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Perricone C, Cafaro G, Ilenia R, Calvacchi S, Marcucci E, Cipriani S, Bistoni O, Gerli R, Bartoloni Bocci E. AB0743 Biomarkers in systemic sclerosis: a 23-plex cytokine/chemokine analysis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5061] [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
BackgroundSystemic Sclerosis (SSc) is a rare inflammatory disease of unknown etiology associated with multi-organ involvement. Biomarkers remain urgently needed as tools for differential diagnosis, prognosis, disease progression, and as therapeutic response predictors in SSc. Ideally, for widespread utility, biomarkers should be easy to sample and analyse.ObjectivesWe aimed at evaluating potentially pathogenic circulating key cytokines/chemokines in a monocentric cohort of SSc patients.MethodsSera were drawn from SSc patients and 23 cytokines/chemokines (CCL2/MCP-1, IP-10/CXCL10, Flt3 Ligand, IFNa2, IL6, IL7, IL12, IL13, IL15, IL17A, TNFa, IL-1Ra, CXCL13, IL21, IL23, IL33, TSLP, IL-2RA, IL1RII, TNFRII, BAFF, CCL19/MIP-3B 66, MMP-8) were quantified using Luminex multiplex immunoassay (BioRad-BioPlex 200 System-Lumine x-Map technology R&D Systems, USA) following the manufacturer’s instructions and customized procedures. Data were acquired using Bioplex manager v 6.1. P value ≤ 0.05 was considered to be significant. Data were analyzed using GraphPad Prism V.8 (GraphPad Software, Inc.) software.ResultsClinical and demographic features of 17 SSc (5 dcSSc, 12 lcSSc) patients are reported in Table 1. Mean±SD age was 55±14.68 years, mean±SD disease duration was 89.47±95.34 months. We found that MCP-1 levels inversely correlated with PAPs (r=-0.55, P=0.03) and IP10 with anti-Scl70 (r=-0.561, P=0.004), Figure 1. No other associations were foundTable 1.N%Sex2M/15F11.8/88.32Age (years, mean±SD)55±14.68Disease duration (months, mean±SD)89.47±95.34Cigarette smoke847Raynaud’s phenomenon17100Skin thickening1482.4Ulcers211.8Rodnan’s Skin Score (mean±SD)5.9±6.6Articular involvement211.8Heart involvement00Paps max (mmhg, mean±SD)28.3±5.9Pulmonary involvement529.4DLCO min (%, mean±SD)90.24±21.2Gastrointestinal involvement317.6ANA17100Rheumatoid factor423.5Anti-Scl70 (U/ml, mean±SD)33.2±59.3Anti-CENP(U/ml, mean±SD)55.9±48.9Anti-SSA211.8Anti-SSB15.9Anti-Sm15.9Anti-RNP15.9Elevated Blood Pressure423.5Obesity15.8Any DMARD529.4ConclusionWe confirm a potential pathogenic role for MCP-1 in SSc. The -2518 promotor polymorphism in the MCP-1 gene has been already associated with disease susceptibility and an increased expression of the molecule both in peripheral blood and in the skin has been described. Intriguingly, MCP-1 seems to drive skin fibrosis while the role played in pulmonary involvement is more controversial. Indeed, similarly to our results, Scala et al. found an inverse correlation between pulmonary fibrosis and MCP-1 from T cell lines (1). At the same extent, the observation that IP-10 has an inverse correlation with anti-Scl70 levels is not novel and the usage of this chemokine as a marker of lcSSc has been already suggested. In this view, Zhu et al. found that Scl-70 negative patients have a higher expression of IP-10 than Scl-70 positive (1,878 (2,964) ng/L vs 1,030 (2,196.6) ng/L, P<0.05) (2). Finally, this is the first report on MMP8 in SSc and we suggest that MMP8 - a collagenase and marker of idiopathic pulmonary fibrosis involved in the migration of fibroblasts - can represent a promising biomarker for SSc diagnosis.References[1]Scala et al. Clin Exp Immunol 2004[2]Beijing Da Xue Xue Bao Yi Xue Ban. 2019Figure 1.Disclosure of InterestsNone declared
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Perricone C, Bursi R, Cafaro G, Ilenia R, Calvacchi S, Marcucci E, Cipriani S, Bistoni O, Gerli R, Bartoloni Bocci E. POS0788 DISTINCT CYTOKINE/CHEMOKINE PROFILE IN SJÖGREN’S SYNDROME IS ASSOCIATED WITH DISEASE ACTIVITY AND CLINICAL MANIFESTIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSjögren’s syndrome (SjS) is an autoimmune disease of unknown aetiology. Several cytokines, chemokines and collagenases have been implicated in the pathogenesis of the disease. Nonetheless, biomarkers of diagnosis, outcome and response to treatment are still lacking.ObjectivesWe aimed at evaluating potentially pathogenic cytokines/chemokines in a monocentric cohort of SjS patients.MethodsSera were drawn from SjS patients classified according to 2016 ACR/EULAR criteria and 23 cytokines/chemokines (CCL2/MCP-1, IP-10/CXCL10, Flt3 Ligand, IFNa2, IL6, IL7, IL12, IL13, IL15, IL17A, TNFa, IL-1Ra, CXCL13, IL21, IL23, IL33, TSLP, IL-2RA, IL1RII, TNFRII, BAFF, CCL19/MIP-3B 66, MMP-8) were quantified using Luminex multiplex immunoassay (BioRad- BioPlex 200 System-Luminex-Map technology R&D Systems, USA) following the manufacturer’s instructions and customized procedures. Data were acquired using Bioplex manager v 6.1. P value ≤ 0.05 was considered significant. Data were analyzed using GraphPad Prism V.8 (GraphPad Software, Inc.) software.ResultsClinical and demographic features of 21 SjS patients are reported in Table 1. Our main findings were that several cytokines positively correlated with indexes of disease activity. Particularly, we observed a correlation between IL-2RA and ESSDAI (r=0.602, P=0.005) and between IL-12p40 and ESSPRI (r=0.674, P=0.016) (Figure 1). Levels of IL-17A seem to be influenced by age (r=0.622, P=0.039) and showed a trend towards a positive correlation with labial salivary gland biopsy focus score (r=0.942, P=0.058). The only patient with cryoglobulins was the male who showed levels of BAFF/BLyS >20x higher than the remaining 20 females (43.4 ng/ml vs 1.8±1.6 ng/ml).Table 1.N%Sex1M/20F4.8/95.2Age (years, mean±SD)53.43±12.27disease duration (months, mean±SD)30.29±10.47ESSDAI (mean±SD)2.20±2.40ESSPRI (mean±SD)4.18±2.12Global dryness VAS (0-10) (mean±SD)5.00±2.32VAS fatigue (0-10) mean±SD)4.00±2.39VAS pain (0-10) (mean± SD)3.48±3.28Dry mouth1571.40Dry eyes1781Parotid Gland Swelling419Articular involvement628 .6Skin Involvement14.7Raynaud’s Phenomenon523.8Other Organs314.3Lymphoma14.7Low Complement (C3 Or C4)314.3Low C3314.3Low C414.7Leukopenia733.3Hypergammaglobulinemia761.9Monoclonal Gammopathy210Ana1990.5Anti-SSA1990.5Anti-SSB1047.6Rheumatoid Factor942.9Cryoglobulins14.7Salivary Gland Biopsy Focus Score (Mean±SD)1.99±1.45Hydroxychloroquine523.8Immunosuppressant14.7Figure 1.ConclusionFor the first time we suggest the potential usefulness of IL-2RA as a marker of disease activity in SjS. Notably, IL2RA has been used as a marker to identify CD4+FoxP3+ regulatory T cells. So far, it is known that T follicular helper (Tfh) cell differentiation is inhibited by IL-2 while regulatory T cell differentiation and survival depend on it. Nonetheless, Wing et al. (1) described a CD25- subpopulation within human PD1+CXCR5+Foxp3+ Tfh cells preferentially located in germinal centers which is reduced by the presence of IL-2, possibly explaining the association with disease activity. IL-12p40 is known to have a pathogenic role in SjS (2) and we suggest that it may represent a complementary tool in the evaluation of patients’ symptoms. The presence of high levels of IL-15 in SjS is not novel and associated with T cell migration and proliferation in germinal centers. Finally, the observation of very high BAFF/BLyS levels in the male with cryoglobulins will require further analysis.References[1]Wing et al. Proc Natl Acad Sci USA. 2017[2]Mathsson L, et al. Clin Exp Immunol. 2007Disclosure of InterestsNone declared
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Cardelli C, Zanframundo G, Cometi L, Marcucci E, Biglia A, Cavagna L, Barsotti S. Idiopathic inflammatory myopathies: one year in review 2021. Clin Exp Rheumatol 2022; 40:199-209. [PMID: 35084320 DOI: 10.55563/clinexprheumatol/vskjxi] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare and complex connective tissue diseases, mainly characterised by inflammatory involvement of skeletal muscles. Several other organs may be affected, particularly lungs, heart, skin, gastrointestinal tract and joints, often determining the morbidity and mortality associated with these autoimmune disorders. The course is generally chronic and the onset subacute. This latter aspect, together with the rarity of these conditions, can result in a clinical challenge for the physician with a considerable diagnostic delay. The scientific literature makes continuous advances in the understanding of these diseases, in particular with regards to the pathogenesis, serological findings, diagnostic strategies and therapeutic approaches. The aim of this review is to highlight the most relevant literature contributions published on this topic over the last year.
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Affiliation(s)
- Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Giovanni Zanframundo
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Rheumatology Unit, University of Florence, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Alessandro Biglia
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
| | - Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Internal Medicine, Ospedale Civile di Livorno, Italy
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Bartoloni E, Angeli F, Marcucci E, Perricone C, Cafaro G, Riccini C, Spighi L, Gildoni B, Cavallini C, Verdecchia P, Gerli R. Unattended compared to traditional blood pressure measurement in patients with rheumatoid arthritis: a randomised cross-over study. Ann Med 2021; 53:2050-2059. [PMID: 34751628 PMCID: PMC8583925 DOI: 10.1080/07853890.2021.1999493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The "unattended" BP measurement aims to reduce the "white-coat effect," a phenomenon associated with cardiovascular risk. Data on "unattended" BP measurement in RA and its impact on hypertensive organ damage are very limited. METHODS BP was measured in the same patient both traditionally ("attended" BP) and by the "unattended" protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage. RESULTS Sixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38-0.68) for systolic BP and 0.73 (95%, CI 0.60-0.82) for diastolic BP. "Unattended" (121.7/68.6 mmHg) was lower than "attended" BP (130.5/72.8 mmHg) for systolic and diastolic BP (both p < .0001). Among the two techniques, only "unattended" systolic BP showed a significant association with left ventricular mass (r = 0.11; p = .40 for "attended" BP; r = 0.27; p = .036 for unattended BP; difference between slopes: z = 3.92; p = .0001). CONCLUSIONS In RA patients, "unattended" BP is lower than traditional ("attended") BP and more closely associated with LV mass. In these patients, the "unattended" automated BP measurement is a promising tool which requires further evaluation.KEY MESSAGES"Unattended" automated blood pressure registration, aimed to reduce the "white-coat effect" is lower than "attended" value in rheumatoid arthritis patients."Unattended" blood pressure is more closely associated with left ventricular mass than "attende" registration.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Clara Riccini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Lorenzo Spighi
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Benedetta Gildoni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Claudio Cavallini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Paolo Verdecchia
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Zanframundo G, Tripoli A, Cometi L, Marcucci E, Furini F, Cavagna L, Barsotti S. One year in review 2020: idiopathic inflammatory myopathies. Clin Exp Rheumatol 2021; 39:1-12. [DOI: 10.55563/clinexprheumatol/qug8tf] [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: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Giovanni Zanframundo
- Division of Rheumatology, Univesity of Pavia and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | | | - Laura Cometi
- Department of Experimental and Clinical Medicine, Rheumatology Unit, University of Florence, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | - Lorenzo Cavagna
- Division of Rheumatology, Univesity of Pavia and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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Perricone C, Conigliaro P, Ciccacci C, Marcucci E, Cafaro G, Bartoloni E, Perricone R, Novelli G, Borgiani P, Gerli R. The differential response to anti IL-6 treatment in COVID-19: the genetic counterpart. Clin Exp Rheumatol 2020; 38:580. [PMID: 32452345] [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: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antigens, CD/genetics
- Antigens, Differentiation, T-Lymphocyte/genetics
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/genetics
- Betacoronavirus
- COVID-19
- Coronavirus Infections/drug therapy
- Coronavirus Infections/genetics
- Humans
- Interleukin-6/antagonists & inhibitors
- Lectins, C-Type/genetics
- Middle Aged
- Pandemics
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/genetics
- Polymorphism, Single Nucleotide
- Receptors, Interleukin-6/genetics
- SARS-CoV-2
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Affiliation(s)
- Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, and Department of Biomedicine and Prevention, Section of Genetics, School of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, Section of Genetics, School of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Borgiani
- Department of Biomedicine and Prevention, Section of Genetics, School of Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
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Tripoli A, Marasco E, Cometi L, De Stefano L, Marcucci E, Furini F, Barsotti S, Cavagna L. One year in review 2019: idiopathic inflammatory myopathies. Clin Exp Rheumatol 2020; 38:1-10. [PMID: 32041680] [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: 11/15/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a rare group of immune, systemic diseases characterised by muscle inflammation and frequently by extramuscular involvement. IIMs are heterogeneous with generally a chronic or subacute onset, which vary from less severe to more serious manifestations, not always easy to diagnose and even less to manage. In the past year, many studies have been published in order to clarify disease pathogenesis and improve patient management and treatment.The purpose of this review article is to provide an overview of the new insights in pathogenesis, serological findings, clinical manifestations and treatment of IIMs, summarising the most relevant studies published over the last year.
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Affiliation(s)
| | - Emiliano Marasco
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | - Laura Cometi
- Rheumatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Ludovico De Stefano
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Federica Furini
- Division of Rheumatology, Department of Medical Sciences, Santa Anna University Hospital, Ferrara, Italy
| | | | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
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Bartoloni E, Luccioli F, La Paglia GMC, Cafaro G, Marcucci E, Gerli R. Effect of Sinovial High-Low® injections in trapeziometacarpal osteoarthritis. Clin Exp Rheumatol 2019; 37:166. [PMID: 30620294] [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: 09/07/2018] [Accepted: 10/05/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
| | - Filippo Luccioli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
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Marcucci E, Bartoloni E, Alunno A, Leone MC, Cafaro G, Luccioli F, Valentini V, Valentini E, La Paglia GMC, Bonifacio AF, Gerli R. Extra-articular rheumatoid arthritis. Reumatismo 2018; 70:212-224. [PMID: 30570239 DOI: 10.4081/reumatismo.2018.1106] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that mainly affects the joints, though a consistent proportion of patients may also display extra articular manifestations (EAMs). From rheumatoid nodules to interstitial lung disease, from cardiovascular events to vasculitis, the spectrum of EAMs encompasses various conditions with different prognoses. EAMs may also occur as first RA manifestation, therefore the coordination with other health professionals, including general practitioners, is needed. The aim of this article is to provide an overview on EAMs in RA with particular focus on the recognised risk factors and the available recommendations for managing them, as well as comorbidities in RA patients.
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Affiliation(s)
- E Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia.
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Bartoloni E, Alunno A, Valentini V, Luccioli F, Valentini E, La Paglia GMC, Leone MC, Cafaro G, Marcucci E, Gerli R. Targeting Inflammation to Prevent Cardiovascular Disease in Chronic Rheumatic Diseases: Myth or Reality? Front Cardiovasc Med 2018; 5:177. [PMID: 30619884 PMCID: PMC6297850 DOI: 10.3389/fcvm.2018.00177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/29/2018] [Indexed: 01/10/2023] Open
Abstract
Evidence for increased risk of cardiovascular morbidity and mortality in chronic inflammatory rheumatic diseases has accumulated during the last years. Traditional cardiovascular risk factors contribute in part to the excess of cardiovascular risk in these patients and several mechanisms, including precocious acceleration of subclinical atherosclerotic damage, inflammation, and immune system deregulation factors, have been demonstrated to strictly interplay in the induction and progression of atherosclerosis. In this setting, chronic inflammation is a cornerstone of rheumatic disease pathogenesis and exerts also a pivotal role in all stages of atherosclerotic damage. The strict link between inflammation and atherosclerosis suggests that cardiovascular risk may be reduced by rheumatic disease activity control. There are data to suggest that biologic therapies, in particular TNFα antagonists, may improve surrogate markers of cardiovascular disease and reduce CV adverse outcome. Thus, abrogation of inflammation is considered an important outcome for achieving not only control of rheumatic disease, but also reduction of cardiovascular risk. However, the actual effect of anti-rheumatic therapies on atherosclerosis progression and CV outcome in these patients is rather uncertain due to great literature inconsistency. In this paper, we will summarize some of the main mechanisms linking the inflammatory pathogenic background underlying rheumatic diseases and the vascular damage observed in these patients, with a particular emphasis on the pathways targeted by currently available therapies. Moreover, we will analyze current evidence on the potential atheroprotective effects of these treatments on cardiovascular outcome pointing out still unresolved questions.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Valentina Valentini
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Filippo Luccioli
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Eleonora Valentini
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | | | - Maria Comasia Leone
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Perugia, University of Perugia, Perugia, Italy
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Di Battista M, Marcucci E, Elefante E, Tripoli A, Governato G, Zucchi D, Tani C, Alunno A. One year in review 2018: systemic lupus erythematosus. Clin Exp Rheumatol 2018; 36:763-777. [PMID: 30272543] [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: 05/09/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune condition characterised by a wide spectrum of clinical manifestations, partly related to the disease itself, but also linked to its comorbidities and drugs adverse reactions. Following the previous annual reviews, we focused on new insights in SLE clinical features, pathogenic pathways, biomarkers of specific organ involvement and therapeutic strategies. We finally concentrated on SLE aspects that could significantly influence patients' quality of life and that need to be investigated in detail through the development and validation of disease-specific patient-reported outcomes.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Tripoli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gianmaria Governato
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
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Bartoloni E, Alunno A, Valentini V, Valentini E, La Paglia GMC, Leone MC, Cafaro G, Marcucci E, Bonifacio AF, Luccioli F, Gerli R. The prevalence and relevance of traditional cardiovascular risk factors in primary Sjögren's syndrome. Clin Exp Rheumatol 2018; 36 Suppl 112:113-120. [PMID: 29998823] [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: 05/01/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
Accelerated atherosclerosis is a distinct feature of some inflammatory and autoimmune disorders and several specific autoimmune mechanisms and persistent inflammation have been identified to exert a pivotal role in precocious atherosclerotic damage in these disorders. Although increased atherosclerotic risk has been well established in some rheumatic autoimmune systemic diseases, such as systemic lupus erythematosus and rheumatoid arthritis, reliable data regarding the prevalence and pathogenetic mechanisms associated with increased atherosclerotic damage in primary Sjögren's syndrome are scarse. Indeed, primary Sjögren's syndrome is an autoimmune disorder characterised by chronic inflammation and autoimmune dysregulation that shares many pathogenic mechanisms and clinical features with systemic lupus erythematosus and rheumatoid arthitis. Higher prevalence of subclinical atherosclerosis has been observed in primary Sjögren's syndrome patients and recent population-based studies demonstrated an increased risk of cardiovascular events in these patients in comparison to general population. Among mechanisms associated with atherosclerotic damage, the prevalence and the role of traditional cardiovascular risk factors have been poorly investigated. In particular, the issue of whether the presence of these cardiovascular risk factors is associated with an increased risk of cardiovascular events needs to be further explored.
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Alunno A, Bartoloni E, Valentini V, La Paglia GMC, Valentini E, Leone MC, Marcucci E, Cafaro G, Bonifacio AF, Luccioli F, Gerli R. Discrepancy between subjective symptoms, objective measures and disease activity indexes: the lesson of primary Sjögren's syndrome. Clin Exp Rheumatol 2018; 36 Suppl 112:210-214. [PMID: 30156545] [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: 05/02/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
Mucosal dryness is a key clinical feature in primary Sjögren's syndrome (pSS) and its assessment relies on both objective measurement of residual secretion and subjective symptoms reported by patients. However, while the objective assessment and grading of glandular dysfunction can be easily performed, the spectrum of clinical symptoms encompassed by the terms 'dry eye' and 'dry mouth' is wide and heterogeneous. Therefore, patient reported outcomes (PROs) for dryness in pSS poorly correlate with the amount of glandular secretion. In addition, subjective dryness is not correlated with the severity of systemic disease and severely affects the patient quality of life even in presence of active extraglandular manifestations. The purpose of this review article is to provide an overview of glandular dysfunction in pSS as well as the impact of discrepancy between objective assessment, subjective symptom and extraglandular disease activity on disease management.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | | | | | | | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | - Filippo Luccioli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
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Leone MC, Alunno A, Cafaro G, Valentini V, Marcucci E, Bartoloni E, Gerli R. The clinical spectrum of primary Sjögren's syndrome: beyond exocrine glands. Reumatismo 2017; 69:93-100. [PMID: 28933131 DOI: 10.4081/reumatismo.2017.1032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
Although primary Sjögren's syndrome (pSS) is a mild indolent chronic disease mainly characterized by mucosal dryness in the majority of cases, a consistent subgroup of patients display extra-glandular manifestations. Virtually any organs and systems can be affected, leading to a more serious disease prognosis. Therefore, the prompt identification of patients at higher risk of extra-glandular manifestations is necessary to start a thorough follow up and an aggressive treatment. The aim of this review article is to provide an overview of epidemiological, clinical and serological features of extra-glandular manifestations in pSS as well as current knowledge about putative biomarkers useful in clinical practice.
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Affiliation(s)
- M C Leone
- Rheumatology Unit, Department of Medicine, University of Perugia.
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Ferro F, Marcucci E, Orlandi M, Baldini C, Bartoloni-Bocci E. One year in review 2017: primary Sjögren's syndrome. Clin Exp Rheumatol 2017; 35:179-191. [PMID: 28337967] [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: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
Primary Sjögren's syndrome (pSS) is a complex and heterogeneous disease. Last year, a great deal of basic and clinical research was carried out in pSS. Following the previous reviews of this publishing series, we will herewith provide a critical digest of the most recent literature on pSS pathogenesis, clinical manifestations and treatment. More specifically, we will focus on the heterogeneity of the disease, on the underlying pathogenetic pathways and on the possible new targeted treatments on the horizon.
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Affiliation(s)
- Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Martina Orlandi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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16
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Cafaro G, Alunno A, Valentini V, Leone MC, Marcucci E, Bartoloni E, Gerli R. The onset site of rheumatoid arthritis: the joints or the lung? Reumatismo 2016; 68:167-175. [PMID: 28299914 DOI: 10.4081/reumatismo.2016.892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/28/2016] [Accepted: 11/02/2016] [Indexed: 11/23/2022] Open
Abstract
The etiopathogenesis of rheumatoid arthritis (RA) is not yet fully elucidated and the site of inflammation onset is still a matter of debate. The presence of autoantibodies as well as clinical manifestations, such as interstitial lung disease, before the onset of arthritis seems to be in favour of the hypothesis that initial pathogenic events take place in tissues other than the joint. In this review article we summarize the most recent literature on extra-synovial autoimmunity triggers eventually leading to RA, with particular focus on the role of the lung. To date, anti-cyclic citrullinated peptide antibodies (ACPAs) are considered central players in RA pathogenesis and represent the gold-standard for disease diagnosis. Lungs and mucosae are exposed to environmental stimuli such as dusts and smoke which have been shown to foster citrullination of peptides in lungs thereby triggering the production of ACPA. In addition, other mechanisms of disease pathogenesis independent of citrullination play an important role. Deeper knowledge of these processes could represent a huge step forward in the management of RA, with dramatic impact on diagnosis, prevention, prognostic stratification and treatment of the disease.
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Affiliation(s)
- G Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia.
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17
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Sfarra S, Marcucci E, Ambrosini D, Paoletti D. Infrared exploration of the architectural heritage: from passive infrared thermography to hybrid infrared thermography (HIRT) approach. ACTA ACUST UNITED AC 2016. [DOI: 10.3989/mc.2016.07415] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Ferro F, Vagelli R, Bruni C, Cafaro G, Marcucci E, Bartoloni E, Baldini C. One year in review 2016: Sjögren's syndrome. Clin Exp Rheumatol 2016; 34:161-171. [PMID: 27095672] [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: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 06/05/2023]
Abstract
Sjögren's syndrome (SS) is a complex heterogeneous disease charactered by a broad spectrum of clinical and serological manifestations, including non-Hodgkin's lymphoma (NHL). Last year, 2015, was an exciting year for research into SS with novel insights into disease pathogenesis, clinical aspects and long-term outcomes. In addition, the use of biologic therapy in SS is rapidly expanding, with new evidence emerging regarding potential therapeutic targets. In this article, we will provide an overview of the recent literature on the pathogenesis, clinical features and novel treatments of SS.
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Affiliation(s)
- Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Roberta Vagelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Cosimo Bruni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | | | | | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Marinović M, Fumić N, Reinić B, Barković I, Marcucci E, Brusić J, Bakota B. [Proposition of algorhythm for treatment with hyperbaric oxygenation Hyperbaric oxygenation in Rijeka Clinical Hospital Center]. Acta Med Croatica 2016; 70 Suppl 1:83-91. [PMID: 29087677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Battistini R, Marcucci E, Verani M, Di Giuseppe G, Dini F, Carducci A. Ciliate–adenovirus interactions in experimental co-cultures of Euplotes octocarinatus and in wastewater environment. Eur J Protistol 2013; 49:381-8. [DOI: 10.1016/j.ejop.2012.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 11/21/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
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21
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Galeazzi R, Marcucci E, Martelli G, Natali D, Orena M, Rinaldi S. Synthesis of a versatile constrained analogue of dipeptide DG (Asp-Gly). Amino Acids 2006; 34:333-6. [PMID: 17136507 DOI: 10.1007/s00726-006-0469-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 10/19/2006] [Indexed: 10/23/2022]
Abstract
The synthesis of an orthogonally protected constrained analogue of dipeptide DG (Asp-Gly) is reported exploiting alkylation of a chiral lactam. The versatility of this analogue was proven by removal of t-Boc protecting group, followed by coupling under homogeneous conditions with t-Boc-Arg(Z(2))-Gly, to give a conformationally restricted analogue of RGDG tetrapeptide.
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Affiliation(s)
- R Galeazzi
- Dipartimento di Scienze dei Materiali e della Terra, Università Politecnica delle Marche, Ancona, Italy
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