNP and lower LV-EF (p = 0.001 for all correlations). All these 7 patients had frequent VEBs, while LV-EF was not reduced in all and its range was wide. At ROC curve, VEBs>1190/24h showed 100% of sensitivity and 83% of specificity to predict the primary end-point (AUROC = 0.92,p<0.0001). Patients with VEBS>1190/24h had lower LV-EF and higher hs-cTnT levels and, at multivariate analysis, the presence of increased hs-cTnT and of right bundle branch block on ECG emerged as independent predictors of VEBs>1190/24h. None of demographic or disease-related characteristics emerged as predictors of poor outcome. Conclusions VEBS>1190/24h identify patients at high risk of life-threatening arrhythmic complications. Thus, 24h-ECG-Holter should be considered a useful additional risk-stratification test to select SSc-patients at high-risk of SCD, in whom an ICD-implantation could represent a potential life-saving intervention.
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Ramonda R, Marchesoni A, Carletto A, Bianchi G, Cutolo M, Ferraccioli G, Fusaro E, De Vita S, Galeazzi M, Gerli R, Matucci-Cerinic M, Minisola G, Montecucco C, Pellerito R, Salaffi F, Paolazzi G, Sarzi-Puttini P, Scarpa R, Bagnato G, Triolo G, Valesini G, Punzi L, Olivieri I. Patient-reported impact of spondyloarthritis on work disability and working life: the ATLANTIS survey. Arthritis Res Ther 2016; 18:78. [PMID: 27037139 PMCID: PMC4818386 DOI: 10.1186/s13075-016-0977-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/18/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim was to establish how patients experience the impact of spondyloarthritis (SpA) on work disability and working life. METHODS The survey was performed in 17/20 regions in Italy (1 January to 31 March 2013). A multiple-choice questionnaire was published on the official website of the sponsor - the National Association of Rheumatic Patients (ANMAR) - and hard-copies were distributed at outpatient clinics for rheumatic patients. RESULTS Respondents (n = 770) were of both sexes (56 % men), educated (62 % at high school or more), of working age (75 % aged ≤60 years), and affected by SpA. The most common types diagnosed were ankylosing spondylitis (AS) (39 %) and psoriatic arthritis (PsA) (36 %). Respondents were working full-time (45 %), part-time (8 %) or had retired (22 %); 15 % were unemployed (for reasons linked to the disease or for other reasons, students or housewives). Patients reported disability (39 %), were receiving disability benefits (34 %), were experiencing important limitations that were hindering their professional development/career (36 %) and some had to change/leave their job or lost it because of SpA (21 %). Employed respondents (n = 383) had worked on average 32.2 h in the last 7 days. More hours of work were lost over the last 7 days due to SpA (2.39 h vs 1.67 h). The indirect costs of the disease amounted to €106/week for patients reporting well-being/good physical conditions/improvement and €216/week for those reporting permanent impairment. CONCLUSIONS Most patients were in the midst of their productive years and were experiencing considerable difficulties in carrying out their job because of the disease: half of them reported disability and one third were experiencing important limitations in their career perspective.
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Ferraccioli G, Tolusso B, Fedele AL, Gremese E. Do we need to apply a T2T strategy even in ACPA-negative early rheumatoid arthritis? YES. RMD Open 2016; 2:e000263. [PMID: 27099779 PMCID: PMC4823584 DOI: 10.1136/rmdopen-2016-000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 12/03/2022] Open
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Tolusso B, Alivernini S, Gigante MR, Ferraccioli G, Gremese E. Biomolecular features of inflammation in obese rheumatoid arthritis patients: management considerations. Expert Rev Clin Immunol 2016; 12:751-62. [PMID: 26950427 DOI: 10.1586/1744666x.2016.1159132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Adipose tissue is an active organ playing a role not only in metabolism but also in immune and inflammatory processes, releasing several pro-inflammatory mediators. This can explain the possible association between obesity and rheumatoid arthritis (RA) and its role in the progression of the disease. Adipose and synovial tissues share common histological features of local inflammation in terms of activation of target tissues infiltrating cells (i.e. myeloid cells). Among the so-called adipocytokines, PEDF and Chemerin orchestrate the cellular cross-talk between adipose and myeloid cells, being possible biomarkers to monitor the effect of weight loss or the decrease of adipose tissue in patients with RA. Moreover, dietary intervention has been demonstrated to reduce Chemerin as well as IL-6 and MCP-1 expression. Finally, epigenetic regulators such as micro-RNAs (i.e. miR-155) are key regulators of myeloid cells activation in RA and obesity as well as in adipocytes. In this review, we will summarize the biological link between obesity/overweight state and RA focusing on pathophysiological mechanisms, consequences and management considerations.
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Carbonella A, Berardi G, Petricca L, Biscetti F, Alivernini S, Bosello SL, Fedele AL, Ferraccioli G, Gremese E. Immunosuppressive Therapy (Methotrexate or Cyclophosphamide) in Combination with Corticosteroids in the Treatment of Giant Cell Arteritis: Comparison with Corticosteroids Alone. J Am Geriatr Soc 2016; 64:672-374. [DOI: 10.1111/jgs.14004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Di Sante G, Tolusso B, Ria F, Laura Fedele A, Gremese E, Ferraccioli G. Is Citrullination Required for the Presence of Restricted Clonotypes Reacting With Type II Collagen? Comment on the Article by Chemin et al. Arthritis Rheumatol 2016; 68:2052-3. [PMID: 26946074 DOI: 10.1002/art.39661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/23/2016] [Indexed: 11/06/2022]
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Iannone F, Gremese E, Ferraccioli G, Lapadula G. Comment on “Tumor necrosis factor-α antagonist therapy for concomitant rheumatoid arthritis and hepatitis C virus infection: a case series study”. Clin Rheumatol 2016; 35:839-40. [DOI: 10.1007/s10067-015-2997-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 12/19/2022]
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Fedele AL, Alivernini S, Gremese E, Ferraccioli G. CTLA-4 Ig as an effective treatment in a patient with type I diabetes mellitus and seropositive rheumatoid arthritis. Clin Exp Rheumatol 2016; 34:315-317. [PMID: 26575162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/23/2015] [Indexed: 06/05/2023]
Abstract
We describe a patient suffering from seropositive rheumatoid arthritis (RA) and type I diabetes mellitus (T1DM), who achieved a good EULAR response together with an improvement of the glycemic profile under treatment with CTLA-4 Ig. A close association is known to exist between T1DM and RA, and CTLA-4 exon 1 polymorphism has been associated to RA with coexisting autoimmune endocrinopathies. The possible common genetic background and the potential role of CTLA-4 Ig in the early phases of T1DM, could be considered in the therapeutic interventions in RA patients with type 1 diabetes.
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Biscetti F, Flex A, Pecorini G, Angelini F, Arena V, Stigliano E, Gremese E, Tolusso B, Ferraccioli G. The role of high-mobility group box protein 1 in collagen antibody-induced arthritis is dependent on vascular endothelial growth factor. Clin Exp Immunol 2016; 184:62-72. [PMID: 26671547 DOI: 10.1111/cei.12758] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022] Open
Abstract
High-mobility group box 1 (HMGB1) has been implicated in angiogenesis and rheumatoid arthritis (RA). The aim of this study was to define more clearly the role of HMGB1 in the synovial angiogenesis and pathogenesis of an immune model of arthritis. BALB/c mice were injected with monoclonal anti-collagen antibody cocktail followed by lipopolysaccharide to induce arthritis. HMGB1 and vascular endothelial growth factor (VEGF) were over-expressed in the areas of the synovium where more inflammation and neoangiogenesis were present. The selective blockade of HMGB1 or VEGF resulted alternatively in a lower severity of arthritis evaluated by the arthritis index. Furthermore, exogenous HMGB1 administration caused a worsening of arthritis, associated with VEGF up-regulation and increased synovial angiogenesis. The selective inhibition of VEGF also resulted in no induction of arthritis in mice receiving exogenous HMGB1. Cytokine enzyme-linked immunosorbent assay (ELISA) analyses performed on peripheral blood and synovial fluid demonstrated a significant reduction of interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α in mice where HMGB1 and VEGF pathways were blocked. Interestingly, the selective blockade of HMGB1 and VEGF resulted in an increase of the peripheral IL-17A concentration. The development of arthritis mediated by HMGB1 and the synovial angiogenesis can be blocked by inhibiting the VEGF activity. The proinflammatory and proangiogenic cytokine IL-17A was increased when HMGB1 is inhibited, but the synovial angiogenesis was nevertheless reduced in this model of arthritis. Taken together, these findings shed new light on the role of this nuclear protein in the pathogenesis of arthritis in an RA-like model.
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Di Sante G, Tolusso B, Fedele AL, Gremese E, Alivernini S, Nicolò C, Ria F, Ferraccioli G. Collagen Specific T-Cell Repertoire and HLA-DR Alleles: Biomarkers of Active Refractory Rheumatoid Arthritis. EBioMedicine 2015; 2:2037-45. [PMID: 26844284 PMCID: PMC4703746 DOI: 10.1016/j.ebiom.2015.11.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is characterized by chronic joint inflammation and associates with HLA-DRB1*04. The Collagen IIp261-273-specific T cell repertoire in the peripheral blood of DR4 + patients at the onset of the disease shows a restricted TCR-beta chain usage among which the most frequent is TRBV25. To define whether this group of DR4-restricted collagen-specific shared T cell could represent markers of active-severe disease and response to therapy, 90 subjects affected by early-RA were enrolled in the study; peripheral blood mononuclear cells were cultured with or without the human collagen II peptide p261-273 and were examined by immunoscope analysis for the usage of the previously identified shared TCR-beta chains. We report that the presence of T cells carrying rearrangement TRBV25 associated with HLA-DR haplotype and disease activity. HLA-DRB1* haplotypes 04–04, 04–01 and 04–11 were significantly associated with usage of TRBV25, higher disease activity at the onset of disease and poor response to DMARDs. Finally, the HLA-DRB1* haplotype appeared complementary with current serologic tools to predict good and poor responders in a treat to target strategy. The data reported here offer clues to predict the course of the disease and to foresee personalized treatments in RA patients. In DR4 + RA patients disease activity is associated with detection of Collagen261-273-specific T cells carrying TRBV25. HLA-DR 04/04, 04/01 and 04/11 alleles were associated with TRBV25, DAS at the onset, and poor response to DMARDs. These findings could lead to tailor the treatment in the subgroup of patients with an active refractory disease.
In the era of costly medical care with monoclonal antibodies and new molecules, and of an increasing request of a personalized medicine, a relevant socio-economic problem in the management of Rheumatoid Arthritis patients is the possible identification of the subgroups of poor responders to treatment. Our study aimed to detect the refractory active patients using an HLA-DR test (available in most hospital centers) combined with a relatively new biomarker of active disease expressed on the cell surface of autoreactive T cells. These tests appear complementary tools to identify the best and the poor responders to a “treat to target strategy”.
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Key Words
- ACPA
- ACPA, anti-cyclic citrullinated peptide antibodies
- APCs, antigen presenting cells
- CDR3, complementarity-determining region 3
- CRP, C-reactive protein
- Clonotypes
- Coll261-273, human collagen derived peptide
- DAS, disease activity score
- Disease activity
- ERA, early rheumatoid arthritis
- ESR, erythrocyte sedimentation rate
- GWAS, genome wide association studies
- HAQ, Health Assessment Questionnaire
- HLA, histocompatibility leucocyte antigen
- HLA-DRB1
- MHC, major histocompatibility complex
- PBMC, peripheral blood mononuclear cells
- RF, rheumatoid factor
- RT-PCR, reverse transcription polymerase chain reaction
- SJC, swollen joint count
- SNP, single nucleotide polymorphism
- TCR, T cell receptor
- TJC, tender joint count
- TRBJ, junctional beta chain gene of TCR
- TRBV 25
- TRBV, variable beta chain gene of TCR
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Gremese E, Tolusso B, Ferraccioli G. Weight Loss, The Obesity Paradox in Rheumatoid Arthritis: Is It a Paradox? Comment on the Article by Baker et al. Arthritis Rheumatol 2015; 68:553. [PMID: 26555326 DOI: 10.1002/art.39496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/29/2015] [Indexed: 11/09/2022]
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Biscetti F, Ferraccioli G, Flex A. New therapeutic effects of cilostazol in patients with ischemic disorders. Curr Vasc Pharmacol 2015; 13:399-404. [DOI: 10.2174/1570161112666141125123743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/07/2014] [Accepted: 11/14/2014] [Indexed: 11/22/2022]
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Iaccarino L, Bartoloni E, Carli L, Ceccarelli F, Conti F, De Vita S, Ferraccioli G, Galeazzi M, Gatto M, Gerli R, Govoni M, Gremese E, Iuliano A, Mansutti E, Moroni G, Mosca M, Nalli C, Naretto C, Padovan M, Palma L, Raffiotta F, Roccatello D, Tincani A, Valesini G, Zen M, Doria A. Efficacy and safety of off-label use of rituximab in refractory lupus: data from the Italian Multicentre Registry. Clin Exp Rheumatol 2015; 33:449-456. [PMID: 26053285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/08/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of rituximab (RTX) in patients with systemic lupus erythematosus (SLE) refractory to standard therapy in the clinical practice setting. METHODS 145 SLE patients (ACR criteria) were treated with RTX in 11 Italian Centres: 118 with two infusions (1 g), two weeks apart; 27 with 4 infusions (375 mg/m2), one week apart, followed in 10 cases by two further doses, after 1 and 2 months. Systemic complete response (CR) was defined as European Consensus Lupus Activity Measurement (ECLAM) score ≤1 and partial response (PR) as 1< ECLAM ≤3. Renal CR (RCR) and renal PR (RPR) were defined according to EULAR recommendations for management of lupus nephritis. RESULTS Data from 134 (92.4%) patients were available. The mean±SD follow-up was 27.3±18.5 months. After the first course of RTX, CR or PR were observed in 85.8% and CR in 45.5% of cases; RCR or RPR in 94.1% and RCR in 30.9% of patients after 12-month follow-up. Disease flares occurred in 35.1% and renal flares in 31.2% of patients during observational period. Among patients retreated, CR or PR were observed in 84.4% and CR in 57.8% of cases. Adverse events, infections, and infusion reactions occurred after first RTX course in 23.8%, 16.4%, and 3.8% of patients and after retreatment in 33.3%, 22.2% and 11.1%, respectively. No severe infusion reactions or deaths occurred. CONCLUSIONS Data from Italian multicentre RTX Registry confirmed the efficacy and safety of RTX in SLE patients refractory to standard treatment in clinical practice setting.
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De Luca G, Bosello SL, Berardi G, Rucco M, Canestrari G, Correra M, Mirone L, Forni F, Di Mario C, Danza FM, Pirronti T, Ferraccioli G. Tumour-associated antigens in systemic sclerosis patients with interstitial lung disease: association with lung involvement and cancer risk. Rheumatology (Oxford) 2015; 54:1991-9. [DOI: 10.1093/rheumatology/kev204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 11/14/2022] Open
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Gigante M, Gremese E, Tolusso B, Fedele A, Canestri S, Aquilanti B, Di Mario C, Petricca L, Alivernini S, Ferraccioli G. FRI0021 Weight Loss in Obese Rheumatoid Arthritis Patients Improves Disease Activity Without Modifying RA Treatment. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gremese E, Tolusso B, Fedele A, Nowik M, Canestri S, Ferraccioli G. FRI0037 Clinical and B Cell Subsets Biomarkers of Response to Tocilizumab in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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138
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Alivernini S, Tolusso B, Kurowska-Stolarska M, Canestri S, Benvenuto R, Mangoni A, Fedele A, Petricca L, Gremese E, McInnes I, Ferraccioli G. THU0007 Microrna-155/PU.1 Axis as an Epigenetic Regulator of B-Cell Activation in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Buch MH, Silva-Fernandez L, Carmona L, Aletaha D, Christensen R, Combe B, Emery P, Ferraccioli G, Guillemin F, Kvien TK, Landewe R, Pavelka K, Saag K, Smolen JS, Symmons D, van der Heijde D, Welling J, Wells G, Westhovens R, Zink A, Boers M. Development of EULAR recommendations for the reporting of clinical trial extension studies in rheumatology. Ann Rheum Dis 2015; 74:963-9. [PMID: 24827533 PMCID: PMC4431343 DOI: 10.1136/annrheumdis-2013-204948] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 04/10/2014] [Accepted: 04/12/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Our initiative aimed to produce recommendations on post-randomised controlled trial (RCT) trial extension studies (TES) reporting using European League Against Rheumatism (EULAR) standard operating procedures in order to achieve more meaningful output and standardisation of reports. METHODS We formed a task force of 22 participants comprising RCT experts, clinical epidemiologists and patient representatives. A two-stage Delphi survey was conducted to discuss the domains of evaluation of a TES and definitions. A '0-10' agreement scale assessed each domain and definition. The resulting set of recommendations was further refined and a final vote taken for task force acceptance. RESULTS Seven key domains and individual components were evaluated and led to agreed recommendations including definition of a TES (100% agreement), minimal data necessary (100% agreement), method of data analysis (agreement mean (SD) scores ranging between 7.9 (0.84) and 9.0 (2.16)) and reporting of results as well as ethical issues. Key recommendations included reporting of absolute numbers at each stage from the RCT to TES with reasons given for drop-out at each stage, and inclusion of a flowchart detailing change in numbers at each stage and focus (mean (SD) agreement 9.9 (0.36)). A final vote accepted the set of recommendations. CONCLUSIONS This EULAR task force provides recommendations for implementation in future TES to ensure a standardised approach to reporting. Use of this document should provide the rheumatology community with a more accurate and meaningful output from future TES, enabling better understanding and more confident application in clinical practice towards improving patient outcomes.
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Alivernini S, Bosello S, Kurowska-Stolarska M, Canestri S, Bui L, Fabrizi M, Tolusso B, McInnes I, Ferraccioli G. FRI0441 Microrna-34A Unbalance is Associated to IL-6/IL-6R Pathway in CD14 Cells and Skin Compartment of Systemic Sclerosis Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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141
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Bosello S, De Luca G, Forni F, Di Mario C, Berardi G, Canestrari G, Rucco M, Parisi F, Gabrielli F, Loperfido F, Ferraccioli G. SAT0445 NT-Probnp and Troponin T in Systemic Sclerosis: Prognostic Biomarkers of Cardiac Involvement. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Simone D, Canestri S, Ramonda R, Nowik M, Lorenzin M, Frallonardo P, Gremese E, Tolusso B, Ferraccioli G. AB0150 Association of the Polymorphism of the IGH Enhancer HS1.2A with Axial-Spondyloarthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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143
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Bosello S, De Luca G, Meduri A, Berardi G, Rucco M, Canestrari G, Parisi F, Silvestri V, Marano R, Bonomo L, Ferraccioli G. FRI0487 Cardiac Magnetic Resonance in the Evaluation of Symptomatic Patients with Systemic Sclerosis: Correlation with Clinical Characteristics and Arrhythmic Burden. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fedele A, Gremese E, Alivernini S, Petricca L, Tolusso B, Canestri S, Ferraccioli G. THU0089 Biomarkers of Erosive Disease in a Cohort of Early-Rheumatoid Arthritis Patients Treated According to the Treat to Target Strategy. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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145
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Bosello S, Peluso G, Iavarone F, Cabras T, Messana I, Castagnola M, Ferraccioli G. SAT0381 Different S100 Protein Salivary Patterns Characterized Sjogren's Syndrome Patients and Patients with Connective Tissue Diseases and Sicca Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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146
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Messuti L, Zoli A, Marino G, Petricca L, Nowik M, Gigante M, Varriano V, Gremese E, Tolusso B, Ferraccioli G. SAT0406 Lupus Arthropathy: the Different forms of Deforming Arthropathy. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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147
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De Luca G, Bosello S, Parisi F, Berardi G, Rucco M, Canestrari G, Ficara A, Gabrielli F, Loperfido F, Ferraccioli G. AB0699 Beta-Blockers Control Frequent Ventricular Ectopic Beats in Systemic Sclerosis: A Monocentric Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Biscetti F, Flex A, Pecorini G, Angelini F, Arena V, Stigliano E, Gremese E, Tolusso B, Ferraccioli G. THU0052 The Role of the Proinflammatory Mediator High-Mobility Group Box Protein 1 (HMGB1) in Anti-Collagen-Antibody-Induced Arthritis is Dependent on Vascular Endothelial Growth Factor (VEGF). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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149
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Quartuccio L, Corazza L, Ramos-Casals M, Retamozo S, Ragab G, Ferraccioli G, Gremese E, Tzioufas A, Voulgarelis M, Vassilopoulos D, Koutsianas C, Scarpato S, Salvarani C, Guillevin L, Terrier B, Cacoub P, Saccardo F, Gabrielli A, Fraticelli P, Tomsic M, Tavoni A, Nishimoto N, Filippini D, Scaini P, Zignego A, Ferri C, Sansonno D, Monti G, Pietrogrande M, Galli M, Bombardieri S, De Vita S. OP0274 Cryoglobulinemic Vasculitis and Primary sjögren's Syndrome are Independent Risk Factors for Lymphoma in a Large Worldwide Population of Patients with Positive Serum Cryoglobulins. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Peluso G, Bosello SL, Gremese E, Mirone L, Di Gregorio F, Di Molfetta V, Pirronti T, Ferraccioli G. Detection of bone erosions in early rheumatoid arthritis: 3D ultrasonography versus computed tomography. Clin Rheumatol 2015; 34:1181-6. [PMID: 26091903 DOI: 10.1007/s10067-015-2938-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 03/02/2015] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
Three-dimensional (3D) volumetric ultrasonography (US) is an interesting tool that could improve the traditional approach to musculoskeletal US in rheumatology, due to its virtual operator independence and reduced examination time. The aim of this study was to investigate the performance of 3DUS in the detection of bone erosions in hand and wrist joints of early rheumatoid arthritis (ERA) patients, with computed tomography (CT) as the reference method. Twenty ERA patients without erosions on standard radiography of hands and wrists underwent 3DUS and CT evaluation of eleven joints: radiocarpal, intercarpal, ulnocarpal, second to fifth metacarpo-phalangeal (MCP), and second to fifth proximal interphalangeal (PIP) joints of dominant hand. Eleven (55.0%) patients were erosive with CT and ten of them were erosive also at 3DUS evaluation. In five patients, 3DUS identified cortical breaks that were not erosions at CT evaluation. Considering CT as the gold standard to identify erosive patients, the 3DUS sensitivity, specificity, PPV, and NPV were 0.9, 0.55, 0.71, and 0.83, respectively. A total of 32 erosions were detected with CT, 15 of them were also observed at the same sites with 3DUS, whereas 17 were not seen on 3DUS evaluation. The majority of these 3DUS false-negative erosions were in the wrist joints. Furthermore, 18 erosions recorded by 3DUS were false positive. The majority of these 3DUS false-positive erosions were located at PIP joints. This study underlines the limits of 3DUS in detecting individual bone erosion, mostly at the wrist, despite the good sensitivity in identifying erosive patients.
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