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Tani C, Trentin F, Parma A, Zucchi D, Cardelli C, Stagnaro C, Elefante E, Signorini V, Carli L, Manca ML, Mosca M. Disease evolution and organ damage accrual in patients with stable UCTD: a long-term monocentric inception cohort. RMD Open 2024; 10:e003967. [PMID: 38670557 DOI: 10.1136/rmdopen-2023-003967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/14/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Undifferentiated connective tissue diseases (UCTDs) are systemic autoimmune conditions that cannot be diagnosed nor classified as defined CTD; the majority maintains an undifferentiated profile (stable UCTD, sUCTD) over time. Data on long-term outcomes of sUCTD are lacking. METHODS Retrospective longitudinal analysis of an inception cohort of 141 patients with sUCTD.Disease evolution and damage accrual were evaluated at 1, 5 and 10 years. Partial least square (PLS) regression was used to identify the basal variables contributing to damage accrual at 1, 5 and 10 years of follow-up. Trend of damage over time was compared with a cohort of age-matched and sex-matched patients with systemic lupus erythematosus (SLE) by means of Nelson-Aalen analysis. RESULTS 11.3% of patients evolved to a definite CTD after a median 11 years (IQR 6-25) from the first symptom. At last visit, 10% were on glucocorticoids and 6% on immunosuppressive therapy. In 27.3%, at least one item of organ damage was recorded according to the SLICC/DI score (mean score 1.19±0.46). At PLS analysis, age at diagnosis and age at first symptoms were related to damage at 1 year, not taking antimalarials and taking immunosuppressants were associated with damage at 5 years.The mean survival without damage was 9.3 years in sUCTD and 8.4 years in SLE. The 10-year probability without damage was 62% and 23% in SLE and sUCTD, respectively (p=0.015). CONCLUSIONS Although less significantly impacted than in patients with SLE, in the long-term UCTDs can accumulate organ damage and evolve into defined connective tissue diseases.
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Affiliation(s)
- Chiara Tani
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Pisa, Italy
| | - Alice Parma
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Cardelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- University of Siena, Siena, Italy
| | - Chiara Stagnaro
- Clinical and Experimental Medicine, Rheumatology Unit, Pisa, Italy
| | - Elena Elefante
- Department of Clinical and Experimental Medicine, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Viola Signorini
- Clinical and Experimental Medicine, Rheumatology Unit, Pisa, Italy
| | | | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- University of Pisa, Pisa, Italy
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Andreoli L, Gerardi MC, Gerosa M, Rozza D, Crisafulli F, Erra R, Lini D, Trespidi L, Padovan M, Ruffilli F, Serale F, Cuomo G, Raffeiner B, Semeraro P, Tani C, Chimenti MS, Conigliaro P, Hoxha A, Nalli C, Fredi M, Lazzaroni MG, Filippini M, Taglietti M, Franceschini F, Zatti S, Loardi C, Orabona R, Ramazzotto F, Zanardini C, Fontana G, Gozzoli G, Barison C, Bizioli P, Caporali RF, Carrea G, Ossola MW, Maranini B, Silvagni E, Govoni M, Morano D, Verteramo R, Doria A, Del Ross T, Favaro M, Calligaro A, Tonello M, Larosa M, Zen M, Zambon A, Mosca M, Zucchi D, Elefante E, Gori S, Iannone F, Anelli MG, Lavista M, Abbruzzese A, Fasano CG, D'Angelo S, Cutro MS, Picerno V, Carbone T, Padula AA, Rovere-Querini P, Canti V, De Lorenzo R, Cavallo L, Ramoni V, Montecucco C, Codullo V, Milanesi A, Pazzola G, Comitini G, Marvisi C, Salvarani C, Epis OM, Benedetti S, Di Raimondo G, Gagliardi C, Lomater C, Crepaldi G, Bellis E, Bellisai F, Garcia Gonzalez E, Pata AP, Zerbinati M, Urban ML, Mattioli I, Iuliano A, Sebastiani G, Brucato AL, Bizzi E, Cutolo M, Santo L, Tonetta S, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A. Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study. RMD Open 2024; 10:e004091. [PMID: 38663885 PMCID: PMC11043763 DOI: 10.1136/rmdopen-2024-004091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. METHODS Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database. RESULTS We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. CONCLUSIONS Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.
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Affiliation(s)
- Laura Andreoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Chiara Gerardi
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Gerosa
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Davide Rozza
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Erra
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Lini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melissa Padovan
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Giovanna Cuomo
- Precision Medicine Department, University of Campania L. Vanvitelli, Naples, Italy
| | - Bernd Raffeiner
- Department of Rheumatology, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Paolo Semeraro
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Sole Chimenti
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Ariela Hoxha
- General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Filippini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Taglietti
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sonia Zatti
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Loardi
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Rossana Orabona
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | | | - Cristina Zanardini
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Giulia Fontana
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giorgia Gozzoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Barison
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paola Bizioli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Felice Caporali
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Giulia Carrea
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Maranini
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ettore Silvagni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Danila Morano
- Dipartimento Materno Infantile, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Ferrara, Italy
| | - Rosita Verteramo
- Dipartimento Cure Primarie, UO Servizi Sanitari 1- AUSL Ferrara, Ferrara, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Genoa, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandra Zambon
- Unit of Obstetrics and Gynecology, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Gori
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Marlea Lavista
- Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
| | - Anna Abbruzzese
- Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
| | | | | | | | - Valentina Picerno
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Teresa Carbone
- Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
| | | | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Canti
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ludovica Cavallo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Véronique Ramoni
- Internal Medicine Department, ASST Lodi - Ospedale Maggiore di Lodi, Lodi, Italy
| | | | - Veronica Codullo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Milanesi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- PhD Program in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Giulia Pazzola
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Department of Obstetrics and Gynecology, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Benedetti
- Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Di Raimondo
- Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Clizia Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Lomater
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gloria Crepaldi
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Bellisai
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Estrella Garcia Gonzalez
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Paola Pata
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Martina Zerbinati
- General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Antonio Luca Brucato
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Emanuele Bizzi
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Leonardo Santo
- Rheumatology Unit, "Mons. Dimiccoli" Hospital, Barletta (BT), Italy
| | - Sara Tonetta
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Gianpiero Landolfi
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Alessandra Bortoluzzi
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Scirè
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Rheumatology Unit, IRCCS San Gerardo dei Tintori Foundation, Milan, Italy
- School of Medicine, Bicocca University, Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Tani C, Zucchi D, Cardelli C, Elefante E, Signorini V, Schilirò D, Cascarano G, Gualtieri L, Valevich A, Puccetti G, Carli L, Stagnaro C, Mosca M. Analysis of belimumab prescription and outcomes in a 10-year monocentric cohort: is there an advantage with early use? RMD Open 2024; 10:e003981. [PMID: 38609320 PMCID: PMC11029263 DOI: 10.1136/rmdopen-2023-003981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE The objective is to evaluate perscriptions of belimumab (BEL), how these have changed over the years and their impact on clinical outcomes in patients with systemic lupus erythematosus (SLE). METHODS This is a retrospective analysis of prospectively collected data. We retrieved demographic and clinical data and concomitant therapies at BEL starting (baseline). Disease activity was assessed at baseline and after 6 and 12 months and organ damage at baseline and at the last visit. RESULTS From 422 patients followed in the Pisa SLE cohort, 102 patients received BEL and were included and 22 (21.6%) were immunosuppressant (IS)-naïve. Lupus Low Disease Activity State (LLDAS) with a glucocorticoid (GC) dosage ≤5 mg/day (LLDAS5) and remission were achieved by 47% and 38% of patients at 6 months, and by 75% and 66% at 12 months. Comparing IS-naïve patients with those who received BEL after at least one conventional IS, we did not find significant differences in baseline characteristics and in the achievement of LLDAS5 and remission. Despite at baseline we did not observe significant differences in mean GC daily dosage, IS-naïve patients were taking a significantly lower GC daily dose at 6 and 12 months. Interestingly, IS-naïve patients were more common in the most recent years. CONCLUSIONS Our data confirm that BEL is effective in controlling disease activity, and in recent years BEL has been considered as an earlier treatment option before other IS. Early introduction of BEL can be at least as effective as a step-up approach and can help to reduce the GC dosage.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Schilirò
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giancarlo Cascarano
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Gualtieri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anastasiya Valevich
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Puccetti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Faraguna U, Porciani C, Colitta A, Bruno S, Frumento P, Stagnaro C, Tani C, Vagelli R, Mosca M. Actigraphic and self-reported characterization of sleep in systemic lupus erythematosus patients. Rheumatology (Oxford) 2024; 63:1076-1083. [PMID: 37432350 PMCID: PMC10986802 DOI: 10.1093/rheumatology/kead344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVES In a cross-sectional study, we explored possible differences in sleep parameters between SLE patients and age- and gender-matched healthy controls through actigraphic and self-reported measures. Furthermore, we aimed to identify possible predictors of such disturbances in the patient cohort. METHODS Participants' sociodemographic data and sleep parameters were collected. Sleep parameters were evaluated through the Pittsburgh Sleep Quality Index, the Insomnia Severity Index and 7-day actigraphic monitoring. The 10-item Perceived Stress Scale was used to investigate stress. Disease activity and daily glucocorticoid dose were assessed in SLE patients. Possible predictors of the SLE group were explored through two binomial logistic models. Within the SLE group, possible predictors of sleep parameters were tested estimating multiple linear regression models. RESULTS A total of 40 SLE patients and 33 controls were included in the study. The SLE group showed worse sleep maintenance actigraphic parameters (i.e. sleep efficiency and wake after sleep onset), higher total sleep time and higher perceived stress. Within the SLE cohort, the daily glucocorticoids dose was associated with an impairment in sleep maintenance despite no reduction in sleep duration, typical of normal sleep duration insomnia, whereas perceived stress was associated with short sleep duration insomnia. CONCLUSION Compared with healthy controls, SLE patients showed worse sleep quality and greater perceived stress severity. As glucocorticoids and perceived stress are associated with different types of insomnia in these patients, a multidimensional approach to both sleep characterization and therapy might be preferred.
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Affiliation(s)
- Ugo Faraguna
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Caterina Porciani
- Department of Clinical Experimental Medicine, Clinical Immunology and Allergy Unit, University of Pisa, Pisa, Italy
| | - Alessandro Colitta
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Simone Bruno
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Chiara Tani
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Roberta Vagelli
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
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Maffi M, Tani C, Cascarano G, Scagnellato L, Elefante E, Stagnaro C, Carli L, Ferro F, Signorini V, Zucchi D, Cardelli C, Trentin F, Collesei A, Mosca M. Which extra-renal flare is 'difficult to treat' in systemic lupus erythematosus? A one-year longitudinal study comparing traditional and machine learning approaches. Rheumatology (Oxford) 2024; 63:376-384. [PMID: 37094218 DOI: 10.1093/rheumatology/kead166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 04/22/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES To describe phenotypes and outcomes of extra-renal flares in SLE, to identify clusters of extra-renal flares based on baseline features, and to develop a machine learning (ML) tool capable of predicting 'difficult to treat' (D2T) flares. METHODS Extra-renal flares that occurred in our cohort over the last five years with at least one year of follow-up were included. Baseline clinical variables were described and flares assigned to clusters. Attainment of remission and low disease activity state (LLDAS) at 12 months were compared. Flares were then considered 'D2T' in case of non-attainment of LLDAS at 6 and 12 months. Baseline features were used to train a ML model able to predict future D2T-flares, at admission. Traditional approaches were then compared with informatic techniques. RESULTS Among 420 SLE patients of the cohort, 114 flares occurred between 2015 and 2021; 79 extra-renal flares, predominantly mucocutaneous (24.1%) and musculoskeletal (45.6%), were considered. After 12 months, 79.4% and 49.4% were in LLDAS and in remission, respectively, while 17 flares were classified as D2T (21.5%); D2T flares received a higher cumulative and daily dose of glucocorticoids. Among the clusters, cluster 'D' (mild-moderate flares with mucocutaneous manifestations in patients with history of skin involvement) was associated with the lowest rate of remission. Among clinical data, not being on LLDAS at 3 months was the unique independent predictor of D2T flares. CONCLUSIONS Our clusterization well separates extra-renal flares according to their baseline features and may propose a new identification standard. D2T flares, especially refractory skin manifestations, are frequent in SLE and represent an unmet need in the management of the disease as they are associated with higher glucocorticoid (GC) dosage and risk of damage accrual. Our ML model could help in the early identification of D2T flares, flagging them to elevate the attention threshold at admission.
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Affiliation(s)
- Michele Maffi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giancarlo Cascarano
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Linda Carli
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
- GenOMeC PhD, University of Siena, Siena, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
- GenOMeC PhD, University of Siena, Siena, Italy
| | - Francesca Trentin
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Antonio Collesei
- Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Familial Cancer Clinics, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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6
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Carmassi C, Tani C, Lorenzoni V, Palla I, Fulvio G, Fantasia S, Andreozzi G, Trentin F, Conti L, Gaglioti A, Turchetti G, Dell'Osso L, Mosca M. Post-traumatic stress disorder and post-traumatic stress symptoms in patients with systemic autoimmune diseases during the COVID-19 pandemic. Clin Exp Rheumatol 2023:20482. [PMID: 38149633 DOI: 10.55563/clinexprheumatol/rnm6tz] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES The COVID-19 outbreak led to an increase in mental disorders, particularly post-traumatic stress disorder (PTSD), in the general population and especially in high-risk populations such as patients with rheumatologic conditions. Although these latters are considered vulnerable to developing PTSD, few specific data have been particularly reported in the framework of the pandemic. The aim of the present study was to investigate PTSD and post-traumatic stress symptoms (PTSS) in a sample of patients with systemic autoimmune disease (SAD), followed in the framework of a prospective observational study during the pandemic. METHODS The PERMAS project is a prospective observational study including patients with SAD and involving the Rheumatology and the Psychiatric Clinics of the Azienda Ospedaliero Universitaria Pisana (AOUP, Pisa, Italy) and the Institute of Management of the Scuola Superiore Sant'Anna (Pisa, Italy). The assessments included: a data-sheet for sociodemographic and clinical characteristics; the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), for PTSD and PTSS; the 36-item Short Form Survey (SF-36) to assess quality of life. RESULTS The total sample consisted of 252 patients with SAD, including 131 with connective tissue disease, 101 with arthritis and 20 with systemic vasculitis. The diagnostic groups differed significantly in age (p<0.001), gender (p<0.001), prevalence of full-blown and partial PTSD (p=0.001), and other psychopathologic variables. Connective tissue disease and SF-36 were significantly associated with the TALS-SR scores in both univariate (p<0.001) and multivariate (p<0.025; p<0.001) analyses. CONCLUSIONS Patients with SAD, and, in particular, patients with connective tissue diseases reported an increased risk of developing stress-related psychopathological symptoms, indicating the need for special psychological monitoring of this high-risk group.
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Affiliation(s)
- Claudia Carmassi
- Psychiatry Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | | | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giovanni Fulvio
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Sara Fantasia
- Psychiatry Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gianni Andreozzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Trentin
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Lorenzo Conti
- Psychiatry Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Gaglioti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Liliana Dell'Osso
- Psychiatry Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Tani C, Cardelli C, Depascale R, Gamba A, Iaccarino L, Doria A, Bandeira M, Dinis SP, Romão VC, Gotelli E, Paolino S, Cutolo M, Di Giosaffatte N, Ferraris A, Grammatico P, Cavagna L, Codullo V, Montecucco C, Longo V, Beretta L, Cavazzana I, Fredi M, Peretti S, Guiducci S, Matucci-Cerinic M, Bombardieri S, Burmester GR, Fonseca JE, Frank C, Galetti I, Hachulla E, Müller-Ladner U, Schneider M, Smith V, Tamirou F, Van Laar JM, Vieira A, D'Urzo R, Cannizzo S, Gaglioti A, Marinello D, Talarico R, Mosca M. Long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases: The ERN-ReCONNET VACCINATE study. J Transl Autoimmun 2023; 7:100221. [PMID: 38162456 PMCID: PMC10755036 DOI: 10.1016/j.jtauto.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Vaccination is one of the most important measures to contain the COVID-19 pandemic, especially for frail patients. VACCINATE is a multicentre prospective observational study promoted by the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET) aimed at assessing the long-term outcomes of COVID-19 vaccination in patients with rare and complex connective tissue diseases (rcCTDs) in terms of efficacy and safety. Methods Adult rcCTDs patients were eligible for recruitment. Demographic, clinical and vaccination data were collected at enrolment. Follow-up visits were scheduled 4, 12, 24, 36 and 48 weeks after completion of the first vaccination cycle; data on adverse events, disease exacerbations and the occurrence of new SARS-CoV-2 infections were collected at these time-points. Findings 365 rcCTDs patients (87 % female, mean age 51.8 ± 14.6 years) were recruited. Overall, 200 patients (54.8 %) experienced at least one adverse event, generally mild and in most cases occurring early after the vaccination. During follow-up, 55 disease exacerbations were recorded in 39 patients (10.7 %), distributed over the entire observation period, although most frequently within 4 weeks after completion of the vaccination cycle. The incidence of new SARS-CoV-2 infections was 8.9 per 1000 person-months, with no cases within 12 weeks from vaccine administration and an increasing trend of infections moving away from the primary vaccination cycle. Only one case of severe COVID-19 was reported during the study period. Interpretation COVID-19 vaccination seems effective and safe in rcCTDs patients. The rate of new infections was rather low and serious infections were uncommon in our cohort. No increased risk of disease flares was observed compared to previous disease history; however, such exacerbations may be potentially severe, emphasising the need for close monitoring of our patients.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Roberto Depascale
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Anna Gamba
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Sara Paiva Dinis
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Emanuele Gotelli
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Internal Medicine Department, University of Genoa, Genoa, Italy
| | - Niccolò Di Giosaffatte
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Alessandro Ferraris
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Paola Grammatico
- Laboratory of Medical Genetics, Department of Experimental Medicine, Sapienza University and San Camillo Forlanini Hospital, Rome, Italy
| | - Lorenzo Cavagna
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Veronica Codullo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Longo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Referral Center for Systemic Autoimmune Diseases, Milan, Italy
| | - Lorenzo Beretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Referral Center for Systemic Autoimmune Diseases, Milan, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Brescia, Italy
| | - Silvia Peretti
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, Department of Clinical and Experimental Medicine, AOU Careggi, University of Florence, Florence, Italy
| | | | - Gerd R. Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - João E. Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte & Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders, Koersel, Belgium
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff-Klinik GmbH, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology and Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Louvain, Belgium
| | - Jacob M. Van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | - Rossella D'Urzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Cannizzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Gaglioti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diana Marinello
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Zucchi D, Racca F, Carli L, Elefante E, Gori S, Tani C, Mosca M. Adherence to medication during pregnancy in systemic autoimmune diseases: results from a prospective study. Clin Exp Rheumatol 2023:20145. [PMID: 37812486 DOI: 10.55563/clinexprheumatol/st5fl0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES To evaluate adherence to medication in patients with systemic autoimmune diseases (SAD), comparing pregnant and non-pregnant women. METHODS 200 patients with SAD were consecutively enrolled, 100 pregnant and 100 non-pregnant women. Each patient completed the 8-item Morisky Medication Adherence Scale (MMAS-8), one copy for hydroxychloroquine (HCQ) and one for other treatments for rheumatic disease, and Hospital Anxiety and Depression Scale (HADS). RESULTS No significant differences were found in ongoing therapies between pregnant and non-pregnant women. 148 patients (74.0%) were taking HCQ and 160 (80.0%) other therapies for rheumatic disease. The mean MMAS-8 score was >6 in all groups indicating a good adherence, on average. The rate of patients with good medication adherence was higher in pregnant patients (73.9% vs. 63.3% and 76.5% vs. 64.5%, for HCQ and other therapies, respectively) although this difference was not statistically significant. Eight patients had very poor medical adherence, and all were non-pregnant women. Anxiety (15% of patients) was associated to low medication adherence for drugs other than HCQ (p=0.02), while depression (4% of patients) did not seem to have an impact on adherence. CONCLUSIONS In our cohort we recorded a good adherence to prescribed medication, although adequate adherence was not achieved in about 30% of patients, confirming that non-adherence is an important issue in SAD. It is difficult to define a profile of patients at risk of poor adherence, but it appears important to implement communication and adherence monitoring strategies since strict monitoring also during pregnancy could improve medical adherence.
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Affiliation(s)
- Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Francesco Racca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Sabrina Gori
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Crisafulli F, Andreoli L, Zucchi D, Reggia R, Gerardi MC, Lini D, Tani C, Zatti S, Franceschini F, Mosca M, Tincani A. Variations of C3 and C4 Before and During Pregnancy in Systemic Lupus Erythematosus: Association With Disease Flares and Obstetric Outcomes. J Rheumatol 2023; 50:1296-1301. [PMID: 37127323 DOI: 10.3899/jrheum.2022-1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To analyze complement level variations in systemic lupus erythematosus (SLE) pregnancies, focusing on disease flares and obstetric complications. METHODS SLE pregnancies prospectively followed by multidisciplinary teams from 1987 to 2018 in 2 Italian rheumatology centers were retrospectively analyzed. As reference, pregnancy-modified ranges of normal levels of C3 and C4 were derived from 175 pregnancies from the general obstetric population (GOP), as previously described by our group. RESULTS Two hundred forty-six pregnancies in 172 patients with SLE were analyzed. Eighty-nine percent were live births. Thirty-five flares were recorded in 30 pregnancies (12.2%) and obstetric complications occurred in 47 pregnancies (19.1%) including 27 pregnancy losses, 11 severely preterm births (2 resulting in perinatal death), and 15 hypertensive disorders. C3 and C4 levels were higher in the GOP than in patients with SLE, at any time point. C3 and C4 levels progressively increased during pregnancy in both GOP and SLE pregnancies without flare and obstetric complications, whereas this physiological increase was not observed in pregnancies with flares or obstetric complications. A significantly higher frequency of low C4 was found in pregnancies with flares (at preconception and in each trimester) and preterm births (at preconception). In multivariate analysis, low C4 at preconception was associated with flares (odds ratio 13.81, 95% CI 3.10-61.43, P < 0.001). CONCLUSION Low C4 at preconception was found to be an independent risk factor for SLE flare during pregnancy. Not only C3 and C4 levels but also their variations should be observed, as their failure to increase can be useful to predict risk of complications and suggest closer monitoring.
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Affiliation(s)
- Francesca Crisafulli
- F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia;
| | - Laura Andreoli
- F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Dina Zucchi
- D. Zucchi, MD, C. Tani, MD, M. Mosca, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Rossella Reggia
- R. Reggia, MD, Internal Medicine, Casa di Cura San Camillo, Cremona
| | - Maria C Gerardi
- M.C. Gerardi, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, and Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Daniele Lini
- F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Chiara Tani
- D. Zucchi, MD, C. Tani, MD, M. Mosca, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Sonia Zatti
- S. Zatti, MD, Obstetrics and Gynecology Unit, Spedali Civili and University of Brescia, Italy
| | - Franco Franceschini
- F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Marta Mosca
- D. Zucchi, MD, C. Tani, MD, M. Mosca, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Angela Tincani
- F. Crisafulli, MD, L. Andreoli, MD, D. Lini, MD, F. Franceschini, MD, A. Tincani, MD, Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia
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10
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Zucchi D, Fischer-Betz R, Tani C. Pregnancy in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2023:101860. [PMID: 37596173 DOI: 10.1016/j.berh.2023.101860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 08/20/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which frequently affects women of childbearing age. Nowadays, pregnancy is not contraindicated in cases of well-controlled disease activity, but pregnancies are still at higher risk of maternal and fetal complications compared to the general population. During pregnancy and puerperium patients are at risk of disease flare, and obstetric complications are more frequent in cases of active disease at conception/beginning of pregnancy, a history of lupus nephritis, and concomitant presence of antiphospholipid syndrome. To improve pregnancy outcomes in SLE patients, appropriate preconception counseling with changes in medication, if necessary, and close rheumatological and obstetrical monitoring are fundamental. This review aims to summarize the risk factors for adverse pregnancy outcomes and provide an update on developments in medical care for pregnancy in SLE patients.
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Affiliation(s)
- Dina Zucchi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Italy; Department of Medical Biotechnologies, University of Siena, Italy
| | - Rebecca Fischer-Betz
- Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Zucchi D, Cardelli C, Elefante E, Tani C, Mosca M. Treat-to-Target in Systemic Lupus Erythematosus: Reality or Pipe Dream. J Clin Med 2023; 12:jcm12093348. [PMID: 37176788 PMCID: PMC10178979 DOI: 10.3390/jcm12093348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023] Open
Abstract
Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic lupus erythematosus (SLE), defining the most meaningful treatment targets has been challenging, due to disease complexity and heterogeneity. Control of disease activity, the reduction of damage accrual and the patient's quality of life should be considered as the main targets in SLE, and several new drugs are emerging to achieve these targets. This review is focused on describing the target to achieve in SLE and the methods to do so, and it is also aimed at discussing if treat-to-target could be a promising approach also for this complex disease.
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Affiliation(s)
- Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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12
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Zucchi D, Silvagni E, Elefante E, Signorini V, Cardelli C, Trentin F, Schilirò D, Cascarano G, Valevich A, Bortoluzzi A, Tani C. Systemic lupus erythematosus: one year in review 2023. Clin Exp Rheumatol 2023; 41:997-1008. [PMID: 37133502 DOI: 10.55563/clinexprheumatol/4uc7e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 05/04/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide range of clinical manifestations and a relapsing-remitting course. New data regarding pathogenic pathways, biomarkers and clinical manifestations of SLE are emerging, and new drugs and therapeutic protocols have been proposed to improve the control of disease activity. Furthermore, new insights into comorbidities and reproductive health in SLE patients are constantly emerging.This annual review aims to summarise the most relevant data on SLE that was published in 2022.
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Affiliation(s)
- Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy.
| | - Ettore Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Davide Schilirò
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Giancarlo Cascarano
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Anastasiya Valevich
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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13
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Zen M, Gatto M, Depascale R, Regola F, Fredi M, Andreoli L, Franceschini F, Urban ML, Emmi G, Ceccarelli F, Conti F, Bortoluzzi A, Govoni M, Tani C, Mosca M, Ubiali T, Gerosa M, Bozzolo EP, Canti V, Cardinaletti P, Gabrielli A, Tanti G, Gremese E, De Marchi G, De Vita S, Fasano S, Ciccia F, Pazzola G, Salvarani C, Negrini S, Di Matteo A, De Angelis R, Orsolini G, Rossini M, Faggioli P, Laria A, Piga M, Cauli A, Scarpato S, Rossi FW, De Paulis A, Brunetta E, Ceribelli A, Selmi C, Prete M, Racanelli V, Vacca A, Bartoloni E, Gerli R, Zanatta E, Larosa M, Saccon F, Doria A, Iaccarino L. Early and Late Response and Glucocorticoid-Sparing Effect of Belimumab in Patients with Systemic Lupus Erythematosus with Joint and Skin Manifestations: Results from the Belimumab in Real Life Setting Study-Joint and Skin (BeRLiSS-JS). J Pers Med 2023; 13:jpm13040691. [PMID: 37109077 PMCID: PMC10146447 DOI: 10.3390/jpm13040691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
AIM To assess the efficacy of belimumab in joint and skin manifestations in a nationwide cohort of patients with SLE. METHODS All patients with skin and joint involvement enrolled in the BeRLiSS cohort were considered. Belimumab (intravenous, 10 mg/kg) effectiveness in joint and skin manifestations was assessed by DAS28 and CLASI, respectively. Attainment and predictors of DAS28 remission (<2.6) and LDA (≥2.6, ≤3.2), CLASI = 0, 1, and improvement in DAS28 and CLASI indices ≥20%, ≥50%, and ≥70% were evaluated at 6, 12, 24, and 36 months. RESULTS DAS28 < 2.6 was achieved by 46%, 57%, and 71% of patients at 6, 12, and 24 months, respectively. CLASI = 0 was achieved by 36%, 48%, and 62% of patients at 6, 12, and 24 months, respectively. Belimumab showed a glucocorticoid-sparing effect, being glucocorticoid-free at 8.5%, 15.4%, 25.6%, and 31.6% of patients at 6, 12, 24, and 36 months, respectively. Patients achieving DAS-LDA and CLASI-50 at 6 months had a higher probability of remission at 12 months compared with those who did not (p = 0.034 and p = 0.028, respectively). CONCLUSIONS Belimumab led to clinical improvement in a significant proportion of patients with joint or skin involvement in a real-life setting and was associated with a glucocorticoid-sparing effect. A significant proportion of patients with a partial response at 6 months achieved remission later on during follow-up.
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Affiliation(s)
- Margherita Zen
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Depascale
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Francesca Regola
- ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, 25123 Brescia, Italy
| | - Micaela Fredi
- ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, 25123 Brescia, Italy
| | - Laura Andreoli
- ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, 25123 Brescia, Italy
| | - Franco Franceschini
- ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology, 25123 Brescia, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, 50139 Firenze, Italy
| | - Fulvia Ceccarelli
- Dipartimento Universitario di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari (SCIAC) 'Sapienza' University, 00185 Rome, Italy
| | - Fabrizio Conti
- Dipartimento Universitario di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari (SCIAC) 'Sapienza' University, 00185 Rome, Italy
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, 44121 Ferrara, Italy
| | - Chiara Tani
- Rheumatology, University of Pisa, 56124 Pisa, Italy
| | - Marta Mosca
- Rheumatology, University of Pisa, 56124 Pisa, Italy
| | - Tania Ubiali
- Clinical Rheumatology Unit Milano, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, Lombardia, 20129 Milan, Italy
| | - Maria Gerosa
- Clinical Rheumatology Unit Milano, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, Lombardia, 20129 Milan, Italy
| | - Enrica P Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20100 Milan, Italy
| | - Valentina Canti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20100 Milan, Italy
| | - Paolo Cardinaletti
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Armando Gabrielli
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Giacomo Tanti
- Division of Rheumatology, Università Cattolica del Sacro Cuore Sede di Roma, 00168 Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Università Cattolica del Sacro Cuore Sede di Roma, 00168 Rome, Italy
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Ginevra De Marchi
- Rheumatology Unit, University of Udine, Medical Area, 33100 Udine, Italy
| | - Salvatore De Vita
- Rheumatology Unit, University of Udine, Medical Area, 33100 Udine, Italy
| | - Serena Fasano
- Deparment of Precision Medicine Napoli, Università degli Studi della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Francesco Ciccia
- Deparment of Precision Medicine Napoli, Università degli Studi della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Rheumatology Unit, University of Modena and Reggio Emilia, 41125 Reggio Emilia, Italy
| | - Simone Negrini
- Internal Medicine Unit, Department of Internal Medicine, Università degli Studi di Genova, 16146 Genoa, Italy
| | - Andrea Di Matteo
- Deparment of Clinical and Experimental Sciences, Università Politecnica delle Marche, Rheumatology Clinic, 60131 Ancona, Italy
| | - Rossella De Angelis
- Deparment of Clinical and Experimental Sciences, Università Politecnica delle Marche, Rheumatology Clinic, 60131 Ancona, Italy
| | | | - Maurizio Rossini
- Unit of Rheumatology, University of di Verona, 37134 Verona, Italy
| | - Paola Faggioli
- ASST OVEST Milanese Presidio di Legnano, 20025 Legnano, Italy
| | - Antonella Laria
- ASST OVEST Milanese Presidio di Magenta, 20013 Magenta, Italy
| | - Matteo Piga
- Rheumatology Unit, AOU University Clinic, University of Cagliari, 09124 Cagliari, Italy
| | - Alberto Cauli
- Rheumatology Unit, AOU University Clinic, University of Cagliari, 09124 Cagliari, Italy
| | | | - Francesca Wanda Rossi
- Dipartimento di Scienze Mediche, Traslazionali e Centro di Ricerca Immunologia Base e Clinica (CISI), University of Napoli Federico II, 80131 Napoli, Italy
| | - Amato De Paulis
- Dipartimento di Scienze Mediche, Traslazionali e Centro di Ricerca Immunologia Base e Clinica (CISI), University of Napoli Federico II, 80131 Napoli, Italy
| | - Enrico Brunetta
- IRCCS Humanitas Research Hospital, Milan, Italy, 20089 Milan, Italy
| | - Angela Ceribelli
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20133 Milan, Italy
| | - Carlo Selmi
- Department of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, 20133 Milan, Italy
| | - Marcella Prete
- Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University of Bari, 70125 Bari, Italy
| | - Vito Racanelli
- Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University of Bari, 70125 Bari, Italy
| | - Angelo Vacca
- Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University of Bari, 70125 Bari, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06121 Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06121 Perugia, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Francesca Saccon
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
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14
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Trentin F, Signorini V, Manca ML, Cascarano G, Gualtieri L, Schilirò D, Valevich A, Cardelli C, Carli L, Elefante E, Ferro F, Stagnaro C, Zucchi D, Tani C, Mosca M. Gender differences in SLE: report from a cohort of 417 Caucasian patients. Lupus Sci Med 2023; 10:10/1/e000880. [PMID: 37185240 PMCID: PMC10151995 DOI: 10.1136/lupus-2022-000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND SLE is an autoimmune disease that predominantly affects women. As most epidemiological and interventional studies are on populations with a clear female prevalence, the influence of gender in disease course, drug response and damage accrual is yet to be fully explored and comprehended. OBJECTIVES To describe gender differences in disease course, comorbidities, use of medications and long-term outcomes of a large cohort of patients with SLE. METHODS Retrospective gender-based analysis of prospectively collected data from a monocentric cohort of Caucasian patients with SLE with at least 1 year of follow-up. RESULTS 417 patients were included, 51 men and 366 women. Men displayed a significantly higher median age at disease onset and diagnosis and a higher prevalence of late-onset SLE, serositis at disease onset, antiphospholipid syndrome (APS) and use of mycophenolate within the first year of disease. Women had a higher prevalence of haematological abnormalities, a higher cumulative exposure to azathioprine and higher cumulative dose of glucocorticoids at 5 years. Male patients had a shorter time to first damage item and a higher prevalence of damage at 1 and 5 years, but this association was no longer significant when late-onset patients were excluded. No differences were found in prevalence of childhood onset, delay between onset and diagnosis, time to renal involvement and histology, cumulative autoantibody positivity, number of flares and hospitalisations, median SLE Damage Index score, type of damage, age and time to first cardiovascular event, chronic kidney disease and death. CONCLUSIONS In our cohort, clinical manifestations and disease course were similar in male and female patients; however, male patients displayed higher prevalence of APS and early damage accrual probably due to the later disease onset. These data highlight the importance of an intensive follow-up, prevention and treatment of complications in this category of patients, especially in the first years of disease.
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Affiliation(s)
- Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine and Department of Mathematics, University of Pisa, Pisa, Italy
| | - Giancarlo Cascarano
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Gualtieri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Schilirò
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anastasiya Valevich
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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15
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Talarico R, Ramirez GA, Barreira SC, Cardamone C, Triggianese P, Aguilera S, Andersen J, Avcin T, Benistan K, Bertsias G, Bortoluzzi A, Bouillot C, Bulina I, Burmester GR, Callens S, Carreira PE, Cervera R, Cutolo M, Damian L, Della-Torre E, Faria R, Fonseca JE, Galetti I, Hachulla E, Iaccarino L, Jacobsen S, Khmelinskii N, Limper M, Marinello D, Meyer A, Moroncini G, Nagy G, Olesinska M, Pamfil C, Pileckyte M, Pistello M, Rednic S, Richez C, Romão VC, Schneider M, Sciascia S, Scirè CA, Simonini G, Smith V, Sulli A, Tani C, Tas SW, Tincani A, Vonk MC, Tektonidou M, Mosca M. ERN ReCONNET points to consider for treating patients living with autoimmune rheumatic diseases with antiviral therapies and anti-SARS-CoV-2 antibody products. Clin Exp Rheumatol 2023; 41:543-553. [PMID: 36916322 DOI: 10.55563/clinexprheumatol/jpargp] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/16/2023]
Abstract
Recent studies have shown that people who are immunocompromised may inadvertently play a role in spurring the mutations of the virus that create new variants. This is because some immunocompromised individuals remain at risk of getting COVID-19 despite vaccination, experience more severe disease, are susceptible to being chronically infected and remain contagious for longer if they become infected and considering that immunocompromised individuals represent approximately 2% of the overall population, this aspect should be carefully considered. So far, some autoimmune rheumatic disease (ARD) patients with COVID-19 have been treated with antiviral therapies or anti-SARS-CoV-2 antibody products. However, there is no homogeneous approach to these treatment strategies. This issue was addressed within the European Reference Network (ERN) on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ReCONNET) in a discussion among experts and patient's representatives in the context of the rare and complex connective tissue diseases (rCTDs) covered by the Network. ERN ReCONNET is one of the 24 ERNs launched by the European Commission in 2017 with the aim of tackling low prevalence and rare diseases that require highly specialised treatment and promoting concentration of knowledge and resources through virtual networks involving healthcare providers (HCPs) across the European Union (EU). Considering the urgent need to provide guidance not only to the rCTDs community, but also to the whole ARDs community, a multidisciplinary Task Force, including expert clinicians and European Patient Advocacy Group (ePAG) Advocates, was created in the framework of ERN ReCONNET with the aim of developing overarching principles (OP) and points-to-consider (PtC) on a homogenous approach to treat immunocompromised patients with ARDs (with a particular focus on CTDs) affected by COVID-19 using antiviral therapies and anti-SARS-CoV-2 antibody products. The present work reports the final OP and PtC agreed by the Task Force.
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Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, and Università Vita-Salute San Raffaele, Milan, Italy
| | - Sofia C Barreira
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Chiara Cardamone
- Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Aguilera
- Spanish Association for Antiphospholipid Syndrome (SAF España), Elche, Spain
| | | | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Karelle Benistan
- AP-HP, GHU Paris Saclay, Hôpital Raymond Poincaré, Centre de Référence des Syndromes d'Ehlers-Danlos non vasculaires, Garches, France
| | - George Bertsias
- Rheumatology and Clinical Immunology, University of Crete Medical School, Heraklion, Greece
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, Rheumatology Section, University of Ferrara, Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy
| | | | - Inita Bulina
- Department of Internal Diseases, Rheumatology Centre, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steven Callens
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Ghent, Belgium
| | - Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Universidad Complutentense de Madrid, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Laura Damian
- Department of Rheumatology, County Emergency Clinical Hospital Cluj, Iuliua Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Emanuel Della-Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, and Università Vita-Salute San Raffaele, Milan, Italy
| | - Raquel Faria
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto; UMIB, Unit for Multidisciplinary Research in Biomedicine, ICBAS, School of Medicine and Biomedical Sciences, University of Porto; ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - João E Fonseca
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Université de Lille, CHU Lille, France
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine-DIMED, University Hospitalof Padova, AO Padova, Italy
| | - Søren Jacobsen
- Copenhagen Research Center for Autoimmune Connective Tissue Diseases, COPEACT, Rigshospitalet, Copenhagen, Denmark
| | - Nikita Khmelinskii
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alain Meyer
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Marche Polytechnic University, and Clinica Medica, Department of Internal Medicine, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Gyorgy Nagy
- Department of Rheumatology and Clinical Immunology, Department. of Internal Medicine and Oncology, Semmelweis University, Budapest; Heart and Vascular Center, Semmelweis University, Budapest, and Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest; Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary
| | - Marzena Olesinska
- Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Cristina Pamfil
- Department of Rheumatology, County Emergency Clinical Hospital Cluj, Iuliua Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Margarita Pileckyte
- Department of Rheumatology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mauro Pistello
- Retrovirus Centre, Department of Translational Medicine and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Simona Rednic
- Department of Rheumatology, County Emergency Clinical Hospital Cluj, Iuliua Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christophe Richez
- Department of Rheumatology, CHU Bordeaux (Groupe Hospitalier Pellegrin), Bordeaux, France
| | - Vasco C Romão
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), San Giovanni Bosco Hub Hospital, Turin, Italy, and Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | | | - Gabriele Simonini
- NEUROFARBA Department, Rheumatology Unit, Meyer Children's University Hospital, University of Florence, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent, and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology and Clinical Immunology, Amsterdam UMC, location AMC, University of Amsterdam, the Netherlands
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Italy
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, and Rheumatology Unit, University of Pisa, Italy
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16
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Andreoli L, Chighizola CB, Iaccarino L, Botta A, Gerosa M, Ramoni V, Tani C, Bermas B, Brucato A, Buyon J, Cetin I, Chambers CD, Clowse MEB, Costedoat-Chalumeau N, Cutolo M, De Carolis S, Dolhain R, Fazzi EM, Förger F, Giles I, Haase I, Khamashta M, Levy RA, Meroni PL, Mosca M, Nelson-Piercy C, Raio L, Salmon J, Villiger P, Wahren-Herlenius M, Wallenius M, Zanardini C, Shoenfeld Y, Tincani A. Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11 th International Conference on Reproduction, Pregnancy and Rheumatic Diseases. Autoimmun Rev 2023; 22:103259. [PMID: 36549355 DOI: 10.1016/j.autrev.2022.103259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Autoimmune rheumatic diseases (ARD) can affect women and men during fertile age, therefore reproductive health is a priority issue in rheumatology. Many topics need to be considered during preconception counselling: fertility, the impact of disease-related factors on pregnancy outcomes, the influence of pregnancy on disease activity, the compatibility of medications with pregnancy and breastfeeding. Risk stratification and individualized treatment approach elaborated by a multidisciplinary team minimize the risk of adverse pregnancy outcomes (APO). Research has been focused on identifying biomarkers that can be predictive of APO. Specifically, preeclampsia and hypertensive disorders of pregnancy tend to develop more frequently in women with ARD. Placental insufficiency can lead to intrauterine growth restriction and small-for-gestational age newborns. Such APO have been shown to be associated with maternal disease activity in different ARD. Therefore, a key message to be addressed to the woman wishing for a pregnancy and to her family is that treatment with compatible drugs is the best way to ensure maternal and fetal wellbeing. An increasing number of medications have entered the management of ARD, but data about their use in pregnancy and lactation are scarce. More information is needed for most biologic drugs and their biosimilars, and for the so-called small molecules, while there is sufficient evidence to recommend the use of TNF inhibitors if needed for keeping maternal disease under control. Other issues related to the reproductive journey have emerged as "unmet needs", such as sexual dysfunction, contraception, medically assisted reproduction techniques, long-term outcome of children, and they will be addressed in this review paper. Collaborative research has been instrumental to reach current knowledge and the future will bring novel insights thanks to pregnancy registries and prospective studies that have been established in several Countries and to their joint efforts in merging data.
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Affiliation(s)
- Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cecilia B Chighizola
- Paediatric Rheumatology Unit, ASST G. Pini & CTO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Angela Botta
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Gerosa
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Center for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Véronique Ramoni
- Medicina Generale Lodi, ASST Lodi-Ospedale Maggiore, Lodi, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Antonio Brucato
- Internal Medicine, Fatebenefratelli Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jill Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Irene Cetin
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Woman, Mother and Child, Luigi Sacco and Vittore Buzzi Children Hospitals, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Christina D Chambers
- Department of Pediatrics, University of California, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Megan E B Clowse
- Division of Rheumatology & Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Nathalie Costedoat-Chalumeau
- Internal Medicine Department, Cochin Hospital, Referral center for rare autoimmune and systemic diseases, Université de Paris, CRESS, INSERM, INRA, Paris, France
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal M edicine, University of Genoa, IRCSS San Martino Polyclinic, Genoa, Italy
| | - Sara De Carolis
- Department of Obstetrics, Gynaecology and Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Radboud Dolhain
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elisa M Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Child Neurology and Psychiatry Unit, ASST Spedali Civili, Brescia, Italy
| | - Frauke Förger
- Department of Rheumatology and Immunology, University Hospital (Inselspitaland University of Bern, Bern, Switzerland
| | - Ian Giles
- Centre for Rheumatology, Department of Inflammation, Division of Medicine, University College London, Department of rheumatology, University College London Hospital, London, UK
| | - Isabell Haase
- Department for Rheumatology and Hiller Research Institute, Heinrich-Heine-University, Düsseldorf, Germany
| | - Munther Khamashta
- Women & Children's Health, King's College, London, UK; GlaxoSmithKline Global Medical Expert, Dubai, United Arab Emirates
| | - Roger A Levy
- Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil; GlaxoSmithKline Global Medical Expert, Collegeville, PA, USA
| | - Pier Luigi Meroni
- IRCCS Istituto Auxologico Italiano, Immunorheumatology Research Laboratory, Milan, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital (Inselspitaland University of Bern, Bern, Switzerland
| | - Jane Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Peter Villiger
- Rheumatology and Clinical Immunology, Medical Center Monbijou, Bern, Switzerland
| | - Marie Wahren-Herlenius
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Wallenius
- National Advisory Unit on Pregnancy and Rheumatic Diseases, St Olavs Hospital, Trondheim, University Hospital and Institute of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Cristina Zanardini
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Ariel University, Ariel, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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17
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Abstract
This case report describes 2 women with severe and refractory discoid lupus erythematosus that was treated with anifrolumab.
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Affiliation(s)
- Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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18
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Cornet A, Andersen J, Tani C, Mosca M. Consequences of medication unavailability on patient anxiety: the example of the 2020 hydroxychloroquine availability crisis for patients with SLE - 18 months later. Lupus Sci Med 2023; 10:10/1/e000895. [PMID: 36697031 PMCID: PMC9884871 DOI: 10.1136/lupus-2023-000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Affiliation(s)
| | | | - Chiara Tani
- Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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19
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Tani C, Zucchi D, Bellis E, Birru Talabi M, Frise C, de Jesús GR, Koksvik HS, Lledó GM, Mekinian A, Marinello D, Palla I, Mehta P, Sáez Comet L, Shaimaa S, Smeele HTW, Talarico R, Brucato A, Khamashta M, Shoenfeld Y, Tincani A, Mosca M. Patient Care Pathways for Pregnancy in Rare and Complex Rheumatic Diseases: Results From an International Survey. J Rheumatol 2023:jrheum.220773. [PMID: 36642433 DOI: 10.3899/jrheum.220773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To map existing organizational care pathways in clinical centers of expertise that care for pregnant women affected by rare and complex connective tissue diseases (rcCTDs). METHODS An international working group composed of experts in the field of pregnancy in rcCTDs co-designed a survey focused on organizational aspects related to the patient's pathway before, during, and after pregnancy. The survey was distributed to subject experts through referral sampling. RESULTS Answers were collected from 69 centers in 21 countries. Patients with systemic lupus erythematosus and/or antiphospholipid syndrome were followed by more than 90% of centers, whereas those with disorders such as IgG4-related diseases were rarely covered. In the majority of centers, a multidisciplinary team was involved, including an obstetrician/gynecologist in 91.3% of cases and other healthcare professionals less frequently. Respondents indicated that 96% of the centers provided routine pre-pregnancy care, whereas the number of patient visits during pregnancy varied across centers. A formalized care pathway was described in 49.2% of centers, and 20.3% of centers had a predefined protocol for the monitoring of pregnant patients. Access to therapies during pregnancy also was heterogeneous among different centers. CONCLUSION In international referral centers, a high level of care is provided to patients with rcCTDs before, during, and after pregnancy. No significant discrepancies were found between European and non-European countries. However, this work highlights a potential benefit to streamlining the care approaches across countries to optimize pregnancy and perinatal outcomes among patients with rcCTDs.
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Affiliation(s)
- Chiara Tani
- C. Tani, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- D. Zucchi, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Bellis
- E. Bellis, MD, Rheumatology Unit, Mauriziano Umberto I Hospital, Turin Italy, and Rheumatology Unit, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Mehret Birru Talabi
- M. Birru Talabi, MD, PhD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charlotte Frise
- C. Frise, MD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hege Svean Koksvik
- H.S. Koksvik, MD, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gema Maria Lledó
- G.M. Lledó, MD, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Arsène Mekinian
- A. Mekinian, MD, Sorbonne University, Internal Medicine Department, Saint Antoine Hospital, Paris, France
| | - Diana Marinello
- D. Marinello, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Ilaria Palla
- I. Palla, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Puja Mehta
- P. Mehta, MD, Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Luis Sáez Comet
- L.S. Comet, MD, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Shoela Shaimaa
- S. Shaimaa, MD, Internal Medicine & Rheumatology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Hieronymus T W Smeele
- H.T.W. Smeele, MD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
| | - Rosaria Talarico
- R. Talarico, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Brucato
- A. Brucato, MD, Università di Milano, Department of Biomedical and Clinical Sciences, Milan, Italy
| | - Munther Khamashta
- M. Khamashta, MD, PhD, Department of Women and Children's Health, King's College London, London, UK, and Gulf Medical Expert-Lupus, GSK, Dubai, UAE
| | | | - Angela Tincani
- A. Tincani, MD, Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marta Mosca
- M. Mosca, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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20
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Prevete I, Iuliano A, Cauli A, Piga M, Iannone F, Coladonato L, Bortoluzzi A, Silvagni E, Tani C, Elefante E, Doria A, Iaccarino L, Franceschini F, Fredi M, Conti F, Spinelli FR, Frediani B, Gonzales Garcìa E, Scirè CA, Zanetti A, Rozza D, Carrara G, Sebastiani GD. Similarities and differences between younger and older disease onset patients with newly diagnosed systemic lupus erythematosus. Clin Exp Rheumatol 2023; 41:145-150. [PMID: 35894063 DOI: 10.55563/clinexprheumatol/oo5ymg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Several studies show that age at onset has an impact on the clinical-serological presentation, comorbidities and disease course of patients with systemic lupus erythematosus (SLE). We evaluated whether, in patients with recent onset SLE, the age at onset correlates with clinical-serological manifestations and with comorbidities. METHODS We analysed 171 patients with a SLE diagnosis obtained within 12 months of diagnosis enrolled in the Early Lupus project. Based on the age of onset of the first disease symptom, they were stratified into 2 groups: early onset (18-45 years) and late onset (>45 years). The analysis was replicated by stratifying patients based on age at diagnosis (fulfillment of ACR classification criteria). Each comparison was made at baseline and at 36 months of follow-up. RESULTS Baseline: patients with late onset displayed comorbidities (hypertension, dyslipidemia and osteoporosis) more frequently than early onset group. 11.4% of late onset patients had a malignancy in medical history, not recorded in the early onset cohort. The two groups differed neither in organ involvement (domain BILAG) nor in disease activity (ECLAM). Patients with early onset showed a disease with signs of higher serologic activity (higher frequency of anti-dsDNA positivity and lower mean C3 and C4 levels) and had malar rash more frequently than the late onset group (36.2% vs. 18.2%, p=0.042). Similar results were obtained by stratifying patients by age of diagnosis (18-45 years and >45 years), except for the higher frequency of discoid rash in the group with age at diagnosis >45 years (18% vs. 6.6%, p=0.045). 36 months: the 2 groups of patients independently of the stratification applied did not differ in the accumulation of damage, but showed a different pattern of 8 organ involvement. Musculoskeletal involvement was more frequent both in the late onset group (18.6% vs. 7.3%, p=0.043) and in the group with age at diagnosis >45 years (20.4% vs. 5.9%, p=0.009) compared to their counterparts, while renal involvement was more frequent in the group with age at diagnosis 18-45 years (21.4% vs. 6.1%, p=0.03).A sub analysis at 36 months on patients without hypertension and osteoporosis at enrollment showed that patients with older age at onset had a higher frequency of these comorbidities, compared to their counterparts. CONCLUSIONS In our cohort, younger disease SLE onset seems to correlate with a more active immunological profile, while late onset with a higher incidence of comorbidities.
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Affiliation(s)
- Immacolata Prevete
- UOC Reumatologia, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy.
| | - Annamaria Iuliano
- UOC Reumatologia, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Alberto Cauli
- UOC Reumatologia, Policlinico AOU e Università degli Studi di Cagliari, Italy
| | - Matteo Piga
- UOC Reumatologia, Policlinico AOU e Università degli Studi di Cagliari, Italy
| | | | | | - Alessandra Bortoluzzi
- UOC Reumatologia, Azienda Ospedaliera-Universitaria S. Anna e Università di Ferrara, Italy
| | - Ettore Silvagni
- UOC Reumatologia, Azienda Ospedaliera-Universitaria S. Anna e Università di Ferrara, Italy
| | - Chiara Tani
- UO Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | - Elena Elefante
- UO Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | - Andrea Doria
- Unità di Reumatologia, Dipartimento di Medicina, Università di Padova, Italy
| | - Luca Iaccarino
- Unità di Reumatologia, Dipartimento di Medicina, Università di Padova, Italy
| | - Franco Franceschini
- UOC Reumatologia e Immunologia Clinica, Dipartimento di Scienze cliniche e Sperimentali, Università degli Studi di Brescia, Italy
| | - Micaela Fredi
- UOC Reumatologia e Immunologia Clinica, Dipartimento di Scienze cliniche e Sperimentali, Università degli Studi di Brescia, Italy
| | - Fabrizio Conti
- Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Italy
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Italy
| | | | | | - Carlo A Scirè
- Unità di Epidemiologia, Società Italiana di Reumatologia-SIR, Milano, Italy
| | - Anna Zanetti
- Unità di Epidemiologia, Società Italiana di Reumatologia-SIR, Milano, Italy
| | - Davide Rozza
- Unità di Epidemiologia, Società Italiana di Reumatologia-SIR, Milano, Italy
| | - Greta Carrara
- Unità di Epidemiologia, Società Italiana di Reumatologia-SIR, Milano, Italy
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21
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Floris A, Chessa E, Sebastiani GD, Prevete I, Iannone F, Coladonato L, Govoni M, Bortoluzzi A, Mosca M, Tani C, Doria A, Iaccarino L, Franceschini F, Fredi M, Conti F, Spinelli FR, Bellisai F, D'Alessandro R, Zanetti A, Carrara G, Scirè CA, Cauli A, Piga M. Glucocorticoid tapering and associated outcome in patients with newly diagnosed systemic lupus erythematosus: the real-world GULP prospective observational study. RMD Open 2022; 8:rmdopen-2022-002701. [PMID: 36581383 PMCID: PMC9806067 DOI: 10.1136/rmdopen-2022-002701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE A subanalysis of the multicentre Early Lupus inception cohort was performed to investigate the real-world Glucocorticoids (GCs) Use in newly diagnosed systemic lupus erythematosus (SLE) Patients (GULP). METHODS Patients starting prednisone (PDN) ≥5 mg/day and concomitant hydroxychloroquine or immunosuppressant within 12 months of SLE classification were enrolled. Core set variables were recorded at baseline and every 6 months, including changes in PDN dose, European Consensus Lupus Activity Measurement (ECLAM) and Systemic Lupus International Collaborating Clinics damage index. Regression models analysed predictors of tapering PDN<5 mg/day at any time and outcomes associated with different patterns of GCs tapering. RESULTS The GULP study included 127 patients with SLE; 73 (57.5%) tapered and maintained PDN <5 mg/day, and 17 (13.4%) discontinued PDN within a 2-year follow-up. Renal involvement (HR: 0.41; p=0.009) and lower C3 serum levels (HR: 1.04; p=0.025) predicted a lack of PDN tapering below 5 mg/day. High ECLAM scores were associated with a greater probability of increasing PDN dose (OR: 1.6; p=0.004), independently of daily intake. Disease relapse rate did not statistically differ (p=0.706) between patients tapering PDN <5 mg/day (42/99, 42.4%) and those tapering PDN without dropping below 5 mg/day (13/28, 46.4%). Every month on PDN <5 mg/day associated with lower damage accrual (IRR: 0.96; p=0.007), whereas never tapering PDN <5 mg/day associated with a higher risk of developing GC-related damage (OR 5.9; p=0.014). CONCLUSION Tapering PDN <5 mg/day was achieved and maintained in half of newly diagnosed patients with SLE and may represent a good balance between the need to prevent damage accrual and the risk of disease relapse.
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Affiliation(s)
- Alberto Floris
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy,UOC Reumatologia, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Elisabetta Chessa
- UOC Reumatologia, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | | | - Immacolata Prevete
- UOC di Reumatologia, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Florenzo Iannone
- Dipartimento dell’Emergenza e dei Trapianto di Organi - Sezione di Reumatologia, Università degli Studi di Bari Aldo Moro Scuola di Medicina, Bari, Italy
| | - Laura Coladonato
- Dipartimento dell’Emergenza e dei Trapianto di Organi - Sezione di Reumatologia, Università degli Studi di Bari Aldo Moro Scuola di Medicina, Bari, Italy
| | - Marcello Govoni
- UOC e Sezione di Reumatologia - Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - Alessandra Bortoluzzi
- UOC e Sezione di Reumatologia - Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - Marta Mosca
- Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy,U.O. Reumatologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Chiara Tani
- U.O. Reumatologia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine - DIMED, Università degli Studi di Padova, Padova, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine - DIMED, Università degli Studi di Padova, Padova, Italy
| | - Franco Franceschini
- Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy,UOC di Reumatologia e Immunologia Clinica, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Micaela Fredi
- Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy,UOC di Reumatologia e Immunologia Clinica, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Francesca Romana Spinelli
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Università degli Studi di Roma La Sapienza, Rome, Italy
| | | | | | - Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy
| | | | - Alberto Cauli
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy,UOC Reumatologia, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Matteo Piga
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy,UOC Reumatologia, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
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Marinello D, Zucchi D, Palla I, Aguilera S, Galetti I, Holmner M, Sandulescu S, Scarle L, Tremarias D, Bouillot C, Cattaneo L, Gaglioti A, Ticciati S, Brucato A, Khamashta M, Shoenfeld Y, Tincani A, Talarico R, Tani C, Mosca M. Exploring patient's experience and unmet needs on pregnancy and family planning in rare and complex connective tissue diseases: a narrative medicine approach. RMD Open 2022; 8:rmdopen-2022-002643. [PMID: 36597980 PMCID: PMC9748988 DOI: 10.1136/rmdopen-2022-002643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this work is to explore patient' unmet needs of rare and complex rheumatic tissue diseases (rCTDs) patients during pregnancy and its planning by means of the narrative-based medicine (NBM) approach. METHODS A panel of nine rCTDs patients' representatives was identified to codesign a survey aimed at collecting the stories of rCTD patients who had one or more pregnancies/miscarriages. The results of the survey and the stories collected were analysed and discussed with a panel of patients' representatives to identify unmet needs, challenges and possible strategies to improve the care of rCTD patients. RESULTS 129 replies were collected, and 112 stories were analysed. Several unmet needs in the management of pregnancy in rCTDs were identified, such as fragmentation of care among different centres, lack of education and awareness on rCTD pregnancies among midwifes, obstetricians and gynaecologists. The lack of receiving appropriate information and education on rCTDs pregnancy was also highlighted by patients and their families. The need for a holistic approach and the availability specialised pregnancy clinics with a multidisciplinary organisation as well as the provision of psychological support during all the phases around pregnancy was considered also a priority. CONCLUSION The adoption of the NBM approach enabled a direct identification of unmet needs, and a list of possible actions was elaborated to improve the care of rCTD patients and their families in future initiatives.
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Affiliation(s)
- Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore di Studi Universitari e di Perfezionamento Sant'Anna, Pisa, Toscana, Italy
| | - Silvia Aguilera
- Asociación Española Síndrome Antifosfolipídico - SAF España, Elche, Spain
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Saint Maur, Belgium
| | - Monica Holmner
- Federation of European Scleroderma Associations (FESCA), Saint Maur, Belgium
| | - Silvia Sandulescu
- Federation of European Scleroderma Associations (FESCA), Saint Maur, Belgium
| | | | | | | | | | - Andrea Gaglioti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Simone Ticciati
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio Brucato
- Department of biomedical and clinical sciences, University of Milan, Milano, Italy
| | | | | | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy,Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy,Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy,Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Cardelli C, Caruso T, Tani C, Pratesi F, Talarico R, Di Cianni F, Italiano N, Laurino E, Moretti M, Cascarano G, Diomedi M, Gualtieri L, D'Urzo R, Migliorini P, Mosca M. COVID-19 mRNA vaccine booster in patients with autoimmune rheumatic diseases. Rheumatology (Oxford) 2022; 61:e328-e330. [PMID: 35608304 PMCID: PMC9384146 DOI: 10.1093/rheumatology/keac296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chiara Cardelli
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Teresita Caruso
- Department of Clinical and Experimental Medicine, University of Pisa
- Immunoallergology Unit, Azienda Ospedaliero-Universitaria Pisana
| | | | - Federico Pratesi
- Department of Clinical and Experimental Medicine, University of Pisa
- Department of Translational Research and NTMS, University of Pisa, Pisa, Italy
| | | | - Federica Di Cianni
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Nazzareno Italiano
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Elenia Laurino
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Michele Moretti
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Giancarlo Cascarano
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Michele Diomedi
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | - Luca Gualtieri
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
| | | | - Paola Migliorini
- Department of Clinical and Experimental Medicine, University of Pisa
- Immunoallergology Unit, Azienda Ospedaliero-Universitaria Pisana
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, University of Pisa
- Rheumatology Unit
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Trentin F, Carli L, Tani C, Mosca M. Unveiling Deficiency of Adenosine Deaminase 2: An Adult Patient With Recurrent Strokes, Vasculitic Ulcers, and Bowel Perforation. J Rheumatol 2022; 49:1291-1293. [PMID: 35777819 DOI: 10.3899/jrheum.220218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Here we describe the case of a 38-year-old man with a history of ischemic transient attacks and strokes from the age of 9 years, livedo reticularis, asymmetrical sensorimotor neuropathy, optic neuritis, testicular ischemia, digital ulcers, ulcerative colitis, and diastolic hypertension. Disease course was characterized by severe disease bouts treated with high-dose intravenous (IV) glucocorticoid (GC) pulse therapy, short periods of paucisymptomatic disease, and inability to taper GCs despite the use of traditional oral and IV immunosuppressants, interferon, and plasmapheresis.
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Affiliation(s)
- Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Trentin, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Trentin, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Trentin, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. F. Trentin, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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Elefante E, Tani C, Signorini V, Stagnaro C, Zucchi D, Trentin F, Carli L, Ferro F, Mosca M. POS0753 PROSPECTIVE EVALUATION OF HEALTH-RELATED QUALITY OF LIFE (HRQoL) IN A MONOCENTRIC COHORT OF PATIENTS WITH LONGSTANDING SYSTEMIC LUPUS ERYTHEMATOSUS (SLE). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe optimization of HRQoL in SLE patients is defined as one of the treatment goals in the 2019 EULAR recommendations1 for the management of SLE. Most studies have examined HRQoL at one point in time, while the few longitudinal studies do not report a clear variation in Patient Reported Outcomes (PROs) with respect to changes in disease activity. It would be important to understand if, even in a real-life setting, the improvement of patients’ HRQoL may represent an achievable target.Objectivesthe aim of this study was to analyze HRQoL over time in a monocentric cohort of patients with SLE and investigate which disease-related factors determine short-term variation of HRQoL in a real-life setting.Methodsthis is a longitudinal, prospective monocentric study which included consecutive adult outpatients with SLE (1997 ACR classification criteria), regularly followed at the Rheumatology Unit of Pisa. Patients were enrolled over a period of 2 years, before the pandemic outbreak, and had at least 2 assessments per year. For each patient, demographics, comorbidities, treatment, clinical and laboratory data were collected. Disease activity was evaluated with the SELENA-SLEDAI and organ damage with the SLICC/DI. We defined as a significant variation of disease activity, a difference of clinical SELENA-SLEDAI ≥ 4 points between 2 subsequent evaluations. At each visit, patients completed the following PROs: SF-36, FACIT-Fatigue and LIT.Resultswe enrolled 210 consecutive SLE patients, mainly female (93.8%) and of Caucasian ethnicity (97.1%), with a mean age at enrollment of 45.1±12.7 years and a median disease duration of 13 years (IQR 5-21). At baseline, the median SLEDAI of the cohort was 2 (IQR 0-4). The most frequent active disease manifestations were: articular (17.1%) and hematological (15.2%); 6.7% of patients had active renal disease. 47.14% had a SLICC-DI > 0 with a median SLICC-DI among them of 2 (IQR 1-3). 11.43% of patients had a concomitant fibromyalgia. Most patients were on Hydroxychloroquine (78.1%) and low dose glucocorticoid (55.2%), with a median daily dose of 2 mg (IQR 0-4) of prednisone equivalent; 41.4% were on conventional immunosuppressants and 11.9% on biologics, mainly belimumab. The median scores of PROs at enrollment are reported in Table 1. At baseline, fibromyalgia confirmed to have a significant negative impact on all PROs after adjustment for confounding factors (p<0.05). Each patient underwent two consecutive evaluations, with a median interval between them of 11.4 months. We observed a significant variation of disease activity in 36/210 patients (17.14%). Then, we compared the subgroup of patients with unchanged disease activity with that of patients who showed a significant variation of disease activity. We found that FACIT and LIT scores didn’t change over time in both subgroups, whereas PCS (p<0.001) and MCS (p<0.01) scores of the SF-36 showed a significant variation in both groups, between the first and the second clinical assessment. However, in the subgroup of patients with a significant change of disease activity, the variation of PCS and MCS was not correlated with the variation of disease activity or ongoing treatment. In particular, patients with a significant improvement of HRQoL over time didn’t have a corresponding significant reduction of the SLEDAI score or of the daily glucocorticoid dose.Table 1.PROs scores at baseline.PROsMedian scores at baselineSF-36 PCS58 (IQR 49.09- 68)SF-36 MCS57 (IQR 46.42-67)FACIT42 (IQR 32-46)LIT20 (IQR 7.5-40)Conclusionour findings seem to suggest that HRQoL over time in outpatients with longstanding SLE tends to be stable (maybe because patients are able to adapt to their illness) or varies unpredictably, maybe influenced by not disease-related factors. Further studies are needed to better understand which factors influence HRQoL over time and which questionnaires are more sensitive to catch its variation.References[1]PMID: 30926722Disclosure of InterestsNone declared
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Schilirò D, Elefante E, Stagnaro C, Signorini V, Zucchi D, Trentin F, La Rocca G, Carli L, Ferro F, Tani C, Mosca M. AB0555 SYMPTOMATIC NON-SEROSITIC LUNG INVOLVEMENT IN A MONOCENTRIC COHORT OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): A REAL-LIFE EXPERIENCE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundA growing interest has been addressed to the study of lung involvement in systemic autoimmune diseases. Non-serositic pulmonary manifestations have also been described in SLE. However, little is known about their exact prevalence, clinical features and outcomes.ObjectivesTo describe the prevalence, clinical and immunological characteristics of symptomatic non-serositic lung involvement in a monocentric cohort of SLE patients.MethodsThis observational, retrospective study included patients with SLE, regularly followed at the Rheumatology Unit of Pisa, that presented a clinically relevant non-serositic pulmonary involvement during their disease history. Patients with lung manifestations related to other causes (e.g. infections, emphysema, Chronic Obstructive Lung Disease, bronchial asthma etc.) were excluded. The following data were collected from clinical charts: demographics, smoke exposure, comorbidities, respiratory symptoms, disease duration and disease activity (SELENA-SLEDAI) at the onset of lung involvement, immunological profile, treatment, CT and spirometry parameters.ResultsOver 450 SLE patients in regular follow-up, we found 11 female patients with a history of clinically relevant non-serositic lung involvement: 7 interstitial lung disease (ILD), 2 acute lupic pneumonitis (ALP), 1 diffuse alveolar hemorrhage (DAH) and 1 shrinking lung syndrome. 45.4% of patients had a history of smoke exposure and had stopped smoking on average 9 years before the onset of lung manifestations. For the 2 patients with ALP, this was the first manifestation of SLE. Among the other 9 patients, lung involvement was diagnosed after a mean disease duration of 14 ± 15 years. At the diagnosis of pulmonary involvement, 10/11 patients presented respiratory symptoms and an overall active disease, with a median SLEDAI of 9 (IQR 6-13). Clinical characteristics are summarized in Table 1. All patients were hospitalized and 2 of them (1 ALP and 1 DAH) were admitted in intensive care unit.Table 1.Clinical characteristics at the diagnosis of lung involvementSystemicActive skin manifestations36%Arthritis36%Fever36%Leukopenia36%Hypocomplementemia91%Anti-dsDNA positivity36%RespiratoryDyspnea54%Exertional dyspnea18%Cough45%Acute respiratory failure27%As for the immunologic profile, SSA/Ro60 were positive in 72% of patients and SSA/Ro52, SSB, U1-RNP in 36%; 36% had Sjogren Syndrome (SS) in overlap.Spirometry was available for 6/11 patients: a restrictive pattern and a moderate/severe reduction of diffusing capacity of the lung for carbon monoxide was found in 5 patients.In the ILD subgroup, the most prevalent CT pattern was the Non-specific interstitial pneumonia (NSIP) (5/7). 2 patients presented a Bronchiolitis obliterans/organizing pneumonia (BOOP) pattern.Lung involvement was the driving manifestation in the treatment choice for 6/11 patients: 1 DAH, 2 ALP, 1 Shrinking lung and 2 ILD. All received pulse steroids and in 3 cases (2 ILD and 1 DAH) cyclophosphamide was added for the induction treatment; the patient with Shrinking lung had an overlap SS and was treated with Rituximab.At last visit (mean follow-up of 8 ± 8.7 years since lung disease onset), 7/11 patients presented no respiratory symptoms and a complete resolution of CT alterations. 3/11 presented a residual exertional dyspnea and mild spirometry alterations. No patients developed respiratory insufficiency; only 1 patient died for cardiovascular complications.ConclusionIn our large cohort of SLE patients, non-serositic lung involvement seems to be overall rare; the most frequent type of lung manifestation is ILD which appears to be associated with anti-SSA/SSB and anti-U1RNP positivity. The low prevalence of lung involvement (2.4%) in our cohort could be due to the presence of patients with a subclinical involvement. Further studies are needed to assess the real prevalence of subclinical lung manifestations in SLE and to identify the clinical phenotype of patients more prone to develop pulmonary disease.Disclosure of InterestsDavide Schilirò: None declared, Elena Elefante: None declared, Chiara Stagnaro: None declared, Viola Signorini: None declared, Dina Zucchi: None declared, Francesca Trentin: None declared, Gaetano La Rocca: None declared, Linda Carli: None declared, Francesco Ferro: None declared, Chiara Tani: None declared, Marta Mosca Speakers bureau: advisor LILLY, ASTRA ZENECA, GSK, Consultant of: advisor LILLY, ASTRA ZENECA, GSK
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Maffi M, Scagnellato L, Collesei A, Elefante E, Stagnaro C, Ferro F, Carli L, Signorini V, Zucchi D, Trentin F, Tani C, Mosca M. POS0364 UNMET NEEDS IN THE TREATMENT OF EXTRA-RENAL FLARES IN SLE PATIENTS: REAL LIFE EXPERIENCE VS ARTIFICIAL APPROACH. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) is a heterogeneous disease which can affect various organs and is characterized by different clinical phenotypes. While the treatment of renal involvement is quite standardized, the therapeutic approach to extra-renal manifestations is subjected to a degree of variability.Objectives1. To describe extra-renal disease flares in terms of clinical phenotype and outcomes in SLE patients 2. To compare data from a real-life setting with a machine learning (ML) approach.MethodsThis study is a retrospective analysis of data from a monocentric cohort of SLE patients who experienced a disease flare between 2015 and 2020. Each flare was followed for one year and was classified according to the organ involvement and categorized according to the BILAG definition of flare. At baseline and at 3,6,12 months the following variables were collected: disease activity (SELENA-SLEDAI score), ongoing therapy and disease state (DORIA definition of remission). Demographic data and previous organ involvement were retrieved from clinical charts. Flares’ features at baseline and during follow up were analyzed in terms of explained variance across the dataset’s Principal Components and clustered with a hierarchical unsupervised learning approach. A ML model based on neural networks was built to early detect flares’ therapeutic difficulty: it was validated after data augmentation to satisfy statistical requirements during the training phase.Results66 extra-renal flares were investigated (Table 1); 5 flares (7.5%) were treated with glucocorticoid (GC) pulses and 61 (92.5%) with oral GC therapy, while an immunosuppressive (IS) treatment was prescribed in 44 flares (66.7%). The remission rate at 12 months for the whole group was 50%, with musculo-skeletal (MS) flares, mucocutaneous (MC) flares and others (neuropsychiatric, cardiopulmonary, constitutional, haematologic) that was respectively 63.6%, 31.3% and 41.2%, showing lower rate of remission for MC flares. In 12 months, 17 flares (25.8%) did not respond to treatment (non-responders), requiring an increase in the dose of GC or the introduction of a new IS therapy. Using a machine learning approach, we were able to identify 4 flare clusters, grouping flares in relation to phenotypic characteristics (Figure 1), and recognized statistically relevant features for patients’ stratification (cluster 1“flare in systemic disease with high activity”, cluster 2 “outcast flares”, cluster 3 “flare in polymorphic disease with mild activity” and cluster 4 “recurrent skin flares”). Interestingly, cluster 4 (recurrent skin flares) was associated with the lowest rate of remission at 12 months with respect to clusters 1, 2, and 3 (33% vs 40%, 76.5% and 56% respectively). Moreover the neural network model correctly predicts difficult to treat flares in up to 80% of the casesTable 1.WHOLE GROUPMUSKELMUCOCUTCONSTITUTIONALCARDIOPULMHAEMATOLNEUROpNUMBER (%)6633 (50)16 (24.2)7 (10.6)4 (6.1)5 (7.6)1 (1.5)SLEDAI at baseline median (IQR)7 (4-29)8 (6-10)5.5 (4-10)5 (4-9)9 (4.5-12)5 (5-6)29 (29-29)SLEDAI 12 mos median (IQR)2 (0-20)0.5 (0-4)3 (0-4)3 (2 – 4)0 (0-0)2 (0-3)14 (14 – 14)REMISSION 12 mos number (%)33 (50)21 (63.6)5 (31.3)4 (57.1)2 (40)2 (40%)1 (100)0.217NON RESPONSE 12 mos number (%)17 (25.8)8 (25)5 (31.3)2 (28.6)1 (20)1 (20%)1 (100)0.467Figure 1.Flare clusters.ConclusionThese data suggest that, in a real-life setting, the clinical response rate to therapy of patients with an extra-renal flare is not satisfactory, thus identifying an unmet need in the treatment of SLE and highlighting the absence of a standard treatment. Both the real-life data and the machine learning approach identify flares with MC manifestations as the most difficult to treat with the lower rate of remission after one year. Further prospective studies are necessary to improve the neural network model; ML techniques could help in the early identification of difficult to treat flares to be candidates for new and more aggressive therapeutic strategies for extra-renal manifestations.Disclosure of InterestsNone declared
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Cardelli C, Caruso T, Tani C, Pratesi F, Talarico R, DI Cianni F, Italiano N, Laurino E, Moretti M, Cascarano G, Diomedi M, Gualtieri L, D’urzo R, Migliorini P, Mosca M. AB1152 COVID-19 mRNA VACCINE BOOSTER IN PATIENTS WITH SYSTEMIC AUTOIMMUNE DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with systemic autoimmune diseases (SADs) are often treated with drugs that interfere with the immune system and previous data showed a reduced seroconversion rate after anti-SARS-CoV2 vaccine in these subjects compared to healthy controls1. Administration of a booster dose of the vaccine could be particularly important in these patients, but data available to date are still scarce.ObjectivesTo evaluate the antibody response to the booster dose of mRNA SARS-CoV2 vaccine in patients with SADs and to compare it to the response after completion of the first vaccination course. Secondly, to find possible correlations between a low antibody titre and patients’ clinical features, with special regard to ongoing immunosuppressive therapies.MethodsConsecutive patients with an established diagnosis of SADs undergoing SARS-CoV2 vaccine were prospectively enrolled from January 2021; among them, we selected the patients who received the third vaccination dose between September and December 2021. Demographic and clinical data were collected at enrolment (sex, age, diagnosis, disease duration, ongoing therapies, previous SARS-CoV2 infection, presence of hypogammaglobulinemia); the last three elements were reassessed at each follow-up visit. Blood samples were collected 4 weeks both after the second (W4a) and the third (W4b) dose of the vaccine; a minority of patients was also tested 12 weeks after the second dose (W12). IgG antibodies to SARS-CoV2 receptor-binding domain (RBD) and neutralizing antibodies inhibiting the interaction between RBD and angiotensin converting enzyme 2 were evaluated. IgG anti-RBD were detected by solid phase assay on plates coated with recombinant RBD, while neutralising antibodies by using the kit SPIA (Spike Protein Inhibition Assay). Cut-off values were defined as the 97.5th percentile of a pre-vaccine healthy population. Statistical analysis was performed using IBM SPSS Statistics 20 and GraphPad Prism statistical packages. P values <0.05 were considered significant.ResultsForty-five patients (95.6% female; mean age ±SD 55.6±14.1 years; mean disease duration 12.9±10.6 years) were enrolled. Diagnosis was in most cases connective tissue disease (31/45, 68.9%), followed by inflammatory arthritis (11/45, 24.4%) and systemic vasculitis (3/45, 6.7%). Two patients (4.4%) had a previous SARS-CoV2 infection and three had hypogammaglobulinemia (6.7%). At the time of the second dose, 18/45 patients were treated with glucocorticoids (GCs) [mean daily 6-methylprednisolone (6MP) dose 3.9 mg (min. 2, max. 14)], 17/45 with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and 12/45 with biologic DMARDs (bDMARDs). At the third dose administration, 19/45 patients were treated with GCs [mean daily 6MP dose 4.1 mg (min. 1.5, max. 10)], 18/45 with csDMARDs and 13/45 with bDMARDs. Anti-RBD IgG were positive in 42/45 patients (93.3%) at W4a, in 16/18 (88.9%) at W12 and in 42/45 (93.3%) at W4b. Neutralizing antibodies were present in 38/45 patients (84.4%) at W4a, in 14/18 (77.8%) at W12 and in 42/45 (93.3%) at W4b. Both anti-RBD IgG titers and neutralizing antibody titers significantly increased after the third dose if compared to W4a (p<0.0001 both) (Figure 1). Interestingly, of the 7 patients who had not developed an adequate neutralizing antibody response after the first vaccination course, 5 mounted an adequate titer after the booster. Two non-responder patients were both on combination therapy (one with low dose of GCs plus mycophenolate mofetil, the other with methotrexate and infliximab).ConclusionOur data suggest that in patients with SADs there is a decline in the antibody titers developed after COVID-19 vaccination, however the booster dose is effective in restoring an adequate antibody titre. These data consolidate the importance of a booster dose of COVID-19 vaccination in patients with SADs to aid in the generation of an immune response.References[1]Jena A et al. Response to SARS-CoV-2 vaccination in immune mediated inflammatory diseases: systematic review and meta-analysis. Autoimmun Rev. 2022AcknowledgementsThe authors would like to thank all the patients who participated in the study and the nurses Sabrina Gori, Rosanna Lo Coco, Lucia Pedrocco, Carla Puccini, Pasqualina Semeraro, Manuela Terachi, Maria Tristano, Valentina Venturini and Catiuscia Zoina who took care of the patients.Disclosure of InterestsNone declared
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Di Cianni F, Cardelli C, Italiano N, Laurino E, Moretti M, Depascale R, Gamba A, Iaccarino L, Doria A, Sousa Bandeira MJ, Dinis SP, C Romão V, Alessandri E, Gotelli E, Paolino S, DI Giosaffatte N, Grammatico P, Ferraris A, Cavagna L, Montecucco C, Longo V, Beretta L, Cavazzana I, Fredi M, Tincani A, D’urzo R, Bombardieri S, Burmester GR, Cutolo M, Fonseca JE, Frank CH, Galetti I, Hachulla E, Houssiau F, Marinello D, Müller-Ladner U, Schneider M, Smith V, Talarico R, Van Laar JM, Vieira A, Tani C, Mosca M. POS1232 LONG-TERM OUTCOMES OF COVID-19 VACCINATION IN PATIENTS WITH RARE AND COMPLEX CONNECTIVE TISSUE DISEASES: AN AD-INTERIM ANALYSIS OF ERN-ReCONNET VACCINATE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSince the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefits of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group).ObjectivesTo evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://brightoncollaboration.us/wp-content/uploads/2021/01/SO2_D2.1.2_V1.2_COVID-19_AESI-update-23Dec2020-review_final.pdf)MethodsThe first ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defined as at least one of the following: new manifestations attributable to disease activity, hospitalization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants.ResultsA cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren’s syndrome (SS,12%), idiopathic inflammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Danlos’s syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the first and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%).ConclusionThis preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the first month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.Table 1.AEs and disease exacerbations per diseaseDiagnosisPatients enrolled (%) (n=300)EAs after 1st and 2nd dose (%)Exacerbations (%)APS25714EDS45033IIM10527MCTD44225SS12598SLE44698SSC16492UCTD850-AcknowledgementsVACCINATE is a study promoted by the European Reference Network on rare and complex connective tissue diseases, ERN ReCONNET. This publication was funded by the European Union’s Health Programme (2014-2020)Disclosure of InterestsNone declared
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Lini D, Nalli C, Andreoli L, Crisafulli F, Fredi M, Lazzaroni MG, Bitsadze V, Calligaro A, Canti V, Caporali R, Carubbi F, Chighizola C, Conigliaro P, Conti F, De Carolis C, Del Ross T, Favaro M, Gerosa M, Iuliano A, Khizroeva J, Makatsariya A, Meroni PL, Mosca M, Padovan M, Perricone R, Rovere-Querini P, Sebastiani GD, Tani C, Tonello M, Truglia S, Zucchi D, Franceschini F, Tincani A. POS0721 ASSOCIATION BETWEEN PRECONCEPTION COMPLEMENT LEVELS AND USE OF HYDROXYCHLOROQUINE WITH PREGNANCY OUTCOME IN PATIENTS WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME AND CARRIERS OF ANTIPHOSPHOLIPID ANTIBODIES: AN INTERNATIONAL MULTICENTER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAntiphospholipid Syndrome (APS) is a rare autoimmune disease characterized by thrombotic events and/or pregnancy morbidities in the presence of confirmed positivity for antiphospholipid antibodies (aPL). Complement was demonstrated to be involved in aPL-related pregnancy loss in animal models and several groups investigated the significance of complement levels in human disease. C3 and C4 serum levels were assessed in several cohorts of pregnant patients with APS and/or aPL positivity in order to relate complement consumption with adverse pregnancy outcome (APO).According to some authors, hydroxychloroquine (HCQ) can control the activation of the complement system, improve pregnancy outcome and reduce aPL title.ObjectivesThis study was designed to verify the effect of HCQ in addition to low dose aspirin (LDA) + low molecular weight heparin (LMWH) treatment in a multicenter cohort of primary APS (PAPS) and aPL carriers pregnant women and the possible correlation with preconception serum C3/C4 levels.MethodsMedical records of pregnant women with confirmed positivity for aPL antibodies attending twelve referral centers from January 2010 to December 2020 were retrospectively evaluated. We considered as aPL-related APO: spontaneous abortions (<10 weeks of gestation), fetal loss (≥10 weeks of gestation), neonatal death (death of a formed fetus alive at birth in the first 28 days of life), preterm delivery before 37 weeks of gestation, preeclampsia, eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet).ResultsWe have analyzed 164 singleton PAPS/aPL carrier pregnancies (22 aPL carriers - 13%) in 128 patients: all were treated with combination therapy (LDA+LMWH), and in 30 HCQ was added. 58 pregnancies (43%) had low levels of preconception C3/C4. A triple aPL positivity was observed in 54 pregnancies, 14 of them were treated with combination therapy + HCQ. When considering the whole cohort, the addition of HCQ had not significantly improved the gestational outcome. Further stratification was performed on the basis of complement consumption. In the group of patients with preconception low C3/C4 levels the addition of HCQ had not significantly improved pregnancy outcome. We have lastly evaluated 40 pregnancies with a high-risk profile (triple aPL positivity and complement consumption), in which we have found that HCQ significantly improved gestational outcome (p=0.018, Table 1).Table 1.Relationship between APO, therapy during pregnancy and risk profile.All pregnancies (n=164)Reduced C3/C4 (n=58)Triple aPL+ and reduced C3/C4 (n=40)LDA+LMWH (n, %)LDA+LMWH+HCQ (n, %)pLDA+LMWH (n, %)LDA+LMWH+HCQpLDA+LMWHLDA+LMWH+HCQp(n, %)(n, %)(n, %)APO62 (46%)16 (53%)ns32 (68%)4 (36%)ns23 (77%)3 (30%)0.018No APO72 (54%)14 (47%)15 (32%)7 (64%)7 (23%)7 (70%)Total1343047113010This observation could not be confirmed in patients with single or double aPL positivity.ConclusionThe study shows that administering HCQ in addition to combination therapy can improve gestational outcome in aPL/PAPS high-risk patients. This observation confirms that HCQ exerts a beneficial effect on aPL pregnancies by complement inhibition as it was shown in animal models. In addition, our results provide the clinicians a useful tool to implement conventional treatment in patients at high risk of pregnancy complication or loss.References[1]De Carolis S, et al. Is there any role for the hydroxychloroquine (HCQ) in refractory obstetrical antiphospholipid syndrome (APS) treatment? Autoimmun Rev 2015;14:760-2.[2]Mekinian A, et al. The efficacy of hydroxychloroquine for obstetrical outcome in antiphospholipid syndrome: data from a European multicenter retrospective study. Autoimmun Rev 2015;40:498-502.[3]Mekinian A et al. Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome? Autoimmun Rev 2015;14:23-9.Disclosure of InterestsNone declared
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Petri MA, Bertsias G, Daniels M, Fox NL, Hahn BH, Hammer A, Harris J, Quasny H, Tani C, Askanase A. POS0183 THE EFFECT OF BELIMUMAB ON SRI-4 RESPONSE IN MULTIPLE SUBGROUPS OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: RESULTS OF A LARGE INTEGRATED ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundBelimumab (BEL) is approved for the treatment of active autoantibody-positive systemic lupus erythematosus (SLE).1 Four Phase 3 studies have consistently demonstrated greater SLE Responder Index (SRI) response rates with BEL vs placebo (PBO).2-5 This robust dataset allows for additional exploration of the onset of efficacy of BEL and response rates by patient (pt) characteristics.ObjectivesTo perform a post hoc analysis evaluating the effect of BEL on SRI-4 response across a large, pooled population and pt subgroups.MethodsThe Belimumab Summary of Lupus Efficacy (Be-SLE) integrated analysis evaluated data from adults with SLE from 5 double-blind, PBO-controlled BEL trials: BLISS-76, BLISS-52, BLISS-NEA, BLISS-SC, and EMBRACE.2-6 Pts were randomised to BEL (monthly intravenous 10 mg/kg or weekly subcutaneous 200 mg) or PBO, plus standard therapy. Data were collected every 4 weeks (wks) from baseline (BL) to Wk 52. The SRI-4 response rate (a composite measure that includes ≥4-point reduction in Safety of Estrogens in Lupus Erythematosus National Assessment - SLE Disease Activity Index [SELENA-SLEDAI] score, stable Physician Global Assessment [PGA] increase of <0.3, and no new British Isles Lupus Assessment Group [BILAG] 1A/2B organ domain scores) by visit and time to first SRI-4 response maintained through Wk 52 were determined for both treatment groups. SRI-4 response rates at Wk 52 were evaluated by BL characteristic subgroups: SELENA-SLEDAI score; SLE International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score; disease duration; biomarker levels (anti-dsDNA, complement [C]3/C4); glucocorticoid (GC), immunosuppressant (IS), and antimalarial (AM) use.ResultsOverall, 3086 pts were included (BEL, n=1869; PBO, n=1217). Most were female (94.4%); mean (standard deviation [SD]) age was 37.0 (11.6) years. Mean (SD) SLE duration was 6.4 (6.4) years.At Wk 52, in the overall population, significantly more BEL vs PBO pts were SRI-4 responders (Figure 1). A significantly greater proportion of SRI-4 responders was observed with BEL vs PBO as early as Wk 8 (38.4% vs 33.3%; odds ratio, OR [95% confidence interval, CI] 1.25 [1.07, 1.46]; p=0.0060), which continued to increase to Wk 52 (54.8% vs 41.6%; OR [95% CI] 1.70 [1.46, 1.98]; p<0.0001). At Wk 52, more BEL vs PBO pts had a 4-point reduction in SELENA-SLEDAI (56.3% vs 43.1%; OR [95% CI] 1.71 [1.47, 2.00]; p<0.0001), no worsening in PGA (76.6% vs 67.9%; OR [95% CI] 1.52 [1.28, 1.79]; p<0.0001), and no new BILAG 1A/2B organ domain scores (77.1% vs 69.4%; OR [95% CI] 1.47 [1.25, 1.74]; p<0.0001). Pts on BEL were 52% more likely to experience an SRI-4 response that was maintained through Wk 52 (hazard ratio, HR [95% CI] 1.52 [1.36, 1.69]; p<0.0001).Figure 1.SRI-4 response at Wk 52 in the overall population and by BL characteristic subgroups.*OR (95% CI) and p-value are from a logistic regression model for BEL vs PBO comparison with covariates of treatment group, study and BL SELENA-SLEDAI score (≤9 vs ≥10)SRI-4 response rates were significantly higher with BEL vs PBO in most subgroups, with the highest response rates observed in pts with SELENA-SLEDAI score of ≥10, low C3 and/or C4 + anti-dsDNA ≥30 IU/ml, and low C3 and/or C4 at BL (Figure 1).ConclusionSignificantly more pts receiving BEL had SRI-4 response rates that occurred from Wk 8 and were maintained through Wk 52 compared with pts receiving PBO. The efficacy of BEL was consistent across multiple pt subgroups, with higher response rates in pts with SELENA-SLEDAI scores of ≥10, low C3 and/or C4 + anti-dsDNA ≥30 IU/ml and low C3 and/or C4 at BL. These results further substantiate the benefits of BEL in the treatment of adults with SLE.References[1]GlaxoSmithKline. Benlysta US prescribing information. 2021[2]Furie R, et al. Arthritis Rheumatol 2011;63(12):3918–30[3]Navarra SV, et al. Lancet 2011;377(9767):721–31[4]Stohl W, et al. Arthritis Rheum 2017;69(5):1016–27[5]Zhang F, et al. Ann Rheum Dis 2018;77(3):355–63[6] Ginzler E, et al. Arthritis Rheum 2021; doi: 10.1002/art.41900AcknowledgementsThis analysis was funded by GlaxoSmithKline (GSK). Medical writing support was provided by Lulu Hill, MPharmacol, Fishawack Indicia Ltd. UK, part of Fishawack Health, and was funded by GSK.Disclosure of InterestsMichelle A Petri Consultant of: GSK, Grant/research support from: GSK, George Bertsias Speakers bureau: Pfizer, Aenorasis, UCB, Novartis, Lilly, SOBI, Consultant of: Novartis, GSK, AstraZeneca, Grant/research support from: GSK, Pfizer, Mark Daniels Shareholder of: GSK, Employee of: GSK, Norma Lynn Fox Shareholder of: GSK, Employee of: GSK, Bevra H. Hahn Consultant of: UCB, GSK, Anne Hammer Shareholder of: GSK, Employee of: GSK, Julia Harris Shareholder of: GSK, Employee of: GSK, Holly Quasny Shareholder of: GSK, Employee of: GSK, Chiara Tani Speakers bureau: GSK, AstraZeneca, Anca Askanase Consultant of: AstraZeneca, Aurinia Pharmaceuticals Inc., Amgen, AbbVie Inc., BMS, GSK, Grant/research support from: AstraZeneca, Eli Lilly and Company, GSK, Idorsia Pharmaceuticals Ltd, Janssen Pharmaceuticals, Pfizer
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Scagnellato L, Maffi M, Tani C, Elefante E, Trentin F, Ferro F, Zucchi D, Stagnaro C, Carli L, Mosca M. AB0423 STRATEGIES FOR GLUCOCORTICOID TREATMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS FLARES: A REAL-LIFE EXPERIENCE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundGlucocorticoids (GC) are a cornerstone for the treatment of Systemic Lupus Erythematosus (SLE) manifestations but there is still open debate concerning their optimal therapeutic employment.ObjectivesTo describe and compare the GC therapeutic strategies used in a real-life setting for the initial treatment of SLE flares.MethodsThis study is a retrospective analysis of data from a monocentric cohort of SLE patients who registered a disease flare between 2015 and 2020. Flares were first categorized in “pulse-treated” (PT) and “non pulse-treated” (NPT). PT flares were then divided into “low-dose regimen” (250 mg iv 6MP for 3 consecutive days or less) and “high-dose regimen” (more than 250 mg iv 6MP for 3 days). GC daily and cumulative 6MP doses, rate of remission and relapse were evaluated at 3, 6 and 12 months.Results101 flares were analyzed (30 PT and 71 NPT). PT flares were more severe in terms of median SLEDAI (PT 16(12-22) vs NPT 8(5-10) p=0,00) and BILAG score index (BILAG A PT 71% vs NPT 30% p=0,001). PT patients received significantly higher GC doses at 1 month (PT median cumulative dose 1372 IQR 1028 – 3076 mg of 6MP vs NPT median 160 IQR 120-288 mg of 6MP, p=0,000), 6 months (PT median cumulative dose 2964 IQR 2294 – 4305 mg of 6MP vs NPT 880 IQR 720 – 1284 mg of 6MP, p=0,000) and 12 months (PT median cumulative dose 3510 IQR 3014-5025 vs NPT median cumulative dose 1571 IQR 1098 – 2122 mg of 6MP, p=0,000). Characteristics of flares that were treated with low-dose (N=19) or high-dose (N=11) pulse regimen are summarized in Table 1. As expected, the “low-dose regimen” subgroup received lower cumulative GC dosage over time. However, no statistically significant differences were found neither in term of disease severity at baseline nor in term of disease activity, remission rates or new flares over time.Table 1.Comparison between low-dose pulse regimen and high-dose pulse regimen in terms of cumulative GC dose and outcome in the first year after a SLE flareMedian GC doses (6MP)Low-dose regimenN=19 (63,33%)High-dose regimenN=11 (36,67%)P value Median SLEDAI16 (12 -20)18 (8-24)0,6186BILAG score (A, B, C)A=14, B=4, C=1A=10, B=1, C=00,488Cum. dose 1 mo1350 (1028 – 1534)1752 (960 – 2356)0,126Cum. dose 3 mos1858 (1604 – 2463)2784 (2184 – 3240)0,040Cum. dose 6 mos2450 (2218 – 3586)3456 (2906 – 4380)0,029Cumulative doses 12 mos3150 (2851 - 4448)4246 (3591 – 5772)0,011Remission 3 mos no – (%)2 (10%)0 (0%)0,265Remission 6 mos no – (%)8 (42%)1 (9%)0,057Remission 12 mos no – (%)12 (63%)5 (45%)0,346Median SLEDAI 3 mos4 (2 – 9)9 (4 – 12)0,138Median SLEDAI 6 mos3 (0 - 4)4 (0 – 9)0,154Median SLEDAI 12 mos2 (0 – 5)2 (0 – 12)0,363New flares 6 mos no – (%)2 (10%)1 (9%)0,900New flares 12 mos no – (%)2 (10%)2 (18%)0,552GC=glucocorticoids, 6MP=6-methylprednisolone, no=number, Cum.=cumulative, mos=monthsConclusionThese data suggest that in a real-life setting, pulse GC therapy is preferred over oral administration for severe SLE flares and entails administration of high cumulative doses of GC. However, the experience outlined suggests that the low-dose pulse regimen is as effective in remission induction of severe flares as the high-dose regimen, allowing significant GC sparing. Since the cumulative GC dose is a known strong predictor of organ damage, strategies aimed to minimize the GC dosage should be encouraged.Disclosure of InterestsNone declared
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Elefante E, Tani C, Signorini V, Stagnaro C, Lunardi L, Zucchi D, Trentin F, Carli L, Ferro F, Mosca M. POS1502-HPR A PHYSICAL EXERCISE PROGRAM FOR THE MANAGEMENT OF FATIGUE IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) AT THE TIME OF PANDEMIC: A PILOT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFatigue in SLE has a multifactorial origin and disease activity seems to contribute only minimally to its genesis. Therefore, non-pharmacological therapeutic strategies should also be considered in the management of fatigue. There is some evidence on the effectiveness of aerobic exercise programs in improving fatigue, without a negative impact on disease manifestations.Objectivesthe aim of this study was to analyze fatigue and Health Related Quality of Life (HRQoL) in a monocentric cohort of patients with SLE, in a condition of stable remission or low disease activity, before and after a program of physical exercise, through the administration of validated Patient Reported Outcomes (PROs).Methodsthis is a cross-sectional interventional study which included patients with SLE, aged between 18 and 55 years, in a condition of stable (≥12 months) remission (DORIS)1 or low disease activity (LLDAS)2. Patients enrolled had a FACIT score ≤40 in the previous 6 months. Patients with other possible causes of fatigue (e.g.: anemia, hypothyroidism, severe vitamin D deficiency), active arthritis or physical disabilities were excluded. For each patient, demographics, comorbidities, treatment, clinical and laboratory data were collected. Disease activity was evaluated with the SELENA-SLEDAI and organ damage with the SLICC/DI. Each patient completed the following PROs before and after the interventional program: SF-36, FACIT-Fatigue, LIT, HADS. Due to the limitations related to the COVID-19 pandemic, the physical exercise sessions were carried out using the Google Meet digital platform. Patients were asked to participate to at least 70% of the lessons. The physical exercise program included moderate intensity aerobic exercises (muscle strengthening, joint mobility, breathing, static and dynamic stretching, balance and neuro-dynamics); workouts were performed 3 times a week, consisting of 60 minutes each. The program lasted for 12 weeks.Resultswe enrolled 12 female patients, regularly followed at the Rheumatology Unit of Pisa; only 9 of them completed the study (mean age 38.56 ± 9.1 years; median disease duration 7 years (IQR 5,25-9,75)). 8/9 were in stable remission, while 1/9 was in LLDAS for the presence of leukopenia.2/9 patients presented organ damage, one for cataract and one for renal insufficiency, while none presented damage in the musculoskeletal system. 33.3% of patients had fibromyalgia. 88.8% was on treatment with Hydroxychloroquine, 55.5% was on low dose steroids (2±1.9 mg/daily), 33.3% was on Mycophenolate Mofetil; only 1 patient was on Belimumab. All PROs showed a trend to improvement at the end of the 12-week program of physical activity (Table 1). We demonstrated a statistically significant improvement of: FACIT, LIT, depression score of the HADS and MCS of the SF-36. The items of role physical (RP), vitality (VT) and mental health (MH) of the SF-36 also showed a significant improvement.Table 1.Scores of PROs before and after the physical exercise program.PROsMean scores at baselineMean scores after the 12-week exercise programpFACIT30.2 ± 4.939.3 ± 7.20.01PF73.18 ± 10.978.9 ± 10.50.18RP50 ± 13.267.4 ± 18.60.03BP52 ± 12.154.1 ± 11.10.73GH41.7 ± 11.148.4 ± 11.10.07VT34.7 ± 12.559.0 ± 14.20.002SF58.3 ± 15.666.7 ± 16.70.3RE55.5 ± 21.569.4 ± 18.00.13MH58.3 ± 15.867.2 ± 16.20.03PCS43.8 ± 4.046.1 ± 4.80.19MCS38.6 ± 8.845.6 ± 8.70.03LIT36.9 ± 14.227.5 ± 14.10.05HADS (A)9 ± 4.47.7 ± 3.20.4HADS (D)7.9 ± 4.45.1 ± 2.960.05ConclusionIn a small cohort of SLE patients in remission but with severe fatigue, in the difficult context of COVID-19 pandemic, we demonstrated that an online program of physical exercise may determine a significant improvement of fatigue, perception of disease burden and mental health. In the context of a multidisciplinary management, finding effective intervention programs to improve fatigue and HRQoL in SLE patients appears of utmost importance, with the final aim of improving patients’ health status.References[1]PMID 27884822; 2PMID 26458737Disclosure of InterestsNone declared
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Trentin F, Fulvio G, Andreozzi G, Cigolini C, Da Rio M, Dell’Oste V, Elefante E, Fattorini F, Fonzetti S, Lorenzoni V, Maffi M, Navarro García IC, Palla I, Pedrinelli V, Scagnellato L, Schilirò D, Valevich A, Gaglioti A, Carmassi C, Tani C, Dell’osso L, Turchetti G, Mosca M. AB1410 IMPACT OF COVID-19 PANDEMIC ON HEALTHCARE RESOURCE USE AND CLINICAL OUTCOMES IN A COHORT OF PATIENTS WITH SYSTEMIC AUTOIMMUNE DISEASES- AN INTERIM ANALYSIS FROM THE PER-MAS PROJECT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundManagement of the health emergency caused by COVID-19 pandemic majorly disrupted the delivery of healthcare services to patients with chronic conditions like Systemic Autoimmune Diseases (SAD), both because resources were mainly channeled towards the care of infected patients, but also because patients tended to avoid seeking medical care for fear of becoming infected. PER-MAS is a 2-year project aimed at assessing the clinical, psychopathological, and socio-economic impact of COVID-19 in a cohort of patients with SAD.ObjectivesTo assess the impact of COVID-19 pandemic on drug withdrawal, disease flares and hospitalizations for disease exacerbation in a cohort of patients with SAD through an interim analysis of data from the PER-MAS project.MethodsA sample of 214 consecutive patients was recruited in a reference center for rare and complex autoimmune diseases from April 2021 to January 2022. Inclusion criteria were definite diagnosis of SAD (Connective Tissue Disease (CTD), Inflammatory Arthritis (IA) or Vasculitis), regular follow-up and at least 2 years of disease. Patients were asked to fill out an extensive self-administered questionnaire on disease activity and healthcare resource use during the pandemic (March 2020-moment of assessment). Pre-pandemic (March 2019-February 2020) and early pandemic (March 2020-February 2021) clinical data were recorded through retrospective chart review and patient interview.ResultsAt enrolment, 119 patients were affected by CTDs (55.6%), 71 by IA (33.18%), 24 by vasculitis (11.21%), with mean age 50.44± 12.97, and mean disease duration 11.17 ± 8.94. 30.37% took steroids, 39.7% hydroxychloroquine, 61.68% DMARDs, and 9.3% vasoactive drugs.Overall, disease course was similar in pre-pandemic and early pandemic phase: in the first period, rheumatologic condition was stable in 57.35% of patients, persistently active in 27.3% and 35.61% had ≥ 1 episode of disease exacerbation (mean 0.665±1.15, range 0-6); in the second period, 60.56% of patients was stable, 24.88% persistently active, and 39.44% had ≥1 exacerbation (mean 0.49 ±0.77, range 0-4). Mean number of visits (2.56±2.57 and 2.61±2.79), hospitalizations (0.168±0.698 and 0.14±0.473, p=0.6), number of patients with outpatient visits=0 (7.47 vs 7%), and number of patients with ≥ 1 hospital admission (10.28 vs 11.6%) were also similar, while the number of patients with hospital admissions for disease exacerbation was significantly higher in the second period (6.1 vs 11.21%, p=0.001).170 patients completed the survey: from March 2020 to enrolment, 18.2% suspended ≥1 anti-rheumatic drug (6.25% of them for fear of contracting COVID-19 disease, 15.6% for difficulty in obtaining medications), 20% self-managed ≥ 1 disease exacerbation, and 40% had ≥ 1 telemedicine consult. From March to July 2020, 41.76% had their visit rescheduled (35.23% for hospital access restrictions, 5.3% for travel restrictions, 1.17% for fear). Conversely, only 14.7% of patients had their visit rescheduled (8.23% for hospital access restrictions, 4.7% for other reasons) from July 2020 to enrolment.ConclusionIn the early pandemic phase, overall disease course was similar to the pre-pandemic phase, but we observed an increase in the number of patients with ≥ 1 hospitalization for disease. Moreover, despite our efforts, patients reported a non-negligible rate of drug discontinuation for non-medical indication and difficulty to get access to rheumatologic consultation, highlighting the need of alternative organizational models in case of future pandemics.AcknowledgementsGiulia Sacco for helping in patient recruitment and data management.Disclosure of InterestsFrancesca Trentin: None declared, Giovanni Fulvio: None declared, Gianni Andreozzi: None declared, Cosimo Cigolini: None declared, Mattia Da Rio: None declared, Valerio Dell’Oste: None declared, Elena Elefante: None declared, Federico Fattorini: None declared, Silvia Fonzetti: None declared, Valentina Lorenzoni: None declared, Michele Maffi: None declared, Inmaculada Concepción Navarro García: None declared, Ilaria Palla: None declared, Virginia Pedrinelli: None declared, Laura Scagnellato: None declared, Davide Schilirò: None declared, Anastasiya Valevich: None declared, Andrea Gaglioti: None declared, Claudia Carmassi: None declared, Chiara Tani: None declared, Liliana Dell’Osso: None declared, Giuseppe Turchetti: None declared, Marta Mosca Speakers bureau: Lilly, Astra Zeneca, GSK, Consultant of: Lilly, Astra Zeneca, GSK
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Zucchi D, Racca F, Tani C, Elefante E, Stagnaro C, Carli L, Signorini V, Ferro F, Trentin F, Gori S, Mosca M. OP0128 ADHERENCE TO MEDICATIONS DURING PREGNANCY IN SYSTEMIC AUTOIMMUNE DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLow medication adherence is a well known issue in the management of patients with systemic autoimmune diseases (SAD), little however is known on adherence to medication during pregnancy, especially in these patients with high risk pregnancies.ObjectivesThis study is aimed at evaluating the level of adherence to medication in pregnant patients with SAD in comparison with non-pregnant patients with SAD, and at identifying determinants of low adherence.MethodsPregnant and non-pregnant patients with an established diagnosis of SAD were consecutively enrolled. Pregnant patients were included in a tight monitoring protocol for high risk pregnancies, and treatments were checked every month. The following data were collected at enrolment: epidemiological and demographic characteristics, disease duration and type of medications. Each patient completed the following anonymous questionnaires: the 8-item Morisky Medication Adherence Scale (MMAS-8) and Hospital Anxiety and Depression Scale (HADS) to assess the presence of anxiety and depression. With regard to MMAS-8, we assessed adherence to hydroxychloroquine (HCQ) and to other disease modifying antirheumatic drugs (DMARDs) separately. We considered a score ≥ 6 as indicator of good adherence. Vitamins and dietary supplements were not considered.ResultsA total of 80 pregnant women and 72 non-pregnant women were enrolled. Clinical data and results of the questionnaires are summarized in Table 1.Table 1.Characteristics of the cohortPregnant patients N=80Non-pregnant patients N=72P valueAge at study entry (years, mean ±SD)35.8±4.340.1±12.20.001Disease duration (years, mean ±SD)8.5±6.68.6±9.1n.sNumber of tablets/day (mean ±SD)4.3±1.64.1±1.8n.sNumber of assumption/day (mean ±SD)1.4±0.61.6±0.8n.sScore MMAS for HCQ (mean ±SD)6.99±0.26.38±0.20.039Score MMAS for other DMARDs (mean ±SD)6.99±0.36.39±0.20.018Patients with good adherence to HCQ (%)38/50 (76.0%)34/59 (57.6%)0.044Patients with good adherence to medications (%)53/71 (74.6%)37/60 (61.7%)n.sPatients with low adherence to HCQ (%)12/50 (24%)25/59 (42.4%)0.044Patients with low adherence to medications (%)18/71 (25.4%)23/60 (38.3%)n.sAnxiety (%)20 (25%)30 (41.7%)0.029Depression (%)11 (13.7%)19 (26.4%)0.051MMAS-8 score was significantly higher in pregnant women both for HCQ (p=0.039) and other DMARDs (p=0.018), as well as the rate of patients with good medication adherence for HCQ (76.0% vs 57.6%, p=0.044). The rate of patients with good medication adherence for other DMARDs was higher in pregnant patients (74.6% vs 61.7%) but this different was not statistically different.Demographic and clinical characteristics and the number of therapies received didn’t seem to influence treatment adherence. Fifty patients (32.8%) suffered from anxiety, and this disorder was a significant determinant of low medication adherence in all groups. Conversely, depression didn’t seem to have an impact on adherence on neither group.ConclusionOverall, pregnant patients with SAD had a good adherence to prescribed medication; nevertheless, 25% of patients didn’t take therapies adequately despite being closely monitored in a dedicated clinic for high risk pregnancies and an adequate pregnancy counselling; anxiety seems to be one determinant of low medications adherence both in pregnant and non-pregnant women.Disclosure of InterestsNone declared
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Fulvio G, Pedrinelli V, Andreozzi G, Trentin F, Fantasia S, Fonzetti S, Fustini C, Da Rio M, Cappellato G, Cigolini C, Schilirò D, Maffi M, Scagnellato L, Valevich A, Fattorini F, Navarro García IC, Palla I, Lorenzoni V, Gaglioti A, Carmassi C, Tani C, Turchetti G, Dell’Osso L, Mosca M. OP0197 POST-TRAUMATIC STRESS DISORDER AND SYMPTOMS IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES DURING THE COVID-19 PANDEMIC: PRELIMINARY RESULTS FROM THE PERMAS STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people’s everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders.ObjectivesTo assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy.MethodsPERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum- Self Report (TALS-SR) and the Impact of Event Scale- Revised (IES-R), aimed to assess symptomatological PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic.ResultsA total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females; 112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defined by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with significant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031).ConclusionThe present findings point out high prevalence rates of symptomatological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.References[1]Fiorillo A, Sampogna G, Giallonardo V, Del Vecchio V, Luciano M, Albert U, Carmassi C, Carrà G, Cirulli F, Dell’Osso B, Nanni MG, Pompili M, Sani G, Tortorella A, Volpe U. Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: Results from the COMET collaborative network. Eur Psychiatry 2020; 63(1), e87.[2]Carmassi C, Dell’Oste V, Bui E, Foghi C, Bertelloni CA, Atti AR, Buselli R, Di Paolo M, Goracci A, Malacarne P, Nanni MG, Gesi C, Cerveri G, Dell’Osso L. The interplay between acute post-traumatic stress, depressive and anxiety symptoms on healthcare workers functioning during the COVID-19emergency: A multicenter study comparing regions with increasing pandemic incidence. J Affect Disord 2022; 298(Pt A), 209-216.[3]Garrido-Cumbrera M, Marzo-Ortega H, Christen L, Plazuelo-Ramos P, Webb D, Jacklin C, Irwin S, Grange L, Makri S, Frazão Mateus E, Mingolla S, Antonopoulou K, Sanz-Gómez S, Correa-Fernández J, Carmona L, Navarro-Compán V. Assessment of impact of the COVID-19 pandemic from the perspective of patients with rheumatic and musculoskeletal diseases in Europe: results from the REUMAVID study (phase 1). RMD 2021; 7(1), e001546. doi: 10.1136/rmdopen-2020-001546[4]Wang XA, Duculan R, Mancuso CA. Coping Mechanisms Mitigate Psychological Stress in Patients With Rheumatologic Diseases During the COVID-19 Pandemic. J Clin Rheumatol 2021. doi: 10.1097/RHU.0000000000001757Disclosure of InterestsGiovanni Fulvio: None declared, Virginia Pedrinelli: None declared, Gianni Andreozzi: None declared, Francesca Trentin: None declared, Sara Fantasia: None declared, Silvia Fonzetti: None declared, Chiara Fustini: None declared, Mattia Da Rio: None declared, Gabriele Cappellato: None declared, Cosimo Cigolini: None declared, Davide Schilirò: None declared, Michele Maffi: None declared, Laura Scagnellato: None declared, Anastasiya Valevich: None declared, Federico Fattorini: None declared, Inmaculada Concepción Navarro García: None declared, Ilaria Palla: None declared, Valentina Lorenzoni: None declared, Andrea Gaglioti: None declared, Claudia Carmassi: None declared, Chiara Tani: None declared, Giuseppe Turchetti: None declared, Liliana Dell’Osso: None declared, Marta Mosca Speakers bureau: Lillly, Astra Zeneca, GSK, Consultant of: Lillly, Astra Zeneca, GSK
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Tani C, Zucchi D, Haase I, Gerosa M, Larosa M, Cavagna L, Bortoluzzi A, Crisafulli F, Mucke J, Strigini FAL, Baglietto L, Fornili M, Monacci F, Elefante E, Erra R, Bellis E, Padovan M, Andreoli L, Coletto LA, Zanframundo G, Govoni M, Iaccarino L, Tincani A, Doria A, Fischer-Betz R, Mosca M. Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: results from a multicentre study. Lupus Sci Med 2022; 9:9/1/e000714. [PMID: 35701044 PMCID: PMC9198794 DOI: 10.1136/lupus-2022-000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022]
Abstract
Objective It is still a matter of debate whether low-dose acetylsalicylic acid (LDASA) should be prescribed to all patients with SLE during pregnancy. This study aimed at investigating the impact of LDASA on pregnancy outcomes in patients with SLE without history of renal involvement and without antiphospholipid antibodies (aPL). Methods This is a retrospective analysis of prospectively monitored pregnancies at seven rheumatology centres. Previous/current renal involvement and aPL positivity were the exclusion criteria. Adverse pregnancy outcome (APO) is the composite outcome of the study and included proteinuric pre-eclampsia, preterm delivery <37 weeks, small-for-gestational age infant, low birth weight <2500 g, intrauterine growth restriction and intrauterine fetal death after 12 weeks of gestation of a morphologically normal fetus. Results 216 pregnancies in 187 patients were included; 82 pregnancies (38.0%) were exposed to LDASA treatment. No differences in terms of age at conception, disease duration, clinical manifestations, comorbidities and disease flare during pregnancy were observed between patients taking LDASA and those who did not take LDASA during pregnancy. APO was observed in 65 cases (30.1%), including 13 cases (6.1%) of pre-eclampsia. The incidence of all complications was similar in the two groups. However, it is interesting to note that pre-eclampsia had lower frequency in patients taking LDASA versus those not taking LDASA (2.4% vs 8.3%, p=0.14). Conclusions In pregnant patients with SLE without renal involvement and were aPL-negative, there is a low risk of severe obstetric complications, such as early pre-eclampsia. LDASA treatment does not provide a statistically significant advantage over these complications. However, a careful individual risk–benefit balance is warranted.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Isabell Haase
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Maria Gerosa
- Division of Clinical Rheumatology, ASST Pini-CTO, Research Centre for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Lorenzo Cavagna
- Rheumatology Unit, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Francesca Crisafulli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Francesca A L Strigini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Monacci
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Erra
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Bellis
- Rheumatology Unit, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Melissa Padovan
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, ASST Pini-CTO, Research Centre for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Zanframundo
- Rheumatology Unit, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Angela Tincani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Rebecca Fischer-Betz
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Andreoli L, Gerardi MC, Crisafulli F, Zanetti A, Rozza D, Gerosa M, Lini D, Filippini M, Fredi M, Nalli C, Lazzaroni MG, Taglietti M, Franceschini F, Caporali R, Trespidi L, Erra R, Mosca M, Tani C, Zucchi D, Melissa P, Ruffilli F, Maranini B, Rovere-Querini P, Canti V, De Lorenzo R, Cutro MS, Picerno V, Montecucco C, Ramoni V, Anelli MG, Abbruzzese A, Serale F, Romeo N, Chimenti MS, Cuomo G, Larosa M, Pata AP, Iuliano A, Crepaldi G, Brucato A, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A. OP0125 THE MANAGEMENT OF PREGNANCY IN AUTOIMMUNE RHEUMATIC DISEASES: ANALYSIS OF 758 PREGNANCIES FROM THE PROSPECTIVE NATIONWIDE P-RHEUM.IT STUDY (THE ITALIAN REGISTRY OF PREGNANCY IN THE RHEUMATIC DISEASES). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPregnancy is a topic of fundamental importance for women living with autoimmune rheumatic diseases (ARD). Efforts at national and international levels have been put in the collection and harmonization of data in order to implement an evidence-based management of pregnant patients.ObjectivesThe P-RHEUM.it study was designed as a nationwide, web-based longitudinal observational cohort study to collect data about pregnancy in ARD in 26 centers in Italy. The study started in May 2018 and has been supported by the Italian Society for Rheumatology.MethodsPregnant patients with a definite rheumatic disease according international criteria were enrolled up to gestational week (GW) 20. The course of maternal disease activity, the use of medications, fetal and maternal complications, and the quality of life (EuroQoL questionnaire) were collected for each trimester, as well as pregnancy outcome, mode of delivery, neonatal complications, and maternal and children’s follow-up to 6 months after delivery, including the screening for post-partum depression by means of EPDS (Edinburgh Postnatal Depression Scale).ResultsAs of December 2021, 758 pregnancies had been enrolled, 205 (27%) ongoing and 553 (73%) with outcome. Pregnancy loss occurred in 54 (9.8%) cases (40 spontaneous miscarriages; 6 voluntary terminations). Live births were 495 (89.5%), perinatal death occurred in 4 (0.7%) cases. Table 1 reports on the group of 495 live births, along with subgroups of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), the two most represented diseases. Regarding treatments, 166 (30%) pregnancies were exposed to corticosteroids, 239 (43%) to hydroxychloroquine, 59 (10.7%) to csDMARDs, 84 (15.2%) to TNF inhibitors, 1 (0.2%) to non-TNFi bDMARDs, 299 (54%) to low dose acetylsalicylic acid, and 126 (22.8%) to heparin.Table 1.PREGNANCIES WITH LIVE BIRTHS, EXCLUDING PERINATAL DEATHSTotal pregnancies (n=495)RA pregnancies (n=69)SLE pregnancies (n=93)Age at conception (years)34 (31 - 37)34.5 (32 - 38)34 (31 - 36)Disease duration (years)6.1 (2.2 - 11.1)7.1 (4.3 - 11.6)9.3 (5.9 - 15.9)Caucasian431 (87.8%)53 (79.1%)75 (80.6%)Never smokers358 (73.8%)53 (80.3%)66 (71.7%)Body Mass Index >3045 (9.5%)7 (10.3%)5 (5.6%)Arterial Hypertension6 (1.2%)0 (0%)2 (2.2%)Time to pregnancy (months)3 (1 - 6)3 (1 - 6)3 (0 - 10)Physician-reported flares in the 12 months prior to conception107 (23%)22 (34.4%)13 (14.8%)Physician global assessment at enrolment (VAS 0-100)5 (0 - 17)5 (0 - 20)4 (0 - 10)Patient global health at enrolment (VAS 0-100)18 (7 - 30)10 (5 - 29)10 (5 - 25)EuroQoL at enrolment (-1.6 – 1)1 (0.8 - 1)1 (0.8 - 1)1 (0.8 - 1)Flares during pregnancy35 (7.1%)6 (8.7%)7 (7.5%)Hypertensive disturbances*8 (1.7%)1 (1.6%)6 (6.6%)Delivery at term (≥37 GW)410 (85.1%)53 (77.9%)74 (80.4%)Spontaneous vaginal delivery173 (35.9%)23 (33.8%)23 (25.3%)Congenital malformations11 (2.4%)2 (3.1%)1 (1.1%)Small for gestational age (SGA) neonate24 (4.9%)1 (1.4%)9 (9.9%)Breastfeeding in the first 4 weeks after delivery341 (79.7%)45 (77.6%)59 (76.6%)EPDS score at risk for post-partum depression22 (14.1%)0 (0%)3 (10.3%)Continuous variables are expressed as median (interquartile range); *gestational hypertension/preeclampsia/HELLP syndrome/eclampsia.ConclusionMultiple factors may have contributed to the high rate of live births, including good disease control before and during pregnancy thanks to the use of anti-rheumatic drugs and low frequency of general risk factors. SLE pregnancy was affected by a higher frequency of complications (hypertensive disturbances, SGA babies) as compared to RA pregnancy. Nearly 80% of patients breastfed in the first month after delivery. For the first time, data about the screening questionnaire for post-partum depression were collected, showing at least 1 out 10 patients can be at risk.References[1]Meissner Y et al. Arthritis Res Ther;21(1):241; Ann Rheum Dis. 2021;80(1):49-56.AcknowledgementsP-RHEUM.it study is supported by the Italian Society for Rheumatology (SIR). All the Investigators are acknowledged for their contribution.Disclosure of InterestsNone declared
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Talarico R, Aguilera S, Alexander T, Amoura Z, Andersen J, Arnaud L, Avcin T, Marsal Barril S, Beretta L, Bombardieri S, Bortoluzzi A, Bouillot C, Bulina I, Burmester GR, Cannizzo S, Cavagna L, Chaigne B, Cornet A, Corti P, Costedoat-Chalumeau N, Dāvidsone Z, Doria A, Fenech C, Ferraris A, Fischer-Betz R, Fonseca JE, Frank C, Gaglioti A, Galetti I, Guimarães V, Hachulla E, Holmner M, Houssiau F, Iaccarino L, Jacobsen S, Limper M, Malfait F, Mariette X, Marinello D, Martin T, Matthews L, Matucci-Cerinic M, Meyer A, Milas-Ahić J, Moinzadeh P, Montecucco C, Mouthon L, Müller-Ladner U, Nagy G, Patarata E, Pileckyte M, Pruunsild C, Rednic S, Romão VC, Schneider M, Scirè CA, Smith V, Sulli A, Tamirou F, Tani C, Taruscio D, Taulaigo AV, Tincani A, Ticciati S, Turchetti G, van Hagen PM, van Laar JM, Viera A, de Vries-Bouwstra JK, Zschocke J, Cutolo M, Mosca M. The added value of a European Reference Network on rare and complex connective tissue and musculoskeletal diseases: insights after the first 5 years of the ERN ReCONNET. Clin Exp Rheumatol 2022; 40 Suppl 134:3-11. [DOI: 10.55563/clinexprheumatol/d2qz38] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Silvia Aguilera
- Spanish Association for Antiphospholipid Syndrome (SAF España), Elche, Spain
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, French National Referral Center for SLE and APS, Paris, France
| | | | - Laurent Arnaud
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Alessandra Bortoluzzi
- Department of Medical Sciences, Rheumatology Section, University of Ferrara, Azienda Ospedaliero-Universitaria Sant’Anna di Cona, Ferrara, Italy
| | | | - Inita Bulina
- Department of Internal Diseases, Rheumatology Centre, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Gerd R. Burmester
- Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sara Cannizzo
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Lorenzo Cavagna
- Department of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Benjamin Chaigne
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, France
| | | | - Paolo Corti
- Relapsing Polychondritis Awareness and Support, Worcester, UK
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, France
| | - Zane Dāvidsone
- Departement of Paediatrics, Riga Stradiņš University (RSU), Riga, Latvia
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | | | - Alessandro Ferraris
- Medical Genetics Laboratory, Molecular Medicine Department, San Camillo Forlanini Hospital, Sapienza University, Rome, Italy
| | - Rebecca Fischer-Betz
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Charissa Frank
- Flemish Association for Hereditary Connective Tissue Disorders, Koersel, Belgium
| | - Andrea Gaglioti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Vera Guimarães
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, Université de Lille, CHU Lille, France
| | - Monica Holmner
- Federation of European Scleroderma Associations (FESCA), Milan, Italy
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen, Denmark
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital and Department for Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, CEA, Centre de recherche en Immunologie des infections virales et des maladies auto-immunes; AP-HP, Hôpital Bicêtre, Rheumatology Department, Le Kremlin Bicêtre, France
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thierry Martin
- Service d’Immunologie Clinique, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Autoimmunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Lisa Matthews
- Relapsing Polychondritis Awareness and Support, Worcester, UK
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alain Meyer
- Service de rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Jasminka Milas-Ahić
- Department of Rheumatology, Clinical Immunology and Allergology, University Hospital Osijek, Croatia
| | - Pia Moinzadeh
- Department of Dermatology, Universitätsklinikum, Cologne, Germany
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence Maladies Systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, France
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus Liebig University of Giessen, Bad Nauheim, Germany
| | - György Nagy
- Department of Rheumatology and Clinical Immunology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Eunice Patarata
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Margarita Pileckyte
- Department of Rheumatology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Chris Pruunsild
- Children’s Clinic, Tartu University Hospital, Tartu, Estonia
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | | | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital Department of Internal Medicine, Ghent, Belgium, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Italy
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Anna V. Taulaigo
- Auto-immune Disease Unit, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University of Brescia, Italy
| | - Simone Ticciati
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - P. Martin van Hagen
- Department of Internal Medicine and Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Ana Viera
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | | | - Johannes Zschocke
- Institute of Human Genetics, Medical University of Innsbruck, Austria
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Rheumatology Unit, University of Pisa, Italy. ,
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Tani C, Elefante E, Arnaud L, Barreira SC, Bulina I, Cavagna L, Costedoat-Chalumeau N, Doria A, Fonseca JE, Franceschini F, Fredi M, Iaccarino L, Limper M, Majnik J, Nagy G, Pamfil C, Rednic S, Reynolds JA, Tektonidou MG, Troldborg A, Zanframundo G, Mosca M. Rare clinical manifestations in systemic lupus erythematosus: a review on frequency and clinical presentation. Clin Exp Rheumatol 2022; 40 Suppl 134:93-102. [PMID: 35485422 DOI: 10.55563/clinexprheumatol/jrz47c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to review the frequency and clinical presentation of the rarest clinical manifestations of systemic lupus erythematosus (SLE). METHODS A list of 6 rare SLE manifestations were defined: gastrointestinal, liver, pulmonary, cardiac, ocular and neurological manifestations. Each topic was assigned to a pair of authors to perform a literature search and article review. RESULTS In total, 149 articles were included in the literature review: 37 for gastrointestinal manifestations, 6 for liver manifestations, 27 for pulmonary manifestations, 50 for cardiac manifestations, 16 for ocular manifestations, 13 for neurological manifestations. Gastrointestinal disorders included several clinical presentations with variable frequency (from 0.5% to 10.7% of the cases); liver involvement included lupus-related hepatitis (9.3%) and autoimmune hepatitis (2.3%). The rarest pulmonary manifestations identified were shrinking lung syndrome, described in 1.5% of patients, while interstitial lung disease and lupus pneumonia were reported in 4% and 3% of patients respectively. Myocarditis and pulmonary hypertension were also rarely described in SLE patients although ranging from 0.4-16% and 1-14% respectively, depending on the methodology used for its identification. Ocular manifestations in SLE included some rare manifestations (reported in less than 5% of patients) and lupus retinopathy that is described in 1.2-28.8% of patients depending on methods of ascertainment. Aseptic meningitis and chorea were also confirmed as very rare manifestations being reported in less than 1% and in 0.3-2.4% of cases respectively. CONCLUSIONS The results of this literature review provide the basis for a better understanding of some less-known manifestations of SLE and for stressing the need for a higher awareness in diagnostic and therapeutic protocols regarding these rare disease aspects.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Elena Elefante
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg, INSERM UMR-S 1109, Centre National de Référence des Maladies Auto-immunes Systémiques Rares (RESO), Strasbourg, France
| | - Sofia C Barreira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, and Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Inita Bulina
- Reimatoloģijas centra vadītāja VSIA P. Stradiņa KUS IMK Reimatoloģijas centrs, LPRB (Latvijas pieaugušo Reimatoloģijas biedrība) valdes locekle, ERN ReCONNET Affiliated Partner representative of Latvia adults rheumatologists, Pauls Stradins Clinical University hospital, Internal Medicine Clinic, Centre of Rheumatology, Riga, Latvia
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes et Systémiques Rares Île de France, APHP, Hôpital Cochin, Paris, and Université de Paris, Centre de Recherche Épidémiologie et Biostatistiques de Sorbonne Paris Cité, France
| | - Andrea Doria
- Dipartimento di Medicina-DIMED, Azienda Ospedaliera/Università di Padova, Italy
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, and Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Luca Iaccarino
- Dipartimento di Medicina-DIMED, Azienda Ospedaliera/Università di Padova, Italy
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, Division of Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Judit Majnik
- Semmelweis University, Department of Rheumatology and Clinical Immunology, Hospital of Hospitaller Brothers of St. John of God, Rheumatology and Clinical Immunology, Department of Genetics, Cell- and Immunobiology Semmelweis University, Budapest, Hungary
| | - Gyorgy Nagy
- Semmelweis University, Department of Rheumatology and Clinical Immunology, Hospital of Hospitaller Brothers of St. John of God, Rheumatology and Clinical Immunology, Department of Genetics, Cell- and Immunobiology Semmelweis University, Budapest, Hungary
| | - Cristina Pamfil
- Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, County Emergency Clinical Hospital Cluj, Cluj-Napoca, Romania
| | - Simona Rednic
- Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, County Emergency Clinical Hospital Cluj, Cluj-Napoca, Romania
| | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, and Rheumatology Department, City Hospital, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Academic Program, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University, Denmark
| | - Giovanni Zanframundo
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, and Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Elefante E, Tani C, Stagnaro C, Signorini V, Lenzi B, Zucchi D, Trentin F, Carli L, Ferro F, Mosca M. Self-Reported Anxiety and Depression in a Monocentric Cohort of Patients With Systemic Lupus Erythematosus: Analysis of Prevalence, Main Determinants, and Impact on Quality of Life. Front Med (Lausanne) 2022; 9:859840. [PMID: 35425779 PMCID: PMC9001926 DOI: 10.3389/fmed.2022.859840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/04/2022] [Indexed: 12/04/2022] Open
Abstract
Aims of the study To analyze the prevalence of self-reported anxiety and depression in a monocentric cohort of patients with Systemic Lupus Erythematosus (SLE); to study the main determinants and the impact on quality of life (QoL). Methods A cross-sectional observational study including adult outpatients with SLE. Demographic and clinical data were analyzed: indices of disease activity (SELENA-SLEDAI); damage (SLICC-DI); comorbidities and concomitant therapies. The definitions for remission (DORIS) and “Lupus Low Disease Activity State” (LLDAS) were applied. At enrollment, each patient completed the following questionnaires: SF-36, FACIT-Fatigue, Lupus Impact Tracker (LIT), Systemic Lupus Activity Questionnaire (SLAQ), and the Hospital Anxiety and Depression Scale (HADS) in order to self-assess anxiety and depression symptoms. The Student t-test and Chi2 tests were conducted for univariate analysis. The Spearman test was used for linear correlation between continuous data. Multivariate analysis was performed by multiple linear and logistic regression. Results One hundred fifty-four consecutive patients with SLE were enrolled, the majority female and Caucasian with a mean age = 43.3 ± 13.7 years. 79.9% were in LLDAS or remission. 36.4% had a SDI > 1. 13.7% of patients had concomitant fibromyalgia. 37.4% had symptoms indicating anxiety and 25% of depression according to the HADS questionnaire. In the multivariate analysis, patients with active disease were significantly more anxious and depressed (p < 0.01) compared to patients in LLDAS or remission. Fibromyalgia and older age were independently associated with anxiety and depression, respectively (p < 0.05). Active skin involvement was significantly linked to depression (p < 0.05). Higher scores on the HADS questionnaire (higher levels of anxiety and depression) were found to be significantly linked to patients’ perception of higher disease activity and worse quality of life, irrespective of disease activity, age and fibromyalgia. Conclusion Symptoms of anxiety and depression are frequent in SLE patients, including outpatients with mild/moderate disease. Such symptoms have a significant negative impact on QoL and perception of disease activity, regardless of other factors. Moreover, disease activity, advanced age and fibromyalgia appear to be significantly linked to mood disorders. Assessing symptoms of the anxious-depressive spectrum in patients with SLE could lead to improvement in patients’ perception of health status and quality of life.
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Affiliation(s)
- Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Beatrice Lenzi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Linda Carli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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42
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Zucchi D, Elefante E, Schilirò D, Signorini V, Trentin F, Bortoluzzi A, Tani C. One year in review 2022: systemic lupus erythematosus. Clin Exp Rheumatol 2022; 40:4-14. [PMID: 35088691 DOI: 10.55563/clinexprheumatol/nolysy] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem auto-immune disease with extremely varied clinical manifestations and a complex pathogenesis. New insights in SLE about pathogenetic pathways, biomarkers, and data on clinical manifestations are progressively emerging, and new drugs and new therapeutic strategies have been proposed to improve the control of disease activity. Thus, this review is aimed to summarise the most relevant data about SLE emerged during 2021, following the previous annual review of this series.
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Affiliation(s)
- Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Davide Schilirò
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Viola Signorini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesca Trentin
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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43
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Falsini S, Tani C, Sambuco G, Papini A, Faraoni P, Campigli S, Ghelardini L, Bleve G, Rizzo D, Ricciolini M, Scarpelli I, Drosera L, Gnerucci A, Hand FP, Marchi G, Schiff S. Anatomical and biochemical studies of Spartium junceum infected by Xylella fastidiosa subsp. multiplex ST 87. Protoplasma 2022; 259:103-115. [PMID: 33860374 PMCID: PMC8752565 DOI: 10.1007/s00709-021-01640-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Spartium junceum L. is a typical species of Mediterranean shrubland areas, also grown in gardens and parks as an ornamental. In recent years in Europe, S. junceum has been recurrently found to be infected by different subspecies and genotypes of the quarantine regulated bacterium Xylella fastidiosa (Xf). This work presents for the first time the anatomy of S. junceum plants that we found, by means of genetic and immunochemistry analysis, to be naturally infected by Xf subsp. multiplex ST87 (XfmST87) in Monte Argentario (Grosseto, Tuscany, Italy), a new outbreak area within the EU. Our anatomical observations showed that bacteria colonized exclusively the xylem conductive elements and moved horizontally to adjacent vessels through pits. Interestingly, a pink/violet matrix was observed with Toluidine blue staining in infected conduits indicating a high content of acidic polysaccharides. In particular, when this pink-staining matrix was observed, bacterial cells were either absent or degenerated, suggesting that the matrix was produced by the host plant as a defense response against bacterial spread. In addition, a blue-staining phenolic material was found in the vessels and, at high concentration, in the pits and inter-vessels. SEM micrographs confirmed that polysaccharide and phenolic components showed different structures, which appear to be related to two different morphologies: fibrillary and granular, respectively. Moreover, our LM observations revealed bacterial infection in xylem conductive elements of green shoots and leaves only, and not in those of other plant organs such as roots and flowers.
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Affiliation(s)
- S Falsini
- Dipartimento di Biologia, Università degli studi di Firenze, via P.A. Micheli 3, 50121, Firenze, Italy.
| | - C Tani
- Dipartimento di Biologia, Università degli studi di Firenze, via P.A. Micheli 3, 50121, Firenze, Italy
| | - G Sambuco
- Dipartimento di Biologia, Università degli studi di Firenze, via P.A. Micheli 3, 50121, Firenze, Italy
| | - A Papini
- Dipartimento di Biologia, Università degli studi di Firenze, via P.A. Micheli 3, 50121, Firenze, Italy
| | - P Faraoni
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Università degli Studi di Firenze, viale G. Pieraccini 6, 50139, Firenze, Italy
| | - S Campigli
- Dipartimento di Scienze delle Produzioni Agroalimentari e dell'Ambiente, Università degli Studi di Firenze, Piazzale delle Cascine 28, 50100, Firenze, Italy
| | - L Ghelardini
- Dipartimento di Scienze delle Produzioni Agroalimentari e dell'Ambiente, Università degli Studi di Firenze, Piazzale delle Cascine 28, 50100, Firenze, Italy
| | - G Bleve
- Istituto di Scienze delle Produzioni Alimentari, Consiglio Nazionale delle Ricerche, Lecce, Italy
| | - D Rizzo
- Regione Toscana, Servizio Fitosanitario Regionale e di Vigilanza e Controllo Agroforestale, Via A. Manzoni 16, 50121, Firenze, Italy
| | - M Ricciolini
- Regione Toscana, Servizio Fitosanitario Regionale e di Vigilanza e Controllo Agroforestale, Via A. Manzoni 16, 50121, Firenze, Italy
| | - I Scarpelli
- Regione Toscana, Servizio Fitosanitario Regionale e di Vigilanza e Controllo Agroforestale, Via A. Manzoni 16, 50121, Firenze, Italy
| | - L Drosera
- Regione Toscana, Servizio Fitosanitario Regionale e di Vigilanza e Controllo Agroforestale, Via A. Manzoni 16, 50121, Firenze, Italy
| | - A Gnerucci
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Università degli Studi di Firenze, viale G. Pieraccini 6, 50139, Firenze, Italy
- Dipartimento di Fisica e Astronomia, Università di Firenze, Via Sansone 1, 50019, Sesto Fiorentino, (FI), Italy
| | - F Peduto Hand
- Department of Plant Pathology, Ohio State University, Columbus, OH, 43220, USA
| | - G Marchi
- Dipartimento di Scienze delle Produzioni Agroalimentari e dell'Ambiente, Università degli Studi di Firenze, Piazzale delle Cascine 28, 50100, Firenze, Italy
| | - S Schiff
- Dipartimento di Biologia, Università degli studi di Firenze, via P.A. Micheli 3, 50121, Firenze, Italy.
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Tani C, Pratesi F, Talarico R, Cardelli C, Caruso T, Di Cianni F, Laurino E, Italiano N, Moretti M, Manca ML, Migliorini P, Mosca M. Efficacy of anti-SARS-CoV-2 mRNA vaccine in systemic autoimmune disorders: induction of high avidity and neutralising anti-RBD antibodies. RMD Open 2021; 7:e001914. [PMID: 34880126 PMCID: PMC8655339 DOI: 10.1136/rmdopen-2021-001914] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/01/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES In patients with systemic autoimmune rheumatic disorders (SARDs), vaccination with SARS-CoV-2 mRNA vaccines has been proposed. The aim of this study is to evaluate the immune response elicited by vaccination with mRNA vaccine, testing IgM, IgA and IgG antibodies to SARS-CoV-2 receptor-binding domain (RBD) and measuring neutralising antibodies. METHODS IgG, IgM and IgA anti-RBD antibodies were measured in 101 patients with SARDs. Antibodies inhibiting the interaction between RBD and ACE2 were evaluated. Antibody avidity was tested in a chaotropic ELISA using urea. Twenty-one healthcare workers vaccinated with mRNA vaccine served as control group. RESULTS Anti-RBD IgG and IgA were produced after the first dose (69% and 64% of the patients) and after the boost (93% and 83%). Antibodies inhibiting the interaction of RBD with ACE2 were detectable in 40% of the patients after the first dose and 87% after boost, compared with 100% in healthy controls (p<0.01). Abatacept and mycophenolate had an impact on the titre of IgG anti-RBD antibodies (p<0.05 and p<0.005, respectively) and on the amount of neutralising antibodies. No effect of other therapies was observed. Vaccinated patients produce high avidity antibodies, as healthy controls. CONCLUSIONS These data show that double-dose vaccination induced in patients with SARDs anti-RBD IgG and IgA antibodies in amounts not significantly different from controls, and, most interestingly, characterised by high avidity and endowed with neutralising activity.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Federico Pratesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Immunoallergology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Teresita Caruso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Immunoallergology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Federica Di Cianni
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elenia Laurino
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nazzareno Italiano
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Moretti
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Immunoallergology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Paola Migliorini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Immunoallergology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Otani M, Hasegawa K, Kita K, Horikawa D, Mizukami S, Takeda T, Ohara M, Tani C, Shonaka T, Matsuno N, Sumi Y. Assessment of post-operative changes in body composition after pylorus-preserving gastrectomy for early gastric cancer. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gatto M, Saccon F, Andreoli L, Bartoloni E, Benvenuti F, Bortoluzzi A, Bozzolo E, Brunetta E, Canti V, Cardinaletti P, Ceccarelli F, Ciccia F, Conti F, De Marchi G, de Paulis A, De Vita S, Emmi G, Faggioli P, Fasano S, Fredi M, Gabrielli A, Gasparotto M, Gerli R, Gerosa M, Govoni M, Gremese E, Laria A, Larosa M, Mosca M, Orsolini G, Pazzola G, Petricca L, Ramirez GA, Regola F, Rossi FW, Rossini M, Salvarani C, Scarpato S, Tani C, Tincani A, Ubiali T, Urban ML, Zen M, Doria A, Iaccarino L. Durable renal response and safety with add-on belimumab in patients with lupus nephritis in real-life setting (BeRLiSS-LN). Results from a large, nationwide, multicentric cohort. J Autoimmun 2021; 124:102729. [PMID: 34600347 DOI: 10.1016/j.jaut.2021.102729] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Belimumab was recently approved for treatment of lupus glomerulonephritis (LN). AIM To evaluate renal response and its predictors in LN patients receiving belimumab in real-life. PATIENTS AND METHODS We considered all patients fulfilling the SLEDAI-2K renal items and/or having estimated glomerular filtration rate (eGFR)≤60 ml/min/1.73 m2, with positive anti-dsDNA and/or low C3/C4 enrolled in the multicentre Italian lupus cohort BeRLiSS (BElimumab in Real LIfe Setting Study), treated with monthly IV Belimumab 10 mg/kg over standard treatment. Primary efficacy renal response (PERR), defined as proteinuria ≤0.7 g/24 h, eGFR≥60 ml/min/1.73 m2 without rescue therapy, was considered as primary outcome. Complete renal response (CRR; proteinuria <0.5 g/24 h, eGFR≥90 ml/min/1.73 m2) was considered as secondary outcome. Prevalence and predictors of PERR were evaluated at 6, 12, 24 months by multivariate logistic regression. RESULTS Among the 466 SLE patients of BeRLiSS, 91 fulfilled the inclusion criteria, 79 females, median age 41.0 (33.0-47.0) years, median follow-up 22.0 (12.0-36.0) months. Sixty-four (70.3%) achieved PERR, of whom 38.4% reached CRR. Among patients achieving PERR at 6 months, 86.7% maintained response throughout the follow-up. At multivariable analysis, hypertension (OR [95%CI]: 0.28 [0.09-0.89], p = 0.032), high baseline serum creatinine (0.97 [0.95-0.99], p = 0.01) and high baseline proteinuria (0.37, [0.19-0.74], p = 0.005) negatively predicted PERR. Positive predictors of PERR at 12 and 24 months were baseline anti-Sm positivity (OR [95%CI]: 6.2 [1.21-31.7], p = 0.029; 19.8 [2.01-186.7], p = 0.009, respectively) and having achieved PERR at 6 months (14.4 [3.28-63.6]; 11.7 [2.7-48.7], p = 0.001 for both). CONCLUSIONS Add-on therapy with belimumab led to durable renal response in patients with LN in a real-life setting.
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Affiliation(s)
- Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
| | - Francesca Saccon
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesco Benvenuti
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandra Bortoluzzi
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Italy
| | - Enrica Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Brunetta
- Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20090, Pieve Emanuele, Milan, Italy
| | - Valentina Canti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Cardinaletti
- Università Politecnica Delle Marche, Dipartimento di Scienze Cliniche e Molecolari, Ancona, Italy
| | - Fulvia Ceccarelli
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari (SCIAC), Sezione di Reumatologia, 'Sapienza' University, Rome, Italy
| | - Francesco Ciccia
- Università Degli Studi Della Campania Luigi Vanvitelli, Department of Precision Medicine, Napoli, Italy
| | - Fabrizio Conti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari (SCIAC), Sezione di Reumatologia, 'Sapienza' University, Rome, Italy
| | | | - Amato de Paulis
- Dipartimento di Scienze Mediche Traslazionali e Centro di Ricerca Immunologia Base e Clinica (CISI), University of Napoli Federico II, Napoli, Italy
| | | | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, Lupus Clinic, University of Florence, Firenze, Toscana, IT, Italy
| | - Paola Faggioli
- ASST OVEST Milanese - Legnano, Internal Medicine, Rheumatology, Italy
| | - Serena Fasano
- Università Degli Studi Della Campania Luigi Vanvitelli, Department of Precision Medicine, Napoli, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Armando Gabrielli
- Università Politecnica Delle Marche, Dipartimento di Scienze Cliniche e Molecolari, Ancona, Italy
| | - Michela Gasparotto
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maria Gerosa
- ASST Gaetano Pini, Department of Clinical Sciences and Community Health, Clinical Rheumatology Unit Milano, Lombardia, IT, Italy
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Italy
| | - Elisa Gremese
- Università Cattolica Del Sacro Cuore Sede di Roma, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Antonella Laria
- ASST OVEST Milanese Presidio di Magenta, Unit of Rheumatology, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marta Mosca
- Rheumatology, University of Pisa, Pisa, Italy
| | | | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Petricca
- Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesca Regola
- Rheumatology and Clinical Immunology, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesca W Rossi
- Dipartimento di Scienze Mediche Traslazionali e Centro di Ricerca Immunologia Base e Clinica (CISI), University of Napoli Federico II, Napoli, Italy
| | | | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Università Degli Studi di Modena e Reggio Emilia, Reggio Emilia, Italy
| | | | - Chiara Tani
- Rheumatology, University of Pisa, Pisa, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tania Ubiali
- ASST Gaetano Pini, Department of Clinical Sciences and Community Health, Clinical Rheumatology Unit Milano, Lombardia, IT, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, Lupus Clinic, University of Florence, Firenze, Toscana, IT, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
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Della Rocca G, Posarelli I, Morandi F, Tani C, Barberini S, Danti R, Moricca S, Papini A. Different Polyphenolic Parenchyma Cell and Phloem Axial Resin Duct-Like Structure Formation Rates in Cupressus sempervirens Clones Infected with Seiridium cardinale. Plant Dis 2021; 105:2801-2808. [PMID: 33904337 DOI: 10.1094/pdis-01-21-0098-re] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of this study was the characterization of constitutive and induced defense mechanisms in the bark tissues of Cupressus sempervirens before and after infection with the bark fungus Seiridium cardinale, which is responsible for cypress canker disease. The time-course development of polyphenolic parenchyma (PP) cells and phloem axial resin duct (PARD)-like structures in the phloem was investigated in two C. sempervirens clones, one resistant and one susceptible to the disease, through anatomical and histological observations carried out by light microscope during a 19-day trial. PP cells were constitutively more abundant in the canker-resistant clone (R clone) compared with the susceptible clone (S clone), whereas PARD-like structures were not present in the bark of untreated plants of both clones. PP cells increased in both clones as a response to infection, but in the R clone, they were more abundant 5 and 12 days after inoculation. After inoculation, PARD-like structures appeared in the phloem after 5 days in the R clone and only after 12 days in the S clone. Even the number of cells surrounding the PARD-like structures was higher in the R clone 5 and 12 days after inoculation compared with the S clone. These observations demonstrate a faster phloem response of the R clone in the early phase of the infection. This may slow down initial growth of the fungus, contributing to the resistance mechanism.
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Affiliation(s)
- G Della Rocca
- Istituto per la Protezione Sostenibile delle Piante, Consiglio Nazionale delle Ricerche, 50019 Sesto Fiorentino, Italy
| | - I Posarelli
- Dipartimento di Scienze e Tecnologie Agrarie, Alimentari, Ambientali e Forestali, Università di Firenze, 50144 Firenze, Italy
| | - F Morandi
- Dipartimento di Biologia, Università di Firenze, 50121 Firenze, Italy
| | - C Tani
- Dipartimento di Biologia, Università di Firenze, 50121 Firenze, Italy
| | - S Barberini
- Istituto per la Protezione Sostenibile delle Piante, Consiglio Nazionale delle Ricerche, 50019 Sesto Fiorentino, Italy
| | - R Danti
- Istituto per la Protezione Sostenibile delle Piante, Consiglio Nazionale delle Ricerche, 50019 Sesto Fiorentino, Italy
| | - S Moricca
- Dipartimento di Scienze e Tecnologie Agrarie, Alimentari, Ambientali e Forestali, Università di Firenze, 50144 Firenze, Italy
| | - A Papini
- Dipartimento di Biologia, Università di Firenze, 50121 Firenze, Italy
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Micheli C, Parma A, Tani C, Di Bello D, Falaschi A, Chiaramonte A, Testi S, Mosca M, Scarpato R. UCTD and SLE patients show increased levels of oxidative and DNA damage together with an altered kinetics of DSB repair. Mutagenesis 2021; 36:429-436. [PMID: 34559237 DOI: 10.1093/mutage/geab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/23/2021] [Indexed: 01/13/2023] Open
Abstract
Immunological tolerance is a critical feature of the immune system; its loss might lead to an abnormal response of lymphocytes causing autoimmune diseases. One of the most important groups belonging to autoimmune disorders is the connective tissue diseases (CTD). CTD are classified among systemic rheumatic diseases and include pathologies such as systemic lupus erythematosus (SLE), and undifferentiated CTD (UCTD). In this study, we evaluated oxidative and genome damage in peripheral blood lymphocytes from patients with SLE and UCTD, further classified on the basis of disease activity and the presence/absence of a serological profile. Oxidative damage was evaluated in cell membrane using the fluorescent fatty acid analogue BODIPY 581/591 C11. The percentage of oxidised lymphocytes in both SLE and UCTD patients was higher than in the control group, and the oxidative stress correlated positively with both disease activity and autoantibody profile. The γH2AX focus assay was used to quantify the presence of spontaneous double strand breaks (DSBs), and to assess the abilities of DSBs repair system after T cells were treated with mitomycin C (MMC). Subjects with these autoimmune disorders showed a higher number of γH2AX foci than healthy controls, but no correlation with diseases activity and presence of serological profile was observed. In addition, patients displayed an altered response to MMC-induced DSBs, which led their peripheral cells to greatly increase apoptosis. Taken together our results confirmed an interplay among oxidative stress, DNA damage and impaired DNA repair, which are directly correlated to the aggressiveness and clinical progression of the diseases. We propose the evaluation of these molecular markers to better characterize SLE and UCTD, aiming to improve the treatment plan and the quality of the patients' life.
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Affiliation(s)
- Consuelo Micheli
- Dipartimento di Biologia, Unità di Genetica, University of Pisa, Via Derna 1, 56126, Pisa, Italy
| | - Alice Parma
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Chiara Tani
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Domenica Di Bello
- Dipartimento di Biologia, Unità di Genetica, University of Pisa, Via Derna 1, 56126, Pisa, Italy
| | - Aurora Falaschi
- Dipartimento di Biologia, Unità di Genetica, University of Pisa, Via Derna 1, 56126, Pisa, Italy
| | - Anna Chiaramonte
- Dipartimento di Biologia, Unità di Genetica, University of Pisa, Via Derna 1, 56126, Pisa, Italy
| | - Serena Testi
- Dipartimento di Biologia, Unità di Genetica, University of Pisa, Via Derna 1, 56126, Pisa, Italy
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Roberto Scarpato
- Dipartimento di Biologia, Unità di Genetica, University of Pisa, Via Derna 1, 56126, Pisa, Italy
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Tani M, Tani C, Tasaki H, Harumoto S, Yoshimatsu R, Ito S, Koutaka T, Hattori N, Moritomo Y, Osawa T. Correlation of foetal body weight by coronet width measurement using ultrasonography in prepartum cows: a pilot study. Aust Vet J 2021; 99:469-472. [PMID: 34389980 DOI: 10.1111/avj.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/01/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
This study aimed to clarify the effectiveness of foetal body weight estimation by measuring foetal coronet width using transrectal ultrasonography in beef cows during near-term pregnancy. A characteristic 'gull wing' pattern was obtained from the foetal coronet cross-section from the dewclaw side using ultrasonography. This pattern was matched to the bone surface of the distal part of the middle phalanx. Then, the relationship between coronet width and body weight at birth of 22 Japanese Brown calves was analysed and a high correlation coefficient of 0.8965 (P < 0.001) was obtained. In conclusion, the coronet width of the fetus is depicted as a 'gull wing' hyperechoic structure and can be measured by ultrasonography per rectum during near-term pregnancy. This technique may be a useful tool to identify high-risk cows with dystocia before calving. High foetal coronet values may predispose cattle to dystocia.
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Affiliation(s)
- M Tani
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - C Tani
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - H Tasaki
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - S Harumoto
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - R Yoshimatsu
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - S Ito
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - T Koutaka
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - N Hattori
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - Y Moritomo
- Department of Animal Science, School of Agriculture, Tokai University, Kumamoto, 862-8652, Japan
| | - T Osawa
- Faculty of Agriculture, University of Miyazaki, Miyazaki, 889-2192, Japan
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Signorini V, Tani C, Elefante E, Zucchi D, Stagnaro C, Ferro F, Carli L, Mosca M. POS0756 HOW HAS OUR MANAGEMENT OF SLE CHANGED OVER THE LAST THREE DECADES? REAL LIFE DATA FROM A MONOCENTRIC COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Over the last decades new therapies have been approved and new treatment strategies have been proposed in the treatment of SLE. In particular, recently, EULAR recommendations1 and the Treat to Target2 approach established a new paradigm for the treatment of SLE based on the early introduction of immunosuppressive treatment and glucocorticoids (GC) minimization.Objectives:to evaluate changes in therapeutic approach and outcomes over the last three decades in a monocentric cohort of SLE patients.Methods:This is a retrospective analysis of prospectively collected data from a monocentric cohort of patients with SLE with disease diagnosis between 1990 and 2020. Based on the year of diagnosis, patients were divided in three groups, each of them corresponding to a decade: group 1: decade 1990-1999; group 2: decade 2000-2009; group 3: decade 2010-2020. For each patient, epidemiological and demographic characteristics, cumulative organ involvement and serology, previous and ongoing therapies, comorbidities were collected and compared among the 3 groups. Organ damage was evaluated by the SLICC-DI (SDI)3 at 1 and 5 years from diagnosis, as comorbidities we considered hypertension, diabetes, osteoporosis and cardiovascular (CV) events occurred during the follow-up.Results:A total of 262 SLE patients were enrolled in the study (97% Caucasian, 90.5% females): 69 patients in group 1, 100 in group 2 and 93 in group 3. Demographic and clinical characteristics of whole cohort and of the three groups are summarized in table 1. Differences in therapies during the first year from diagnosis among the groups are summarized in table 1. In group 3 the use of Micophenolate Mofetil was significantly more common with respect to the group 1 (25% vs 1.4%, p= 0.001) and similar to group 2 (25% vs 25.5%, p=ns); on the contrary, in group 3, Azathioprine (AZA) and Cyclosporine (Cya) were less used (13.2% vs 27.5%, p=0.003 and 3.3% vs 14.3%, p= 0.019 respectively). As Cyclophosphamide (CYC) is concerned, it was used with the same frequency in the three decades, but in group 1, the total dose of CYC was significantly higher than second and third group (4.8 g vs 2.3 and 0.9, p=0.02 and p=0.001 respectively). In group 2 and 3, during the first year of disease, biological drugs (Rituximab or Belimumab) have been used more frequently (2% and 2.2% vs 0%, p=0.04). Any differences have not been showed for GC among the groups. However, in group 3 a significantly higher proportion of patients stopped GC therapy within 5 years from diagnosis (34.5% vs 8.8% and 12.5%, p=0.001) and in the same group the duration of GC therapy was significantly shorter with respect to previous two decades (3.1 years vs 16.8 and 10.5 respectively, p=0.001). As regard damage accrual, at 1 and 5 years from diagnosis, no significant differences among groups were observed; however, hypertension resulted significantly less common in group 3 (10% vs 26% and 37.3%, p=0.001), even adjusting for age (OR=0.2); less CV events were recorded in group 3, but significance is lost adjusting for age.Table 1.Whole cohortGroup 1Group 2Group 3pPatients (n)2626910093Caucasian (%)97%99%98%94.6%.n.s.Females (%)90.5%94.2%95%92.5%n.s.Median age at diagnosis IQR)29 (20-36)27 (20-32)28.5 (20-36)34 (23-44)0.001Cumulative organ involvementRenal48.1%52.2%57%35.5%0.007Articular74.4%75.3%66%82.8%n.s.Serositic19.5%20.3%22%16.1%n.s.Neuropsychiatric8%11.6%6%7.5%n.s.Cutaneous63%70%60%61.3%n.s.Hematological58.4%51.5%61%61.3%n.s.Therapies 1styearAZA17.2%8.7%27.5%13.2%0.003MMF18.7%1.4%25.5%25.3%0.001CYC22.5%21.7%27%17%n.s.Cya9.9%13%14.3%3.30.019Biologicals1.5%0%2%2.2%n.sConclusion:These data show that new therapies and new treatment strategies have actually been implemented in clinical practice over the past 30 years; further studies with a longer follow-up are necessary to appreciate the impact of these advancement on clinical outcomes.References:[1]Bertsias G, et al. Ann Rheum Dis 2008.[2]van Vollenhoven RF, et al.Ann Rheum Dis 2014.[3]Gladman DD, et al. J Rheumatol 2000.Disclosure of Interests:None declared
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