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Calcagno A, Coppola N, Sarmati L, Tadolini M, Parrella R, Matteelli A, Riccardi N, Trezzi M, Di Biagio A, Pirriatore V, Russo A, Gualano G, Pontali E, Surace L, Falbo E, Mencarini J, Palmieri F, Gori A, Schiuma M, Lapadula G, Goletti D. Drugs for treating infections caused by non-tubercular mycobacteria: a narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine. Infection 2024:10.1007/s15010-024-02183-3. [PMID: 38329686 DOI: 10.1007/s15010-024-02183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) are generally free-living organism, widely distributed in the environment, with sporadic potential to infect. In recent years, there has been a significant increase in the global incidence of NTM-related disease, spanning across all continents and an increased mortality after the diagnosis has been reported. The decisions on whether to treat or not and which drugs to use are complex and require a multidisciplinary approach as well as patients' involvement in the decision process. METHODS AND RESULTS This review aims at describing the drugs used for treating NTM-associated diseases emphasizing the efficacy, tolerability, optimization strategies as well as possible drugs that might be used in case of intolerance or resistance. We also reviewed data on newer compounds highlighting the lack of randomised clinical trials for many drugs but also encouraging preliminary data for others. We also focused on non-pharmacological interventions that need to be adopted during care of individuals with NTM-associated diseases CONCLUSIONS: Despite insufficient efficacy and poor tolerability this review emphasizes the improvement in patients' care and the needs for future studies in the field of anti-NTM treatments.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
- Stop TB Italy, Milan, Italy.
| | - N Coppola
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Sarmati
- Department of System Medicine, Tor Vergata University and Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - M Tadolini
- Stop TB Italy, Milan, Italy
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - R Parrella
- Stop TB Italy, Milan, Italy
- Respiratory Infectious Diseases Unit, Cotugno Hospital, A. O. R. N. dei Colli, Naples, Italy
| | - A Matteelli
- Institute of Infectious and Tropical Diseases, WHO Collaborating Centre for TB Prevention, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - N Riccardi
- Stop TB Italy, Milan, Italy
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - M Trezzi
- Stop TB Italy, Milan, Italy
- Infectious and Tropical Diseases Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - A Di Biagio
- Infectious Diseases Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - V Pirriatore
- Stop TB Italy, Milan, Italy
- Unit of Infectious Diseases, "DivisioneA", Ospedale Amedeo di Savoia, ASL CIttà di Torino, Turin, Italy
| | - A Russo
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Gualano
- Stop TB Italy, Milan, Italy
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - L Surace
- Stop TB Italy, Milan, Italy
- Dipartimento Di Prevenzione, Azienda Sanitaria Provinciale di Catanzaro, Centro di Medicina del Viaggiatore e delle Migrazioni, P. O. Giovanni Paolo II, Lamezia Terme, CZ, Italy
| | - E Falbo
- Stop TB Italy, Milan, Italy
- Dipartimento Di Prevenzione, Azienda Sanitaria Provinciale di Catanzaro, Centro di Medicina del Viaggiatore e delle Migrazioni, P. O. Giovanni Paolo II, Lamezia Terme, CZ, Italy
| | - J Mencarini
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - F Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Rome, Italy
| | - A Gori
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, ASST Fatebenefratelli Sacco-Ospedale Luigi Sacco-Polo Universitario and Università Degli Studi di Milano, Milano, Italy
| | - M Schiuma
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, ASST Fatebenefratelli Sacco-Ospedale Luigi Sacco-Polo Universitario and Università Degli Studi di Milano, Milano, Italy
| | - G Lapadula
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy
| | - D Goletti
- Stop TB Italy, Milan, Italy
- Translational Research Unit, Epidemiology Department, National Institute for Infectious Diseases-IRCCS L. Spallanzani, Rome, Italy
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Fornaro M, Franceschini F, Gremese E, Cauli A, Sebastiani M, Montecucco C, Conti F, Rossini M, Foti R, Cantatore FP, Fusaro E, Lomater C, Frediani B, Govoni M, Atzeni F, Ramonda R, D’angelo S, Ferraccioli G, Lapadula G, Caporali R, Iannone F. POS0634 SAFETY PROFILE OF b/tsDMARD IN RHEUMATOID ARTHRITIS PATIENTS WITH IMPAIRED GLOMERULAR FILTRATION RATE. AN ANALYSIS FROM THE GISEA REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5130] [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
BackgroundIn real-life setting, a greater number of elderly rheumatoid arthritis (RA) patients with impaired glomerular filtration rate (GFR) needs treatment with biologic or target synthetic disease-modifying anti-rheumatic drugs (b/tsDMARD) to achieve disease control and reduce NSAIDs intake. Long-term observational data from the real-life on the use of b/tsDMARD in these patients are scarce.ObjectivesThe aim of this study was to evaluate the retention rate of b/tsDMARD in RA patients with impaired GFR in real-life setting.MethodsData of RA patients treated with at least one b/tsDMARD were retrospectively analyzed form the national Italian GISEA registry from January 2016 to December 2021. Estimated-GFR (eGFR) was calculated with the Cockcroft-Gault equation at the time of any b/tsDMARD prescription. For the purpose of this study, patients were divided in two groups, patients with impaired GFR (eGFR ≤60) and patients with normal GFR (eGFR >60). The retention rate was calculated by the Kaplan-Meier method and compared between these two groups by a log-rank test.ResultsThe study population included 2443 treatment-line with b/tsDMARD from 1888 patients (female 80.4%, age 57±12 years, mean baseline CDAI 17±12, FR/ACPA+ 69.5%) who started a new b/tsDMARD. Disease characteristics are shown in Table 1. 288 treatments with b/tsDMARD were started in patients with impaired eGFR and 2155 in patients with normal eGFR. Compared to patients with eGFR >60, patients with eGFR ≤60 showed higher HAQ-DI (1.3±0.8 vs 1±0.8, p<0.001) at the start of b/tsDMARD treatment. Glucocorticoids were more prescribed in patients with impaired eGFR (80.2% vs 72.8%, p<0.01), while csDMARDs were more prescribed in association with b/tsDMARD in patients with normal eGFR (83.1% vs 76.4%, p<0.01). Of note, CTLA4-Ig treatment was more prescribed in patients with impaired eGFR (26% vs 17.1%, p<0.05), while no difference in b/tsDMARD prescription was observed for other mechanism of actions. Drug survival was similar between RA patients with impaired eGFR [58.2%, mean survival time 35 months (CI95% 31-39)]and RA patients with normal eGFR [55%, mean survival time 34.4 months (CI95% 33-36), log rank: 0.88] (Figure 1). Cox regression model adjusted for age, sex and b/tsDMARD showed no impact of eGFR on drug survival [HR: 0.9 (CI95%: 0.7-1.2).ConclusionOur data show that impaired eGFR seems to not influence the persistence of b/tsDMARD treatment in RA patients.Disclosure of InterestsNone declared
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Favalli EG, Iannone F, Gremese E, Gorla R, Foti R, Conti F, Rossini M, Fusaro E, Cantatore FP, Montecucco C, Sebastiani M, Cauli A, Ferraccioli G, Lapadula G, Caporali R. POS0675 THE COMPARATIVE 3-YEAR RETENTION RATE OF TARGETED-SYNTHETIC AND BIOLOGIC DRUGS FOR RHEUMATOID ARTHRITIS: REAL-LIFE DATA FROM THE ITALIAN GISEA REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3557] [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:Long-term observational data on the real-life use of JAK inhibitors (JAKis) for rheumatoid arthritis (RA) and their comparison with biological drugs are still very limited. Large population-based registries have been increasingly used to investigate the performance of targeted drugs in a real-life setting.Objectives:The aim of this study is to evaluate and compare the 3-year retention rate of JAKis, TNF inhibitors (TNFis) and biologic drugs with other mechanisms of action (OMAs) in the large cohort of RA patients included in the Italian national GISEA registry.Methods:Data of all RA patients treated with targeted synthetic or biologic drugs were prospectively collected in the Italian multicentric GISEA registry. The analysis was limited to patients who started a first- or second-line targeted drug in the period after the first JAKi was marketed in Italy (1st December 2017). The 3-year retention rate was calculated by the Kaplan-Meier method and compared between different drug classes by a log-rank test. A descriptive analysis of reasons for discontinuation was performed.Results:The study population included 1027 RA patients (79.8% females, mean age [±SD] 56.9 [±13.5] years, mean disease duration 9.8 [±9] years, mean baseline SDAI 17.5 [±11.9], ACPA positive 67.4%, RF positive 62.7%) who received JAKis (baricitinib or tofacitinib, n=297), TNFis (n=365), or OMAs (n=365) as first or second targeted drug. Main baseline characteristics of study population were overall well balanced between treatment groups. Retention rate was numerically but not statistically higher (p=0.18) in patients treated with JAKis compared with TNFis or OMAs (80.6, 78.9 and 76.4% at 1 year and 73, 56.8 and 63.8% at 3 years, respectively) (Figure 1). Drug survival was significantly higher in patients receiving concomitant methotrexate (MTX) compared with monotherapy only in TNFis (66.8 vs 47.1%, p=0.04) but not in JAKis (76.1 vs 70.1%, p=0.54) and OMAs (66.1 vs 61.9%, p=0.41) group. Therapy was discontinued in a total of 211 patients because of ineffectiveness (n=107), adverse events (n=88), or compliance/other reasons (n=16). The most frequent reason for treatment withdrawal was ineffectiveness in both JAKis (n=30 out of 56) and TNFis (n=45 out of 74) groups, whereas OMAs were discontinued more frequently because of adverse events (n=41 out of 81).Conclusion:Our data confirmed in a real-life setting a favorable 3-year retention rate of all available targeted mechanisms of action for RA therapy. As expected, concomitant MTX significantly impacted persistence on therapy of TNFis only. Discontinuations of JAKis for adverse events were infrequent overall, confirming the safety profile observed in randomized clinical trials.Figure 1.Three-year retention rate by treatment groupDisclosure of Interests:None declared
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Praino E, Scioscia F, Scioscia C, Loseto G, Gramegna F, Ieva S, Pinto A, Ruta M, DI Sciascio E, Lapadula G, Iannone F. THU0628-HPR SSCENTRY: A PERSONAL DISEASE DIARY APP FOR SYSTEMIC SCLEROSIS PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
Background:Systemic Sclerosis (SSc) is a connective tissue disease characterized by severe alterations in the microvasculature and progressive fibrosis of the skin and internal organs [1]. Management of SSc is not easy, for both patients and physicians [2]. Symptoms are manifold and have a significant impact on patient’s daily autonomy and psychological well-being.Objectives:SScEntry (SSc data Entry tool; Figure 1) is a solution conceived to assist SSc patients in monitoring their disease, as a kind of “sentry”. The core idea is to provide patients with a personal diary to annotate and track the onset, evolution and resolution of symptoms as well as any changes in their general health condition, through an app for iOS and Android smartphones and tablets.Figure 1.SScEntry logo.Methods:SScEntry is a smartphone/tablet app designed by rheumatology and computer science engineering specialists in close partnership [3]. A carefully designed user interface (UI), inspired to a social network wall, allows annotating the evolution of symptoms by means of standard clinical investigation methods such as scientifically validated questionnaires. The UI facilitates data collection through speech-based interaction as well as touch and gestures optimized for patients with finger skin lesions and joints impairments. User engagement over the course of time is fostered by: follow-up reminders to update information on the evolution of past events and periodic questionnaires for general health assessment; the integration of symptom photos taken with on-device camera and health data collected from wearable devices; gamification features. Privacy and security have been a primary design concern, with app access protection and full on-device data encryption; no personal data transmission occurs without explicit user consent. SScEntry generates a disease activity summary report, for displaying to the physician during visit or emailing/printing.Results:SScEntry is ready for Android and iOS smartphones and tablets. All planned features have been implemented (Figure 2). Currently supported languages are English and Italian. Areas of interest include vascular, cutaneous, articular, visceral (gastro-intestinal and cardio-pulmonary) as well as relationship, sexual and working life.Figure 2.SScEntry features.Conclusion:Novel Narrative-based Medicine approaches are getting increasing attention to enhance the mutual understanding between patient and physician, reinforcing the therapeutic adherence at the core of healthcare. This is particularly important with chronic and disabling diseases like SSc. Involving patients in disease management with SScEntry will increase their compliance and confidence, with benefits on psychological well-being. Expected benefits for rheumatologists include better evaluation of target therapy and outcomes, as no data on disease activity is lost during the patient clinical history.References:[1]J. Varga et al. (2017) Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord 2:137–52.[2]L. Mouthon et al. (2017) Patients’ views and needs about systemic sclerosis and its management: a qualitative interview study. BMC Musculoskelet Disord 18(1):230.[3]M. Bradway et al. (2015) Mobile Health: empowering patients and driving change. Trends in Endocrinology & Metabolism, 26(3):114-117.Disclosure of Interests:Emanuela Praino: None declared, Floriano Scioscia: None declared, Crescenzio Scioscia: None declared, Giuseppe Loseto: None declared, Filippo Gramegna: None declared, Saverio Ieva: None declared, Agnese Pinto: None declared, Michele Ruta: None declared, Eugenio Di Sciascio: None declared, Giovanni Lapadula: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD
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Rotondo C, Nivuori M, Chialà A, Praino E, Matucci Cerinic M, Cutolo M, Lapadula G, Iannone F. Evidence for increase in finger blood flow, evaluated by laser Doppler flowmetry, following iloprost infusion in patients with systemic sclerosis: a week-long observational longitudinal study. Scand J Rheumatol 2018; 47:311-318. [PMID: 29409385 DOI: 10.1080/03009742.2017.1397187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Iloprost plays an important role in the treatment of Raynaud's phenomenon (RP), but has transient vasodilatory effects owing to its very short half-time. We aimed to evaluate short- and medium-term haemodynamic effects of iloprost by measuring dorsal finger microvessel blood flow using laser Doppler flowmetry (LDF), in patients with RP associated with systemic sclerosis (SSc). METHOD In 24 consecutive SSc patients with RP (disease duration 10.5 ± 1.3 years), LDF with heating probes was used to measure blood flow in four fingers by occlusive and heating tests, at baseline, after 3 consecutive days of iloprost infusion, and at 24 h and 7 days after last iloprost infusion. Nailfold videocapillaroscopy (NVC) patterns of microvascular damage were investigated. Sixteen healthy controls were studied to compare baseline flows. RESULTS Compared to controls, SSc patients showed significantly impaired axon reflex vasoregulation and nitric oxide responses at baseline (p = 0.001 and p = 0.03, respectively). After iloprost, a prompt but transient significant improvement in endothelial-dependent vasodilation (occlusive test) was seen only in SSc patients with an 'active' NVC pattern (p ≤ 0.05). The iloprost effects vanished within 7 days after the last infusion. No significant differences were found, in the whole study, between patients with and without digital ulcers. CONCLUSIONS Microcirculatory blood flow increases following 3 days of iloprost infusion but fades shortly after treatment. Although iloprost is effective in reducing the severity of RP in SSc, the most suitable regimen and timing to obtain longer lasting vasodilatory benefits remain to be established.
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Affiliation(s)
- C Rotondo
- a Rheumatology Unit, Department of Emergency and Transplantation , University of Bari , Bari , Italy
| | - M Nivuori
- a Rheumatology Unit, Department of Emergency and Transplantation , University of Bari , Bari , Italy
| | - A Chialà
- a Rheumatology Unit, Department of Emergency and Transplantation , University of Bari , Bari , Italy
| | - E Praino
- a Rheumatology Unit, Department of Emergency and Transplantation , University of Bari , Bari , Italy.,b Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.,c Department of Geriatric Medicine, Division of Rheumatology AOUC , University of Florence , Florence , Italy
| | - M Matucci Cerinic
- b Department of Experimental and Clinical Medicine , University of Florence , Florence , Italy.,c Department of Geriatric Medicine, Division of Rheumatology AOUC , University of Florence , Florence , Italy
| | - M Cutolo
- d Research Laboratory and Division of Clinical Rheumatology, Department of Emergency and Transplantation , University of Genoa, IRCCS AOU San Martino , Genoa , Italy
| | - G Lapadula
- a Rheumatology Unit, Department of Emergency and Transplantation , University of Bari , Bari , Italy
| | - F Iannone
- a Rheumatology Unit, Department of Emergency and Transplantation , University of Bari , Bari , Italy
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Lapadula G, Marchesoni A, Salaffi F, Ramonda R, Salvarani C, Punzi L, Costa L, Caso F, Simone D, Baiocchi G, Scioscia C, Di Carlo M, Scarpa R, Ferraccioli G. Evidence-based algorithm for diagnosis and assessment in psoriatic arthritis: results by Italian DElphi in psoriatic Arthritis (IDEA). Reumatismo 2016; 68:126-136. [DOI: 10.4081/reumatismo.2016.913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease involving skin, peripheral joints, entheses, and axial skeleton. The disease is frequently associated with extrarticular manifestations (EAMs) and comorbidities. In order to create a protocol for PsA diagnosis and global assessment of patients with an algorithm based on anamnestic, clinical, laboratory and imaging procedures, we established a DElphi study on a national scale, named Italian DElphi in psoriatic Arthritis (IDEA). After a literature search, a Delphi poll, involving 52 rheumatologists, was performed. On the basis of the literature search, 202 potential items were identified. The steering committee planned at least two Delphi rounds. In the first Delphi round, the experts judged each of the 202 items using a score ranging from 1 to 9 based on its increasing clinical relevance. The questions posed to experts were How relevant is this procedure/observation/sign/symptom for assessment of a psoriatic arthritis patient? Proposals of additional items, not included in the questionnaire, were also encouraged. The results of the poll were discussed by the Steering Committee, which evaluated the necessity for removing selected procedures or adding additional ones, according to criteria of clinical appropriateness and sustainability. A total of 43 recommended diagnosis and assessment procedures, recognized as items, were derived by combination of the Delphi survey and two National Expert Meetings, and grouped in different areas. Favourable opinion was reached in 100% of cases for several aspects covering the following areas: medical (familial and personal) history, physical evaluation, imaging tool, second level laboratory tests, disease activity measurement and extrarticular manifestations. After performing PsA diagnosis, identification of specific disease activity scores and clinimetric approaches were suggested for assessing the different clinical subsets. Further, results showed the need for investigation on the presence of several EAMs and risk factors. In the context of any area, a rank was assigned for each item by Expert Committee members, in order to create the logical sequence of the algorithm. The final list of recommended diagnosis and assessment procedures, by the Delphi survey and the two National Expert Meetings, was also reported as an algorithm. This study shows results obtained by the combination of a DElphi survey of a group of Italian rheumatologists and two National Expert Meetings, created with the aim of establishing a clinical procedure and algorithm for the diagnosis and the assessment of PsA patients. In order to find accurate and practical diagnostic and assessment items in clinical practice, we have focused our attention on evaluating the different PsA domains. Hence, we conceived the IDEA algorithm in order to address PsA diagnosis and assessment in the context of daily clinical practice. The IDEA algorithm might eventually lead to a multidimensional approach and could represent a useful and practical tool for addressing diagnosis and for assessing the disease appropriately. However, the elaborated algorithm needs to be further investigated in daily practice, for evidencing and proving its eventual efficacy in detecting and staging PsA and its heterogeneous spectrum appropriately.
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Praino E, Rotondo C, Scioscia C, Anelli M, Chialà A, Coladonato L, Perniola S, Natuzzi D, Bruni C, Guiducci S, Matucci-Cerinic M, Lapadula G, Iannone F. OP0050 Serum Levels of Adipokines in The Categories of Body Mass Index (BMI) in Patients with Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5256] [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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Rotondo C, Nivuori M, Chialà A, Praino E, Coladonato L, Anelli M, Giannini M, Lascaro N, Fanizzi R, Laselva G, Cacciapaglia F, Lapadula G, Iannone F. SAT0217 Axon Reflex Vasodilatation of Digital Arteries in Systemic Sclerosis Patients, Evaluated by Laser-Doppler Fluxmetry. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4665] [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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Giannitti C, Lopalco G, Vitale A, Anelli M, Fabbroni M, Manganelli S, Frediani B, Barone M, Galeazzi M, Lapadula G, Iannone F, Cantarini L. SAT0384 Long-Term Safety of Anti-Tnf Agents in Patients with Spondyloarthritis and Potential Occult HBV: An Observational Multicenter Study on 131 Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4720] [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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Lopalco G, Lucherini O, Cantarini L, Lopalco A, Vitale A, Venerito V, Chialà A, Fornaro M, Anelli M, Scioscia C, Cacciapaglia F, Natuzzi D, Lapadula G, Iannone F. AB0041 Serum Amyloid A Stimulates The Induction of Inflammatory Mediators in Monocytes from Behçet's Disease Patients: A Proof of Concept Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4965] [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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Rotondo C, Chialà A, Nivuori M, Coladonato L, Giannini M, Anelli M, Righetti G, Scioscia C, Fiorentini C, Lopalco G, Lapadula G, Iannone F. SAT0216 Chest Ultrasound Signs of Interstitial Lung Disease in Systemic Sclerosis Patients: A Comparison between High Resolution Chest Computed Tomography Findings. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Chialà A, Rotondo C, Anelli M, Scioscia C, Praino E, Perniola S, Nivuori M, Natuzzi D, Fiorentini C, Lopalco G, Lapadula G, Iannone F. SAT0212 Pericardial Effusion Related To Systemic Sclerosis: A Possible Contribution of The Serum Levels of Adipokines and Interleukines. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4704] [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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Bello S, Rinaldi A, Trabucco S, Serafino L, Bonali C, Lapadula G. Erasmus syndrome in a marble worker. Reumatismo 2015; 67:116-22. [PMID: 26876191 DOI: 10.4081/reumatismo.2015.826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 11/23/2022] Open
Abstract
Erasmus syndrome is defined as the association of silica exposure and subsequent development of systemic sclerosis. The limited number of cases reported in the literature mainly involves miners and only sporadically other professionals. We describe a case of Erasmus syndrome in a marble worker. A 68 year old man came to our observation complaining pelvic and scapular girdle pain, evening fever, intense weakness and emaciation for about 1 month. He also reported to have had Raynaud's phenomenon in his hands for the last 13 years. Also, his occupational history revealed a chronic exposure to silica dust. The patient presented pain in his shoulders and hips, moderate skin thickening and sclerosis in his hands and fingers extending proximally to his wrists. The diagnosis of systemic sclerosis was determined according to his clinical and medical history, the positivity of anti-Scl 70 antibodies, the nailfold capillaroscopy suggestive of an active scleroderma pattern and the detection of a mild restrictive pulmonary syndrome. The evaluation of the organbased complications excluded a gastroenterological and cardiovascular involvement, while the chest computed tomography (CT) detected multiple small nodules with a mantle distribution and enlarged lymph nodes with no signs of interstitial lung disease and fibrosis. Additional tests (positron emission tomography-CT, flexible bronchoscopy and broncho-alveolar lavage) excluded infectious diseases and cancer. However, given the pulmonary involvement, we performed a histological examination of the parenchyma and lymph nodes, which revealed a picture of pneumoconiosis. In the end, the occupational history and the findings from the diagnostic procedures led to the diagnosis of pulmonary silicosis. The precise definition of the pulmonary involvement was essential to the therapeutic approach to this patient.
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Affiliation(s)
- S Bello
- Rheumatology Unit, Policlinico Hospital, University of Bari, Bari.
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Cacciapaglia F, Anelli MG, Rizzo D, Morelli E, Scioscia C, Mazzotta D, Iannone F, Lapadula G. Influence of TNF-α inhibition on oxidative stress of rheumatoid arthritis patients. Reumatismo 2015; 67:97-102. [PMID: 26876188 DOI: 10.4081/reumatismo.2015.829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess circulating levels of reactive oxygen metabolites (ROMs) as a marker of oxidative stress in rheumatoid arthritis (RA) patients during an anti-tumor necrosis factor alpha (TNF-α) treatment. We enrolled 40 patients with RA (36 females; age 53 ± 13 yrs) treated with different subcutaneously administered TNF-α inhibitors. The oxidative status was determined on the basis of plasma samples taken before, at 24 and 52 weeks of the anti-TNF-α treatment. Hydroperoxide levels were measured using the d-ROMs test, a useful clinically proven oxidative stress marker. During the anti-TNF-α therapy, we observed a significant reduction in serum ROMs levels in RA patients from 33.2 ± 10 mg H2O2/L at baseline to 29.5 ± 7 and 29.3 ± 9 mg H2O2/L, at 24 and 52 weeks, respectively (p<0.05). We also identified a significant correlation between the oxidative stress status and the disease activity score on 28 joints/C-reactive protein and health assessment questionnaire disability index. The results of our study demonstrate that a good control of the disease with anti-TNF-α agents can reduce oxidative stress in RA patients. However, further studies of larger patient cohorts are needed to confirm these preliminary data.
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Affiliation(s)
- F Cacciapaglia
- Internal Medicine Unit and Rheumatology Clinic, N. Melli Hospital, San Pietro Vernotico (BR).
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15
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Idolazzi L, Adami S, Capozza R, Bianchi G, Cozzolongo A, Epis O, Fusaro E, Lapadula G, Migliore A, Pellerito R, Pucino A, Sinigaglia L, Visalli E, Rossini M. Suboptimal methotrexate use in rheumatoid arthritis patients in Italy: the MARI study. Clin Exp Rheumatol 2015; 33:895-899. [PMID: 26690890] [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: 03/12/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Methotrexate (MTX) is the first choice in the treatment of rheumatoid arthritis (RA), but the doses and regimens vary significantly. For this purpose, we conducted an observational study on the use of MTX for RA in Italy (MARI study). METHODS The MARI study included 1,327 RA patients on MTX treatment for at least 12 months, at 60 Italian rheumatology units. Concomitant medications with corticosteroids, other DMARDs or biological therapies were recorded. The clinical assessment included the Disease Activity Score 28 (DAS28) and the serological positivity for the rheumatoid factor or for the anti-citrullinated protein antibodies. RESULTS The included patients were treated with either oral (n=288) or parenteral (n=1039) MTX. Only 15.5% of the total number of the patients was on adequate MTX dose (i.e. ≥ 15 mg for the oral route of administration and >12 mg for the parenteral one). The initially established MTX dose was modified in 37.1% of the patients, for intolerance or clinical criteria. A DAS28 remission (DAS28 <2.6) was observed only in 58.5% of the cases, while 52.9% of the patients still presenting an active form of the disease were on suboptimal doses of MTX. CONCLUSIONS The weekly dose of MTX prescribed for the treatment of RA is often suboptimal, even in conditions of inadequate control of the disease activity. The recommendations for the use of MTX in RA patients should take into account the efficacy and tolerability data derived from its use in real clinical practice.
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Affiliation(s)
- L Idolazzi
- Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - S Adami
- Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - R Capozza
- Rheumatology, Ospedale CTO A. Alesini, ASL Roma C, Rome, Italy
| | - G Bianchi
- Rheumatology, Ospedale La Colletta, Arenzano, Genoa, Italy
| | | | - O Epis
- Rheumatology, A.O. Ospedale Niguarda Ca' Granda, Milan, Italy
| | - E Fusaro
- Rheumatology, Azienda Ospedaliero-Universitaria S.Giovanni Battista, Torino, Italy
| | - G Lapadula
- Rheumatology, Ospedale Policlinico, Bari, Italy
| | - A Migliore
- Rheumatology, Ospedale S. Pietro Fatebenefratelli, Rome, Italy
| | - R Pellerito
- Rheumatology, A.O. Ordine Mauriziano di Torino, ASL TO1, Torino, Italy
| | - A Pucino
- Rheumatology, ASL Napoli 1 Centro Distretti 24 -27 -31, Napoli, Italy
| | - L Sinigaglia
- Rheumatology, Azienda Ospedaliera Istituto Ortopedico G. Pini, Milano, Italy
| | - Elisa Visalli
- Rheumatology, A.O.U. Policlinico Universitario G. Martino, Messina, Italy
| | - Maurizio Rossini
- Rheumatology, Department of Internal Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Lopalco G, Iannone F, Rigante D, Vitale A, Mancini ME, Covelli M, Lapadula G, Cantarini L. Coexistence of axial spondyloarthritis and thromboangiitis obliterans in a young woman. Reumatismo 2015; 67:17-20. [PMID: 26150270 DOI: 10.4081/reumatismo.2015.810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 11/23/2022] Open
Abstract
A peculiar coexistence of axial spondyloarthritis and ischemia of the feet and the fourth finger of the left hand in a young woman, who was a heavy smoker, is discussed in this report. This picture was considered within the context of thromboangiitis obliterans. Positivity of anti-nuclear antibodies and mild elevation of inflammatory parameters were noted. Computed tomography angiograms of upper and lower limbs showed luminal narrowing and occlusion of the left humeral, left anterior/posterior tibial and right anterior tibial arteries. Daily iloprost perfusions were started, and smoking cessation was strongly recommended. Coldness and rest pain in the distal extremities improved within a few weeks. The possibility that spondyloarthritis might precede the clinical picture of thromboangiitis obliterans should be considered in heavy smokers.
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Affiliation(s)
- G Lopalco
- Interdisciplinary Department of Medicine, Rheumatology Unit, Policlinico of Bari.
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17
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Pipitone N, Notarnicola A, Scardapane A, Spaggiari L, Levrini G, Iannone F, Lapadula G, Salvarani C. OP0278 Does MRI Provide an Added Value Over Serum Creatine Kinase Measurement in Myositis?:. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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18
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Pipitone N, Notarnicola A, Levrini G, Spaggiari L, Scardapane A, Iannone F, Lapadula G, Zuccoli G, Salvarani C. FRI0483 Do Dermatomyositis and Polymyositis Affect Different Thigh Muscle Groups? A Comparative MRI-Based Study: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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19
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Perniola S, Natuzzi D, Lacarpia N, Bizzoca R, Venerito V, Moretti B, Notarnicola A, Maccagnano G, Lapadula G, Iannone F. AB0107 Regulation of the Expression of Runx2 in Human Osteoarthritis Osteoblasts with SP, IGF-1 and TNF-Alpha: An in Vitro Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2303] [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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20
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Cacciapaglia F, Maria Grazia A, Rinaldi A, Scioscia C, Lopalco G, Covelli M, Iannone F, Lapadula G. AB0452 Changes in Lipoproteins Associated with Tocilizumab Treatment Do not Influence the Atherogenic Index of Plasma of Rheumatoid Arthritis Patients: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4058] [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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21
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Rotondo C, Nivuori M, Chialà A, Praino E, Coladonato L, Covelli M, Lapadula G, Iannone F. SAT0448 Micro-Vessels Hemodynamics Effects Induced by Iloprost in Systemic Sclerosis Patients Evaluated by Laser Doppler Flowmetry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3968] [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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22
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Bello S, Rotondo C, Bonali C, Serafino L, Lapadula G. SAT0265 Secondary Sjogren's Syndrome in Patients with Spondyloarthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2510] [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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23
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Giannini M, Fiorella M, Coladonato L, D'Abbicco D, Amati A, Lopalco G, Laselva G, Lapadula G, Iannone F. AB0714 Improvement of Refractory Dysphagia in Patients with Idiopathic Inflammatory Myopathies Receveing Immunoglobulin Intravenous Therapy. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5076] [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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24
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Pipitone N, Notarnicola A, Spaggiari L, Scardapane A, Levrini G, Iannone F, Lapadula G, Zuccoli G, Salvarani C. SAT0472 Role of MRI in the Follow-up of Patients with Myositis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2864] [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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25
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Cacciapaglia F, Iervolino S, Anelli M, Mazzotta D, Zincarelli C, Pappone N, Iannone F, Lapadula G. AB0347 Effects of Physical Activity and Anti-TNF-Alpha Disease Control on Lipid Profile of Rheumatoid Arthritis Patients:. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4074] [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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26
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Lopalco G, Lucherini O, Cantarini L, Vitale A, Talarico R, Giannini M, Scioscia C, Anelli M, Cacciapaglia F, Natuzzi D, Bizzoca R, Perniola S, Lapadula G, Iannone F. AB0065 Possible Interplay Between Serum Amyloid-A and Pro-Inflammatory Cytokines Into the Pathogenesis of Behçet's Disease. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3901] [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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27
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Lenzi J, Lapadula G, D'amico T, Delfinis CP, Iuorio R, Caporlingua F, Mecca N, Mercuri V, Bassotti G, Rillo M, Santoro F, Tamburrano G, Santoro A, Gargiulo P. Evaluation of trans-sphenoidal surgery in pituitary GH-secreting micro- and macroadenomas: a comparison between microsurgical and endoscopic approach. J Neurosurg Sci 2015; 59:11-18. [PMID: 25658052] [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] [Indexed: 06/04/2023]
Abstract
AIM Acromegaly is caused by a GH-secreting pituitary adenoma, associated with many comorbidities and increased risk of mortality. Surgery is the first-line therapy. Success of therapy is measured by symptomatic improvement, preservation of pituitary function and biochemical control. Trans-sphenoidal surgery (TSS), endoscopic or microscopic, is the preferred treatment. To evaluate surgery effectiveness and individuate the technique associated with a higher remission rate, patients undergoing TSS were retrospectively selected. METHODS Thirty-seven consecutive patients underwent surgery between 1996 and 2006. Tumors were classified into macroadenomas or microadenomas and into intrasellar, extrasellar and extrasellar with cavernous sinus invasion. Surgery was performed in 22 patients with endoscopic technique, in 15 patients with microsurgical approach. The hormonal assays were performed 6 months and yearly after surgery for an average of 5 years. RESULTS Ten patients were affected by microadenoma, 27 by macroadenoma. In microadenomas remission rate was independent of the used technique. Within macroadenomas, remission percentage in endoscopic approach (68.75%) was significantly higher than in microscopic approach (18.18%) (P=0.018). Postsurgical biochemical remission was calculated combining the surgical technique and tumor extension: the endoscopic approach was associated with a significantly higher remission rate in extrasellar than both in intrasellar and extrasellar with cavernous sinus invasion. In the latter group, any technique had not reached biochemical remission. CONCLUSION TSS is able to induce a long-term remission of acromegaly, with low risk of recurrence and complications. Endoscopic approach is more suitable than microscopic technique in macroadenomas and adenomas with suprasellar extension.
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Affiliation(s)
- J Lenzi
- Division of Neurosurgery Department of Neurological Sciences Sapienza University of Rome Policlinico Umberto I, Rome, Italy -
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28
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Iannone F, Lopriore S, Bucci R, Scioscia C, Anelli MG, Notarnicola A, Lapadula G. Two-year survival rates of anti-TNF-α therapy in psoriatic arthritis (PsA) patients with either polyarticular or oligoarticular PsA. Scand J Rheumatol 2015; 44:192-9. [DOI: 10.3109/03009742.2014.962081] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Notarnicola A, Lapadula G, Natuzzi D, Lundberg IE, Iannone F. Correlation between serum levels of IL-15 and IL-17 in patients with idiopathic inflammatory myopathies. Scand J Rheumatol 2014; 44:224-8. [DOI: 10.3109/03009742.2014.956141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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30
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Notarnicola A, Lapadula G, Natuzzi D, Iannone F. Possible interplay between interleukin-15 and interleukin-17 into the pathogenesis of idiopathic inflammatory myopathies. Reumatismo 2014; 66:215-23. [DOI: 10.4081/reumatismo.2014.746] [Citation(s) in RCA: 3] [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] [Received: 04/07/2014] [Revised: 08/23/2014] [Accepted: 08/30/2014] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to assess the serum levels of interleukin (IL)-15 and IL-17 in patients with idiopathic inflammatory myopathies (IIM) and correlate them with IL-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), MIP-1β levels. Possible correlations with disease activity parameters were also evaluated. Sera from 14 polymyositis (PM), 10 dermatomyositis (DM), 7 anti-synthetase syndrome new onset patients and 19 healthy controls (HCs) were analyzed by multiplex immunoassay. Sera from 19 patients were analyzed after 5 months median follow-up. All patients underwent physical examination, the 5-points manual muscle test (MMT), the health assessment questionnaire and serum creatine kinase measurement. All patients received glucocorticoids, and 13 were taking also immunosuppressive therapy. At baseline, serum levels of IL-15, IL-17, MCP-1 and MIP-1β were significantly higher in IIM patients than in HCs. IL-17 serum levels were directly correlated with disease duration (r=0.39, P=0.02), while a significant inverse correlation was detected between IL-17 levels and MMT scores (r=-0.4, P=0.02). The highest IL-15 levels were present in DM patients (P=0.02 vs PM). The most striking finding was the strong correlation between IL-15 and IL-17 levels (r=0.60, P=0.0001), and this correlation was even stronger in DM patients (r=0.82, P=0.006). The strong correlation between IL-15 and IL-17 in IIM patients, and especially in DM, suggests that there may be a interplay between the two cytokines in the pathogenesis of myositis. Further studies of larger patient cohorts and muscle biopsies are needed to confirm these preliminary data.
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31
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Giacomelli R, Gorla R, Trotta F, Tirri R, Grassi W, Bazzichi L, Galeazzi M, Matucci-Cerinic M, Scarpa R, Cantini F, Gerli R, Lapadula G, Sinigaglia L, Ferraccioli G, Olivieri I, Ruscitti P, Sarzi-Puttini P. Quality of life and unmet needs in patients with inflammatory arthropathies: results from the multicentre, observational RAPSODIA study. Rheumatology (Oxford) 2014; 54:792-7. [DOI: 10.1093/rheumatology/keu398] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Indexed: 11/12/2022] Open
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32
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Cogliandro V, Lapadula G, Bandera A, Muscatello A, Marcolin R, Abbruzzese C, Rona R, Gori A. ECMO: an alternative support for acute respiratory failure caused by tuberculosis? Int J Tuberc Lung Dis 2014; 18:879-81. [DOI: 10.5588/ijtld.13.0752] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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33
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Perniola S, Lacarpia N, Bizzoca R, Natuzzi D, Notarnicola A, Moretti B, Lapadula G, Iannone F. SAT0571 Role of Obesity in the Expression of Cytokines and Metalloproteinases in Human Osteoarthritis Chondrocytes. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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34
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Bello S, Fanizzi R, Rotondo C, Rinaldi A, Dinoia L, Lopriore S, Serafino L, Bonali C, Iannone F, Lapadula G. AB0448 Drug Survival of A Patients Cohort with Chronic Inflammatory RHEUMATISM Treated with Abatacept. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2669] [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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35
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Cacciapaglia F, Anelli M, Rizzo D, Morelli E, Rotondo C, Rinaldi A, Covelli M, Iannone F, Lapadula G. AB0380 The Inhibition of Tumor Necrosis Factor-Alpha (TNFA) Reduce Plasmatic Reactive Oxygen Metabolites (ROM) of Rheumatoid Arthritis (RA) Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2556] [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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36
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Notarnicola A, Lapadula G, Natuzzi D, Lundberg I, Iannone F. AB0056 Correlation between Serum Levels of IL-15 and IL-17 in Patients with Idiopathic Inflammatory Myopathies. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1053] [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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37
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Iannone F, Marchesoni A, Sarzi-Puttini P, Gorla R, Govoni M, Carletto A, Ferraccioli G, Ferri C, Punzi L, Salaffi F, Foti R, Lapadula G. AB0381 Long-Term Clinical Effectiveness of Adalimumab, Etanercept, and Infliximab in Rheumatoid Arthritis (RA): an Observational Study from Italian Register, Gisea. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5721] [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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38
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Sfriso P, Priori R, Colafrancesco S, Valesini G, Rossi S, Montecucco C, D'Ascanio A, Carli L, Bombardieri S, La Selva G, Iannone F, Lapadula G, Alivernini S, Ferraccioli G, Caso F, Colaci M, Ferri C, Iacono D, La Montagna G, Costa L, Scarpa R, Lo Monaco A, Bagnari V, Govoni M, Piazza I, Adami S, Schinocca C, Ciccia F, Triolo G, Alessandri E, Cutolo M, Cantarini L, Galeazzi M, Punzi L. THU0395 Adult Onset Still's Disease: A Multicenter Retrospective Cohort Study of 233 Italian Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5300] [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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39
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Lapadula G, Marchesoni A, Armuzzi A, Blandizzi C, Caporali R, Chimenti S, Cimaz R, Cimino L, Gionchetti P, Girolomoni G, Lionetti P, Marcellusi A, Mennini FS, Salvarani C. Adalimumab in the treatment of immune-mediated diseases. Int J Immunopathol Pharmacol 2014; 27:33-48. [PMID: 24774505 DOI: 10.1177/03946320140270s103] [Citation(s) in RCA: 57] [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] [Indexed: 12/13/2022] Open
Abstract
Tumour necrosis factor (TNF) plays an important role in the pathogenesis of immune-mediated inflammatory diseases (IMIDs). TNF inhibition results in down-regulation of abnormal and progressive inflammatory processes, resulting in rapid and sustained clinical remission, improved quality of life and prevention of target organ damage. Adalimumab is the first fully human monoclonal antibody directed against TNF. In this article, we review the role and cost effectiveness of adalimumab in the treatment of IMIDs in adults and children. The efficacy and tolerability of adalimumab has been demonstrated in patients with a wide range of inflammatory conditions, leading to regulatory approval in rheumatoid arthritis (RA), psoriatic arthritis (PsA), plaque psoriasis, inflammatory bowel diseases (Crohn's disease, ulcerative colitis, paediatric Crohn's disease, and intestinal Behçet's disease), ankylosing spondylitis (AS), axial spondyloarthritis (SpA) and juvenile idiopathic arthritis. The major tolerability issues with adalimumab are class effects, such as injection site reactions and increased risk of infection and lymphoma. As with all anti-TNF agents, adalimumab is immunogenic, although less than infliximab, and some patients receiving long-term adalimumab will develop anti-drug antibodies, causing a loss of response. Comparisons of its clinical utility and cost effectiveness have shown it to be a valid treatment choice in a wide range of patients. Recent data from Italian economic studies show the cost effectiveness of adalimumab to be below the threshold value for health care interventions for most indications. In addition, analysis of indirect costs shows that adalimumab significantly reduces social costs associated with RA, PsA, AS, Crohn's disease and psoriasis. The fact that adalimumab has the widest range of approved indications, many often presenting together in the same patient due to the common pathogenesis, may further improve the utility of adalimumab. Current clinical evidence shows adalimumab to be a valuable resource in the management of IMIDs. Further research, designed to identify patients who may benefit most from this drug, will better highlight the role and cost-effectiveness of this versatile TNF inhibitor.
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Affiliation(s)
- G Lapadula
- Rheumatology Unit, Interdisciplinary Department of Medicine, Medical School, University of Bari, Bari, Italy
| | | | - A Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - C Blandizzi
- Division of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Caporali
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - R Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Childrens Hospital, University of Florence, Firenze, Italy
| | - L Cimino
- Ocular Immunology Unit, Ophthalmology, Unit, Arcispedale S Maria Nuova Reggio, Reggio, Emilia, Italy
| | - P Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - P Lionetti
- Gastroenterology Unit, Anna Meyer Childrens Hospital, Department of Paediatrics, University of Firenze, Firenze, Italy
| | - A Marcellusi
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - F S Mennini
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - C Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
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40
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Armuzzi A, Lionetti P, Blandizzi C, Caporali R, Chimenti S, Cimino L, Gionchetti P, Girolomoni G, Lapadula G, Marchesoni A, Marcellusi A, Mennini FS, Salvarani C, Cimaz R. anti-TNF agents as therapeutic choice in immune-mediated inflammatory diseases: focus on adalimumab. Int J Immunopathol Pharmacol 2014; 27:11-32. [PMID: 24774504 DOI: 10.1177/03946320140270s102] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The complex pathogenesis of immune-mediated inflammatory diseases (IMIDs) has been extensively investigated and dysregulation of cytokines, such as tumour necrosis factor (TNF) has been shown to play a dominant role in the pathogenesis of various IMIDs, such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis and psoriatic arthritis. The subsequent development of biological agents capable of blocking TNF has led to important advances in the pharmacotherapy of such diseases and confirmed the concept of a common pathophysiology among IMIDs with TNF having a predominant role. Five TNF inhibitors have currently been approved for treatment of one or more IMIDs; these include infliximab, etanercept, adalimumab, golimumab and certolizumab pegol. Given the similarities in the pathogenic background of IMIDs, one could expect that anti-TNF agents be similarly effective and with comparable tolerability profiles; however, this may not be the case. Structural and pharmacological differences among the anti-TNF drugs are likely to result in differences in efficacy and tolerability among the agents in the different IMIDs, together with differences in potency, therapeutic dose ranges, dosing regimens, administration routes, and propensity for immunogenicity. Among the five TNF inhibitors approved for treatment of IMIDs, adalimumab has the widest range of indications. Data from controlled clinical trials of adalimumab, showing its excellent efficacy and tolerability in a wide range of indications, are supported by real-world long-term data from observational studies, which confirm the value of adalimumab as a suitable choice in the management of IMIDs.
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Affiliation(s)
- A Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - P Lionetti
- Gastroenterology Unit, Anna Meyer Childrens Hospital, Department of Paediatrics, University of Firenze, Firenze, Italy
| | - C Blandizzi
- Division of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Caporali
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S Chimenti
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - L Cimino
- Ocular Immunology Unit, Ophthalmology, Unit, Arcispedale S Maria Nuova Reggio, Reggio, Emilia, Italy
| | - P Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G Lapadula
- Rheumatology Unit, Interdisciplinary Department of Medicine, Medical School, University of Bari, Bari, Italy
| | | | - A Marcellusi
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - F S Mennini
- CEIS Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - C Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - R Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Childrens Hospital, University of Florence, Firenze, Italy
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41
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Notarnicola A, Iannone F, Lopalco G, Covelli M, Lapadula G. A false occult hepatitis B virus infection developed in a patient with psoriatic arthritis under infliximab and methotrexate therapy. Reumatismo 2014; 65:298-301. [DOI: 10.4081/reumatismo.2013.727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/29/2014] [Accepted: 01/28/2014] [Indexed: 11/23/2022] Open
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42
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Bello S, Bonali C, Serafino L, Rotondo C, Terlizzi N, Lapadula G. Intra-articular therapy with tumor necrosis factor-α antagonists: an update. Reumatismo 2014; 65:257-63. [PMID: 24705028 DOI: 10.4081/reumatismo.2013.721] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 11/23/2022] Open
Abstract
The aim of the study was to review from the present literature the intra-articular (IA) use of the TNF-blocking drugs. A total of 28 papers about this topic were found through a search in PubMed; the first publication's date was July 2003. These studies include a total of 214 patients affected by 12 different joint diseases that reported a total of 1046 intra-articular therapies carried out in 10 different joint sites. Infliximab and etanercept were the most widely used medications. The safety of this treatment clearly emerges from our analysis, while more difficult was the evaluation of its efficacy. Nevertheless we deduced an ideal patient profile that may better respond to the IA anti-TNF treatment.
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Affiliation(s)
- S Bello
- Rheumatology Unit, Policlinico Hospital, University of Bari.
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43
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Iannone F, Ferraccioli G, Ferri C, Galeazzi M, Gerli R, Giacomelli R, Grassi W, Gorla R, Govoni M, Marchesoni A, Punzi L, Sarzi-Puttini P, Triolo G, Lapadula G. AB0465 Etanercept therapy in rheumatoid arthritis patients with moderate or severe disease activity. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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44
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Blandizzi C, Gionchetti P, Armuzzi A, Caporali R, Chimenti S, Cimaz R, Cimino L, Lapadula G, Lionetti P, Marchesoni A, Marcellusi A, Mennini F, Salvarani C, Girolomoni G. The Role of Tumour Necrosis Factor in the Pathogenesis of Immune-Mediated Diseases. Int J Immunopathol Pharmacol 2014; 27:1-10. [DOI: 10.1177/03946320140270s101] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis, psoriatic arthritis, psoriasis, axial spondyloarthropathies, Crohn's disease, ulcerative colitis and juvenile idiopathic arthritis, comprise a group of chronic disorders characterized by an immune-mediated pathogenesis. Although at clinical presentation these diseases appear unrelated, they have been recognized to share similar pathogenic mechanisms. Data from epidemiological and genetic studies further support the concept that IMIDs are interrelated, as they can co-occur in the same patient and share a similar genetic susceptibility. The specific aetiologies of IMIDs remain unknown, but all are known to involve dysregulation of the immune system, including an over-expression of the pro-inflammatory cytokine tumour necrosis factor (TNF). The pivotal role played by TNF in the pathogenesis and pathophysiology of IMIDs has been documented by extensive preclinical and clinical investigations, and confirmed by the efficacy of anti-TNF biotechnological drugs, such as etanercept, infliximab and adalimumab, in the therapeutic management of these disorders. In this narrative review, we discuss the available data on the TNF-dependent pathogenesis of IMIDs and associations among the different disorders. Although much remains to be discovered about the pathogenesis and aetiology of IMIDs, their common inflammatory pathological features may explain why they can be successfully targeted by anti-TNF drugs. Among these, adalimumab, a fully human monoclonal antibody, has been approved for treatment ofnine distinct IMID indications and it is likely to become a valuable therapeutic tool for this complex cluster of chronic inflammatory disorders.
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Affiliation(s)
- C. Blandizzi
- Division of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P. Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - A. Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Via G. Moscati 31-33 00168 Rome, Italy
| | - R. Caporali
- Chair and Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - S. Chimenti
- Department of Dermatology, University of Rome “Tor Vergata”, Rome, Italy
| | - R. Cimaz
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence, Viale Pieraccini, Firenze 24 50139, Italy
| | - L. Cimino
- Ocular Immunology Unit, Ophthalmology, Unit, Arcispedale S Maria Nuova Reggio, Viale Risorgimento, 80 Reggio, Emilia, 42123 Italy
| | - G. Lapadula
- Rheumatology Unit, Interdisciplinary Department of Medicine, Medical School, University of Bari
| | - P. Lionetti
- Gastroenterology Unit, Anna Meyer Children's Hospital, Department of Paediatrics, University of Firenze, Viale Peraccini 24, 50139, Firenze, Italy
| | - A. Marchesoni
- G. Pini Orthopedic Institute, Piazza A. Ferrari 1, 20122 Milano, Italy
| | - A. Marcellusi
- CEIS - Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - F.S. Mennini
- CEIS - Economic Evaluation and HTA (EEHTA), IGF Department, University of Tor Vergata, Rome, Italy
| | - C. Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, Reggio Emilia 42123, Italy
| | - G. Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Covelli M, Lanciano E, Notarnicola A, Coladonato L, Lopalco G, Scioscia C, Anelli M, Lapadula G. AB0561 Risk of HBV infection reactivation in patients with rheumatoid arthritis undergoing treatment with ANTI-CD20 (RITUXIMAB). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.561] [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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46
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Lanciano E, Ciccone M, Zito A, Pinto M, Gesualdo M, Scicchitano P, Sassara M, Iannone F, Lapadula G. FRI0255 Evaluation of early markers of cardiovascular risk in subjects affected by systemic rheumatic diseases. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2712] [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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47
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Bello S, Fanizzi R, Serafino L, Albanese L, Bonali C, Lapadula G. FRI0190 Safety of certolizumab pegol in rheumatoid arthritis patients with previous hepatitis b virus exposure. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1317] [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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48
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Covelli M, Rotondo C, De Marino A, Lanciano E, Notarnicola A, Rinaldi A, Montinaro C, Lapadula G. AB0318 Patient acceptable symptom state (pass) in rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.318] [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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49
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Covelli M, Notarnicola A, Lanciano E, Coladonato L, Rotondo C, Di Teo C, Locorotondo M, Mandurino C, Dachille A, Carbonara R, Ciccone M, Lapadula G. AB0560 Evaluation of endothelial function in tocilizumab-treated rheumatoid arthritis patients refractory to TNF alfa inhibitors therapy. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.560] [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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50
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Iannone F, Lopriore S, Bucci R, Scioscia C, Anelli MG, Covelli M, Lapadula G. AB0578 Anti-tnfa therapy in psoriatic arthritis: different rate of remission in polyarticular and oligoarticular subsets. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2900] [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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