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Del Papa N, Vitali C, Minniti A, Caporali R. Is adipose-tissue or its fraction grafting really effective in the treatment of scleroderma hand? Rheumatology (Oxford) 2021; 61:1756-1757. [PMID: 34559208 DOI: 10.1093/rheumatology/keab707] [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: 08/16/2021] [Accepted: 09/06/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicoletta Del Papa
- Department of Rheumatology, ASST G. Pini-CTO; Research Center for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, Università degli Studi, di Milano, Milano, Italy
| | - Claudio Vitali
- Mater Domini Humanitas Hospital, Rheumatology Outpatient Clinics, Castellanza, Italy
| | - Antonina Minniti
- Department of Rheumatology, ASST G. Pini-CTO; Research Center for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, Università degli Studi, di Milano, Milano, Italy
| | - Roberto Caporali
- Department of Rheumatology, ASST G. Pini-CTO; Research Center for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, Università degli Studi, di Milano, Milano, Italy
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Vitali C, Minniti A, Pignataro F, Maglione W, Del Papa N. Management of Sjögren's Syndrome: Present Issues and Future Perspectives. Front Med (Lausanne) 2021; 8:676885. [PMID: 34164418 PMCID: PMC8215198 DOI: 10.3389/fmed.2021.676885] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
In view of the new possibilities for the treatment of primary Sjögren's syndrome (pSS) given by the availability of new biotechnological agents targeting the various molecular and cellular actors of the pathological process of the disease, classification criteria aimed at selecting patients to be enrolled in therapeutic trials, and validated outcome measures to be used as response criteria to these new therapies, have been developed and validated in the last decades. Unfortunately, the therapeutic trials so far completed with these new treatments have yielded unsatisfactory or only partially positive results. The main issues that have been evoked to justify the poor results of the new therapeutic attempts are: (i) the extreme variability of the disease phenotypes of the patients enrolled in the trials, which are dependent on different underlying patterns of biological mechanisms, (ii) the fact that the disease has a long indolent course, and that most of the enrolled patients might already have irreversible clinical features. The advances in the research of new disease biomarkers that can better distinguish the different clinical phenotypes of patients and diagnose the disease in an earlier phase are also discussed.
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Affiliation(s)
- Claudio Vitali
- Rheumatology Outpatient Clinics, "Mater Domini" Humanitas Hospital, Castellanza, Italy
| | | | | | - Wanda Maglione
- Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
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Del Papa N, Minniti A, Lorini M, Carbonelli V, Maglione W, Pignataro F, Montano N, Caporali R, Vitali C. The Role of Interferons in the Pathogenesis of Sjögren's Syndrome and Future Therapeutic Perspectives. Biomolecules 2021; 11:biom11020251. [PMID: 33572487 PMCID: PMC7916411 DOI: 10.3390/biom11020251] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 01/02/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/16/2022] Open
Abstract
There is a great deal of evidence pointing to interferons (IFNs) as being key cytokines in the pathogenesis of different systemic autoimmune diseases, including primary Sjögren’s syndrome (pSS). In this disease, a large number of studies have shown that an overexpression of type I IFN, the ‘so-called’ type I IFN signature, is present in peripheral blood mononuclear cells, and that this finding is associated with the development of systemic extra-glandular manifestations, and a substantial production of autoantibodies and inflammatory cytokines. In contrast, the absence or a milder expression of type I IFN signature and low level of inflammatory cytokines characterizes patients with a different clinical phenotype, where the disease is limited to glandular involvement and often marked by the presence of widespread pain and depression. The role of type II (IFNγ) in this subset of pSS patients, together with the potentially related activation of completely different immunological and metabolic pathways, are emerging issues. Expression of both types of IFNs has also been shown in target tissues, namely in minor salivary glands where a predominance of type II IFN signature appeared to have a certain association with the development of lymphoma. In view of the role played by IFN overexpression in the development and progression of pSS, inhibition or modulation of IFN signaling has been regarded as a potential target for the therapeutic approach. A number of therapeutic compounds with variable mechanisms of action have been tested or are under consideration for the treatment of patients with pSS.
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Affiliation(s)
- Nicoletta Del Papa
- Department of Rheumatology, ASST G. Pini-CTO, 20122 Milano, Italy; (A.M.); (W.M.); (F.P.); (R.C.)
- Correspondence:
| | - Antonina Minniti
- Department of Rheumatology, ASST G. Pini-CTO, 20122 Milano, Italy; (A.M.); (W.M.); (F.P.); (R.C.)
| | - Maurizio Lorini
- Department of Clinical Sciences and Community Health, Ca’ Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy; (M.L.); (V.C.); (N.M.)
| | - Vincenzo Carbonelli
- Department of Clinical Sciences and Community Health, Ca’ Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy; (M.L.); (V.C.); (N.M.)
| | - Wanda Maglione
- Department of Rheumatology, ASST G. Pini-CTO, 20122 Milano, Italy; (A.M.); (W.M.); (F.P.); (R.C.)
| | - Francesca Pignataro
- Department of Rheumatology, ASST G. Pini-CTO, 20122 Milano, Italy; (A.M.); (W.M.); (F.P.); (R.C.)
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, Ca’ Granda IRCCS Foundation, Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milano, Italy; (M.L.); (V.C.); (N.M.)
| | - Roberto Caporali
- Department of Rheumatology, ASST G. Pini-CTO, 20122 Milano, Italy; (A.M.); (W.M.); (F.P.); (R.C.)
- Research Center for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy
| | - Claudio Vitali
- Mater Domini Humanitas Hospital, Rheumatology Outpatient Clinics, 21053 Castellanza, Italy;
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Riccardi A, Marcoccia A, Modesti M, Bondanini F, Irace R, Messiniti V, Vitali C, Del Papa N, Valentini G. Undifferentiated connective tissue disease at risk for systemic sclerosis: Development of a short-term predictive score and a risk stratification tool. Autoimmun Rev 2021; 20:102751. [PMID: 33476821 DOI: 10.1016/j.autrev.2021.102751] [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: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Antonella Riccardi
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Italy
| | - Antonella Marcoccia
- Centro di Riferimento Interdisciplinare, Interdipartimentale per la diagnosi precoce della Sclerodermia (CRIIS), Sandro Pertini Hospital, Rome, Italy
| | - Mariagrazia Modesti
- Centro di Riferimento Interdisciplinare, Interdipartimentale per la diagnosi precoce della Sclerodermia (CRIIS), Sandro Pertini Hospital, Rome, Italy
| | - Francesco Bondanini
- Centro di Riferimento Interdisciplinare, Interdipartimentale per la diagnosi precoce della Sclerodermia (CRIIS), Sandro Pertini Hospital, Rome, Italy
| | - Rosaria Irace
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Italy
| | - Valentina Messiniti
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Italy
| | - Claudio Vitali
- Mater Domini' Humanitas Hospital, Rheumatology Outpatient Clinics, Castellanza, Italy
| | - Nicoletta Del Papa
- Department of Rheumatology, UOC Day Hospital of Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Gabriele Valentini
- Formerly Professor of Rheumatology, University of Campania "Luigi Vanvitelli", Italy.
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Del Papa N, Pignataro F, Maglione W, Minniti A, Sambataro D, Sambataro G, Valentini G, Caporali R, Vitali C. High NEMO score values in nailfold videocapillaroscopy are associated with the subsequent development of ischaemic digital ulcers in patients with systemic sclerosis. Arthritis Res Ther 2020; 22:237. [PMID: 33050944 PMCID: PMC7556978 DOI: 10.1186/s13075-020-02342-5] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nailfold videocapillaroscopy (NVC) is a feasible method that allows the observation of the microvascular changes that mark the course of systemic sclerosis (SSc). In previous studies, we demonstrated that the NEMO score, i.e. the cumulative number of microhaemorrhages and microthromboses, is a good indicator of the steady-state level and overtime changes of disease activity (DA) in SSc. OBJECTIVES To verify whether high NEMO scores, which mirror a very active microvascular derangement in the fingers, may be associated with the subsequent development of ischaemic digital ulcers (IDUs). METHODS The NEMO score was assessed at baseline (T0) in 98 patients with SSc, all classified according to the ACR-EULAR criteria. Of them, 90 were females, 48 had the limited and 50 had the diffuse cutaneous variant of SSc. Afterwards, the patients were closely followed up for 2 years, and the appearance of new IDUs recorded at any time of the follow-up. The T0-NEMO score values of patients who developed IDUs were compared to those of patients who did not. A receiver operating curve (ROC) was constructed, and the area under the curve (AUC) calculated by plotting the sensitivity and 1-specificity of the different NEMO score values in predicting the subsequent development of IDUs. RESULTS During the follow-up, 38 out of 98 patients developed one or more IDUs. The NEMO score at T0 was significantly higher in those who developed IDUs with respect to those who did not [median 14.5 (95% CI 11.0-21.5) and 4.5 (95% CI 4.0-6.0), respectively, p < 0.0001]. The ROC curve derived from different T0-NEMO score values had an AUC of 0.79 (95% CI 0.69-0.86, p < 0.0001). A NEMO score of ≥ 12 had a sensitivity of 83.3% (95% CI 71.5-91.7) and a specificity of 63.2% (95% CI 46.0-78.2), with positive (P) and negative (N) predictive (PV) values of 58.9% (95% CI 44.7-72.2) and 85.6% (71.8-94.4), respectively. A NEMO score of ≥ 16 had a sensitivity of 95.0% (95% CI 86.1-99.0) and a NPV of 93.4% (77.5-99.2). CONCLUSIONS Being a valid tool to measure DA levels in SSc, the NEMO score also appears to be closely related to the subsequent development of IDUs in this disease.
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Affiliation(s)
- Nicoletta Del Papa
- Department of Rheumatology, UOC Day Hospital of Rheumatology, ASST G.Pini-CTO, 20122, Milan, Italy.
| | - Francesca Pignataro
- Department of Rheumatology, UOC Day Hospital of Rheumatology, ASST G.Pini-CTO, 20122, Milan, Italy
| | - Wanda Maglione
- Department of Rheumatology, UOC Day Hospital of Rheumatology, ASST G.Pini-CTO, 20122, Milan, Italy
| | - Antonina Minniti
- Department of Rheumatology, UOC Day Hospital of Rheumatology, ASST G.Pini-CTO, 20122, Milan, Italy
| | - Domenico Sambataro
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, Section of Rheumatology, University of Catania, Catania, Italy
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, University of Catania, Catania, Italy
| | - Gabriele Valentini
- Department of Internal Medicine, Rheumatology Unit, 2nd University of Naples, Naples, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Claudio Vitali
- Rheumatology Outpatient Clinics, 'Mater Domini' Humanitas Hospital, Castellanza, Italy
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Del Papa N, Sambataro G, Minniti A, Maglione W, Pignataro F, Caminati A, Harari S, Sambataro D, Vitali C, Caporali RF. Impact of COVID-19 outbreak in an Italian cohort of patients with systemic sclerosis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20953356. [PMID: 33029203 PMCID: PMC7522815 DOI: 10.1177/1759720x20953356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/08/2020] [Accepted: 08/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Mortality rate in patients infected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can be related to the presence of comorbidities like diabetes, cardiovascular and pulmonary diseases. On the contrary, few data exist on the impact of CoronaVirus Disease 2019 (COVID-19) on patients with rheumatic disorders, namely in those having pulmonary involvement and treated with immunosuppressive agents. The present survey is aimed at knowing the impact of COVID-19 in a cohort of patients with systemic sclerosis (SSc). Methods Telephone interviews were carried out during the COVID-19 outbreak in patients with SSc followed in a Rheumatic Disease Unit in Italy. Patients were asked for confirmed SARS-CoV-2 infection, symptoms suggestive of COVID-19, and modification of their therapy. Results A total number of 526 patients with SSc were contacted and interviewed. Of them, 270 and 256 had limited cutaneous and diffuse cutaneous SSc, respectively. Interstitial lung disease (ILD) was present in 45% of patients and most of them (68.2%) were treated with immunosuppressive therapy. Only two patients were hospitalized for COVID-19-related pneumonia, and one of them died despite invasive ventilator support. An additional 11 patients reported flu-like symptoms compatible with a mild form of COVID-19. Nobody modified the therapy during the COVID-19 outbreak. Conclusion Despite the large prevalence of ILD and immunosuppressive therapies, which can be considered risk factors for the occurrence and severity of incidental viral infections, the impact of COVID-19, in terms of mortality rate and morbidity, does not appear particularly severe in this large cohort of patients with SSc. Possible mechanisms influencing this figure are discussed.
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Affiliation(s)
- Nicoletta Del Papa
- Department of Rheumatology, G. Pini Hospital, Via Pini, Milano 9 - 20122, Italy
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, Catania, Italy
| | | | - Wanda Maglione
- Department of Rheumatology, G. Pini Hospital, Milan, Italy
| | | | - Antonella Caminati
- Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sergio Harari
- Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Domenico Sambataro
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, Catania, Italy
| | - Claudio Vitali
- 'Mater Domini' Humanitas Hospital, Rheumatology Outpatient Clinics, Castellanza, Italy
| | - Roberto Felice Caporali
- Department of Rheumatology, G. Pini Hospital, Milan, Italy Department of Clinical Sciences and Community Health and Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, Milan, Italy
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Del Papa N, Pignataro F, Maglione W, Minniti A, Sambataro D, Sambataro G, Valentini G, Vitali C, Caporali R. FRI0234 A HIGH NEMO SCORE IN VIDEOCAPILLAROSCOPY IS PREDICTIVE OF FUTURE DEVELOPMENT OF DIGITAL ULCERS IN PATIENTS WITH SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Nailfold videocapillaroscopy (NVC) is a feasible method that allows the observation and follow-up of the microvascular changes that mark the course of Systemic Sclerosis (SSc). In previous studies, we demonstrated that the NEMO score, namely the cumulative Number of microhaEMOrrhages and microthromboses, is a good indicator of the steady state level and over time changes of disease activity (DA) in SSc (1-3).Objectives:To verify whether a high NEMO score, and then a high level of active microvascular derangement in the fingers may be predictive of the subsequent development of ischemic digital ulcers (IDUs).Methods:The NEMO score was assessed at baseline (T0) in 98 patients affected by SSc, according to the ACR-EULAR criteria. Out of them, 90 were females, 48 had the limited form and 50 the diffuse cutaneous variant of SSc. ACA and anti-Scl-70 antibodies were positive in 42 and 50 patients, respectively. The NVC pattern was early, active and late in 16, 42 and 40 patients, respectively.Afterwards, patients were closely followed up for 3 years, and the appearance of new IDUs was recorded in any time of the follow up.The T0-NEMO score values of patients who developed IDUs were compared to those of patients who did not. A receiver operating curve (ROC) was constructed, and the area under the curve (AUC) calculated, by plotting the sensitivity and 1-specificity of the different NEMO score values in predicting the development of IDUs.Results:During the follow up, 38 out of 98 patients developed one or more DUs. The NEMO score at T0 was significantly higher in those who developed IDUs with respect to those who did not [median 14.5 (CI 11.0-21.5), and 4.5 (CI 4.0-6.0), respectively, p<.0001]. The AUC was 0.79 (CI 0.69-0.86, p<0.0001). A NEMO score of 12 or more had a sensitivity of 83.3 (CI 71.5-91.7), and a specificity of 63.2 (CI 46.0-78.2), with positive (P) and negative (N) predictive values (PV) of 59.1 (CI 44.9-72.3), and 85.6 (CI 71.7-94.3), respectively. A NEMO score of 16 or more had a sensitivity of 95.0 (CI 86.1-99.0), and a NPV of 93.3 (CI 77.4-99.2).Conclusion:NEMO score is not only a valid tool to assess the level of DA in the course of SSc, but this NVC parameter could also be used as a good predictor of the future development of IDUs in patients with this disease.References:[1]Sambataro et al. Arthritis Res Ther 2014;16:462-69[2]Andracco et al. Arthritis Res Ther 2017;19:133-41[3]Pignataro et al. Arthritis Res Ther. 2019;21(1):258Disclosure of Interests:Nicoletta Del Papa: None declared, Francesca Pignataro: None declared, Wanda Maglione: None declared, Antonina Minniti: None declared, Domenico Sambataro: None declared, Gianluca Sambataro: None declared, Gabriele Valentini Grant/research support from: BMS, MSD, NOVARTIS, LILLY, PFIZER, ABBVIE, CELGENE, Claudio Vitali: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB
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Del Papa N, Vitali C, Lorini M, Carbonelli V, Maglione W, Pignataro F, Minniti A, Montano N, Caporali R. AB0125 EXPRESSION OF INTERFERON TYPE I- AND TYPE II-INDUCED GENES IN PATIENTS WITH SJÖGREN’S SYNDROME WITH AND WITHOUT EXTRAGLANDULAR INVOLVEMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2845] [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: 11/03/2022]
Abstract
Background:It is well known that Sjögren’s syndrome (SjS) is characterized by an upregulation of interferon (IFN)-induced genes. Namely, IFN type I signature has been reported in peripheral blood mononuclear cells (PBMCs) and in salivary glands of patients with this disease. However, few data are available on possible variability of IFN-induced gene upregulation in different clinical phenotypes of SjS.Objectives:To verify whether upregulation of IFN-induced genes is comparable in patients with SjS characterized by different clinical phenotypes, i.e., patients with systemic extraglandular manifestations (EGMs) versus patients with a disease limited to glandular features (GFs) and with widespread pain (WP).Methods:The study population was composed by 11 patients with SjS and EGMs (1 male, age range 18-78 years), and 10 patients with only GFs and WP (all females, age range 46-81 years), all classified according to ACR-EULAR criteria. The prevalence of anti-SSA(Ro) antibodies was 11/11 and 8/10, respectively. Lip biopsy was positive in all cases. Six healthy normal subjects were also included in the study as control population.Four IFN type I- and 5 IFN type II-induced genes were chosen for the study on the basis of previous literature data. Total RNA from each patient and control was isolated from purified PBMCs, followed by cDNA preparation and real time quantitative-PCR (RQ-PCR) analysis, using specific primer/probe sets. For calculation of relative expression, all samples were normalised against expression of a household gene (beta actin). A further normalization was performed against the mean value of relative expression obtained in the normal controls. Final fold change values were determined from the double-normalised values using the 2−ΔΔCT method (Applied Biosystems).Results:Fold change values of gene expression of both IFN type I- and type II-induced genes in PBMCs were different in the two clinical phenotypes of SjS. Fold change values of IFN type I-induced genes appeared strongly higher in patients with EGM, and some of them only moderately increased in those with only GF and WP. The expression of some of IFN type II-induced genes were slightly increased in patients belonging to both clinical phenotypes. Results are detailed in the table.Table.Fold change values of gene expression in patients with SjS plus EGMs, in patients with disease limited to GF and WP, and in controls.GeneMX1IFIT1IFT3IFI44IDO1GRP1MIGIP-10P2RY14SjS-EGMs85.938.524.440.425.18.34.51.55.5SJS-GF-WP4.21.72.04.84.11.20.60.31.3Controls2.11.61.11.51.41.31.51.31.4Legend. IFN type I-induced genes: MIX, IFN-induced GTP binding protein 1; IFIT1, IFN-induced protein with tetratricopeptide repeats 1; IFIT3, IFN-induced protein with tetratricopeptide repeats 3; IFI44, IFN-induced protein 44.IFN type II-induced genes: IDO1, indolamine-deoxygenase 1; GBP1, guanylate binding protein 1; MIG, C-X-C chemokine 9 (CXCL9); IP-10, C-X-C chemokine 10 (CXCL10); P2RY14, purinergic receptor 14.Conclusion:The present data indicate that IFN type I- and, to a lesser degree, type II-induced genes are upregulated in patients with SjS, but this phenomenon is consistently stronger in patients with systemic EGMs. In patients with only GFs IFN-induced gene upregulation is milder in PBMCs, and then probably more restricted to the exocrine target tissues.Disclosure of Interests:Nicoletta Del Papa: None declared, Claudio Vitali: None declared, Maurizio Lorini: None declared, Vincenzo Carbonelli: None declared, Wanda Maglione: None declared, Francesca Pignataro: None declared, Antonina Minniti: None declared, Nicola Montano: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB
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Vitali C, Minniti A, Caporali R, Del Papa N. Occurrence of pulmonary embolism in a patient with mild clinical expression of COVID-19. Thromb Res 2020; 192:21-22. [PMID: 32416365 PMCID: PMC7199727 DOI: 10.1016/j.thromres.2020.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Claudio Vitali
- 'Mater Domini' Humanitas Hospital, Via Gerenzano 2, 21053 Castellanza, Italy.
| | - Antonina Minniti
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Roberto Caporali
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy; University of Milan, Dept. of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Milan, Italy
| | - Nicoletta Del Papa
- Dept Rheumatology, ASST Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
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Del Papa N, Vitali C, Bilia S, Giannini D, Pignataro F, Minniti A, Maglione W, Tavoni A. Selexipag may be effective in inducing digital ulcers healing in patients with systemic sclerosis. Clin Exp Rheumatol 2020; 38 Suppl 125:181-182. [PMID: 32452347] [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: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | - Claudio Vitali
- Reumatologia, 'Mater Domini' Ospedale Humanitas, Castellanza, Italy
| | - Silvia Bilia
- UOC Immuno-Allergologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | - Daiana Giannini
- UOC Immuno-Allergologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | | | | | - Wanda Maglione
- Dipartimento di Reumatologia, ASST Pini-CTO, Milano, Italy
| | - Antonio Tavoni
- UOC Immuno-Allergologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
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Deb S, Kuckovic A, Anderson A, Berei J, Sreenivasappa S, Ross J, Martell S, Vitali C, Schulz W, Racherla K, Puri N. P1.19 Lung Cancer Screening Initiative and Identification of Novel Blood Biomarkers for Early Detection of Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.076] [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: 10/25/2022]
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Ramos-Casals M, Brito-Zerón P, Bombardieri S, Bootsma H, De Vita S, Dörner T, Fisher BA, Gottenberg JE, Hernandez-Molina G, Kocher A, Kostov B, Kruize AA, Mandl T, Ng WF, Retamozo S, Seror R, Shoenfeld Y, Sisó-Almirall A, Tzioufas AG, Vitali C, Bowman S, Mariette X. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Ann Rheum Dis 2019; 79:3-18. [DOI: 10.1136/annrheumdis-2019-216114] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.
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Brito-Zerón P, Retamozo S, Kostov B, Baldini C, Bootsma H, De Vita S, Dörner T, Gottenberg JE, Kruize AA, Mandl T, Ng WF, Seror R, Tzioufas AG, Vitali C, Bowman S, Mariette X, Ramos-Casals M. Efficacy and safety of topical and systemic medications: a systematic literature review informing the EULAR recommendations for the management of Sjögren's syndrome. RMD Open 2019; 5:e001064. [PMID: 31749986 PMCID: PMC6827762 DOI: 10.1136/rmdopen-2019-001064] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 07/23/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate current evidence on the efficacy and safety of topical and systemic medications in patients with primary Sjögren syndrome (SjS) to inform European League Against Rheumatism treatment recommendations. Methods The MEDLINE, EMBASE and Cochrane databases were searched for case-control/prospective cohort studies, randomised controlled trials (RCTs) and systematic reviews. Results Current evidence in primary SjS patients fulfilling the 2002 criteria is based on the data from 9 RCTs, 18 prospective cohort studies and 5 case-control studies. Two Cochrane systematic literature reviews (SLRs) have reported that topical treatments for dry mouth and dry eye are safe and effective. Ocular cyclosporine A was safe and effective in two RCTs including 1039 patients with dry eye syndrome. Two Cochrane SLRs on serum tear drops and plugs showed inconsistency in possible benefits, both for symptoms and objective measures. Five RCTs reported significant improvements in oral dryness and salivary flow rates for pilocarpine and cevimeline. An RCT showed no significant placebo-differences for hydroxychloroquine 400 mg/day for the primary outcome (visual analogue scale (VAS) composite of dryness, fatigue and pain). We identified seven RCTs carried out in primary SjS patients. RCTs using infliximab, anakinra and baminercept found no placebo-differences for the primary outcomes. The two largest RCTs randomised 255 patients to receive rituximab or placebo and reported no significant results in the primary outcome (VAS composite), while prospective studies suggested efficacy in systemic disease. Conclusion The current evidence supporting the use of the main topical therapeutic options of primary SjS is solid, while limited data from RCTs are available to guide systemic therapies.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain.,Laboratory of Autoimmune Diseases Josep Font, CELLEX, IDIBAPS, Barcelona, Spain
| | - Soledad Retamozo
- Department of Rheumatology, Instituto Modelo de Cariología Privado S.R.L, Instituto Universitario de Ciencias Biomédicas de Córdoba, Cordoba, Argentina.,Instituto De Investigaciones En Ciencias De La Salud (INICSA), Universidad Nacional de Córdoba (UNC), Cordoba, Argentina
| | - Belchin Kostov
- Research Primary Healthcare Transversal Research Group, CAP Les Corts, CAPSBE, IDIBAPS, Barcelona, Spain.,Statistics and Operations Research Department, Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Chiara Baldini
- Rheumatology Unit, Universita degli Studi di Pisa, Pisa, Italy
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Salvatore De Vita
- Clinic of Rheumatology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Thomas Dörner
- Department of Medicine/Rheumatology and Clinical Immunology and DRFZ, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, National Reference Center for Rare Systemic Autoimmune Diseases, CNRS, IBMC, UPR 3572, Université de Strasbourg, Strasbourg, France
| | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Wan-Fai Ng
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Raphaele Seror
- Department of Rheumatology, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Le Kremlin-Bicetre, France.,Center for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR 1184, Université Paris-Sud, Université Paris-Saclay, Paris, France
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Simon Bowman
- Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Xavier Mariette
- Department of Rheumatology, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Le Kremlin-Bicetre, France.,Center for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR 1184, Université Paris-Sud, Université Paris-Saclay, Paris, France
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, CELLEX, IDIBAPS, Barcelona, Spain.,Department of Autoimmune Diseases, ICMiD, Hospital Clinic de Barcelona, Barcelona, Spain
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Vitali C, Dolcino M, Del Papa N, Minniti A, Pignataro F, Maglione W, Lunardi C, Puccetti A. Gene Expression Profiles in Primary Sjögren's Syndrome With and Without Systemic Manifestations. ACR Open Rheumatol 2019; 1:603-613. [PMID: 31872181 PMCID: PMC6917337 DOI: 10.1002/acr2.11082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/13/2019] [Accepted: 08/23/2019] [Indexed: 12/26/2022] Open
Abstract
Objective To investigate the gene expression profile in patients with Sjögren's syndrome that is characterized by different clinical phenotypes. Methods RNA from peripheral blood mononuclear cells was purified in 8 patients with glandular features (GFs) and widespread pain (WP) and 11 with extraglandular manifestations (EGMs) and then was analyzed by hybridization on a human gene chip exploring more than 40,000 human genes. Differentially expressed genes (DEGs) in the two subgroups (ie, those with false discovery rate–corrected P values ≤ 0.01) with respect to 20 healthy controls have been submitted to functional classification using a Gene Ontology database and were mapped to define the networks of protein to protein interactions (PPIs). Results The enriched pathway analyses of DEGs and of the highly interconnected modules identified in the PPI networks showed that the pathological processes characterizing the two subgroups were substantially different. The predominant pathways in patients with EGMs are related to T‐ and B‐cell activation, Toll‐like receptor, interferon signaling, and apoptosis. Conversely, pathological processes related to pain transmission and modulation are preferentially operative in patients with GFs and WP. These data suggest that a neuroinflammatory pathway driven by cytokines and chemokines may play a central role in triggering WP features in this phenotype of patients. Conclusion The present study supports the hypothesis that different biological pathways are operative in patients with primary Sjögren's syndrome with different clinical phenotypes. A better knowledge of these specific processes might help in tailoring more effective target therapies.
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Dolcino M, Tinazzi E, Vitali C, Del Papa N, Puccetti A, Lunardi C. Long Non-Coding RNAs Modulate Sjögren's Syndrome Associated Gene Expression and Are Involved in the Pathogenesis of the Disease. J Clin Med 2019; 8:jcm8091349. [PMID: 31480511 PMCID: PMC6780488 DOI: 10.3390/jcm8091349] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 07/31/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
Primary Sjögren's syndrome (pSjS) is a chronic systemic autoimmune disorder, primarily affecting exocrine glands; its pathogenesis is still unclear. Long non-coding RNAs (lncRNAs) are thought to play a role in the pathogenesis of autoimmune diseases and a comprehensive analysis of lncRNAs expression in pSjS is still lacking. To this aim, the expression of more than 540,000 human transcripts, including those ascribed to more than 50,000 lncRNAs is profiled at the same time, in a cohort of 16 peripheral blood mononuclear cells PBMCs samples (eight pSjS and eight healthy subjects). A complex network analysis is carried out on the global set of molecular interactions among modulated genes and lncRNAs, leading to the identification of reliable lncRNA-miRNA-gene functional interactions. Taking this approach, a few lncRNAs are identified as targeting highly connected genes in the pSjS transcriptome, since they have a major impact on gene modulation in the disease. Such genes are involved in biological processes and molecular pathways crucial in the pathogenesis of pSjS, including immune response, B cell development and function, inflammation, apoptosis, type I and gamma interferon, epithelial cell adhesion and polarization. The identification of deregulated lncRNAs that modulate genes involved in the typical features of the disease provides insight in disease pathogenesis and opens avenues for the design of novel therapeutic strategies.
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Affiliation(s)
- Marzia Dolcino
- Department of Medicine, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Elisa Tinazzi
- Department of Medicine, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Claudio Vitali
- Sections of Rheumatology, Villa S. Giuseppe, Como and Casa di Cura di Lecco, 23900 Lecco, Italy
| | | | - Antonio Puccetti
- Department of Experimental Medicine, Section of Histology, University of Genova, Via G.B. Marsano 10, 16132 Genova, Italy
| | - Claudio Lunardi
- Department of Medicine, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Bajaj A, Vitali C, Cuchel M, Rader D. Literature Survey Of Lcat Deficiency: Natural History And Biomarker Identification. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Del Papa N, Di Luca G, Andracco R, Zaccara E, Maglione W, Pignataro F, Minniti A, Vitali C. Regional grafting of autologous adipose tissue is effective in inducing prompt healing of indolent digital ulcers in patients with systemic sclerosis: results of a monocentric randomized controlled study. Arthritis Res Ther 2019; 21:7. [PMID: 30616671 PMCID: PMC6322261 DOI: 10.1186/s13075-018-1792-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 06/25/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background A randomized controlled trial (RCT) was performed to confirm preliminary uncontrolled data indicating that regional adipose tissue (AT) grafting (G) is effective in inducing ischemic digital ulcer (IDU) healing in patients with systemic sclerosis (SSc). Patients and methods SSc patients with IDUs were randomized to be blindly treated with AT-G or a sham procedure (SP). AT-G consisted of injection, at the base of the finger with the IDU, of 0.5–1 ml AT after centrifugation of fat aspirate. The SP consisted of false liposuction and local injection of saline solution. The primary endpoint was to compare the cumulative prevalence of healed IDUs in the two groups within the following 8 weeks. Results AT-G and the SP were carried out in 25 and 13 patients, respectively. The two groups were comparable for age, gender, disease duration, and SSc subtypes. IDU healing was observed in 23/25 and 1/13 patients treated with AT-G and the SP, respectively (p < 0.0001). The 12 patients who received the unsuccessful SP underwent a rescue AT-G. In all of them, IDU healing was observed after 8 weeks of observation. It was noticeable that in the AT-G-treated patients a significant reduction of pain intensity (measured by visual analogue scale) was recorded after 4 and 8 weeks (p < 0.0001 in all cases). Similarly, a significant increase of capillary numbers in the affected finger was recorded by nailfold videocapillaroscopy after 4 and 8 weeks (p < 0.0001 in both cases). Conclusion This RCT strongly confirms that AT-G is effective in inducing IDU healing in SSc patients. Trial registration ClinicalTrials.gov, NCT03406988. Registered retrospectively on 25 January 2018.
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Affiliation(s)
| | | | - Romina Andracco
- U.O.C. Day Hospital Reumatologia, ASST G. Pini-CTO, Milan, Italy
| | - Eleonora Zaccara
- U.O.C. Day Hospital Reumatologia, ASST G. Pini-CTO, Milan, Italy
| | - Wanda Maglione
- U.O.C. Day Hospital Reumatologia, ASST G. Pini-CTO, Milan, Italy
| | | | - Antonina Minniti
- U.O.C. Day Hospital Reumatologia, ASST G. Pini-CTO, Milan, Italy
| | - Claudio Vitali
- Sections of Rheumatology, Villa S. Giuseppe, Como and Casa di Cura di Lecco, Lecco, Italy
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18
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Giacomelli R, Afeltra A, Alunno A, Bartoloni-Bocci E, Berardicurti O, Bombardieri M, Bortoluzzi A, Caporali R, Caso F, Cervera R, Chimenti MS, Cipriani P, Coloma E, Conti F, D'Angelo S, De Vita S, Di Bartolomeo S, Distler O, Doria A, Feist E, Fisher BA, Gerosa M, Gilio M, Guggino G, Liakouli V, Margiotta DPE, Meroni P, Moroncini G, Perosa F, Prete M, Priori R, Rebuffi C, Ruscitti P, Scarpa R, Shoenfeld Y, Todoerti M, Ursini F, Valesini G, Vettori S, Vitali C, Tzioufas AG. Guidelines for biomarkers in autoimmune rheumatic diseases - evidence based analysis. Autoimmun Rev 2019; 18:93-106. [PMID: 30408582 DOI: 10.1016/j.autrev.2018.08.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/11/2018] [Indexed: 12/21/2022]
Abstract
Autoimmune rheumatic diseases are characterised by an abnormal immune system response, complement activation, cytokines dysregulation and inflammation. In last years, despite many progresses in managing these patients, it has been shown that clinical remission is reached in less than 50% of patients and a personalised and tailored therapeutic approach is still lacking resulting in a significant gap between guidelines and real-world practice. In this context, the need for biomarkers facilitating early diagnosis and profiling those individuals at the highest risk for a poor outcome has become of crucial interest. A biomarker generally refers to a measured characteristic which may be used as an indicator of some biological state or condition. Three different types of medical biomarkers has been suggested: i. mechanistic markers; ii. clinical disease markers; iii. therapeutic markers. A combination of biomarkers from these different groups could be used for an ideal more accurate diagnosis and treatment. However, although a growing body of evidence is focused on improving biomarkers, a significant amount of this information is not integrated on standard clinical care. The overarching aim of this work was to clarify the meaning of specific biomarkers during autoimmune diseases; their possible role in confirming diagnosis, predicting outcome and suggesting specific treatments.
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Affiliation(s)
- Roberto Giacomelli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy.
| | - Antonella Afeltra
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Onorina Berardicurti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Alessandra Bortoluzzi
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Roberto Caporali
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Maria Sole Chimenti
- Department of Medicina dei Sistemi, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Emmanuel Coloma
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Fabrizio Conti
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Salvatore D'Angelo
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, Azienda Ospedaliero Universitaria S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Salvatore Di Bartolomeo
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, DIMED, University of Padua, Padua, Italy
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology of the Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK; Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Maria Gerosa
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Michele Gilio
- PhD Scholarship in Life Sciences, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica, Rheumatology section, University of Palermo, Italy
| | - Vasiliki Liakouli
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Domenico Paolo Emanuele Margiotta
- Department of Medicine, Unit of Allergology, Immunology, Rheumatology, Campus Bio-Medico University of Rome, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Pierluigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Chiara Rebuffi
- Grant Office and Scientific Documentation Center, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Science, Rheumatology Unit, School of Medicine, University of L'Aquila, Delta 6 Building, Via dell'Ospedale, 67100 L'Aquila, Italy
| | - Raffaele Scarpa
- Department of Clinical Medicine and Surgery, Rheumatology Unit, University of Naples Federico II, Naples, Italy
| | - Yehuda Shoenfeld
- Zabludowitz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Israel
| | - Monica Todoerti
- IRCCS Policlinico San Matteo Foundation, Division of Rheumatology, University of Pavia, Pavia, Italy
| | - Francesco Ursini
- Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Serena Vettori
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Athanasios G Tzioufas
- Pathophysiology Department, General Hospital of Athens "Laiko", Medical School, National and Kapodistrian University of Athens, Greece
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La Maida GA, Peroni DR, Ferraro M, Della Valle A, Vitali C, Misaggi B. Apical vertebral derotation and translation (AVDT) for adolescent idiopathic scoliosis using screws and sublaminar bands: a safer concept for deformity correction. Eur Spine J 2018; 27:157-164. [PMID: 29846809 DOI: 10.1007/s00586-018-5626-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To assess the efficacy and safety of a new deformity correction philosophy treatment for AIS called apical vertebral derotation and translation (AVDT). METHODS It is a retrospective study of prospectively collected data concerning two different scoliosis correction techniques used in our department. A total of 81 patients (22M, 59F) with a mean age of 15.5 years and minimum follow-up of 2 years were reviewed. Patients were divided into two groups according to the correction technique: 36 patients underwent single-rod derotation using all screws construct (AS), while 45 patients underwent apical vertebral derotation and translation using screws and sublaminar bands (SB). RESULTS The mean improvement of the MT curve was 70% in the AS group and 60.6% in the SB group, while the mean improvement of the TL/L curve was 65.5 and 72.4%, respectively. PT increased in both groups after surgery with a mean amount of 2.5° in the AS group and only 1° in the SB group. We observed also a greater amount of cervical lordosis reduction in the AS group (4.5°) compared with the SB group (only 1°). The SB group had less operative time and less blood loss. CONCLUSION There was no significant difference between the two groups at the final follow-up and both techniques led to an excellent correction in the frontal plane; in the sagittal plane, the AVDT technique seemed to give less sagittal imbalance with better cervical profile; the surgical procedure is easy with less operative time, less blood loss and less risk of potential complications. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Giovanni Andrea La Maida
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy.
| | - Donata Rita Peroni
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Marcello Ferraro
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Andrea Della Valle
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
| | - Claudio Vitali
- Santo Stefano Institute, Villa San Giuseppe, Como, Italy
| | - Bernardo Misaggi
- Spine Surgery Department, Orthopaedic Institute Gaetano Pini, Via Gaetano Pini, 1, 20121, Milan, Italy
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Abstract
The starting mode of the pathological process in rheumatoid arthritis (RA) is the presentation of an unknown ‘rheumatoid’ antigen by an antigen presenting cell to the receptor on the CD4+ T cell. The activation of the CD4+ T cell, and consequently of the cytokine network, is the second step in the inflammatory process. Immunosuppression in RA, obtained using either immunosuppressive drugs (azathioprine, cyclophosphamide, methotrexate), or physical procedures (lymphoapheresis, total lymphoid irradiation) acts aspecifically on all lymphocyte populations, and can induce a number of side effects, such as myelotoxicity and opportunistic infections. Two promising new therapeutic approaches are being developed, one aimed at specifically reducing the proliferation of activated T cell clones, and the second designed to modulate the activity of the cytokines involved in the inflammatory process. Encouraging results have been so far obtained with: a) cyclosporine A, a somewhat more specific immunosuppressive agent; b) monoclonal antibodies against surface antigens (CD4, CDS, CD7, CD25, CD54) expressed on activated T cells; c) T cell vaccination; and finally (iv) recombinant cytokines, their agonists or antagonists. Besides their utility in the treatment of the disease, these new therapeutical procedures should also lead to a better understanding of pathological processes in RA.
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Affiliation(s)
- C. Vitali
- Rheumatology and Clinical Immunology Units, University of Pisa, Pisa - Italy
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Del Papa N, Vitali C. Management of primary Sjögren's syndrome: recent developments and new classification criteria. Ther Adv Musculoskelet Dis 2018; 10:39-54. [PMID: 29387177 DOI: 10.1177/1759720x17746319] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 09/12/2017] [Accepted: 11/12/2017] [Indexed: 12/14/2022] Open
Abstract
For many years primary Sjögren's syndrome (pSS) has been considered an orphan disease, since no specific therapies were recognized as being capable of contrasting the development and progression of this disorder. The treatment of oral and ocular features, as well as of the systemic organ involvement, has been entrusted to the joint management of different subspecialty physicians, like ophthalmologists, otolaryngologists, dentists and rheumatologists. These latter subspecialty doctors are usually more involved in the treatment of systemic extraglandular involvement and, to do it, they have long been using the conventional therapies borrowed by the treatment schedules adopted in other systemic autoimmune diseases. The increasing knowledge of the biological pathways that are operative in patients with pSS, and the parallel development of molecular biology technology, have allowed the production and availability of a number of biological agents able to positively act on different disease mechanisms, and thus are candidates for testing in therapeutic trials. Meanwhile, the scientific community has made a great effort to develop new accurate and validated classification criteria and outcome measures to be applied in the selection of patients to be included and monitored in therapeutic studies. Some of the new-generation biotechnological agents have been tested in a number of open-label and randomized controlled trials that have produced in many cases inconclusive or contradictory results. Behind the differences in trial protocols, adopted outcome measures and predefined endpoints, reasons for such unsatisfactory results can be found in the large heterogeneity of clinical subtypes in the examined cohorts. The future challenge for a substantial advancement in the therapeutic approach to pSS could be to identify the pathologic mechanisms, outcome tools and biomarkers that characterize the different subsets of the disease in order to test carefully selected target therapies with the highest probability of success in each different clinical phenotype.
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Affiliation(s)
- Nicoletta Del Papa
- Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, via Pini 3, 20122 Milan, Italy
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Diacinti D, Pisani D, Vitali C, Gussoni G, Albanese CV. Misdiagnosis of vertebral fractures: Unresolved but resolvable problem. Bone 2017; 105:308. [PMID: 28552662 DOI: 10.1016/j.bone.2017.05.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Daniele Diacinti
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy.
| | - Daniela Pisani
- Department of Clinical and Molecular Medicine, Sant' Andrea Hospital, University Sapienza, Rome, Italy
| | | | - Gualberto Gussoni
- Internal Medicine, Hospital of Piombino, Livorno, Italy; FADOI Foundation, Research Department, Milan, Italy
| | - Carlina V Albanese
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy
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Giacomelli R, Afeltra A, Alunno A, Baldini C, Bartoloni-Bocci E, Berardicurti O, Carubbi F, Cauli A, Cervera R, Ciccia F, Cipriani P, Conti F, De Vita S, Di Benedetto P, Doria A, Drosos AA, Favalli EG, Gandolfo S, Gatto M, Grembiale RD, Liakouli V, Lories R, Lubrano E, Lunardi C, Margiotta DPE, Massaro L, Meroni P, Minniti A, Navarini L, Pendolino M, Perosa F, Pers JO, Prete M, Priori R, Puppo F, Quartuccio L, Ruffatti A, Ruscitti P, Russo B, Sarzi-Puttini P, Shoenfeld Y, Somarakis GA, Spinelli FR, Tinazzi E, Triolo G, Ursini F, Valentini G, Valesini G, Vettori S, Vitali C, Tzioufas AG. International consensus: What else can we do to improve diagnosis and therapeutic strategies in patients affected by autoimmune rheumatic diseases (rheumatoid arthritis, spondyloarthritides, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome and Sjogren's syndrome)? Autoimmun Rev 2017; 16:911-924. [DOI: 10.1016/j.autrev.2017.07.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 02/06/2023]
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Diacinti D, Vitali C, Gussoni G, Pisani D, Sinigaglia L, Bianchi G, Nuti R, Gennari L, Pederzoli S, Grazzini M, Valerio A, Mazzone A, Nozzoli C, Campanini M, Albanese CV. Misdiagnosis of vertebral fractures on local radiographic readings of the multicentre POINT (Prevalence of Osteoporosis in INTernal medicine) study. Bone 2017; 101:230-235. [PMID: 28511873 DOI: 10.1016/j.bone.2017.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/28/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Osteoporotic vertebral fractures (VFs) are often misdiagnosed because asymptomatic and occurring in the absence of specific trauma. Further, diagnostic assessment of VFs may be suboptimal. AIM OF THE STUDY To assess the misdiagnosis of vertebral fractures on local radiographic readings in the cohort of patients enrolled in the POINT study. METHODS We enrolled hospitalised patients, admitted for any cause to the Internal Medicine Units of 37 hospitals participating to the cross-sectional previously published POINT study. The assessment of VFs was performed both by local radiologists and by two expert skeletal radiologists, by using semiquantitative method (SQ). To better evaluate mild vertebral deformities, the two central radiologists also used the algorithm-based qualitative assessment (ABQ). RESULTS The radiographs of 661 patients (401 females; mean age 75.8±8.0) were evaluated. The inter-reader percent agreement between two central expert radiologists per-vertebra assessment was excellent (99.78%; k=0.984; 95% CI, 0.977-0.991). Central reading identified 318/661 (48.1%) patients with at least one VF. Local and central readings agreed in 502/661 (75.9%) patients, resulting in a fair reproducibility (k=0.52; 95% confidence interval 0.44-0.59). Diagnostic performance parameters of local readings were: sensitivity 76.1%; specificity 75.8%; PPV 74.46%; NPV 77.38%). By examining 9254 vertebrae, central and local readers diagnosed 665 (7.2%) and 562 (6.1%) VFs respectively. Misdiagnosis (102 false positives and 205 false negatives) mainly occurred for mild VFs. Local readings identified correctly 460 out 665 VFs diagnosed by central readings, resulting in sensitivity of 69.2% and PPV of 81.8%. CONCLUSIONS Following a standardized protocol of acquisition techniques and of interpretation criteria, an excellent agreement between local and central readings for moderate and severe vertebral fractures resulted. However a significant amount of mild vertebral fractures, that are the most of VFs, were misdiagnosed by local radiologists. In order to improve VFs assessment, the radiologists should be trained and sensitized in relation to the relevant clinical significance of osteoporotic VFs identification.
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Affiliation(s)
- Daniele Diacinti
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy.
| | | | | | - Daniela Pisani
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza Rome, Italy
| | | | - Gerolamo Bianchi
- Department of Locomotor System, Division of Rheumatology, ASL3 - Azienda Sanitaria Genovese, Genoa, Italy
| | - Ranuccio Nuti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | - Luigi Gennari
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | | | | | | | - Antonino Mazzone
- Department of Internal Medicine, Legnano Hospital, Legnano, Italy
| | - Carlo Nozzoli
- Department of Internal Medicine, AOU "Careggi", Florence, Italy
| | - Mauro Campanini
- Department of Internal Medicine, Hospital "Maggiore della Carità", Novara, Italy
| | - Carlina V Albanese
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy
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Fisher BA, Jonsson R, Daniels T, Bombardieri M, Brown RM, Morgan P, Bombardieri S, Ng WF, Tzioufas AG, Vitali C, Shirlaw P, Haacke E, Costa S, Bootsma H, Devauchelle-Pensec V, Radstake TR, Mariette X, Richards A, Stack R, Bowman SJ, Barone F. Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome. Ann Rheum Dis 2017; 76:1161-1168. [PMID: 27965259 PMCID: PMC5530351 DOI: 10.1136/annrheumdis-2016-210448] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [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: 08/31/2016] [Revised: 10/28/2016] [Accepted: 11/19/2016] [Indexed: 12/31/2022]
Abstract
Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0-10 scale) and comments. Criteria for agreement were a mean score ≥6/10 and 75% of respondents scoring ≥6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus.
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Affiliation(s)
- Benjamin A Fisher
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Troy Daniels
- Department of Orofacial Sciences, University of California San Francisco, San Francisco California, USA
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
| | - Rachel M Brown
- Department of Pathology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Peter Morgan
- Department of Pathology, King's College London, London, UK
| | | | - Wan-Fai Ng
- Musculoskeletal Research Group and NIHR Biomedical Research Centre in Ageing and Chronic Diseases, Newcastle University, Newcastle, UK
| | | | - Claudio Vitali
- Section of Rheumatology, Casa di Cura di Lecco, Lecco, Italy
| | - Pepe Shirlaw
- Department of Oral Medicine, King's College London, London, UK
| | - Erlin Haacke
- Department of Pathology, University of Groningen, Groningen, The Netherlands
| | - Sebastian Costa
- Department of Pathology, Brest University Hospital, Brest, France
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, Groningen, The Netherlands
| | | | - Timothy R Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Xavier Mariette
- Rheumatology Department, Université Paris-Sud, Assistance Publique-Hôpitaux de Paris, INSERM U1184, Le Kremlin-Bicêtre, France
| | - Andrea Richards
- Department of Oral Medicine, Dental Hospital, Birmingham, UK
| | - Rebecca Stack
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
| | - Simon J Bowman
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
- Department of Rheumatology, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Francesca Barone
- Rheumatology Research Group and Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), University of Birmingham, Birmingham, UK
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Capaccio P, Canzi P, Torretta S, Rossi V, Benazzo M, Bossi A, Vitali C, Cavagna L, Pignataro L. Combined interventional sialendoscopy and intraductal steroid therapy for recurrent sialadenitis in Sjögren's syndrome: Results of a pilot monocentric trial. Clin Otolaryngol 2017; 43:96-102. [DOI: 10.1111/coa.12911] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 12/11/2022]
Affiliation(s)
- P. Capaccio
- ENT Clinic; Department of Biomedical, Surgical and Dental Sciences; University of Milan; Fondazione IRCCS Ca’ Granda Policlinico; Milan Italy
| | - P. Canzi
- Department of Otorhinolaryngology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - S. Torretta
- Otolaryngology Unit; Department of Clinical Sciences and Community Health; University of Milan; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - V. Rossi
- Department of Otorhinolaryngology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - M. Benazzo
- Department of Otorhinolaryngology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - A. Bossi
- Branch of Medical Statistics, Biometry and Epidemiology “G. A. Maccacaro”; Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - C. Vitali
- Istituto Villa San Giuseppe; Como Italy
- Casa di Cura di Lecco; Lecco Italy
| | - L. Cavagna
- Division of Rheumatology; University of Pavia; IRCCS Policlinico S. Matteo Foundation; Pavia Italy
| | - L. Pignataro
- Otolaryngology Unit; Department of Clinical Sciences and Community Health; University of Milan; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
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Andracco R, Irace R, Zaccara E, Vettori S, Maglione W, Riccardi A, Pignataro F, Ferrara R, Sambataro D, Sambataro G, Vitali C, Valentini G, Del Papa N. The cumulative number of micro-haemorrhages and micro-thromboses in nailfold videocapillaroscopy is a good indicator of disease activity in systemic sclerosis: a validation study of the NEMO score. Arthritis Res Ther 2017; 19:133. [PMID: 28610600 PMCID: PMC5470283 DOI: 10.1186/s13075-017-1354-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/30/2017] [Indexed: 11/20/2022] Open
Abstract
Background Some abnormalities in nailfold videocapillaroscopy (NVC), such as the presence of micro-haemorrhages (MHEs), micro-thromboses (MTs), giant capillaries (GCs) and reduction in the number of capillaries (nCs), suggest a disease activity (DA) phase in systemic sclerosis (SSc). In a previous paper, we showed that the number of micro-haemorrhages and micro-thromboses (the so-called NEMO score) was the NVC feature more closely associated with DA. The present study was aimed at validating the NEMO score as a measure of DA in patients with SSc. Methods Two cohorts of 122 and 97 patients with SSc who were referred to two different rheumatology units, one in Milan and one in Naples, respectively, constituted the validation cohorts. The NEMO score, the total number of GCs and the mean nCs per digit were the parameters defined in each patient by eight-finger NVC. An expert operator analysed the NVCs in each of the participating units. The European Scleroderma Study Group (ESSG) index was used to define the DA level in each patient at the time of NVC examination. Results The NEMO score was the NVC parameter more strictly correlated with the ESSG score in both the Milan and Naples cohorts (p < 0.0001), and it was the only one among the NVC variables that gave a significant contribution in a logistic model where the ESSG score represented the dependent variable. ROC curve analysis confirmed that the NEMO score had the best performance in measuring DA. The AUC of the NEMO score was significantly greater than the AUCs obtained by plotting the sensitivity and specificity of the number of GCs and the mean nCs (p < 0.0001 in all cases). The NEMO score values that showed the best sensitivity-specificity balance in capturing patients with a relevant DA level were slightly higher in the Naples cohort than in the Milan cohort. Conclusions This study confirms that the presence of a certain number of MHEs and MTs in NVC may be considered a strong warning signal of a current phase of DA in patients with SSc.
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Affiliation(s)
- Romina Andracco
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
| | - Rosaria Irace
- Rheumatology Unit, Department of Internal Medicine, 2nd University of Naples, Naples, Italy
| | - Eleonora Zaccara
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
| | - Serena Vettori
- Rheumatology Unit, Department of Internal Medicine, 2nd University of Naples, Naples, Italy
| | - Wanda Maglione
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
| | - Antonella Riccardi
- Rheumatology Unit, Department of Internal Medicine, 2nd University of Naples, Naples, Italy
| | - Francesca Pignataro
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
| | - Roberta Ferrara
- Rheumatology Unit, Department of Internal Medicine, 2nd University of Naples, Naples, Italy
| | - Domenico Sambataro
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
| | - Gianluca Sambataro
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy
| | - Claudio Vitali
- Section of Rheumatology, Villa San Giuseppe, Istituto Santo Stefano, Como, Italy
| | - Gabriele Valentini
- Rheumatology Unit, Department of Internal Medicine, 2nd University of Naples, Naples, Italy
| | - Nicoletta Del Papa
- UOC Day Hospital of Rheumatology, Department of Rheumatology, ASST G. Pini-CTO, Milan, Italy.
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28
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Vitali C, Del Papa N. Classification and diagnostic criteria in Sjögren's syndrome: a long-standing and still open controversy. Ann Rheum Dis 2017; 76:1953-1954. [PMID: 28522453 DOI: 10.1136/annrheumdis-2017-211378] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/17/2017] [Accepted: 04/22/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Claudio Vitali
- Rheumatology section, Istituto Santo Stefano, Villa San Giuseppe, Como, Italy.,Study Group on Sjögren's Syndrome, Gaetano Pini Hospital, Milan, Italy
| | - Nicoletta Del Papa
- Study Group on Sjögren's Syndrome, Gaetano Pini Hospital, Milan, Italy.,Day Hospital of Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy
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Vitali C, Scofield H, Shiboski SC, Criswell LA, Lietman TM, Seror R, Labetoulle M, Mariette X, Rasmussen A, Bowman SJ, Shiboski CH. Reply. Arthritis Rheumatol 2017; 69:1342. [DOI: 10.1002/art.40085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/23/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Claudio Vitali
- Istituto Villa San Giuseppe, Como, Italy and Casa di Cura di LeccoLecco Italy
| | - Hal Scofield
- Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center and Department of Veterans Affairs Medical CenterOklahoma City OK
| | | | | | | | - Raphaèle Seror
- Université Paris‐Sud AP‐HP, Hôpitaux Universitaires Paris‐Sud, INSERM U1184Paris France
| | - Marc Labetoulle
- Université Paris‐Sud AP‐HP, Hôpitaux Universitaires Paris‐Sud, INSERM U1184Paris France
| | - Xavier Mariette
- Université Paris‐Sud AP‐HP, Hôpitaux Universitaires Paris‐Sud, INSERM U1184Paris France
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Capelli C, Zaccara E, Cipriani P, Di Benedetto P, Maglione W, Andracco R, Di Luca G, Pignataro F, Giacomelli R, Introna M, Vitali C, Del Papa N. Phenotypical and Functional Characteristics of In Vitro-Expanded Adipose-Derived Mesenchymal Stromal Cells From Patients With Systematic Sclerosis. Cell Transplant 2017; 26:841-854. [PMID: 28139194 DOI: 10.3727/096368917x694822] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) have received attention as an ideal source of regenerative cells because of their multipotent differentiation potential. Adipose tissue is an attractive source of MSCs. Recent studies have shown that autologous fat grafting may be effective in the treatment of systemic sclerosis (SSc), but no specific study exists that aimed at investigating whether adipose tissue-derived stromal cells (ADSCs) from SSc patients maintain normal phenotypic and functional characteristics. The purpose of the current study was to investigate whether ADSCs from patients with SSc (SSc-ADSCs) are phenotypically and functionally identical to those from healthy controls (HC-ADSCs). Adipose tissue samples were obtained from 10 patients with SSc and from 8 HCs. Both MSC populations were evaluated for their capacity to (a) express specific MSC surface antigens by flow cytometry analysis, (b) proliferate, (c) differentiate along the adipogenic and osteogenic lineages, (d) suppress in vitro lymphocyte proliferation induced by a mitogenic stimulus, and (e) support endothelial cell (EC) tube formation. ADSCs from SSc patients and HCs showed similar surface phenotype and multilineage differentiation capabilities. In PBMC proliferation inhibition assays, no significant differences were observed between SSc- and HC-ADSCs. Using ADSC/EC cocultures, both SSc- and HC-ADSCs improved tube formation by both HC- and SSc-ECs. This effect was enhanced under hypoxic conditions in all of the cocultures. SSc-ADSCs exhibited the same phenotypic pattern, proliferation and differentiation potentials, and immunosuppressive properties as those from HCs. The proangiogenic activity shown by SSc-ADSCs, namely, under hypoxic conditions, suggests that autologous ADSC grafting may represent a possible therapeutic option for SSc.
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Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol 2017; 69:35-45. [PMID: 27785888 PMCID: PMC5650478 DOI: 10.1002/art.39859] [Citation(s) in RCA: 815] [Impact Index Per Article: 116.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/25/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To develop and validate an international set of classification criteria for primary Sjögren's syndrome (SS) using guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). These criteria were developed for use in individuals with signs and/or symptoms suggestive of SS. METHODS We assigned preliminary importance weights to a consensus list of candidate criteria items, using multi-criteria decision analysis. We tested and adapted the resulting draft criteria using existing cohort data on primary SS cases and non-SS controls, with case/non-case status derived from expert clinical judgment. We then validated the performance of the classification criteria in a separate cohort of patients. RESULTS The final classification criteria are based on the weighted sum of 5 items: anti-SSA/Ro antibody positivity and focal lymphocytic sialadenitis with a focus score of ≥1 foci/4 mm2 , each scoring 3; an abnormal ocular staining score of ≥5 (or van Bijsterveld score of ≥4), a Schirmer's test result of ≤5 mm/5 minutes, and an unstimulated salivary flow rate of ≤0.1 ml/minute, each scoring 1. Individuals with signs and/or symptoms suggestive of SS who have a total score of ≥4 for the above items meet the criteria for primary SS. Sensitivity and specificity against clinician-expert-derived case/non-case status in the final validation cohort were high, i.e., 96% (95% confidence interval [95% CI] 92-98%) and 95% (95% CI 92-97%), respectively. CONCLUSION Using methodology consistent with other recent ACR/EULAR-approved classification criteria, we developed a single set of data-driven consensus classification criteria for primary SS, which performed well in validation analyses and are well-suited as criteria for enrollment in clinical trials.
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Affiliation(s)
- Caroline H. Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, California, USA
| | - Stephen C. Shiboski
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, California, USA
| | - Raphaèle Seror
- Université Paris-Sud; Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud; INSERM U1184; Le Kremlin-Bicêtre; Paris, France
| | - Lindsey A. Criswell
- Rosalind Russell / Ephraim P. Engleman Rheumatology Research Center, Department of Medicine, School of Medicine, University of California San Francisco, California, USA
| | - Marc Labetoulle
- Université Paris-Sud; Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud; INSERM U1184; Le Kremlin-Bicêtre; Paris, France
| | - Thomas M. Lietman
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, California, USA
| | | | - Hal Scofield
- Oklahoma Medical Research Foundation, Oklahoma, USA
- University of Oklahoma Health Sciences Center, and Department of Veterans Affairs Medical Center, Oklahoma, USA
| | - Claudio Vitali
- Istituto Villa San Giuseppe, Como, and Casa di Cura di Lecco, Lecco, Italy
| | - Simon J. Bowman
- Rheumatology Department, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Xavier Mariette
- Université Paris-Sud; Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud; INSERM U1184; Le Kremlin-Bicêtre; Paris, France
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Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis 2016; 76:9-16. [PMID: 27789466 DOI: 10.1136/annrheumdis-2016-210571] [Citation(s) in RCA: 741] [Impact Index Per Article: 92.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To develop and validate an international set of classification criteria for primary Sjögren's syndrome (SS) using guidelines from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). These criteria were developed for use in individuals with signs and/or symptoms suggestive of SS. METHODS We assigned preliminary importance weights to a consensus list of candidate criteria items, using multi-criteria decision analysis. We tested and adapted the resulting draft criteria using existing cohort data on primary SS cases and non-SS controls, with case/non-case status derived from expert clinical judgement. We then validated the performance of the classification criteria in a separate cohort of patients. RESULTS The final classification criteria are based on the weighted sum of five items: anti-SSA/Ro antibody positivity and focal lymphocytic sialadenitis with a focus score of ≥1 foci/4 mm2, each scoring 3; an abnormal Ocular Staining Score of ≥5 (or van Bijsterveld score of ≥4), a Schirmer's test result of ≤5 mm/5 min and an unstimulated salivary flow rate of ≤0.1 mL/min, each scoring 1. Individuals with signs and/or symptoms suggestive of SS who have a total score of ≥4 for the above items meet the criteria for primary SS. Sensitivity and specificity against clinician-expert-derived case/non-case status in the final validation cohort were high, that is, 96% (95% CI92% to 98%) and 95% (95% CI 92% to 97%), respectively. CONCLUSION Using methodology consistent with other recent ACR/EULAR-approved classification criteria, we developed a single set of data-driven consensus classification criteria for primary SS, which performed well in validation analyses and are well suited as criteria for enrolment in clinical trials.
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Affiliation(s)
| | | | - Raphaèle Seror
- Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud, INSERM U1184, Paris, France
| | | | - Marc Labetoulle
- Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud, INSERM U1184, Paris, France
| | | | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Hal Scofield
- Department of Veterans Affairs Medical Center, Oklahoma Medical Research Foundation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Claudio Vitali
- Istituto Villa San Giuseppe, Como, Italy.,Casa di Cura di Lecco, Lecco, Italy
| | - Simon J Bowman
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Xavier Mariette
- Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud, INSERM U1184, Paris, France
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Ruscica M, Pavanello C, Morlotti B, Gomaraschi M, Vitali C, Bosisio R, Sirtori C, Arnoldi A, Magni P. Soya-enriched mixed diet significantly improves cardiovascular and metabolic risk factors: A randomized controlled trial. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Del Papa N, Onida F, Zaccara E, Saporiti G, Maglione W, Tagliaferri E, Andracco R, Vincenti D, Montemurro T, Mircoli L, Vitali C, Cortelezzi A. Autologous hematopoietic stem cell transplantation has better outcomes than conventional therapies in patients with rapidly progressive systemic sclerosis. Bone Marrow Transplant 2016; 52:53-58. [DOI: 10.1038/bmt.2016.211] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/09/2022]
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Neri R, Tavoni A, Cristofani R, Levanti C, Sodini G, d'Ascanio A, Vitali C, Ferri C, Bombardieri S. Antinuclear Antibody Profile in Italian Patients with Connective Tissue Diseases. Lupus 2016; 1:221-7. [PMID: 1363806 DOI: 10.1177/096120339200100405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the present work we report data on the specificity of antinuclear antibodies (ANA) in a large series of Italian patients suffering from a broad spectrum of connective tissue diseases (CTD), by using a series of homogeneous and validated techniques. The present study confirms, on the one hand, generally accepted concepts, i.e. that certain autoantibodies are strictly associated to certain disease states (such as anti-PCNA and anti-Sm in systemic lupus erythematosus, Jo1 in polymyositis, and ACA and Scl-70 in scleroderma); the presence of 'marker' antibodies is, however, restricted to a relative minority of CTD patients. The application of a new methodological approach that considers the entire profile of ANA can greatly augment their diagnostic relevance and may provide useful indications for their interpretation, allowing us to establish for the first time the diagnostic usefulness not only of marker autoantibodies but also of certain associations between non-marker autoantibodies. Finally, the application of a more appropriate and powerful statistical tool (multiple correspondence analysis) has further emphasized the clear relationship existing between antibody specificities and certain disease states.
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Affiliation(s)
- R Neri
- Clinical Immunology Unit, University of Pisa, Italy
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Del Papa N, Irace R, Andracco R, Sambataro D, Vettori S, Pignataro F, Ferrara R, Zaccara E, Maglione W, Vitali C, Valentini G. SAT0239 The Cumulative Number of Micro-Haemorrhages and Micro-Thrombosis in Nailfold Videocapillaroscopy Is A Good Predictor of Disease Activity in Systemic Sclerosis: A Validation Study of Nemo Score. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Seror R, Meiners P, Baron G, Bootsma H, Bowman SJ, Vitali C, Gottenberg JE, Theander E, Tzioufas A, De Vita S, Ramos-Casals M, Dörner T, Quartuccio L, Ravaud P, Mariette X. Development of the ClinESSDAI: a clinical score without biological domain. A tool for biological studies. Ann Rheum Dis 2016; 75:1945-1950. [DOI: 10.1136/annrheumdis-2015-208504] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/20/2015] [Indexed: 11/04/2022]
Abstract
ObjectiveTo develop and validate ClinESSDAI (Clinical European League Against Rheumatism Sjögren's Syndrome Disease Activity Index), ie, ESSDAI without the biological domain.Patients and methodsThe 702 fictive vignettes derived from 96 real cases of primary Sjögren's syndrome of the ESSDAI development study were used. As for ESSDAI development, the physician assessment of disease activity (0–10 scale) was used as the ‘gold standard’ in a multivariate model for weighting domains, after removing the biological domain. The reliability, assessed by intraclass correlation coefficient (ICC) between ClinESSDAI and ESSDAI, explored if ClinESSDAI was equivalent to ESSDAI. Its psychometric (ie, measurement) properties were compared with that of ESSDAI in an independent cohort. Also, its use was evaluated on data of two clinical trials.ResultsIn multivariate modelling, all 11 domains remained significantly associated with disease activity, with slight modifications of some domain weights. Reliability between clinESSDAI and ESSDAI was excellent (ICC=0.98 and 0.99). Psychometric properties of clinESSDAI, disease activity levels and minimal clinically important improvement thresholds and its ability to detect change over time in clinical trials were very close to that of ESSDAI.ConclusionsClinESSDAI appears valid and very close to the original ESSDAI. This score provides an accurate evaluation of disease activity independent of B-cell biomarkers. It could be used in various circumstances: (i) in biological/clinical studies to avoid data collinearity, (ii) in clinical trials, as secondary endpoint, to detect change independent of biological effect of the drug, (iii) in clinical practice to assess disease activity for visits where immunological tests have not been done.
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Brito-Zerón P, Theander E, Baldini C, Seror R, Retamozo S, Quartuccio L, Bootsma H, Bowman SJ, Dörner T, Gottenberg JE, Mariette X, Bombardieri S, de Vita S, Mandl T, Ng WF, Kruize AA, Tzioufas A, Vitali C, Buyon J, Izmirly P, Fox R, Ramos-Casals M, on behalf of the EULAR Sjögren Synd. Early diagnosis of primary Sjögren’s syndrome: EULAR-SS task force clinical recommendations. Expert Rev Clin Immunol 2015; 12:137-56. [DOI: 10.1586/1744666x.2016.1109449] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Del Papa N, Di Luca G, Sambataro D, Zaccara E, Maglione W, Gabrielli A, Fraticelli P, Moroncini G, Beretta L, Santaniello A, Sambataro G, Ferraresi R, Vitali C. Regional Implantation of Autologous Adipose Tissue-Derived Cells Induces a Prompt Healing of Long-Lasting Indolent Digital Ulcers in Patients with Systemic Sclerosis. Cell Transplant 2015; 24:2297-305. [DOI: 10.3727/096368914x685636] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Digital ulcers (DUs) are a rather frequent and invalidating complication in systemic sclerosis (SSc), often showing a very slow or null tendency to heal, in spite of the commonly used systemic and local therapeutic procedures. Recently, stem cell therapy has emerged as a new approach to accelerate wound healing. In the present study, we have tentatively treated long-lasting and poorly responsive to traditional therapy SSc-related DUs by implantation of autologous adipose tissue-derived cell (ATDC) fractions. Fifteen patients with SSc having a long-lasting DU in only one fingertip who were unresponsive to intensive systemic and local treatment were enrolled in the study. The grafting procedure consisted of the injection, at the basis of the corresponding finger, of 0.5-1 ml of autologous ATDC fractions, separated by centrifugation of adipose tissue collected through liposuction from subcutaneous abdominal fat. Time to heal after the procedure was the primary end point of the study, while reduction of pain intensity and of analgesic consumption represented a secondary end point. Furthermore, the posttherapy variation of the number of capillaries, observed in the nailfold video capillaroscopy (NVC) exam and of the resistivity in the digit arteries, measured by high-resolution echocolor-Doppler, were also taken into account. A rather fast healing of the DUs was reached in all of the enrolled patients (mean time to healing 4.23 weeks; range 2-7 weeks). A significant reduction of pain intensity was observed after a few weeks ( p < 0.001), while the number of capillaries was significantly increased at 3- and 6-month NVC assessment ( p < 0.0001 in both cases). Finally, a significant after-treatment reduction of digit artery resistivity was also recorded ( p < 0.0001). Even with the limitations related to the small number of patients included and to the open-label design of the study, the observed strongly favorable outcome suggests that local grafting with ATDCs could represent a promising option for the treatment of SSc-related DUs unresponsive to more consolidated therapies.
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Affiliation(s)
| | | | | | - Eleonora Zaccara
- U.O.C. Day Hospital Reumatologia, Ospedale G. Pini, Milano, Italy
| | - Wanda Maglione
- U.O.C. Day Hospital Reumatologia, Ospedale G. Pini, Milano, Italy
| | - Armando Gabrielli
- U.O. Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona, Italy
| | - Paolo Fraticelli
- U.O. Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona, Italy
| | - Gianluca Moroncini
- U.O. Clinica Medica, Dipartimento di Medicina Interna, Ospedali Riuniti, Ancona, Italy
| | - Lorenzo Beretta
- Centro di Riferimento per le Malattie Autoimmuni Sistemiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Alessandro Santaniello
- Centro di Riferimento per le Malattie Autoimmuni Sistemiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Gianluca Sambataro
- Dipartimento Medicina Interna e Reumatologia, Campus Biomedico, Roma, Italy
| | - Roberto Ferraresi
- Laboratorio Emodinamica Periferica Interventistica, Humanitas Gavazzeni, Bergamo, Italy
| | - Claudio Vitali
- Servizio di Reumatologia, Istituto San Giuseppe, Anzano del Parco, Como, Italy
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Ramos-Casals M, Brito-Zerón P, Seror R, Bootsma H, Bowman SJ, Dörner T, Gottenberg JE, Mariette X, Theander E, Bombardieri S, De Vita S, Mandl T, Ng WF, Kruize A, Tzioufas A, Vitali C. Characterization of systemic disease in primary Sjögren's syndrome: EULAR-SS Task Force recommendations for articular, cutaneous, pulmonary and renal involvements. Rheumatology (Oxford) 2015; 54:2230-8. [PMID: 26231345 DOI: 10.1093/rheumatology/kev200] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To reach a European consensus on the definition and characterization of the main organ-specific extraglandular manifestations in primary SS. METHODS The EULAR-SS Task Force Group steering committee agreed to approach SS-related systemic involvement according to the EULAR SS Disease Activity Index (ESSDAI) classification and proposed the preparation of four separate manuscripts: articular, cutaneous, pulmonary and renal ESSDAI involvement; muscular, peripheral nervous system, CNS and haematological ESSDAI involvement; organs not included in the ESSDAI classification; and lymphoproliferative disease. Currently available evidence was obtained by a systematic literature review focused on SS-related systemic features. RESULTS The following information was summarized for articular, cutaneous, pulmonary and renal involvement: a clear, consensual definition of the clinical feature, a brief epidemiological description including an estimate of the prevalence reported in the main clinical series and a brief list of the key clinical and diagnostic features that could help physicians clearly identify these features. Unfortunately we found that the body of evidence relied predominantly on information retrieved from individual cases, and the scientific information provided was heterogeneous. The analysis of types of involvement was biased due to the unbalanced reporting of severe cases over non-severe cases, although the main sources of bias were the heterogeneous definitions of organ involvement (or even the lack of definition in some studies) and the heterogeneous diagnostic approach used in studies to investigate involvment of each organ. CONCLUSION The proposals included in this article are a first step to developing an optimal diagnostic approach to systemic involvement in primary SS and may pave the way for further development of evidence-based diagnostic and therapeutic guidelines.
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Affiliation(s)
- Manuel Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain,
| | - Pilar Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Raphaèle Seror
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, Université Paris-Sud 11, UMR 1184, Le Kremlin Bicêtre, Paris, France
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Simon J Bowman
- Rheumatology Department, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Thomas Dörner
- Rheumatology Department, Charité, University Hospital, Berlin, Germany
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, EA 4438, Strasbourg University Hospital, Université de Strasbourg, Strasbourg, France
| | - Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Le Kremlin Bicêtre, Université Paris-Sud 11, UMR 1184, Le Kremlin Bicêtre, Paris, France
| | - Elke Theander
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | | | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Aike Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Athanasios Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, Greece and
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Sambataro D, Sambataro G, Zaccara E, Maglione W, Vitali C, Del Papa N. Tumoral calcinosis of the spine in the course of systemic sclerosis: report of a new case and review of the literature. Clin Exp Rheumatol 2015; 33:S175-S178. [PMID: 26242389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/17/2015] [Indexed: 06/04/2023]
Abstract
We report here a case of a 62-year-old Caucasian woman, suffering from diffuse cutaneous systemic sclerosis (SSc), who developed a tumoural calcinosis (TC) localised in the left side of the neck around the cervical spine that caused severe pain and motion impairment, without involvement of regional neurological structures. A review of the literature on this issue (based on PubMed database) allowed us to identify 35 previously described cases of TC in para-vertebral area in the course of SSc. The main characteristics of these patients have been summarised.
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Affiliation(s)
| | | | - Eleonora Zaccara
- Scleroderma Clinic, Rheumatology Unit, Istituto G. Pini, Milan, Italy
| | - Wanda Maglione
- Scleroderma Clinic, Rheumatology Unit, Istituto G. Pini, Milan, Italy
| | - Claudio Vitali
- Rheumatology Section, Istituto San Giuseppe, Como, Italy
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Ossoli A, Neufeld E, Amar M, Vitali C, Thacker S, Locatelli M, Abbate M, Pryor M, Zoja C, Calabresi L, Remaley A. Role of LPX in the development of renal disease in LCAT deficiency. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pavanello C, Vitali C, Tarlarini C, Penco S, Calabresi L, Mombelli G, Sirtori C. Lipoprotein (a): concentration, isoforms, polymorphisms and association with preclinical atherosclerosis. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Joint and muscle pain are commonly observed in patients with primary Sjögren's syndrome (pSS). Different types of pain can be distinguished, that is, articular pain, neuropathic pain and widespread pain. Articular pain is due to more or less evident synovitis, usually involving peripheral joints such as hand joints, wrists, knees and ankles. Drugs used to treat rheumatoid arthritis, or lupus synovitis, are also employed for articular involvement in pSS. Pure sensory neuropathies and, more often, small fibre neuropathies are responsible for neuropathic pain in pSS. This is usually localised in the legs and arms with a characteristic glove or sock distribution. Widespread pain, often assuming the features of fibromyalgia, has also been reported in patients with pSS. The pathological mechanisms underlying both neuropathic pain and widespread (fibromyalgia) pain in pSS have not been so far completely clarified.
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Affiliation(s)
- Claudio Vitali
- Outpatient Clinics of Rheumatology, Casa di Cura di Lecco, Lecco, Italy; Istituto S. Stefano, Como, Italy.
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Del Papa N, Zaccara E, Maglione W, Sambataro D, Sambataro G, Andracco R, Saporiti G, Giordano R, Vitali C, Cortelezzi A, Onida F. SAT0471 Autologous Hematopoietic Stem Cell Transplantation in Rapidly Progressive Systemic Sclerosis is More Effective Than Conventional Therapies in Inducing Disease Remission and Prologing Survival: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Del Papa N, Sambataro D, Zaccara E, Maglione W, Andracco R, Caviggioli F, Di Luca G, Parafioriti A, Vitali C. SAT0446 Autologous Fat Transplantation Has a Long Term Efficacy on Scleroderma Skin Fibrosis: Results from a Controlled Study Versus Hyaluronic Acid Filler. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Seror R, Baron G, Vitali C, Bowman S, Gottenberg JE, Tzioufas A, Theander E, Bootsma H, Doerner T, Ramos-Casals M, Mariette X, Ravaud P. FRI0421 Development of Clinessdai Score (Clinical Eular Sjögren's Syndrome Disease Activity Index) Without Biological Domain: A Tool For Biological Studies. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Del Papa N, Di Luca G, Sambataro D, Zaccara E, Maglione W, Gabrielli A, Fraticelli P, Moroncini G, Beretta L, Santaniello A, Sambataro G, Ferraresi R, Vitali C. Reply to J. Magalon et al. Cell Transplant 2015; 24:2669-70. [PMID: 25995101 DOI: 10.3727/096368915x688218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vitali C, Gussoni G, Bianchi G, Albanese CV, Diacinti D, Sinigaglia L, Nuti R, Muzzulini CL, Pintaudi C, Scanelli G, Magni G, Valerio A, Iori I, Mazzone A, Campanini M. High prevalence of fragility vertebral fractures in patients hospitalised in Internal Medicine Units. Results of the POINT (Prevalence of Osteoporosis in INTernal medicine) study. Bone 2015; 74:114-20. [PMID: 25623999 DOI: 10.1016/j.bone.2015.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Osteoporotic vertebral fractures (VFs) often go unrecognised in both healthy individuals and in pathological conditions. Few data exist on VFs in patients hospitalised in Internal Medicine Units (IMUs), who often suffer from multiple concomitant chronic disorders. AIM OF THE STUDY This multicentre cross-sectional study was aimed at assessing the prevalence of VFs in an unselected population of patients referring to IMUs. Correlations between VFs and the main coexisting diseases were also investigated. METHODS Information on demographic, clinical and laboratory findings, and on the presence of known risk factors for osteoporosis was recorded. The Genant's semi-quantitative method was used to evaluate, in a central reading centre, the presence and severity of VFs in the thoracic and lumbar spine. RESULTS A cohort of 995 patients was evaluated. At least one VF of any grade was found in 47.5% of patients, with similar prevalence between females (48.1%) and males (46.7%). Older age, chronic obstructive pulmonary disease, and previous diagnosis of osteoporosis showed a significant association with VFs in multivariable analysis. However, 79.7% of the VFs were observed in patients without previous diagnosis of osteoporosis. Moreover, a VF of grade 2 or greater was found in 20.8% of patients. CONCLUSIONS Fragility VFs is a very frequent finding in patients hospitalised in IMUs. Consequently, more attention should be devoted in this clinical setting to this comorbidity, which is known to be an additional factor for mortality and, when localised in the thoracic part of the spine, may negatively influence a concomitant respiratory insufficiency.
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Affiliation(s)
| | | | - Gerolamo Bianchi
- Department of Locomotor System, Division of Rheumatology, ASL3-Azienda Sanitaria Genovese, Genoa, Italy
| | - Carlina V Albanese
- Section of Osteoporosis and Musculoskeletal Diseases, Department of Radiological, Oncological and Anatomical-Pathological Sciences, University "La Sapienza", Rome, Italy
| | - Daniele Diacinti
- Section of Osteoporosis and Musculoskeletal Diseases, Department of Radiological, Oncological and Anatomical-Pathological Sciences, University "La Sapienza", Rome, Italy
| | | | - Ranuccio Nuti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Italy
| | | | | | - Giovanni Scanelli
- Internal Medicine, Azienda Ospedaliero-Universitaria "S. Anna", Ferrara, Italy
| | | | | | - Ido Iori
- Department of Internal Medicine I, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Mauro Campanini
- Department of Internal Medicine, Hospital "Maggiore della Carità", Novara, Italy
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Fantini L, Ambrosini Spinella F, Polidori C, Roatti G, Resta A, Uguccioni F, Servici P, Vitali C. DD-011 Patient compliance with biological drugs: effectiveness of drug switching in multiple sclerosis. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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