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Manzo C, Isetta M, Castagna A. Did the first description of patients with polymyalgia rheumatica take place in Scotland or in Denmark? Reumatismo 2024; 76. [PMID: 38523578 DOI: 10.4081/reumatismo.2024.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/22/2023] [Indexed: 03/26/2024] Open
Abstract
The first description of polymyalgia rheumatica (PMR) is generally attributed to Dr. Bruce. In an 1888 article entitled Senile rheumatic gout, he described five male patients aged from 60 to 74 years whom he had visited at the Strathpeffer spa in Scotland. In 1945, Dr. Holst and Dr. Johansen reported on five female patients examined over several months at the Medical Department of Roskilde County Hospital in Denmark. These patients suffered from hip, upper arms, and neck pain associated with elevated ESR and constitutional manifestations such as low-grade fever or loss of weight. In the same year, Meulengracht, another Danish physician, reported on two patients with shoulder pain and stiffness associated with fever, weight loss, and an increased erythrocyte sedimentation rate. As in the five patients reported by Dr. Holst and Dr. Johansen, a prolonged recovery time was recorded. On reading and comparing these three accounts, we question whether it is correct to attribute the first description of PMR to Dr. Bruce and put forward shifting this accolade to the three Danish physicians.
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Affiliation(s)
- C Manzo
- Internal and Geriatric Medicine Department, Rheumatology Outpatient Clinic, Health Authority Napoli 3 sud, Sant'Agnello.
| | - M Isetta
- Central and North West London NHS Trust, London.
| | - A Castagna
- Primary Care Department, Catanzaro Provincial Health Authority, Soverato.
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Manzo C, Castagna A, Veronese N, Isetta M. Presence of subclinical giant cell arteritis in patients with morning stiffness of duration less than 45 minutes at the time of diagnosis of polymyalgia rheumatica. Reumatologia 2024; 61:432-438. [PMID: 38322103 PMCID: PMC10839912 DOI: 10.5114/reum/176860] [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: 08/27/2023] [Accepted: 12/12/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction In some patients with polymyalgia rheumatica (PMR), giant cell arteritis (GCA) is subclinical as underlying inflammation of large vessels (LV) is present without evidence of related clinical manifestations. Different factors have been proposed as predictive of subclinical GCA in PMR patients. To date, the literature reports scant data about the association between subclinical GCA and long-lasting morning stiffness (MS) in patients at the time of diagnosis of PMR. Given this background, the aim of this study was to assess the association between subclinical GCA and MS < 45 min in patients with newly diagnosed PMR. Material and methods We performed an observational, retrospective, single-centre cohort study of patients consecutively referred to our public out-of-hospital rheumatologic clinic between January 2015 and December 2020, who could be classified as having PMR according to the 2012 EULAR/ACR criteria. Subclinical GCA was investigated through ultrasound examination of a core set of arteries (temporal, axillary, common carotid, and subclavian arteries), in accordance with the EULAR recommendations for the use of imaging in LV vasculitis. Patients who did not have GCA symptoms but showed halo sign in at least one of these arteries were described as having subclinical GCA. Results We included a total of 143 patients (35 men and 108 women). Their median age was of 71.5 years. Thirty-five had MS duration < 45 min at the time of PMR diagnosis. Subclinical GCA was found in 23 PMR patients (16.1%); 18 had a cranial and 5 an extracranial GCA. A univariate analysis highlighted that MS < 45 min was associated with a lower prevalence of GCA (OR = 0.11, 95% CI: 0.04-0.29; p < 0.0001). This association was retained in a multivariable analysis that accounted for 6 different potential covariates (OR = 0.06, 95% CI: 0.01-0.26; p < 0.0001. Conclusions In our study MS < 45 min at the time of PMR diagnosis was associated with a significantly lower risk of subclinical GCA, when patients were screened by ultrasound, of approximately 90%. Identification of a more accurate MS cut-off value could improve the accuracy for subclinical GCA in patients with newly diagnosed PMR.
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Affiliation(s)
- Ciro Manzo
- Rheumatologic Outpatient Clinic, Azienda Sanitaria Napoli 3 sud, Sant' Agnello, Italy
| | - Alberto Castagna
- Department of Primary Care, Health District of Soverato, Azienda Sanitaria Provinciale Catanzaro, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, Italy
| | - Marco Isetta
- Central and North West London NHS Trust, England
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Manzo C. Early referral of patients with suspected polymyalgia rheumatica: An active involvement of the out-of-hospital public rheumatologist is needed. Semin Arthritis Rheum 2023; 63:152309. [PMID: 37951127 DOI: 10.1016/j.semarthrit.2023.152309] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Ciro Manzo
- Department of Internal and Geriatric Medicine, Rheumatologic Outpatient Clinic, Health District No. 59, Azienda Sanitaria Locale Naples sud, viale dei Pini 1, Sant'Agnello, Naples 80065, Italy.
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Pillay SS, Nune A, Manzo C, Barman B, Raza H. A case of anti-neutrophil cytoplasmic antibody-associated vasculitis masquerading as Sjögren syndrome. Int J Rheum Dis 2023; 26:2555-2558. [PMID: 37427846 DOI: 10.1111/1756-185x.14823] [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: 04/02/2023] [Revised: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA) -positive vasculitis is a small-vessel vasculitis that affects multiple body systems. Salivary gland involvement in ANCA-associated vasculitis is rare. When present, it mimics infection or malignancy, which might lead to misdiagnosis. In this report, we describe a 72-year-old man who presented with parotid and submandibular gland pain and swelling in addition to dry mouth and eyes. He had bilateral non-tender parotid gland lumps and no lymphadenopathies. Laboratory tests were positive for ANCA, hematuria, and proteinuria but negative for Anti-Ro and -La. He was treated with corticosteroids and cyclophosphamide for acute kidney injury. Unfortunately, the patient died a few months later. This case report sheds light on a rare manifestation of salivary gland involvement in ANCA-associated vasculitis that mimics Sjögren syndrome and the challenges associated with its diagnosis and treatment.
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Affiliation(s)
| | - Arvind Nune
- Southport and Ormskirk NHS Trust, Southport, UK
| | - Ciro Manzo
- Rheumatologic Outpatient Clinic, Sant'Agnello, Italy
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
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Manzo C, Castagna A, Nune A, Isetta M. Polymyalgia rheumatica and polymyalgia-like syndromes as adverse events following immunisation with COVID-19 vaccines: a 15 months update. Reumatologia 2023; 61:408-409. [PMID: 37970116 PMCID: PMC10634411 DOI: 10.5114/reum/172508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/18/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Ciro Manzo
- Division of Rheumatology, Internal and Geriatric Medicine Department, Azienda Sanitaria Napoli 3 sud, Sant' Agnello, Italy
| | - Alberto Castagna
- Department of Primary Care, Health District of Soverato, Azienda Sanitaria Provinciale Catanzaro, Italy
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom
| | - Marco Isetta
- Central and North West London NHS Trust, England
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Nune A, Durkowski V, Pillay SS, Barman B, Elwell H, Bora K, Bilgrami S, Mahmood S, Babajan N, Venkatachalam S, Ottewell L, Manzo C. New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review. Vaccines (Basel) 2023; 11:1571. [PMID: 37896974 PMCID: PMC10610967 DOI: 10.3390/vaccines11101571] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
A comprehensive, up-to-date systematic review (SR) of the new-onset rheumatic immune-mediated inflammatory diseases (R-IMIDs) following COVID-19 vaccinations is lacking. Therefore, we investigated the demographics, management, and prognosis of new R-IMIDs in adults following SARS-CoV-2 vaccinations. A systematic literature search of Medline, Embase, Google Scholar, LitCovid, and Cochrane was conducted. We included any English-language study that reported new-onset R-IMID in adults following the post-COVID-19 vaccination. A total of 271 cases were reported from 39 countries between January 2021 and May 2023. The mean age of patients was 56 (range 18-90), and most were females (170, 62.5%). Most (153, 56.5%) received the Pfizer BioNTech COVID-19 vaccine. Nearly 50% of patients developed R-IMID after the second dose of the vaccine. Vasculitis was the most prevalent clinical presentation (86, 31.7%), followed by connective tissue disease (66, 24.3%). The mean duration between the vaccine's 'trigger' dose and R-IMID was 11 days. Most (220, 81.2%) received corticosteroids; however, 42% (115) received DMARDs such as methotrexate, cyclophosphamide, tocilizumab, anakinra, IV immunoglobulins, plasma exchange, or rituximab. Complete remission was achieved in 75 patients (27.7%), and 137 (50.6%) improved following the treatment. Two patients died due to myositis. This SR highlights that SARS-CoV-2 vaccines may trigger R-IMID; however, further epidemiology studies are required.
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Affiliation(s)
- Arvind Nune
- Department of Rheumatology, Southport and Ormskirk NHS Trust, Southport PR8 6PN, UK
| | - Victor Durkowski
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L9 7AL, UK
| | | | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati 781101, India
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London WC1H 9JP, UK
| | - Kaustubh Bora
- Haematology Division, ICMR-Regional Medical Research Centre, Dibrugarh 786001, India
| | - Syed Bilgrami
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Sajid Mahmood
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Nasarulla Babajan
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | | | - Lesley Ottewell
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Ciro Manzo
- Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3, 80065 Sant'Agnello, Italy
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Manzo C, Natale M, Nune A, Castagna A. The management of patients with polymyalgia rheumatica: limitations to get it right. Clin Exp Rheumatol 2023; 41 Suppl 135:22. [PMID: 36719744 DOI: 10.55563/clinexprheumatol/dxmvl1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3, Health District no 59, Sant'Agnello, Italy.
| | - Maria Natale
- Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3, Health District no 59, Sant'Agnello, Italy
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southporth, UK
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, Soverato, Italy
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Manzo C, Nune A, Castagna A. Why would immuno- and endocrino-senescence, age-related changes in the gut microbiota, and susceptibility to infection favour polymyalgia rheumatica over seronegative elderly-onset rheumatoid arthritis? Clin Exp Rheumatol 2023; 41 Suppl 135:25-26. [PMID: 37815459 DOI: 10.55563/clinexprheumatol/hb7van] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Ciro Manzo
- Division of Rheumatology, Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3, Health District no. 59,Sant'Agnello, Italy.
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southporth, UK
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, Soverato, Italy
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Manzo C, Castagna A, Isetta M. Absence of Long-Lasting Morning Stiffness at the Time of Diagnosis as Paraneoplastic Warning in Patients with Polymyalgia Rheumatica (PMR): Data from Italian Single-Center Study. Life (Basel) 2023; 13:1285. [PMID: 37374068 DOI: 10.3390/life13061285] [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: 05/03/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND There is little literature on the paraneoplastic value of the absence of long-lasting morning stiffness (MS) at the time of diagnosis of polymyalgia rheumatica (PMR). We investigated whether and to what extent this finding was related to the probability of diagnosing a neoplasia. PATIENTS AND METHODS This was an observational, retrospective, single-center cohort study. We enrolled all patients consecutively referred to our rheumatologic outpatient clinic between January 2015 and December 2020, who could be classified as PMR according to 2012 EULAR/ACR criteria. In particular, we assessed all patients scoring a minimum of five points with a combination of clinical and ultrasound (US) criteria. The exclusion criteria were as follows: (a) follow-up duration <two years; (b) malignancy prior to PMR; (c) first-degree familiarity of malignancy; (d) incomplete data; and (e) diagnostic change during follow-up in different rheumatologic diseases. RESULTS 143 patients (108 women; median age: 71.5 years) were enrolled, and 35 of them did not have long-standing MS at the time of PMR diagnosis. In 10 patients (6.9%), a neoplasia was diagnosed in the first 6 months of follow-ups; among these, 7 did not have long-lasting MS. Among the remaining 133 PMR patients without subsequent malignancy, 28 did not have long-lasting MS. The odds of cancer were 0.114 (C.I. 95% 0.028, 0.471). Long-lasting MS was inversely associated with the development of neoplasias. In all eight PMR patients diagnosed with solid cancers during follow-ups, the removal of the neoplastic mass led to a fast disappearance of clinical, ultrasound and laboratory findings, thus supporting the diagnosis of paraneoplastic PMR. Finally, a positive response to glucocorticoids (GCs) was present in 100% of the 28 PMR patients without long-lasting MS at the time of diagnosis and without neoplasia during their follow-ups. On the contrary, a positive response to GCs was present in 71% of PMR patients without long-lasting MS and neoplasias during follow-up. Among the variables we assessed, a positive response to GCs was the only one that was statistically significant (p < 0.0001). These data suggested that an inadequate response to GCs in PMR patients without long-lasting MS at the time of diagnosis should strengthen investigations to rule out neoplasias. CONCLUSIONS The absence of long-standing MS at the time of diagnosis can be a paraneoplastic warning in patients classified as PMR. A thorough investigation is therefore needed in this subset of patients to rule out neoplasia, before diagnosing an idiopathic PMR and starting treatment with GCs.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3 Sud, Health District No. 59, Sant'Agnello, 80065 Naples, Italy
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, 88068 Soverato, Italy
| | - Marco Isetta
- Library and Knowledge Services, Central and North West London NHS Foundation Trust, London NW1 3AX, UK
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Nune A, Iyengar KP, Manzo C, Barman B, Botchu R. Chat generative pre-trained transformer (ChatGPT): potential implications for rheumatology practice. Rheumatol Int 2023; 43:1379-1380. [PMID: 37145135 DOI: 10.1007/s00296-023-05340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Arvind Nune
- Department of Rheumatology and General Medicine, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK.
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Ciro Manzo
- Rheumatology Outpatient Clinic, Azienda Sanitaria Locale Napoli 3 Sud, Mariano Lauro Hospital, Sant'Agnello, Naples, Italy
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
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Manzo C, Castagna A, Ruberto C, Ruotolo G. Does a steroid dementia syndrome really exist? A brief narrative review of what the literature highlights about the relationship between glucocorticoids and cognition. Geriatr Care 2023. [DOI: 10.4081/gc.2022.10975] [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: 03/17/2023] Open
Abstract
Glucocorticoids (GCs) may cause cognitive impairment through complex pathways involving specific receptors. In the human brain, hippocampal CA1 neurons exhibit the highest level of GCs receptors. Even the elderly expressed these receptors. The purpose of this brief review is to concentrate on the relationship between GCs and cognition in order to discuss the effects of the so-called steroid dementia in routine clinical practice.
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Manzo C, Castagna A, Ruotolo G. A journey inside the elderly-onset primary Sjögren’s syndrome, looking for useful tips for the geriatrician. Geriatr Care 2022. [DOI: 10.4081/gc.2022.10668] [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: 11/07/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is a systemic autoimmune rheumatic disease where xerophthalmia, xerostomia and presence of anti-SSA and anti-SSB antibodies are typical features. Its prevalence is higher in over-65 aged population than in other age groups. In the elderly, pSS diagnosis comes up against a whole series of critical points that may favor its misdiagnosis. The aim of our article is to discuss the most relevant of them: the frequent occurrence of a seronegative subset, the presence of systemic features not related to sicca syndrome, the sicca syndrome as iatrogenic manifestation and the possibility of a biopsy false negative of labial salivary glands.
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Nune A, Iyengar KP, Barman B, Manzo C. Post-COVID-19 Condition and İts Recognition in Low- and Middle-income Countries: Working Notes from the United Kingdom Experience. Balkan Med J 2022; 39:303-304. [PMID: 35873791 PMCID: PMC9326947 DOI: 10.4274/balkanmedj.galenos.2022.2022-5-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Manzo C, Milchert M, Venditti C, Castagna A, Nune A, Natale M, Brzosko M. Fever Correlation with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentrations in Patients with Isolated Polymyalgia Rheumatica (PMR): A Retrospective Comparison Study between Hospital and Out-of-Hospital Local Registries. Life (Basel) 2022; 12:life12070985. [PMID: 35888074 PMCID: PMC9317449 DOI: 10.3390/life12070985] [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: 06/05/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Polymyalgia rheumatica (PMR) is the most common systemic inflammatory rheumatic disease affecting the elderly. Giant cell arteritis (GCA) is a granulomatous vasculitis affecting the aorta and its branches associated with PMR in up to 20% of cases. In recent studies based on university hospital registries, fever correlated with the erythrocyte sedimentation rate (ESR) but not with C-reactive protein (CRP) concentrations at the time of diagnosis in patients with isolated PMR. A long delay to a PMR diagnosis was suggested to explain this discrepancy, possibly caused by laboratory alterations (for instance, anemia of chronic disease type) that can influence only ESR. We performed a retrospective comparison study between the university hospital and two out-of-hospital public ambulatory databases, searching for any differences in fever/low-grade fever correlation with ESR and CRP. Methods: We identified all patients with newly diagnosed PMR between 2013 and 2020, only including patients who had a body temperature (BT) measurement at the time of diagnosis and a follow-up of at least two years. We considered BT as normal at <37.2 °C. Routine diagnostic tests for differential diagnostics were performed at the time of diagnosis and during follow-ups, indicating the need for more in-depth investigations if required. The GCA was excluded based on the presence of suggestive signs or symptoms and routine ultrasound examination of temporal, axillary, subclavian, and carotid arteries by experienced ultrasonographers. Patients with malignancies, chronic renal disease, bacterial infections, and body mass index (BMI) > 30 kg/m2 were excluded, as these conditions can increase CRP and/or ESR. Finally, we used the Cumulative Illness Rating Scale (CIRS) for quantifying the burden of comorbidities and excluded patients with a CIRS index > 4 as an additional interfering factor. Results: We evaluated data from 169 (73 from hospital and 96 from territorial registries) patients with newly diagnosed isolated PMR. Among these, 77.7% were female, and 61.5% of patients had normal BT at the time of diagnosis. We divided the 169 patients into two cohorts (hospital and territorial) according to the first diagnostic referral. Age at diagnosis, ESR, CRP, median hemoglobin (HB), and diagnostic delay (days from first manifestations to final diagnosis) were statistically significantly different between the two cohorts. However, when we assessed these data according to BT in the territorial cohort, we found a statistical difference only between ESR and BT (46.39 ± 19.31 vs. 57.50 ± 28.16; p = 0.026). Conclusions: ESR but not CRP correlates with fever/low-grade fever at the time of diagnosis in PMR patients with a short diagnosis delay regardless of HB levels. ESR was the only variable having a statistically significant correlation with BT in a multilevel regression analysis adjusted for cohorts (β = 0.312; p = 0.014).
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Affiliation(s)
- Ciro Manzo
- Rheumatologic Outpatient Ambulatory, Health District No. 59, Azienda Sanitaria Locale Napoli 3 Sud, 80065 Naples, Italy;
- Correspondence:
| | - Marcin Milchert
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, 71-457 Szczecin, Poland; (M.M.); (M.B.)
| | - Carlo Venditti
- Rheumatologic Outpatient Clinic Health District Campobasso, Via Ugo Petrella 1, 86100 Campobasso, Italy;
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, 88068 Soverato, Italy;
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK;
| | - Maria Natale
- Rheumatologic Outpatient Ambulatory, Health District No. 59, Azienda Sanitaria Locale Napoli 3 Sud, 80065 Naples, Italy;
| | - Marek Brzosko
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, 71-457 Szczecin, Poland; (M.M.); (M.B.)
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Manzo C, Natale M. Fever at diagnosis as a confounding factor in patients with polymyalgia rheumatica. Messages from primary care. Comments on Betrains et al. Clin Exp Rheumatol 2022; 40:666. [DOI: 10.55563/clinexprheumatol/j2r9je] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, Health District no. 59, Rheumatologic Outpatient Clinic, Sant'Agnello, Italy.
| | - Maria Natale
- Azienda Sanitaria Locale Napoli 3 Sud, Health District no. 59, Rheumatologic Outpatient Clinic, Sant'Agnello, Italy
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Milchert M, Castagna A, Manzo C, Brzosko M. Implications of fever on erythrocyte sedimentation rate but not on C-reactive protein concentrations at the time of diagnosis of polymyalgia rheumatica. Comments on Betrains et al. Clin Exp Rheumatol 2022; 40:667. [PMID: 34796849 DOI: 10.55563/clinexprheumatol/8u94jp] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marcin Milchert
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, Szczecin, Poland
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, Italy
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, Health District no. 59, Rheumatologic Outpatient Clinic, Sant'Agnello, Napoli, Italy.
| | - Marek Brzosko
- Katedra Reumatologii i Chorób Wewnętrznych, Klinika Chorób Wewnętrznych Reumatologii Diabetologii Geriatrii i Immunologii Klinicznej PUM, Szczecin, Poland
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Nune A, Iyengar KP, Botchu R, Barman B, Manzo C. Correction to: "Living with COVID"-implications for immunosuppressed and immunocompromised. Clin Rheumatol 2022; 41:3595. [PMID: 36001246 PMCID: PMC9828856 DOI: 10.1007/s10067-022-06346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- A. Nune
- Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN UK
| | - K. P. Iyengar
- Southport and Ormskirk Hospital NHS Trust, Southport, PR8 6PN UK
| | - R. Botchu
- The Royal Orthopaedic Hospital NHS Trust, Birmingham, UK
| | - Bhupen Barman
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya India
| | - C. Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, “Mariano Lauro” Hospital, Rheumatologic Outpatient Clinic, Sant’Agnello, Campania Italy
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Manzo C, Castagna A. Comment on: Risk of giant cell arteritis and polymyalgia rheumatica following COVID-19 vaccination: a global pharmacovigilance study. Rheumatology (Oxford) 2021; 61:e101-e102. [PMID: 34878092 DOI: 10.1093/rheumatology/keab849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3 sud. Rheumatologic Outpatient Clinic, Health District No. 59, Naples, Sant'Agnello, Italy
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, Casa della Salute 'Chiaravalle Centrale', Catanzaro, Chiaravalle, Italy
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Manzo C, Castagna A, Natale M, Ruotolo G. Answer to Cadiou et al. "SARS-CoV-2, polymyalgia rheumatica and giant cell arteritis: COVID-19 vaccine shot as a trigger?". Joint Bone Spine 2021;88:105282. Joint Bone Spine 2021; 89:105284. [PMID: 34601111 PMCID: PMC8483980 DOI: 10.1016/j.jbspin.2021.105284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/05/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic outpatient clinic, health district no. 59, Sant'Agnello, Naples, Italy.
| | - Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro. Primary care department, Casa della salute Chiaravalle Centrale Chiaravalle, Catanzaro, Italy.
| | - Maria Natale
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic outpatient clinic, health district no. 59, Sant'Agnello, Naples, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera "Pugliese-Ciaccio", Geriatric Medicine department, Catanzaro, Italy.
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Castagna A, Fabbo A, Manzo C, Lacava R, Ruberto C, Ruotolo G. A Retrospective Study on the Benefits of Combined Citicoline, Memantine, and Acetylcholinesterase Inhibitor Treatments in Older Patients Affected with Alzheimer's Disease. J Alzheimers Dis 2021; 79:1509-1515. [PMID: 33459645 DOI: 10.3233/jad-201211] [Citation(s) in RCA: 3] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Background: Citicoline has been proven to have beneficial effects in patients with cognitive impairment. In previous studies, combined treatment with memantine and acetylcholinesterase inhibitors (AChEIs) maintained cognitive function in patients with Alzheimer's disease (AD) better than memantine or AChEIs alone. OBJECTIVE To evaluate the effectiveness and safety of a combination therapy of oral citicoline, memantine, and an AChEI in AD when compared with memantine and an AChEI without citicoline. METHODS This was a retrospective multi-centric case-control study, conducted in Italian Centers for Cognitive Impairment and Dementia. Overall, 170 patients were recruited (34.11%of men, mean age 76,81±4.93 years): 48.8%treated with memantine and donepezil; 48.2%with memantine and rivastigmine; 2.9%with memantine and galantamine. 89 patients (control-group) were treated with memantine and an AChEI, whereas 81 patients (case-group) were treated with oral citicoline 1000 mg/day added to memantine and an AChEI given orally. Cognitive functions, activities of daily living, instrumental activities of daily living, comorbidities, mood and behavioral disturbances were assessed at baseline, month 6, and month 12. RESULTS In the case group, MMSE score had a statistically significant increasing trend between T0 and T2 (14.88±2.95 versus 15.09±3.00; p = 0.040), whereas in the control group, MMSE score showed a statistically significant decrease trend (14.37±2.63 versus 14.03±2.92 p = 0.024). CONCLUSION In older patients with AD, a triple therapy with citicoline, memantine, and AChEI was more effective than memantine and AChEI without citicoline in maintaining the MMSE total score after 12 months.
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Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Andrea Fabbo
- Health Authority and Services of Modena (AUSL di Modena), Geriatric Service-Cognitive Disorders and Dementia Unit, Modena, Italy
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Center for Cognitive Disorders and Dementia, Pomigliano d'Arco (Naples), Italy
| | - Roberto Lacava
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Carmen Ruberto
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera Pugliese-Ciaccio, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
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21
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Manzo C, Milchert M, Isetta M, Natale M, Castagna A. Early diagnosis in patients with polymyalgia rheumatica: is a fast track clinic a viable solution? Comment on: "Fast track clinic for early diagnosis of polymyalgia rheumatica: Impact on symptom duration and prednisolone initiation" by Frølund et al. Joint Bone Spine 2021;88:105185. Joint Bone Spine 2021; 88:105262. [PMID: 34506933 DOI: 10.1016/j.jbspin.2021.105262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic outpatient clinic, health district no. 59, Sant'Agnello, Naples, Italy.
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology of Pomeranian Medical University, 71-871 Szczecin, Poland
| | - Marco Isetta
- Library and Knowledge Services, Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Maria Natale
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic outpatient clinic, health district no. 59, Sant'Agnello, Naples, Italy
| | - Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary care department, fragility outpatient clinic. Casa della salute "Chiaravalle Centrale", Chiaravalle, Catanzaro, Italy
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22
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Manzo C. Rheumatic Immuno-related Adverse Events following Immunotherapy with Checkpoint Inhibitors: Adverse Drug Reaction, or Other? Mediterr J Rheumatol 2021; 32:186-187. [PMID: 34447920 PMCID: PMC8369280 DOI: 10.31138/mjr.32.2.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/17/2021] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department - Geronthorheumatological Outpatient Clinic, Poliambulatorio "Mariano Lauro", Sant'Agnello, Naples, Italy
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23
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Manzo C, Natale M, Castagna A. Polymyalgia rheumatica as uncommon adverse event following immunization with COVID-19 vaccine: A case report and review of literature. Aging Med (Milton) 2021; 4:234-238. [PMID: 34518809 PMCID: PMC8426911 DOI: 10.1002/agm2.12171] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ciro Manzo
- Department of Internal and Geriatric Medicine Azienda Sanitaria Locale Napoli 3 sud Geronthorheumatologic Outpatient Clinic Poliambulatorio "Mariano Lauro" Naples Italy
| | - Maria Natale
- Department of Internal and Geriatric Medicine Azienda Sanitaria Locale Napoli 3 sud Geronthorheumatologic Outpatient Clinic Poliambulatorio "Mariano Lauro" Naples Italy
| | - Alberto Castagna
- Primary Care Department Azienda Sanitaria Provinciale Catanzaro Casa Della Salute "Chiaravalle Centrale" Catanzaro Italy
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24
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Manzo C, Serra-Mestres J, Isetta M. Comment on: Comorbidities (excluding lymphoma) in Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:e453-e454. [PMID: 34302468 DOI: 10.1093/rheumatology/keab602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Gerontorheumatologic Outpatient Clinic, Health District no. 59, Naples, Italy
| | - Jordi Serra-Mestres
- Department of Old Age Psychiatry, Woodland Centre, Hillingdon Hospital, Central and North West London NHS Foundation Trust, Uxbridge, UK
| | - Marco Isetta
- Library and Knowledge Services, Central and North West London NHS Foundation Trust, London, UK
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25
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Milchert M, Manzo C, Castagna A, Brzosko M. Calcium pyrophosphate disease and polymyalgia reumatica: association or coincidence? Comment on "Ultrasound shoulder assessment of calcium pyrophosphate disease with suspected polymyalgia rheumatica" Ottaviani et al. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/kcan9r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Health District no. 59, Sant’Agnello, Naples, Italy.
| | - Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Department, Fragility Outpatient Clinic, Casa della salute "Chiaravalle Centrale", Chiaravalle, Catanzaro, Italy
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
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26
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Manzo C, Castagna A. Adalimumab-Induced Rhupus Syndrome in a Female Patient Affected with Anti-Citrullinated Protein Antibody (ACPA)-Positive Rheumatoid Arthritis (RA): A Case Report and Review of Literature. Clin Pract 2021; 11:404-409. [PMID: 34287248 PMCID: PMC8293207 DOI: 10.3390/clinpract11030055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
We report a 38-year-old female patient affected with anti-citrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA) who developed mild hemolytic anemia (Hb = 10.5 vs. >12 gr/dL), indolent oral ulceration, ANA (1:1280, homogeneous pattern), and anti-dsDNA antibody positivity following 8 months of therapy with an adalimumab biosimilar (GP2017). Rhupus syndrome was diagnosed. Replacing GP2017 with infliximab, anemia, oral ulcer, and anti-dsDNA antibodies quickly disappeared, while low-titers (1:80) ANA are still present after more than a year. The possibility that the patient suffered from rhupus rather than drug-induced lupus erythematosus associated to anti-ACPA positivity RA was discussed. To date, after a 14-month follow-up, no manifestations of LE have reappeared. To the best of our knowledge, this is the first report of adalimumab-induced rhupus.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3 Sud, Health District No. 59, Sant’Agnello, 80065 Naples, Italy
- Correspondence: ; Tel.: +39-081-533-1465
| | - Alberto Castagna
- Primary Care Department, Casa Della Salute “Chiaravalle Centrale”, Fragility Outpatient Clinic, Azienda Sanitaria Provinciale di Ca-tanzaro, Chiaravalle, 88064 Catanzaro, Italy;
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27
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Manzo C. Stauffer's syndrome presenting as polymyalgia rheumatica. Rheumatology (Oxford) 2021; 60:e243-e244. [PMID: 33471108 DOI: 10.1093/rheumatology/keab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3 sud, Rheumatologic Outpatient Clinic and Gerontorheumatologic Ambulatory, 'Mariano Lauro' Hospital, Sant'Agnello, Italy
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28
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Manzo C, Milchert M, Natale M, Brzosko M. Polymyalgia rheumatica without elevated baseline acute phase reactants. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/s4c5k3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic Outpatient Clinic, Health District no.59, Sant’Agnello, Naples, Italy.
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
| | - Maria Natale
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department, Rheumatologic Outpatient Clinic, Health District no.59, Sant’Agnello, Naples, Italy
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Poland
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Castagna A, Ruotolo G, Manzo C. Progress in the risk assessment of hydroxychloroquine in frail elderly people. Aging Med (Milton) 2021; 4:53-57. [PMID: 33738381 PMCID: PMC7954841 DOI: 10.1002/agm2.12140] [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: 08/19/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Hydroxychloroquine (HCQ) is an antimalarial drug also known to have anti-inflammatory and antiviral effects. The antiviral action of HCQ has been a point of interest for many researchers because of its mechanism of action and the potential use it could have during the current COVID-19 pandemic. However, HCQ can cause QT interval prolongation. The current therapies used in COVID-19 are changing as the pandemic develops. The aim of this article is to promote a validated risk score for QT prolongation in multidimensional assessment of COVID-19 patients, especially in elderly and polypathological patients.
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Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and DementiaCatanzaroItaly
| | - Giovanni Ruotolo
- Geriatric UnitGeneral HospitalAzienda Ospedaliera Pugliese‐Ciaccio di CatanzaroCatanzaroItaly
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 SudInternal and Geriatric Medicine Department ‐ Gerontorheumatological Outpatient ClinicPoliambulatorio “Mariano Lauro” ‐ Distretto Sanitario 59NaplesItaly
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30
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Serban T, Allara R, Azzolini V, Bellintani C, Belloli L, Belai Beyene N, Bucci R, Caporali R, Cappelli A, Corbelli V, DE Gennaro F, Fusaro E, Giusti A, Govoni M, Magnani L, Manzo C, Romano C, Rossini M, Santilli D, Saviola G, Sinigaglia L, Bianchi G. Long-term methotrexate use in rheumatoid arthritis patients: real-world data from the MARTE study. Minerva Med 2021; 112:246-254. [PMID: 33555152 DOI: 10.23736/s0026-4806.21.06902-0] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND The MARTE study investigated the demographic, clinical, and therapeutic characteristics of rheumatoid arthritis (RA) patients ongoing methotrexate (MTX) treatment for longer than 8 years. METHODS This cross-sectional, observational study considered 587 RA patients from 67 Rheumatology Units across Italy. Data collected included demographic, clinical, and therapeutic characteristics, focusing on MTX prescription patterns (route of administration, dosing regimens, treatment duration, and discontinuation). RESULTS As initial therapy, 90.6% of patients received one conventional synthetic Disease Modifying Anti Rheumatic Drug (csDMARD), with treatment started within the first 3 months from diagnosis in half of the patients. MTX was the first csDMARD in 46.2% of patients. The prevalent route of administration at diagnosis was the intramuscular (60.5%), while at study entry (baseline) 57.6% were receiving subcutaneous MTX. Patients who required a higher MTX dose at study entry were those who received a significantly lower starting MTX dose (P<0.001). Significantly higher MTX doses were currently required in men (P<0.001), current smokers (P=0.013), and overweight patients (P=0.028), whereas patients on oral therapy received significantly lower doses of MTX (P<0.001). CONCLUSIONS The MARTE study confirms once again the potential of the proper use of MTX in the treatment of RA. Data from our study suggest that a higher dose of MTX should be used since the first stages in overweight patients, men, and smokers.
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Affiliation(s)
- Teodora Serban
- S.C. Rheumatology, Department of Locomotor System, ASL3 Genovese, Genoa, Italy -
| | | | | | | | - Laura Belloli
- S.C. Rheumatology, Polyspecialist Medical Department, Niguarda Hospital, Milan, Italy
| | | | - Romano Bucci
- SSD Rheumatology, University Hospital OO. RR. of Foggia, Foggia, Italy
| | | | - Antonella Cappelli
- SS Rheumatology, ASST Settelaghi, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Vincenzo Corbelli
- Unit of Medicine, ASST Lariana, S. Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Fabio DE Gennaro
- US Rheumatology, Hospital of Cremona, ASST of Cremona, Cremona, Italy
| | - Enrico Fusaro
- SC Rheumatology, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Giusti
- S.C. Rheumatology, Department of Locomotor System, ASL3 Genovese, Genoa, Italy
| | - Marcello Govoni
- University of Ferrara, S. Anna University Hospital, Ferrara, Italy
| | - Luca Magnani
- S.C. Rheumatology, IRCCS Arcispedale Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Ciro Manzo
- ASL Napoli 3 Sud, Ambulatory of Rheumatology - Sanitary District 59, Sant'Agnello, Naples, Italy
| | - Ciro Romano
- Division of Internal Medicine and Immuno-allergology, SUN University Hospital, Naples, Italy
| | - Maurizio Rossini
- Section of Rheumatology, Department of Medicine, University Hospital of Borgo Trento, Verona, Italy
| | - Daniele Santilli
- S.S.D. Internal Medicine and Rheumatology, University Hospital of Parma, Parma, Italy
| | - Gianantonio Saviola
- Unit of Rheumatology and Rehabilitation, Institute of Castel Goffredo, IRCCS Maugeri Clinical Scientific Institutes, Mantua, Italy
| | - Luigi Sinigaglia
- Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan, Italy
| | - Gerolamo Bianchi
- S.C. Rheumatology, Department of Locomotor System, ASL3 Genovese, Genoa, Italy
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Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department. Rheumatologic outpatient clinic, health district no. 59 Sant'Agnello, Naples, Italy.
| | - Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro. Primary care department, Casa della salute Chiaravalle Centrale Chiaravalle, Catanzaro, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera "Pugliese-Ciaccio", Geriatric Medicine department, Catanzaro, Italy
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32
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Castagna A, Ruotolo G, Manzo C. Hydroxychloroquine and QT Prolongation in Older Patients with Rheumatic Diseases: Who is afraid of the Boogeyman? We are not! Mediterr J Rheumatol 2021; 31:433-435. [PMID: 33521580 PMCID: PMC7841093 DOI: 10.31138/mjr.31.4.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/07/2020] [Accepted: 09/30/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Geriatric Medicine department - Fragility Outpatient Clinic, Casa della Salute Chiaravalle Centrale, Catanzaro, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera Pugliese-Ciaccio di Catanzaro, Geriatric Unit, General Hospital, Catanzaro, Italy
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine department - Geronthorheumatological Outpatient Clinic, poliambulatorio "Mariano Lauro", Sant'Agnello, Naples, Italy
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33
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Castagna A, Manzo C, Fabbo A, Lacava R, Ruberto C, Ruotolo G. The CITIMERIVA Study: CITIcoline plus MEmantina plus RIVAstigmine in Older Patients Affected with Alzheimer's Disease. Clin Drug Investig 2021; 41:177-182. [PMID: 33484469 DOI: 10.1007/s40261-020-00996-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Combined therapy of memantine or acetylcholinesterase inhibitors, with cholinergic precursors such as citicoline, can be effective in Alzheimer's disease. Indeed, they are able to increase the intrasynaptic levels of acetylcholine more than the single drug. Our aim was to evaluate the efficacy and safety of oral citicoline plus memantine plus rivastigmine in patients with Alzheimer's disease. METHODS This was a multi-centric, retrospective case-control study conducted in Italian Centers for Cognitive Impairment and Dementia on consecutive patients aged 65 years or older affected with Alzheimer's disease. Overall, 104 patients were recruited (27% male, mean age 76.04 ± 4.92 years); 41 (39.42%) treated with citicolin 1000 mg/day given orally + memantine + rivastigmine (Cases) and 63 (60.58%) treated with memantine + rivastigmine (Controls). At baseline (T0), month 6 (T1) and month 12 (T2), cognitive functions were assessed by the Mini Mental State Examination (MMSE), functional dependence by basal Activities (ADL) and Instrumental Activities of Daily Living (IADL), comorbidity by the Cumulative Illness Rating Scale (CIRS), mood by the Geriatric Depression Scale (GDS), and behavioural disturbances by the Neuropsychiatric Inventory (NPI). Adverse events were reported during the study. RESULTS The difference in MMSE score was not significant when comparing the two groups at T0, T1 or T2. However, in the case group, the MMSE total score showed a statistically significant difference at T0 versus T1 (13.63 ± 2.46 vs. 14.17 ± 2.24; p = 0.008), and at T0 versus T2 (13.63 ± 2.46 vs. 14.32 ± 2.53; p = 0.002). In the control group, no statistical differences were found at baseline (T0), T1 and T2. ADL, IADL, GDS and NPI total score did not improve during the study in either the case or the control group. CONCLUSIONS In our study we observed absence of a statistically significant difference between case and control groups for the MMSE total scores. However, in the case group in the MMSE total scores, there was a statistically significant increase between the baseline and the end of the study.
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Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale di Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, viale Crotone, 88100, Catanzaro, Italy.
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Center for Cognitive Disorders and Dementia, Health District no.51, Pomigliano d'Arco, Naples, Italy
| | - Andrea Fabbo
- Azienda Unica Sanitaria Locale di Modena, Geriatric Service, Cognitive Disorders and Dementia Unit, Modena, Italy
| | - Roberto Lacava
- Azienda Sanitaria Provinciale di Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, viale Crotone, 88100, Catanzaro, Italy
| | - Carmen Ruberto
- Azienda Sanitaria Provinciale di Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, viale Crotone, 88100, Catanzaro, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera Pugliese-Ciaccio di Catanzaro, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
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Manzo C. C-reactive protein concentrations as predictors of glucocorticoid-free remission in patients with polymyalgia rheumatica. Int J Rheum Dis 2021; 24:284-285. [PMID: 33423397 DOI: 10.1111/1756-185x.14054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud. Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Poliambulatorio "Mariano Lauro", Sant'Agnello, Naples, Italy
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Manzo C, Serra-Mestres J, Isetta M, Castagna A. Could COVID-19 anosmia and olfactory dysfunction trigger an increased risk of future dementia in patients with ApoE4? Med Hypotheses 2021; 147:110479. [PMID: 33422806 PMCID: PMC7785277 DOI: 10.1016/j.mehy.2020.110479] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/03/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022]
Abstract
The association of the coronavirus disease 2019 (COVID-19) with significant neurological and neuropsychiatric complications has been increasingly reported, both during the acute illness and in its aftermath. However, due to the short duration of patient follow up until now, it is not clear whether this infection will be associated with longer-term neurological and/or neuropsychiatric sequelae. In particular, the question of whether COVID-19 will be associated with an increased risk and rate of future dementia remains open and subject to speculation. During the course of the COVID-19 pandemic, an increasing number of patients have reported sudden anosmia or other olfactory dysfunction as concurrent symptoms. The possibility that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may reach the brain via the olfactory nerve or an upper nasal trancribrial route is an interesting working hypothesis. Among the identified genetic risk factors for Late-onset Alzheimer’s disease (LOAD), Apo E4 is one of the strongest and most frequent. People carrying one or two copies of the e4 allele of Apo E4 have significant odor recognition deficits in comparison to those not carrying this haplotype. The hypothesis invoked in this paper is that anosmia/olfactory dysfunctions induced by SARS-CoV-2 may cause an increased a risk of future neurodegenerative dementia in ApoE4 carriers, and that this risk would be higher than in Apo E4 carriers affected by anosmia not induced by SARS-CoV-2. This would be associated with virus-induced chronic modifications in the central nervous system. It is proposed that COVID-19 patients with anosmia and no other serious symptoms should be followed up as part of specifically designed and approved studies in order to identify the early stages of dementia (especially LOAD and Dementia with Lewy Bodies), thereby improving our knowledge of the mechanisms involved in pre-cognitive stages of neurodegenerative dementia and making best use of any available therapies. This latter opportunity is unique and should not be lost.
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Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Center for Cognitive Disorders and Dementia, Health district no.51 - Pomigliano d'Arco Naples, Italy.
| | - Jordi Serra-Mestres
- Department of Old Age Psychiatry, Central and North West London NHS Foundation Trust, London, UK.
| | - Marco Isetta
- Library and Knowldege Services, Central and North West London NHS Foundation Trust, London, UK.
| | - Alberto Castagna
- Geriatric Medicine Department, Azienda Sanitaria Provinciale Catanzaro, Fragility Outpatient Clinic, Casa della Salute di Chiaravalle Centrale, Chiaravalle Catanzaro, Italy.
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Castagna A, Manzo C, Ruotolo G. Comprensive Geriatric Assessment in hospitalized older patients with COVID-19. Geriatr Gerontol Int 2020; 21:118-119. [PMID: 33260256 PMCID: PMC7753837 DOI: 10.1111/ggi.14103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Department, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 Sud, Internal and Geriatric Medicine Department, Center for Cognitive Disorders and Dementia, Naples, Italy
| | - Giovanni Ruotolo
- Geriatric Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
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Castagna A, Manzo C, Ruotolo G. Comment on: Coronavirus 2019 in Geriatrics and
Long‐Term
Care: The
ABCDs
of
COVID
‐19:. J Am Geriatr Soc 2020; 68:2746. [PMID: 32770838 PMCID: PMC7436577 DOI: 10.1111/jgs.16795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
This letter comments on the article by D'Adamo et al.
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Affiliation(s)
- Alberto Castagna
- Center for Cognitive Disorders and Dementia DSS Catanzaro Azienda Sanitaria Provinciale Catanzaro Catanzaro Italy
| | - Ciro Manzo
- Internal and Geriatric Medicine Department – Geronthorheumatological Outpatient Clinic, Poliambulatorio “Mariano Lauro” –Distretto Sanitario 59 Azienda Sanitaria Locale Napoli 3 sud Naples Italy
| | - Giovanni Ruotolo
- Geriatric Unit Azienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
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Manzo C, Isetta M, Natale M, Castagna A. Identification and Classification of Polymyalgia Rheumatica (PMR) and PMR-Like Syndromes Following Immune Checkpoint Inhibitors (ICIs) Therapy: Discussion Points and Grey Areas Emerging from a Systematic Review of Published Literature. Medicines (Basel) 2020; 7:E68. [PMID: 33153016 PMCID: PMC7693468 DOI: 10.3390/medicines7110068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 12/22/2022]
Abstract
Background: Polymyalgia Rheumatica (PMR) is one of the most frequent rheumatologic immune-related adverse effects (IRAEs) in cancer patients following therapy with immune checkpoint inhibitors (ICIs). Atypical findings in many patients often lead to diagnosing PMR-like syndromes. Materials and methods: The aim of our research was to review reported diagnoses of PMR and PMR-like syndromes following ICIs therapy, and assess whether they can be redefined as adverse drug reaction (ADR). In line with PRISMA guidelines, we carried out a systematic search on three main bibliographic databases, based on a combination of subject headings and free text. We included all studies and case-reports published after 2011 (when FDA approved the use of the first ICI) describing the association of PMR or PMR-like syndromes with all types of ICIs therapy. We excluded reviews, conference abstracts, comments, secondary articles, and non-English language studies. Results: We reviewed data from seven studies and eight case-reports, involving a total of 54 patients. Limitations included: the small size of all studies; only one retrospective study used validated criteria for PMR; most reports assessed IRAEs by clinical judgment only and did not seek validation through assessment scales. To date, it remains a conundrum whether IRAEs-PMR is identical to the idiopathic form of the disease, or whether it should be considered a subset of the disease or a new entity. Conclusions: Our review indicates that the relationship between PMR and ICIs therapy is yet to be clearly understood and defined and that future research should remedy the current limits in study design.
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Affiliation(s)
- Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Health District No. 59, 80065 Sant’Agnello (Naples), Italy
| | - Marco Isetta
- Library and Knowldege Services, Central and North West London NHS Foundation Trust, London NW1 3AX, UK;
| | - Maria Natale
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Health District No. 58, 80054 Gragnano (Naples), Italy;
| | - Alberto Castagna
- Geriatric Medicine Department Azienda Sanitaria Provinciale Catanzaro, Fragility Outpatient Clinic, Casa Della Salute di Chiaravalle Centrale, Chiaravalle, 88100 Catanzaro, Italy;
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Manzo C. Clinical practice guidelines for patients with polymyalgia rheumatica: the need for an active involvement of all stakeholder is still unmet. Reumatismo 2020; 72:120-121. [PMID: 32700879 DOI: 10.4081/reumatismo.2020.1290] [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: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
Not available.
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Affiliation(s)
- C Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Rheumatologic Outpatient Clinic, Health Distict no. 59, Sant'Agnello (NA).
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Manzo C. The role of hydroxychloroquine sulfate in the geriatric patient with coronavirus disease 2019 (COVID-19). What is useful to know for the geriatrician? Geriatr Care 2020. [DOI: 10.4081/gc.2020.9015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The role of hydroxychroloquine (HCQ) sulfate as therapeutic option in coronavirus disease 2019 (COVID-19) patients aroused great interest and hope, so much so as to authorize several studies in the world. Despite the beneficial effects demonstrated in vitro and in some case-series, doubts remain about its clinical use, so that at present more than 20 different therapeutic study protocols have been proposed. Very recently, a protocol has been authorized by the Italian Medicines Agency (AIFA), in order to evaluate the efficacy of out-of-hospital treatment with HCQ in the reducing viral loads and need for hospitalization in symptomatic COVID-19 infected patients who are confined at home. The article describes lights and shadows of HCQ therapy in the elderly and geriatric patients affected by COVID-19, and suggests that the geriatrician should use HCQ only after careful patient selection and be aware of its pharmacokinetic properties and adverse effects, before better-designed studies determine their benefit, if any, in treating COVID-19.
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Castagna A, Coppolino G, Ruberto C, Ruotolo G, Manzo C. Brief report on cognitive function and corticosteroid therapy in elderly. Geriatr Care 2020. [DOI: 10.4081/gc.2020.8785] [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: 11/22/2022] Open
Abstract
Glucocorticoids (GCs) are drugs commonly used for the treatment of a great number of acute or chronic pathological conditions. In a cross-sectional study we analyze a cohort of elderly patients treated for at least four weeks with a glucocorticoid (GC), exactly prednisone therapy, for a renal or rheumatological condition pointing out on functional, mental and clinical status. The main purpose was to assess change in cognitive performances. Corticosteroids administration also at low dosage in older subjects could enhance cognitive function. This observation should be proved in larger population and underlying mechanisms studied in deep.
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Manzo C. Polymyalgia rheumatica following intravesical bacillus Calmette-Guerin instillation: coincidence or true association? A case report and literature review. Geriatr Care 2020. [DOI: 10.4081/gc.2020.8868] [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: 11/23/2022] Open
Abstract
We report the case of a 73-year-old male patient suffering from non muscle invasive bladder cancer (NMIBC) who had violent pains in his neck and shoulders associated with general discomfort and fever, following the second intravesical instillation of bacillus Calmette-Guerin (BCG), with further worsening after the third instillation. During his hospitalization, laboratory tests showed a significant raise of inflammatory markers. An ultrasound (US) examination of his shoulders showed bilateral longhead-biceps exudative tenosynovitis and subdeltoid bursitis. An 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) associated with total body computed tomography (CT) showed pathological inflammatory findings in neck and shoulders, with exclusion of pathological findings in other sites. Cystoscopy was negative for NMIBC recurrence. Polymyalgia rheumatica (PMR) was diagnosed and BCG instillations was stopped. The patient had fast improvement of clinical manifestations and laboratory tests, but when he resumed them a few weeks later, the same manifestations recurred.
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Manzo C, Emamifar A. Polymyalgia Rheumatica and Seronegative Elderly-Onset Rheumatoid Arthritis: Two Different Diseases with Many Similarities. EMJ 2019. [DOI: 10.33590/emj/10313508] [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: 01/13/2023] Open
Abstract
Polymyalgia rheumatica (PMR) and seronegative elderly-onset rheumatoid arthritis (SEORA) are two of the most frequent inflammatory rheumatologic diseases in elderly patients. At first presentation, there are many similarities between PMR and SEORA, that may lead to a real diagnostic conundrum. The most relevant similarities and differences between PMR and SEORA are discussed in this review. In addition to the acute involvement of the shoulder joints, important features characterising both diseases are morning stiffness longer than 45 minutes, raised erythrocyte sedimentation rate, and a good response to low doses of prednisone. Some findings (such as erosive arthritis or symmetrical involvement of metacarpophalangeal and/or proximal interphalangeal joints) can help to make the diagnosis of SEORA, whereas shoulder and hip ultrasonography and 18-FDG PET/CT seem to be less specific. However, in several patients only long-term follow-ups confirm the initial diagnosis. A definite diagnosis of PMR or SEORA has significant therapeutic implications, since patients with PMR should be treated with long-term glucocorticoids, and sometimes throughout life, which predisposes the patients to serious side effects. On the contrary, in patients with SEORA, short-term treatment with glucocorticoids should be considered when initiating or changing disease modifying antirheumatic drugs, followed by rapid tapering.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital “Mariano Lauro”, Sant’Agnello, Italy
| | - Amir Emamifar
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Diagnostic Center, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
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Manzo C. Incidence and Prevalence of Polymyalgia Rheumatica (PMR): The Importance of the Epidemiological Context. The Italian Case. Med Sci (Basel) 2019; 7:medsci7090092. [PMID: 31480261 PMCID: PMC6780278 DOI: 10.3390/medsci7090092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/30/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES to evaluate incidence and prevalence rates of polymyalgia rheumatica (PMR) in Italy, depending on the epidemiological methodology used from time to time. MATERIALS AND METHODS A comprehensive literature search in MEDLINE and EMBASE was carried out. The following search terms were used: polymyalgia rheumatica, incidence, prevalence, epidemiology, general practitioner, family medicine, Italy. A search was also carried out in Google scholar using the search phrase: epidemiology of polymyalgia rheumatica in Italy. The period considered was between 1970 and March 2019. All articles containing data on incidence and prevalence of PMR in Italy were read in full. Reviews and non-original manuscripts were excluded as well as all the studies containing incidence and prevalence rates of giant cell arteritis (GCA), unless clearly distinct from data related to patients with PMR alone (isolated and pure PMR). RESULTS Five articles corresponded to inclusion and exclusion criteria. Two articles were excluded as they were review articles, and three articles were excluded because there were not clear data on incidence and prevalence rates of isolated PMR. Three articles reported data on the annual incidence of PMR (two of them published by the same group of investigators); two articles reported prevalence data. In one article, both incidence and prevalence were calculated. The annual rate of incidence of PMR was between 0.12 and 2.3 cases/1000 inhabitants aged over 50 years. In the two studies publishing prevalence data, they varied from 0.37% to 0.62%. The differences in incidence and prevalence rates were related to several factors such as the different set of diagnostic criteria used for identifying patients or the diagnostic difficulty for patients with atypical presentations, specifically those without raised erythrocyte sedimentation rate (ESR). In the study with higher annual rate of incidence and higher prevalence of PMR, the collaboration between general practitioner (GP) and the out-of-hospital public rheumatologist resulted in significantly different data than in the other studies. All the five articles presented data from monocentric cohorts. CONCLUSION Very few Italian studies addressed the epidemiology of PMR. The contribution of a specific professional figure represented by the out-of-hospital public rheumatologist, present in the Italian National Health System and absent in other countries, can make the Italian experience unique in its kind.
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Affiliation(s)
- Ciro Manzo
- Rheumatology Outpatient Clinic, Poliambulatorio "Mariano Lauro", Sant'Agnello-Distretto Sanitario 59 (Penisola Sorrentina), ASL Napoli 3 sud, 80065 Sant'Agnello, Naples, Italy.
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Manzo C. Are the cognitive functions of patients with rheumatoid arthritis associated with disease activity, with carotid atherosclerotic changes or with mood disorders such as depression and anxiety? Clin Exp Rheumatol 2019; 37:516. [PMID: 30620281] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Ciro Manzo
- Center for Cognitive Diseases and Dementias; and Rheumatologic Outpatient Clinic and Geriatric, Rheumatologic Ambulatory, Azienda Sanitaria, Locale Napoli 3 Sud, Italy.
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Manzo C, Milchert M, Natale M, Brzosko M. Polymyalgia rheumatica with normal values of both erythrocyte sedimentation rate and C-reactive protein concentration at the time of diagnosis. Rheumatology (Oxford) 2019; 58:921-923. [DOI: 10.1093/rheumatology/key431] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Mariano Lauro Hospital, Sant’Agnello, Italy
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
| | - Maria Natale
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic, Mariano Lauro Hospital, Sant’Agnello, Italy
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
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Manzo C, Camellino D. [Polymyalgia rheumatica: diagnostic and therapeutic issues of an apparently straightforward disease.]. Recenti Prog Med 2018. [PMID: 28643813 DOI: 10.1701/2695.27559] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Polymyalgia rheumatica (PMR) is an inflammatory disease characterized by aching and stiffness in the girdles, which affects typically people over 50 years old and could overlap with giant cell arteritis (GCA) in about 15-20% of cases. Although the diagnosis of PMR is usually considered straightforward, clinicians facing this disease should be aware of its atypical manifestations, which can hamper the correct identification of PMR and, conversely, should be aware of other diseases which may present with polymyalgic features. The aim of this review is to synthetize current knowledge about clinical presentations of PMR, the differential diagnoses, the relationship with cancer, the clues to the presence of a concomitant GCA, the role of ultrasonography at the onset and in the follow-up and, finally, treatment approaches. Besides evidence from the literature, this review will highlight some "tips&tricks" useful in everyday clinical practice. The awareness of the different presentations and pitfalls of PMR could improve patients' management and avoid complications consequent upon unrecognized diseases or, conversely, overtreatment.
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Affiliation(s)
- Ciro Manzo
- Ambulatorio Interdistrettuale di Reumatologia e Servizio di Reumatologia Geriatrica, ex Ospedale "Mariano Lauro", Sant'Agnello (NA), Distretto Sanitario 59 ASL NA 3 Sud
| | - Dario Camellino
- SC Reumatologia, Dipartimento Apparato Locomotore, ASL3 "Genovese" - Laboratorio di Autoimmunologia, Dipartimento di Medicina Interna (DiMI), Università di Genova
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Manzo C, Serra-Mestres J, Castagna A, Isetta M. Behavioral, Psychiatric, and Cognitive Adverse Events in Older Persons Treated with Glucocorticoids. Medicines (Basel) 2018; 5:E82. [PMID: 30071590 PMCID: PMC6163472 DOI: 10.3390/medicines5030082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 01/22/2023]
Abstract
Background: Since the introduction of glucocorticoids (GCs) in the physician's pharmacological arsenal, it has been known that they are a cause of behavioral or psychiatric adverse events (BPAE), as well as of cognitive problems. To the best of our knowledge, the relationship between these adverse events and GCs in older persons has never been evaluated, except through case-reports or series with few cases. In this paper, a review of the literature regarding BPAEs and cognitive disorders in older people treated with CSs is undertaken. Methods: A comprehensive literature search for BPAEs was carried out on the three main bibliographic databases: EMBASE, MEDLINE and PsycINFO (NICE HDAS interface). Emtree terms were: Steroid, steroid therapy, mental disease, mania, delirium, agitation, depression, behavior change, dementia, major cognitive impairment, elderly. The search was restricted to all clinical studies and case reports with focus on the aged (65+ years) published in any language since 1998. Results: Data on the prevalence of the various BPAEs in older patients treated with GCs were very scarse, consisting mainly of case reports and of series with small numbers of patients. It was hence not possible to perform any statistical evaluation of the data (including meta-analysis). Amongst BPAEs, he possibility that delirium can be induced by GCs has been recently been questioned. Co-morbidities and polypharmacy were additional risk factors for BPAEs in older persons. Conclusions: Data on BPAEs in older persons treated with GCs, have several unmet needs that need to be further evaluated with appropriately designed studies.
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Affiliation(s)
- Ciro Manzo
- Rheumatologic Outpatient Clinic and Geronthorheumatologic Service, 80065 Sant'Agnello, Italy.
- Center for Cognitive Diseases and Dementias, 80038-ASL Napoli 3 Sud Pomigliano d'Arco, Italy.
| | - Jordi Serra-Mestres
- Department of Old Age Psychiatry, Central and North West London NHS Foundation Trust, London UB8 3NN, UK.
| | - Alberto Castagna
- Center for cognitive diseases and dementias, Catanzaro lido, ASP Catanzaro, 88100 Catanzaro, Italy.
| | - Marco Isetta
- Library and Knowledge services, Central and North West London NHS Foundation Trust, London UB8 3NN, UK.
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Manzo C, Longo C, Bianchin A. C1q Solid-Phase Enzymatic Microassay for Detection of Circulating Immune Complexes: Its Application in Human Breast Cancer. Tumori 2018; 68:47-52. [PMID: 7041380 DOI: 10.1177/030089168206800108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Circulating immune complexes (CIC) were detected and quantitated in human breast cancer to monitor the efficiency of mastectomy. For this aim a microimmunoenzymatic test was set up, applying a solid-phase C1q. Features of this assay can be summarized as follows: ability to estimate as low as 10 ng of aggregated human IgG (ΔIgG), good reproducibility and simplicity of execution, and small serum sample required. A group of women with breast cancer at different stages (TNM classification) was tested for CIC, and 31.75 % were positive. Almost all patients submitted to surgery showed a reduction of this parameter thereafter. A parallel study was carried out in another group of women with benign breast disease, and a significant incidence of CIC was found.
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Sobrero A, Manzo C, Stimamiglio A. The role of the general practitioner and the out-of-hospital public rheumatologist in the diagnosis and follow-up of patients with polymyalgia rheumatica. Reumatismo 2018; 70:44-50. [PMID: 29589402 DOI: 10.4081/reumatismo.2018.1036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/30/2017] [Revised: 01/23/2018] [Accepted: 01/27/2018] [Indexed: 11/22/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is a chronic inflammatory disease characterized by shoulder and pelvic girdle pain. Its onset peaks around the age of 75; the prevalence increases until the age of 90 and it is more frequent in females. Diagnosis is mostly performed on the basis of symptoms. An increase of serum inflammatory markers is indicative, but not essential, while therapy is mainly based on glucocorticoids. Since there is no universal agreement about diagnostic criteria for PMR, its detection is still difficult. There are discordant opinions about the fact that PMR can be recognised and managed by general practitioners (GPs), while patients with atypical features need to be referred to the rheumatologist. In the Italian setting, the absence of recent epidemiological studies is associated with the total lack of a research protocol in primary care, from which relevant information could be derived. The out-of-hospital public rheumatologist is a peculiar figure of the Italian National Health System, who takes care of outpatients. Although differences between the different Italian regional health services exist, this professional figure has proved to be effective in reducing delay and increasing accuracy in PMR diagnosis.
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