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Taraborelli M, Reggia R, Dall'Ara F, Fredi M, Andreoli L, Gerosa M, Hoxha A, Massaro L, Tonello M, Costedoat-Chalumeau N, Cacoub P, Franceschini F, Meroni PL, Piette JC, Ruffatti A, Valesini G, Harris EN, Tincani A. Longterm Outcome of Patients with Primary Antiphospholipid Syndrome: A Retrospective Multicenter Study. J Rheumatol 2017; 44:1165-1172. [PMID: 28572466 DOI: 10.3899/jrheum.161364] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the longterm frequency of thrombotic recurrences, obstetrical complications, organ damage, severe comorbidities, and evolution toward connective tissue disease (CTD) in primary antiphospholipid syndrome (PAPS). METHODS Medical records of patients with PAPS followed in 6 centers for ≥ 15 years were retrospectively reviewed. RESULTS One hundred fifteen patients were studied: 88% women, followed between 1983 and 2014 with a mean (± SD) age at diagnosis of 33 (± 10) years. During a median followup of 18 years (range 15-30), 50 patients (44%) had at least a thrombotic event for a total of 75 events and an annual incidence of 3.5%. Thromboses were more frequent in patients with previous thrombotic history (p = 0.002). A catastrophic antiphospholipid syndrome occurred in 6 patients (5%). The use of oral anticoagulants in patients with thrombotic onset did not appear to be protective against recurrences (p = 0.26). Fifty-two women had 87 pregnancies, successful in 78%. Twenty-nine percent of patients accrued functional damage. Damage was significantly associated with a thrombotic history (p = 0.004) and with arterial events (p < 0.001), especially stroke, but not with demographics, serology, or treatment. Twenty-four major bleeding episodes were recorded in 18 patients, all receiving anticoagulants. Severe infections affected 6 patients (5%), with 1 fatality. A solid cancer was diagnosed in 8 patients (7%). Altogether, 16 patients (14%) developed an autoimmune disease and 13 (11%) a full-blown picture of CTD. CONCLUSION Despite therapy, a high proportion of patients experienced new thrombotic events and organ damage, while evolution toward CTD was infrequent.
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Affiliation(s)
- Mara Taraborelli
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Rossella Reggia
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Francesca Dall'Ara
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Micaela Fredi
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Laura Andreoli
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Maria Gerosa
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Ariela Hoxha
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Laura Massaro
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Marta Tonello
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Nathalie Costedoat-Chalumeau
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Patrice Cacoub
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Franco Franceschini
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Pier Luigi Meroni
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Jean Charles Piette
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Amelia Ruffatti
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Guido Valesini
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Eon Nigel Harris
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica.,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper
| | - Angela Tincani
- From the Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia, Brescia; Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan, Milan; Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua; Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome, Rome, Italy; AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University, Paris, France; University of the West Indies, Kingston, Jamaica. .,M. Taraborelli, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; R. Reggia, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; F. Dall'Ara, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Fredi, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; L. Andreoli, MD, PhD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; M. Gerosa, MD, PhD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; A. Hoxha, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; L. Massaro, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; M. Tonello, BSc, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne; P. Cacoub, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; F. Franceschini, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia; P.L. Meroni, MD, Division of Rheumatology, Department of Clinical Sciences and Community Health, Ospedale Gaetano Pini, University of Milan; J.C. Piette, MD, PhD, AP-HP, Hospital Pitié-Salpêtrière, Centre de référence maladies auto-immunes et systémiques rares, Service de Médecine Interne, Pierre et Marie Curie Paris VI University; A. Ruffatti, MD, PhD, Rheumatology Unit, Department of Medicine - DIMED, University of Padua; G. Valesini, MD, Internal Medicine and Medical Specialties Department, Policlinico Umberto I, La Sapienza University of Rome; E.N. Harris, MPhil, MD, DM, Vice Chancellor Emeritus, University of the West Indies; A. Tincani, MD, Rheumatology and Clinical Immunology Department, Spedali Civili and University of Brescia. Drs. Taraborelli, Reggia, and Dall'Ara contributed equally to this paper.
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