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Cafaro G, Perricone C, Ronconi G, Calabria S, Dondi L, Dondi L, Pedrini A, Esposito I, Gerli R, Bartoloni E, Martini N. Primary Sjögren's syndrome in Italy: Real-world evidence of a rare disease through administrative healthcare data. Eur J Intern Med 2024:S0953-6205(24)00064-5. [PMID: 38369445 DOI: 10.1016/j.ejim.2024.02.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/17/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease with significant impact on morbidity, mortality, and quality of life. This study aimed to evaluate epidemiology, healthcare needs and related costs of pSS patients from the Italian National Health Service perspective. METHODS From the Fondazione Ricerca e Salute's database (∼5 million inhabitants/year), pSS prevalence in 2018 was calculated. Demographics, mean healthcare consumptions and direct costs at one year following index date (first in-hospital diagnosis/disease waiver claim) were analysed through an individual direct matched pair case-control analysis (age, sex, residency). RESULTS In Italy, 3.8/10,000 inhabitants were identified as affected by pSS (1,746 case: 1,746 controls) in 2018. In the year following index date, 53.7% of cases and 42.7% of controls received ≥1 drug (p<0.001); mean per capita cost was €501 and €161, respectively (p<0.01). At least one hospitalization occurred to 7.8% of cases and 3.9% of controls (p<0.001) with mean per capita costs of €416 and €129, respectively (p = 0.46). At least one outpatient specialist service was performed in 49.8% of cases and 30.6% of controls (p<0.001); mean per capita costs were €200 and €75, respectively (p<0.01). Overall, mean annual costs were €1,171 per case and €372 per control (p < 0.01). CONCLUSION According to results of this population-based study, the prevalence of pSS in Italy appears to be consistent with the definition of rare disease. Patients with pSS have higher pharmacological, in-hospital and outpatient specialist care needs, leading to three-times higher overall cost for the INHS, compared to the general population.
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Affiliation(s)
- Giacomo Cafaro
- 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
| | - Giulia Ronconi
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Roma, Italy
| | - Silvia Calabria
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Roma, Italy
| | - Letizia Dondi
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Roma, Italy
| | - Leonardo Dondi
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Roma, Italy
| | - Antonella Pedrini
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Roma, Italy
| | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nello Martini
- Fondazione Ricerca e Salute (ReS) - Research and Health Foundation, Roma, Italy
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Bartoloni E, Perricone C, Cafaro G, Gerli R. Cardiovascular risk in patients with Sjögren's syndrome: is it time for a new approach? Clin Exp Rheumatol 2023; 41:2357-2359. [PMID: 38079325 DOI: 10.55563/clinexprheumatol/grrcod] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy.
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
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Fulvio G, La Rocca G, Chatzis LG, Ferro F, Navarro Garcia IC, Cafaro G, Goules AV, Bartoloni E, Baldini C. Impact of gender and age at onset on Sjögren's syndrome presentation and outcome: state of the art. Clin Exp Rheumatol 2023; 41:2547-2554. [PMID: 38149517 DOI: 10.55563/clinexprheumatol/lygrzv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
Sjögren's syndrome (SS) is a complex and heterogeneous disease that typically affects middle-aged women. However, while it is rare, the disease may occur in male patients and in females during their childhood/adolescence or in the elderly. Contrasting data have been reported on these three subgroups clinical features and long-term outcomes. Notably, recent studies have pinpointed the severity of the disease in male patients and in both the early and the late-onset subgroups.The aim of this review is, therefore, to summarise the available evidence from the recent literature on these phenotypes. The focus will be on the clinical and laboratory features, and on the lymphoma risk observed in the three subgroups distinct phenotypes: of male patients as well as young-onset SS and elderly-onset SS. Ultimately, an accurate phenotypic stratification may represent the first step towards individualised medical approaches.
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Affiliation(s)
- Giovanni Fulvio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gaetano La Rocca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Loukas G Chatzis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Andreas V Goules
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Perricone C, Cafaro G, Fiumicelli E, Bursi R, Bogdanos D, Riccucci I, Gerli R, Bartoloni E. Predictors of complete 24-month remission and flare in patients with polymyalgia rheumatica. Clin Exp Med 2023; 23:3391-3397. [PMID: 36566303 DOI: 10.1007/s10238-022-00976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022]
Abstract
To date, few papers investigated the predictive factors of sustained 24-month remission and of flare in patients with polymyalgia rheumatica (PMR). We retrospectively evaluated clinical charts from PMR patients. Patients were evaluated at baseline, at 1 month, 3 months and subsequently at 6, 12 and 24 months. We analyzed the differences between patients who achieved remission within 6 months of diagnosis, those who achieved remission at 24 months, and patients who did not. Among 137 patients, 57 (41.6%) achieved remission at 6 months and complete remission at 24 months was achieved by 104 patients (75.9%). The erythrocyte sedimentation rate at baseline was higher in patients who did not achieve remission than in patients who achieved it (p = 0.012). Female patients were less likely to achieve complete remission (45/68, 66.2% vs. 59/69, 85.5%, p = 0.01) compared to males. Fifty-four patients (39.4%) experienced at least one flare. Patients who did not achieve sustained complete remission suffered a flare more often (22/39 vs. 32/98, p = 0.01) and earlier than patients who did (10.33 ± 7.89 months vs. 13.64 ± 6.97 months, p = 0.011). Multivariate analysis confirmed that female sex (RR = 3.2, 95% CI 1.3-7.9) and higher baseline prednisone dosage (RR = 1.1, 95% CI 1.007-1.109) were negative independent predictors of complete remission at 24 months. A significant percentage of patients with PMR requires prolonged steroid treatment and may experience flares at 24 months of follow-up. Female sex and higher baseline prednisone dosage are negative independent predictors of complete remission at 24 months.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy.
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Elena Fiumicelli
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Bursi
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Dimitrios Bogdanos
- Internal Medicine and Autoimmune Diseases, Department Internal Medicine, University of Thessaly, Larissa, Greece
| | - Ilenia Riccucci
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Gerli
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
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Colangelo A, Tromby F, Cafaro G, Gerli R, Bartoloni E, Perricone C. Vasculitis associated with adenosine deaminase 2 deficiency: at the crossroads between Behçet's disease and autoinflammation. A viewpoint. Reumatismo 2023; 75. [PMID: 37721348 DOI: 10.4081/reumatismo.2023.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/28/2023] [Indexed: 09/19/2023] Open
Abstract
Adenosine deaminase 2 deficiency (DADA2) is a rare monogenic vasculopathy caused by loss-of-function homozygous or compound heterozygous mutations in ADA2, formerly CECR1 (cat eye syndrome chromosome region 1) gene. The DADA2 phenotype is widely heterogeneous, and patients may present with fever, weight loss, livedo reticularis/racemosa, digital ischemia, cutaneous ulceration, peripheral neuropathy, abdominal pain, bowel perforation, and portal or nephrogenic hypertension. More specific manifestations include early-onset ischemic or hemorrhagic stroke, mild immunodeficiency and hypogammaglobinemia, cytopenia, and vision disturbances. Herein, we present the case of a young male with vasculitis associated with DADA2. The presence of HLA-B51 and the clinical features of this patient raised the question of similarities between ADA2 deficiency, Behçet's disease, and NOD2-associated diseases. Treatment of this rare monogenic disease is challenging and based on small case series. The long-term experience of this patient proved the difficulties of prednisone tapering and the lack of satisfactory therapeutic strategies.
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Affiliation(s)
- A Colangelo
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia.
| | - F Tromby
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia.
| | - G Cafaro
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia.
| | - R Gerli
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia.
| | - E Bartoloni
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia.
| | - C Perricone
- Section of Rheumatology, Department of Medicine and Surgery, University of Perugia.
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Bianconi V, Cafaro G, Mannarino MR, Perricone C, Cosentini E, Bistoni O, Paltriccia R, Lombardini R, Gerli R, Pirro M, Bartoloni E. Exploring the Link between Plasma Levels of PCSK9, Immune Dysregulation and Atherosclerosis in Patients with Primary Sjögren's Syndrome. Biomolecules 2023; 13:1384. [PMID: 37759784 PMCID: PMC10527459 DOI: 10.3390/biom13091384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/12/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates lipid metabolism contributing to cardiovascular (CV) risk in the general population. The relationship between PCSK9 and CV risk in systemic autoimmune diseases has been poorly explored. We investigated the association between plasma PCSK9, measures of immune-inflammatory status and markers of atherosclerosis in 52 consecutive patients with primary Sjögren's syndrome (pSS) in comparison to healthy controls (HCs). Median plasma PCSK9 levels were significantly higher in pSS patients versus HCs (162 (79-255) vs. 53 (39-99) ng/mL). Significantly higher prevalence of subclinical atherosclerosis and lower of dyslipidaemia (61% vs. 85%, p = 0.042) characterized pSS patients versus HCs. In pSS, no significant correlation emerged between PCSK9 and disease activity, atherosclerosis and lipid levels. In HCs, PCSK9 significantly correlated with lipid levels and atherosclerosis. Interestingly, significantly higher PCSK9 levels were found in HCs with high-to-very-high as compared to low-to-moderate CV risk (p = 0.018) while a non-significant trend towards higher PCSK9 levels was detected in pSS patients with low-to-moderate as compared to high-to-very-high CV risk (p = 0.060). This is the first demonstration that pSS patients, despite lower prevalence of dyslipidaemia and higher CV risk profile, are characterized by a 3-fold increase in PCSK9 levels in comparison to HCs. As PCSK9 does not correlate with measures of CV risk, its role in CV morbidity in pSS needs further investigation.
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Affiliation(s)
- Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (V.B.); (M.R.M.); (E.C.); (R.P.); (R.L.); (M.P.)
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (G.C.); (C.P.); (O.B.); (E.B.)
| | - Massimo Raffaele Mannarino
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (V.B.); (M.R.M.); (E.C.); (R.P.); (R.L.); (M.P.)
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (G.C.); (C.P.); (O.B.); (E.B.)
| | - Elena Cosentini
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (V.B.); (M.R.M.); (E.C.); (R.P.); (R.L.); (M.P.)
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (G.C.); (C.P.); (O.B.); (E.B.)
| | - Rita Paltriccia
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (V.B.); (M.R.M.); (E.C.); (R.P.); (R.L.); (M.P.)
| | - Rita Lombardini
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (V.B.); (M.R.M.); (E.C.); (R.P.); (R.L.); (M.P.)
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (G.C.); (C.P.); (O.B.); (E.B.)
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (V.B.); (M.R.M.); (E.C.); (R.P.); (R.L.); (M.P.)
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (G.C.); (C.P.); (O.B.); (E.B.)
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Cafaro G, Bartoloni E, Baldini C, Franceschini F, Riccieri V, Fioravanti A, Fornaro M, Ghirardello A, Palterer B, Infantino M, Rigon A, Del Rosso S, Gerli R, Villalta D, Bizzaro N. Autoantibody status according to multiparametric assay accurately estimates connective tissue disease classification and identifies clinically relevant disease clusters. RMD Open 2023; 9:e003365. [PMID: 37734871 PMCID: PMC10514657 DOI: 10.1136/rmdopen-2023-003365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Assessment of circulating autoantibodies represents one of the earliest diagnostic procedures in patients with suspected connective tissue disease (CTD), providing important information for disease diagnosis, identification and prediction of potential clinical manifestations. The purpose of this study was to evaluate the ability of multiparametric assay to correctly classify patients with multiple CTDs and healthy controls (HC), independent of clinical features, and to evaluate whether serological status could identify clusters of patients with similar clinical features. METHODS Patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjogren's syndrome (SjS), undifferentiated connective tissue disease (UCTD), idiopathic inflammatory myopathies (IIM) and HC were enrolled. Serum was tested for 29 autoantibodies. An XGBoost model, exclusively based on autoantibody titres was built and classification accuracy was evaluated. A hierarchical clustering model was subsequently developed and clinical/laboratory features compared among clusters. RESULTS 908 subjects were enrolled. The classification model showed a mean accuracy of 60.84±4.05% and a mean area under the receiver operator characteristic curve of 88.99±2.50%, with significant discrepancies among groups. Cluster analysis identified four clusters (CL). CL1 included patients with typical features of SLE. CL2 included most patients with SjS, along with some SLE and UCTD patients with SjS-like features. CL4 included anti-Jo1 patients only. CL3 was the largest and most heterogeneous, including all the remaining subjects, overall characterised by low titre or lower-prevalence autoantibodies. CONCLUSION Extended multiparametric autoantibody assay allowed an accurate classification of CTD patients, independently of clinical features. Clustering according to autoantibody titres is able to identify clusters of CTD subjects with similar clinical features, independently of their final diagnosis.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Antonella Fioravanti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese - Policlinico Le Scotte, Siena, Italy
| | - Marco Fornaro
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Anna Ghirardello
- Rheumatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Boaz Palterer
- Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | - Maria Infantino
- Laboratory of Immunology and Allergology, San Giovanni di Dio Hospital, Florence, Italy
| | - Amelia Rigon
- Clinical Immunology and Rheumatology, Campus Bio-Medico University, Rome, Italy
| | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Danilo Villalta
- Immunology and Allergology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, Azienda Sanitaria Universitaria Integrata di Udine, Tolmezzo, Italy
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Ceccarelli F, Perricone C, Natalucci F, Picciariello L, Olivieri G, Cafaro G, Bartoloni E, Roberto G, Conti F. Organ damage in Systemic Lupus Erythematosus patients: A multifactorial phenomenon. Autoimmun Rev 2023:103374. [PMID: 37301273 DOI: 10.1016/j.autrev.2023.103374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
The prevention of chronic damage, especially in early disease phases, remains an unmet need in the management of Systemic Lupus Erythematous (SLE) patients, despite the application of a so-called treat-to-target strategy. The high proportion of SLE patients developing chronic damage suggests a multifactorial aetiology. Thus, besides disease activity, other factors may contribute to the development of damage. The revision of data published so far underlines that, next to disease activity, it is possible to identify other factors playing a relevant role in damage development and progression. In summary, the presence of antiphospholipid antibodies and drugs used to treat SLE patients, in particular glucocorticoids, is strongly associated with SLE-related damage. Furthermore, recent data suggests the possible role of genetic background in determining the development of specific organ damage, in particular renal and neurological. Nonetheless, demographic factors, such as age, sex and disease duration could exert a role along with the presence of comorbidities. The contribution of different factors in determining damage development suggests the need for new outcomes to assess a comprehensive disease control including not only the assessment of disease activity, but also the evaluation of chronic damage development.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Francesco Natalucci
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Licia Picciariello
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Research Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gerli Roberto
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabrizio Conti
- Lupus Clinic, Division of Rheumatology, Department of Internal Clinical Sciences, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Perricone C, Bartoloni E, Cafaro G, Caporali R, Gerli R. Correspondence on 'Anti-inflammatory therapy for COVID-19 infection: the case for colchicine'. Ann Rheum Dis 2023; 82:e81. [PMID: 33509794 DOI: 10.1136/annrheumdis-2021-219872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- 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
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, ASS G Pini, University of Milan, Milano, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia 06129, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia 06129, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia 06129, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia 06129, Italy
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Cafaro G, Perricone C, Gerli R, Bartoloni E. Comment on: "Gluten or no gluten for rheumatic diseases?" by Philippou E et al. Joint Bone Spine 2022;105453. doi: 10.1016/j.jbspin.2022.105453. Joint Bone Spine 2023; 90:105471. [PMID: 36273794 DOI: 10.1016/j.jbspin.2022.105471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Giacomo Cafaro
- 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
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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Manfrè V, Chatzis LG, Cafaro G, Fonzetti S, Calvacchi S, Fulvio G, Navarro Garcia IC, La Rocca G, Ferro F, Perricone C, Bartoloni E, Baldini C. Sjögren's syndrome: one year in review 2022. Clin Exp Rheumatol 2022; 40:2211-2224. [DOI: 10.55563/clinexprheumatol/43z8gu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Valeria Manfrè
- Division of Rheumatology, Academic Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Loukas G. Chatzis
- Pathophysiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Silvia Fonzetti
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - Santina Calvacchi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Giovanni Fulvio
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | | | - Gaetano La Rocca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
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Cafaro G, Perricone C, Bursi R, Riccucci I, Calvacchi S, Lomurno G, Gerli R, Bartoloni E. Ultrasound scoring systems affect the distribution of sialadenitis scores in Sjögren's syndrome: an inter-system reproducibility study. Clin Exp Rheumatol 2022; 40:2253-2257. [PMID: 36200944 DOI: 10.55563/clinexprheumatol/hseeli] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Salivary gland ultrasonography (SGUS) is commonly employed in the diagnosis and follow-up of patients with Sjögren's syndrome (SS) and multiple scoring systems have been developed to quantify the grade of sialadenitis of major salivary glands (SG). Their diagnostic performance seems overall comparable, however, the parameters evaluated by the various systems are different. The objective of this study was to compare how four different scoring systems affect the distribution of sialadenitis grades. METHODS One hundred and three SGUS images from 26 SS patients were blindly scored by two investigators according to the De Vita, Salaffi, Milic and OMERACT scoring systems in independent sessions. RESULTS The distribution of SGUS images according to De Vita, Salaffi, Milic and OMERACT systems was significantly different. At post-hoc analysis, Milic system performed differently compared to the De Vita (p<0.0001), OMERACT (p<0.0001) and Salaffi (p<0.0001) systems, showing a relative overestimation of sialadenitis grade. CONCLUSIONS Milic scoring system showed to relatively overestimate the grade of sialadenitis compared to De Vita, Salaffi and OMERACT systems. Although all scoring systems seem to be comparable in terms of diagnostic accuracy, in the prospect of selecting one system to be potentially included in future versions of SS classification criteria, it is important to compare their ability to classify SGUS images among the various degrees of sialadenitis.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Roberto Bursi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Santina Calvacchi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Giuseppe Lomurno
- Oral Surgery Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
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Erre GL, Cacciapaglia F, Sakellariou G, Manfredi A, Bartoloni E, Viapiana O, Fornaro M, Cauli A, Mangoni AA, Woodman RJ, Palermo BL, Gremese E, Cafaro G, Nucera V, Vacchi C, Spinelli FR, Atzeni F, Piga M. C-reactive protein and 10-year cardiovascular risk in rheumatoid arthritis. Eur J Intern Med 2022; 104:49-54. [PMID: 35821191 DOI: 10.1016/j.ejim.2022.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the association between C-reactive protein (CRP) and 10-year risk of cardiovascular (CV) events using the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), based on conventional and RA-specific risk factors but not CRP, in RA patients without previous cardiovascular events. METHODS ERS-RA was calculated in 1,251 "Cardiovascular Obesity and Rheumatic Disease Study (CORDIS)" database patients [(age 60.4(9.3) years; 78% female; disease duration, 11.6(8) years; CDAI, 9(9); CRP, 6.8(12) mg/L]. RESULTS The mean (SD) 10-year risk of CV events was 12.9% (10). After adjusting for the use of DMARDs and biologics, CRP concentrations were significantly associated with 10-year risk of CV events (coefficient=0.005 for each 10 mg/L CRP increment; 95%CI 0.000-0.111; p = 0.047). In mediation analysis, the association between CRP and ERS-RA was not explained by disease activity. CONCLUSION In a large cohort of RA patients without previous cardiovascular events, a 20 mg/L increase in CRP concentrations was associated with a 1% increase in 10-year risk of CV events. This suggests that actively targeting residual inflammatory risk beyond conventional and RA-specific risk factors might further reduce CV event rates in RA patients.
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Affiliation(s)
- Gian Luca Erre
- University and AOU of Sassari, Dipartimento di Medicina, Chirurgia e Farmacia, Sassari, Italy.
| | - Fabio Cacciapaglia
- University and AOU, Policlinico of Bari, Department of Emergency and Organs Transplantation, Bari, Italy
| | | | - Andreina Manfredi
- Azienda Ospedaliera Universitaria Policlinico di Modena, Unit of Rheumatology, Modena, Italy
| | - Elena Bartoloni
- University of Perugia, Department of Medicine and Surgery, Perugia, Italy
| | | | - Marco Fornaro
- University and AOU, Policlinico of Bari, Department of Emergency and Organs Transplantation, Bari, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Italy
| | - Arduino Aleksander Mangoni
- Flinders University and Flinders Medical Centre, Discipline of Clinical Pharmacology, College of Medicine and Public Health, Adelaide, Australia
| | - Richard John Woodman
- Flinders University, Centre of Epidemiology and Biostatistics, College of Medicine and Public Health, Adelaide, Australia
| | | | - Elisa Gremese
- Policlinico Gemelli, Università Cattolica del Sacro Cuore, Dipartimento di Scienze Mediche e Chirurgiche, Roma, Italy
| | - Giacomo Cafaro
- University of Verona, Dipartimento di Medicina, Verona, Italy
| | - Valeria Nucera
- University of Messina, Dipartimento di Medicina Clinica e Sperimentale, Messina, Italy
| | - Caterina Vacchi
- University of Modena and Reggio Emilia, Clinical and Experimental Medicine PhD Program, Modena, Italy
| | - Francesca Romana Spinelli
- Università La Sapienza, Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e Cardiovascolari, Roma, Italy
| | - Fabiola Atzeni
- University of Messina, Dipartimento di Medicina Clinica e Sperimentale, Messina, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Italy
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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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Abstract
Sjögren Syndrome (SS) seems to be associated with a greater “overall risk” of cardiovascular (CV) and cerebrovascular events. Although not conventionally considered a feature of the disease, CV events represent a major burden in SS patients. CV risk is the consequence of a complex combination of multiple factors, including traditional risk factors and disease-related mechanisms. A complex relationships between disease-related features, endothelial dysfunction and traditional risk factor has been suggested. Several drugs are available for treating the systemic manifestations of SS, however they have shown positive effects on different outcomes of the disease, but until today the data on the role of these drugs on CV events are scarse. Given these data, the aim of this review was to evaluate the risk of CV risk in primary SS and the effect of the drugs on this manifestation.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Correspondence: Fabiola Atzeni,
| | - Francesco Gozza
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giacomo Cafaro
- 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
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Cacciapaglia F, Spinelli FR, Piga M, Erre GL, Sakellariou G, Manfredi A, Viapiana O, Fornaro M, Colella S, Floris A, Mangoni AA, Castagna F, Vacchi C, Orsolini G, Bugatti S, Cafaro G, Cauli A, Gremese E, Atzeni F, Bartoloni E. Estimated 10-year cardiovascular risk in a large Italian cohort of rheumatoid arthritis patients: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group. Eur J Intern Med 2022; 96:60-65. [PMID: 34657778 DOI: 10.1016/j.ejim.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several cardiovascular (CV) risk algorithms are available to predict CV events in the general population. However, their performance in patients with rheumatoid arthritis (RA) might differ from the general population. This cross-sectional multicentre study aimed to estimate the 10-year CV risk using two different algorithms in a large RA cohort and in patients with osteoarthritis (OA). METHODS In a consecutive series of RA patients and matched OA controls without prior CV events, clinical and serologic data and traditional CV risk factors were recorded. The 10-year CV risk was assessed with the Systematic COronary Risk Evaluation (SCORE) and the "Progetto Cuore" algorithms. RESULTS 1,467 RA patients and 342 OA subjects were included. RA patients were more frequently diabetic (9.9% vs 6.4%; p=0.04) and smokers (20.4% vs 12.5%; p=0.002) but had lower prevalence of obesity (15% vs 21%; p=0.003). Dyslipidaemia was more prevalent in OA (32.5% vs 21.7%; p<0.0001). The 10-year estimated CV risk was 1.6% (95%CI 1.3-1.9) in RA and 1.4% (95%CI 1.3-1.6) in OA (p=0.002) according to SCORE and 6.5% (95%CI 6.1-6.9) in RA and 4.4% (95%CI 3.9-5.1) in OA (p<0.001) according to "Progetto Cuore". Regardless of the score used, RA patients had a 3- to-4-fold increased 10-year risk of CV events compared to OA subjects. CONCLUSION RA patients have a significantly higher 10-year risk of CV events than OA subjects. In addition to effective disease control and joint damage prevention, specific protective measures targeting modifiable traditional CV risk factors should be implemented in RA.
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Affiliation(s)
- Fabio Cacciapaglia
- Rheumatology Unit - Department of Emergency Medicine and Transplantation (DETO), Università degli Studi di Bari Facoltà di Medicina e Chirurgia, Bari, Puglia, Italy.
| | - Francesca Romana Spinelli
- Dipartimento di Medicina Interna e Specialità Mediche - Reumatologia, Università degli Studi di Roma La Sapienza, Roma, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari, University Clinic AOU, Cagliari, Italy
| | - Gian Luca Erre
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy
| | - Garifallia Sakellariou
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Andreina Manfredi
- Rheumatology Unit, Azienda Ospedaliera Universitaria Policlinico of Modena, Modena, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Fornaro
- Rheumatology Unit - Department of Emergency Medicine and Transplantation (DETO), Università degli Studi di Bari Facoltà di Medicina e Chirurgia, Bari, Puglia, Italy
| | - Sergio Colella
- Rheumatology Unit - Department of Emergency Medicine and Transplantation (DETO), Università degli Studi di Bari Facoltà di Medicina e Chirurgia, Bari, Puglia, Italy
| | - Alberto Floris
- Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari, University Clinic AOU, Cagliari, Italy
| | - Arduino Aleksander Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Floriana Castagna
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy
| | - Caterina Vacchi
- Rheumatology Unit, Azienda Ospedaliera Universitaria Policlinico of Modena, Modena, Italy
| | - Giovanni Orsolini
- Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Serena Bugatti
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari, University Clinic AOU, Cagliari, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Cafaro G, Petito E, Bistoni O, Falcinelli E, Cipriani S, Borghi MC, Bonifacio AF, Giglio E, Alunno A, Perricone C, Gerli R, Gresele P, Bartoloni E. Methotrexate improves endothelial function in early rheumatoid arthritis patients after 3 months of treatment. Arthritis Res Ther 2022; 24:236. [PMID: 36280849 PMCID: PMC9590167 DOI: 10.1186/s13075-022-02930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Endothelial dysfunction contributes to increased cardiovascular (CV) disease in rheumatoid arthritis (RA). Angiogenic T cells (Tang) are a key regulator of vascular function via their interaction with endothelial progenitor cells (EPCs). Methotrexate (MTX) has been associated to reduced CV disease risk, but its effects on endothelial homeostasis have been poorly explored. We investigated MTX effects on endothelial homeostasis in early, treatment-naïve RA patients. Methods Fifteen untreated, early RA patients and matched healthy controls (HC) were enrolled. RA patients with long-standing disease in remission or low disease activity treated with MTX for at least 6 months were selected as controls. Circulating CD28+ and CD28null Tang cell, endothelial microparticle (EMP), EPC and soluble vascular cell adhesion molecule (sVCAM)-1 levels were measured. Results Tang percentage was higher in early RA than in HCs and significantly increased after 3-month MTX treatment. Tang cells in RA were characterized by higher percentage of CD28null and lower CD28-positive cells than HCs. MTX restored a Tang cell phenotype similar to HCs. Altered sVCAM-1, EMP and EPC were restored to levels similar to HCs after a 3-month MTX. Biomarker levels after 3 months of MTX were not different to those of patients with long-standing treatment. Conclusions MTX has a positive effect on Tang, sVCAM-1, EPCs and EMPs in RA. Restoration of imbalance between CD28 + and CD28null Tang by MTX may be one of the mechanisms underlying its favourable effects on endothelial dysfunction. These effects seem to be long-lasting and independent from systemic inflammation reduction, suggesting a direct effect of MTX on the endothelium.
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Affiliation(s)
- Giacomo Cafaro
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Onelia Bistoni
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Sabrina Cipriani
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Maria Chiara Borghi
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Angelo F. Bonifacio
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Elisa Giglio
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessia Alunno
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy ,grid.158820.60000 0004 1757 2611Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Carlo Perricone
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, 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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Cafaro G, Perricone C, Riccucci I, Bursi R, Calvacchi S, Alunno A, Carubbi F, Gerli R, Bartoloni E. Traditional and disease-related non-computed variables affect algorithms for cardiovascular risk estimation in Sjögren's syndrome and rheumatoid arthritis. Clin Exp Rheumatol 2021; 39 Suppl 133:107-113. [PMID: 34665709 DOI: 10.55563/clinexprheumatol/xef8uz] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Several cardiovascular (CV) risk algorithms are available to predict CV events in the general population. Their performance and validity in rheumatic disease patients is suboptimal as some disease-specific variables which strongly contribute to the pathogenesis of CV disease are not included in these CV algorithms. We aimed to evaluate the performance of two CV algorithms and investigate which variables not included in the score contribute to CV risk score in a cohort of rheumatoid arthritis (RA) and Sjögren's syndrome (SS) patients. METHODS A consecutive cohort of 77 RA and 68 SS patients without prior CV events was included. Clinical and serological features and traditional CV risk factors were collected. The 10-year CV risk was assessed by Reynold Risk Score (RSS) and "Progetto Cuore" algorithms. RESULTS Prevalence of traditional CV risk factors and 10-year risk of fatal and non-fatal CV events assessed by RSS and "Progetto Cuore" were similar between the two cohorts. Multiple linear regression model showed that, among variables not included in both algorithms, body mass index (BMI) and disease activity were predictors of "Progetto Cuore" while BMI and bone erosions of RSS in RA. In SS, C-reactive protein was predictor of "Progetto Cuore" while hypertension, ESSDAI and LDL-cholesterol of RSS. CONCLUSIONS The 10-year risk of fatal and non-fatal CV events is similar in RA and SS. Traditional CV risk factors, as hypertension, strongly contribute to CV risk in these patients. Inflammatory parameters and disease activity are two disease-specific variables which should be included in CV algorithm assessment in rheumatic disease patients.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Roberto Bursi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Santina Calvacchi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, Italy
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, and Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
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Cafaro G, Bursi R, Chatzis LG, Fulvio G, Ferro F, Bartoloni E, Baldini C. One year in review 2021: Sjögren's syndrome. Clin Exp Rheumatol 2021; 39 Suppl 133:3-13. [PMID: 34874834 DOI: 10.55563/clinexprheumatol/eojaol] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022]
Abstract
Sjögren's syndrome (SS) is a multifactorial systemic autoimmune disease of unknown aetiology characterised by a wide spectrum of different clinical manifestations and scattered complications. Recently, great efforts have been made to elucidate mechanisms involved in the pathogenesis of the disease in order to identify exploitable therapeutic targets in SS. Similarly, novel insights have enabled to better define disease phenotypes and different outcomes. Ultimately, the discovery of new potential therapeutic targets and a better stratification of patients are paving new avenues for novel treatment options and treat-to-target therapeutic approach. In this review, we will provide a critical digest of the recent literature published in 2020 on SS pathogenesis, clinical manifestations and novel treatment options.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Roberto Bursi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Loukas G Chatzis
- Department of Pathophysiology, Athens School of Medicine, National and Kapodistrian University of Athens, and Institute for Autoimmune Systemic and Neurological Diseases, Athens, Greece
| | - Giovanni Fulvio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Zabotti A, Luchetti MM, Selmi CF, Ramonda R, Grembiale RD, Dagna L, D'Angelo S, Cafaro G, De Vita S, Felicetti M, Marelli S, Frigerio D, Favalli EG. An Italian Disease-Based Registry of Axial and Peripheral Spondyloarthritis: The SIRENA Study. Front Med (Lausanne) 2021; 8:711875. [PMID: 34631733 PMCID: PMC8492964 DOI: 10.3389/fmed.2021.711875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Data about the clinical presentation and management of early and mild spondyloarthritis (SpA) are limited. Objectives: The objective of this study was to describe the baseline characteristics of disease-modifying antirheumatic drug (DMARD)-naïve patients with axial or peripheral SpA. Methods: The Spondyloarthritis Italian Registry: Evidence from a National Pathway (SIRENA) study is an ongoing, Italian, multicenter, prospective registry of patients with a first or newly confirmed diagnosis of SpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. To be included, patients had to be naïve to conventional, targeted, and biological DMARDs for SpA. Patients were enrolled between June 2017 and June 2019 and classified into groups according to disease presentation: predominantly axial or peripheral manifestations. The study is ongoing, and patients are being followed for 2 years, with an evaluation every 6 months according to clinical practice. Differences in baseline demographics, lifestyle, and clinical characteristics between axial and peripheral SpA were evaluated. Results: In this study, 350 patients were enrolled, of which 123 (35.1%) were axial and 227 (64.9%) were peripheral patients. Patients with axial SpA were significantly younger at enrollment (median age: 44 vs. 53 years), had significantly more anxiety/depression (13 vs. 2.6%), and expressed higher disease activity compared to patients with peripheral SpA. Patients with peripheral SpA had significantly more cardiometabolic disorders (33 vs. 18.7%), skin psoriasis (65.2 vs. 21.1%), and nail psoriasis (35.5 vs. 17.1%) than patients with axial SpA. Dactylitis, enthesitis, and fibromyalgia were observed, respectively, in 17.6, 51.2, and 5.7% of patients with axial SpA and 24.3, 40, and 3.1% of patients with peripheral SpA. In both disease groups, women tended to report depression, joint tenderness, and higher disease activity more frequently than their male counterparts. At inclusion, a new diagnosis of SpA was performed in 58% of axial and 77% of peripheral patients, with a median time from symptom onset to diagnosis of 36 and 24 months, respectively. At baseline, most patients with axial SpA (77%) started a biological DMARD, while over half of the peripheral patients started a conventional DMARD. Conclusions: Based on a well-characterized clinical registry of SpA, we provided real-world insights on the clinical features of DMARD-naïve SpA patients, pointing out major differences between axial and peripheral disease in terms of clinical characteristics and treatment pattern. Future prospective evaluations within the SIRENA study will improve knowledge on SpA and contribute to defining the best therapeutic approach.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Michele Maria Luchetti
- Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Francesco Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Rosa Daniela Grembiale
- Rheumatology Research Unit, Dipartimento di Scienze della Salute, Università "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan and Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania, San Carlo Hospital, Potenza, Italy
| | - Giacomo Cafaro
- Reumatologia, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, University of Udine, Academic Hospital S. Maria della Misericordia, Udine, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Silvia Marelli
- Medical Affairs Department, Immunology, Janssen-Cilag SpA, Milan, Italy
| | - Daniela Frigerio
- Medical Affairs Department, Immunology, Janssen-Cilag SpA, Milan, Italy
| | - Ennio Giulio Favalli
- S.C. Reumatologia ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini - CTO, Milan, Italy
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Bartoloni E, Perricone C, Cafaro G, Alunno A, Gerli R. The facts and fictions of precision medicine in autoimmune diseases: is machine learning approach the response? Rheumatology (Oxford) 2021; 61:484-485. [PMID: 34534273 DOI: 10.1093/rheumatology/keab715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elena Bartoloni
- 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
| | - Alessia Alunno
- Rheumatology Unit. Department of Medicine and Surgery. University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit. Department of Medicine and Surgery. University of Perugia, Perugia, Italy
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Perricone C, Fiumicelli E, Cafaro G, Bursi R, Ilenia R, Bartoloni Bocci E, Gerli R. POS0019 PREDICTORS OF SUSTAINED 6 MONTHS REMISSION AND FLARE IN PATIENTS WITH POLYMYALGIA RHEUMATICA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3593] [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
Background:Polymyalgia rheumatica (PMR) is a typical inflammatory disease of the elderly. The mainstay of treatment is usage of oral glucocorticoids (GC) usually leading to a dramatic response. However, long-term treatment is often required. In some instances, remission cannot be achieved and disease flares can occur. To date, few papers investigated the predictive factors of response to GC therapy suggesting a role for weight, elevated plasma viscosity and C-reactive protein (CRP). Moreover, there are no data on predictor factors of disease flares after 6 months of sustained remission.Objectives:To evaluate the factors predictive of sustained 6 months remission and of flare in patients with PMR.Methods:We evaluated clinical data from 137 PMR patients treated with GC for more than 6 months between September 2002 and June 2020. Patients were evaluated at baseline, re-evaluated at 1 month and after 3 months and then at least every 3 months. We analyzed the differences between patients who achieved remission within 6 months of diagnosis, who maintained it for at least 6 months, and patients who did not. Remission was defined as 1) the absence of clinical symptoms, 2) <7.5 mg / day of prednisone equivalents and 3) negativity of ESR and CRP. Patients treated with methylprednisolone were excluded from the analysis.Results:Among the 137 patients (baseline F68: M69, mean age ± SD 74.5±6.6 years, mean ESR ± SD 49.9±27.7 mm/h, mean CRP ± SD 6.1±11.4 mg/dl), 57 achieved remission at 6 months (41.6%), and after this period, another 47 went into remission for a total of 104 patients (75.9%). The months required to achieve remission averaged 6.4 ± 3. No differences were observed between patients who achieved remission and patients who did not regarding age, sex, CRP, starting dose of GC, anti-CCP and rheumatoid factor. The ESR at baseline was higher in patients who did not achieve remission (58.1±33.4 mm/h) than in patients who achieved it (46±24.8 mm/h, p=0.06). ESR at baseline correlated with the time needed to reach normalization of both ESR and CRP (p=0.01, Figure 1). Thirty-six of 104 patients (34.6%) had a disease flare after a mean of 6.1±2.7 months of remission. The mean GC intake at flare was 2.8±3 mg/day. Only 15/36 (41.6%) patients were able to withhold GCs after flare, compared with 48/68 (70.5%) patients who achieved remission and did not experience flare. There were no significant differences in any analyzed parameters between patients who experienced flares and those who did not, including ESR and CRP values at baseline (50.3±26.7 mm/h and 6.8±12.1 mg/dl, respectively). A higher percentage of patients who did not achieve remission experienced flare than patients who went into remission (p=0.009).Conclusion:Achieving complete remission at 6 months occurs in a consistent percentage of patients with PMR. Despite this, a significant percentage of patients may need prolonged steroid treatment and may experience flare, even after 12 months of follow-up. Remission at 6 months is likely to be a good predictor of remission at 12 months, as already reported in recent studies (1, 2). Elevated ESR at diagnosis appears to be a negative predictor for remission at 6 months. Patients who achieve complete remission are less likely to develop flare. True remission should coincide with the discontinuation of steroid treatment; in fact, the maintenance of steroid therapy, even at low doses, is predictive of the development of flare.References:[1]Hattori K, et al. Int J Rheum Dis. 2020[2]Camellino D, et al. Nat Rev Rheumatol. 2020Figure 1.Disclosure of Interests:Carlo Perricone Speakers bureau: BMS, Lilly, Celgene, UCB, Abbvie, Pfizer, Sanofi, Accord, Novartis, Elena Fiumicelli: None declared, Giacomo Cafaro: None declared, Roberto Bursi: None declared, Ricucci Ilenia: None declared, Elena Bartoloni Bocci: None declared, Roberto Gerli: None declared.
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Zabotti A, Luchetti MM, Selmi C, Ramonda R, Grembiale RD, Dagna L, D’angelo S, Cafaro G, De Vita S, Felicetti M, Marelli S, Frigerio D, Favalli E. POS1061 THE ITALIAN PROSPECTIVE SIRENA STUDY: FOCUS ON EARLY PSORIATIC ARTHRITIS COHORT AND GENDER DIFFERENCES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.607] [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:Limited data on early Psoriatic Arthritis (PsA) are available1,2.Objectives:To describe baseline data of PsA patients naive to any DMARDs.Methods:SIRENA study is an Italian, prospective Registry of Spondyloarthritis patients diagnosed according to ASAS criteria and naïve to any DMARDs. Data on demographic and clinical characteristics of PsA cohort were collected and analysed, also by gender.Results:203/350 (58%) subjects included in SIRENA Registry had PsA (mean age 51.9 years) and in 190/203 (94%) CASPAR classification criteria were fulfilled. In 70% of patients the diagnosis was performed within 24 months from symptom onset. At baseline, 194/203 (95.6%) had mainly peripheral manifestations, 74.4% of patients had skin psoriasis, 40% nail psoriasis, 39.3% clinical enthesitis and 25.9% dactylitis. Mean SJC66 and TJC68 were, respectively, 3 and 7.2; mean PhGA was 46.3; 14.7% of patients were in MDA.The higher tender joint count in women (mean TJC68 9.3 in women vs 5.3 in men) resulted in a higher disease activity according to DAPSA (high disease activity: 11.5% women vs 4.1% men), a higher joint VAS score (mean score 47.1 women vs 39.8 men) and a lower prevalence of MDA (8.3% women vs 20% men). We observed a higher prevalence of moderate or severe psoriasis in men (BSA≥3%: 37% men vs 27.8% women) while all PROs collected (PtGA, pain VAS score, sleep VAS score, BASFI, BASDAI, HAQ-DI, WPAI) were worse in women.The most common comorbidities were cardiometabolic (35.5%), endocrine (9.4%), and gastrointestinal disorders (7.4%). Cardiometabolic disorders were more frequently reported by men, endocrine and gastrointestinal disorders by women; depression exclusively by women.Conclusion:This analysis provides real-life data in a cohort of early PsA subjects. Relevant gender differences were observed, with women showing a higher disease activity and more joint pain and men having more severe psoriasis. Women also perceived a worse disease burden.References:[1]Theander E, et al. Ann Rheum Dis 2014; 73:407–413.[2]Nas K, et al. Mod Rheumatol 2017; 27(2):345-349.Table 1.Baseline dataPsAAll patients (n=203)Women (n=98)Men (n=105)Age (years), mean (SD)51.9 (13.1)51.1 (13.2)52.7 (13.0)Men, n (%)105 (51.7)0 (0)105 (100)BMI (kg/m2), mean (SD)25.9 (4.4)25.4 (4.9)26.4 (3.9)BMI categories^, n (%) Obese40 (21.2)20 (22.2)20 (20.2) Overweight44 (23.3)15 (16.7)29 (29.3) Under/normal weight105 (55.6)55 (61.1)50 (50.5)Comorbidities > 5%*, n (%) Cardiometabolic72 (35.5)28 (28.6)44 (41.9) Endocrine disease19 (9.4)15 (15.3)4 (3.8) Gastrointestinal15 (7.4)10 (10.2)5 (4.8) Depression/Anxiety8 (3.9)8 (8.2)0 (0) Hepatic diseases7 (3.5)1 (1.0)6 (5.7)Clinical assessmentCRP (mg/dl), median (min-max)0.40 (0 – 7.12)0.31 (0 - 5.40)0.49 (0 - 7.12)SJC66, mean (SD)3.0 (4.0)3.2 (4.0)2.7 (4.0)TJC68, mean (SD)7.2 (8.8)9.3 (10.3)5.3 (6.6)Dactylitis, n/tot assessed (%)35/135 (25.9)12/63 (19.1)23/72 (31.9)Enthesitis, n/tot assessed (%)66/168 (39.3)39/80 (48.8)27/88 (30.7)Psoriasis skin, n (%)151 (74.4)68 (69.4)83 (79.1)Psoriasis nails, n/tot assessed (%)62/155 (40.0)29/75 (38.7)33/80 (41.3)Fibromyalgia, n (%)6 (3.0)5 (5.2)1 (1.0)VAS, mean (SD) [range: 0-100] PhGA score46.3 (25.8)51.2 (25.4)41.7 (25.4) Joint score43.3 (26.8)47.1 (25.2)39.8 (27.8) Skin score20.3 (24.0)17.8 (23.1)22.6 (24.8)DAPSA, mean (SD)22.3 (14.1)26.8 (15.4)18.7 (11.9)DAPSA categories^, n (%)High disease activity13 (7.4)9 (11.5)4 (4.1)Moderate disease activity83 (47.2)43 (55.1)40 (40.8)Low disease activity71 (40.3)24 (30.8)47 (48.0)Remission9 (5.1)2 (2.6)7 (7.1)MDA°, n (%)23 (14.7)6 (8.3)17 (20.0)BSA categories, n (%) 3-10% (moderate psoriasis)35 (24.6)13 (21.2)22 (27.1) >10% (severe psoriasis)12 (8.5)4 (6.6)8 (9.9)* A patient could report one or more comorbidities. ^The sum does not add up to the total because of some missing values. ° According to Coates et al. (Ann Rheum Dis. 2010;69: 48).Disclosure of Interests:Alen Zabotti: None declared, Michele Maria Luchetti Speakers bureau: Honorary fees for conferences and workshops by Janssen, Abbvie, Novartis, Lilly, Celgene, Pfizer, Carlo Selmi Speakers bureau: Honoraria and/or speaker bureau from AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer, Sanofi-Regeneron, Grant/research support from: Research support from Amgen, Janssen, Novartis, Pfizer, Roberta Ramonda Speakers bureau: Honoraria and speaker fees from Novartis, Abbvie, Pfizer, MSD, Janssen, Rosa Daniela Grembiale: None declared, Lorenzo Dagna Consultant of: Consultation honoraria from Abbvie, Amgen, Biogen, Celltrion, GlaxoSmithKline, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI, Salvatore D’Angelo Speakers bureau: Consulting fees and/or speakers bureau from AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi and UCB, Giacomo Cafaro: None declared, Salvatore De Vita: None declared, Mara Felicetti: None declared, Silvia Marelli Employee of: Janssen-Cilag SpA, Daniela Frigerio Employee of: Janssen-Cilag SpA, Ennio Favalli Speakers bureau: Consulting fees and/or speaking engagements from AbbVie, Bristol-Myers Squibb, Lilly, Merck Sharp & Dohme, Pfizer, Galapagos, Sanofi-Genzyme, and UCB.
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Erre GL, Cacciapaglia F, Sakellariou G, Manfredi A, Bartoloni Bocci E, Viapiana O, Fornaro M, Dessì M, Mangoni AA, Palermo BL, Gremese E, Cafaro G, Nucera V, Vacchi C, Spinelli FR, Atzeni F, Piga M. POS0214 ASSOCIATION BETWEEN C-REACTIVE PROTEIN AND 10-YEAR RISK OF CARDIOVASCULAR DISEASE IN RHEUMATOID ARTHRITIS USING THE ERS-RA SCORE: A CROSS-SECTIONAL ANALYSIS OF THE CORDIS COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2643] [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
Background:Rheumatoid arthritis (RA) is associated with an increased risk of atherosclerotic cardiovascular disease (CVD). The Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) estimates the 10-year risk of myocardial infarction, stroke or CVD-related death based on conventional and RA-specific (clinical disease activity index, CDAI, disease duration, glucocorticoid use) risk factors (1).Objectives:We evaluated the associations between ERS-RA 10-year risk of CVD, high-sensitivity C-reactive protein (hs-CRP) concentrations, and pharmacological treatment in 1,251 RA patients collected by the “Cardiovascular Obesity and Rheumatic Disease Study (CORDIS)” group of the Italian Society of Rheumatology (SIR).Methods:We assessed independent associations between ERS-RA risk score and each relevant variable using multivariate regression (ENTER approach; listwise deletion analysis). Given the relatively high number of missing hs-CRP data (n=385), regression analysis was also performed using multiple imputation (10 sets, Stata 16.1). Regression models were not adjusted for independent variables included in the ERS-RA score.Results:Among 1,251 RA patients [mean (SD) age 60.4(9.3), range (40-80) years; 78% female; mean (SD) disease duration, 11.6(8) years; mean (SD) CDAI, 9(9); mean (SD) HAQ, 0.77(0.7); mean (SD) hs-CRP, 6.8(12) mg/L] the estimated 10-year CVD risk was 11.6(0.9) % [mean (SD)]. Regarding treatment, 539(43%) received glucocorticoids, 676(54%) a biological or targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) (n missing=1), and 885(81%) at least one conventional synthetic DMARD (csDMARD). Ninety-three (7.4%) patients did not receive any treatment. After adjusting for the use of b/tsDMARD and csDMARD, hs-CRP concentrations were significantly associated with 10-year risk of CVD both in standard multiple regression (n=865; coefficient=0.005 for each 10 mg/L hs-CRP increment, 95% confidence interval (0.000-0.100), p=0.043) and after multiple imputation (n=1,251; coefficient=0.005 for each 10 mg/L hs-CRP increment, 95% confidence interval (0.000-0.114), p=0.035) (Table 1). This corresponds to an increase of 10-year CV risk of 1% for every 20 mg/L increase in hs-CRP concentrations.Conclusion:In a large cohort of RA patients, we observed a significant, positive, and independent association between hs-CRP concentrations and 10-year CV risk estimated by ERS-RA. The cross-sectional design of the study did not allow to establish a cause-effect relationship between hs-CRP and CV risk. Given that conventional CV risk factors and inflammation-related variables are accounted for in the ERS-RA risk score, other, unexplored, mechanisms may underlie the observed association between hs-CRP and CV risk.References:[1]Solomon, D. H., et al. “Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a Consortium of Rheumatology Researchers of North America Registry Study.” Arthritis & rheumatology 67.8 (2015): 1995-2003.Table 1.Multiple regression modelsModel 1n= 865Model 2n= 1, 251ERS-RA scoreCoefficient95% CI, pCoefficient95% CI, phs-CRP, every 10 mg/L increment0.0050.000 to 0.100, 0.0430.0050.000 to 0.011, 0.035b/tsDMARD use-0.002-0.005 to 0.001, 0.199-0.000-0.002 to 0.002, 0.963csDMARD use0.002-0.003 to 0.007, 0.3940.002-0.002 to 0.006, 0.371Prob >F, model with only CRP0.030.03Prob >F, full model0.070.08A multiple linear regression (ENTER method) was performed for the dependent variable ERS-RA score using a listwise deletion analysis (Model 1) and a multiple imputation analysis (Model 2).Disclosure of Interests:None declared
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Bursi R, Cafaro G, Perricone C, Riccucci I, Calvacchi S, Gerli R, Bartoloni E. Contribution of Janus-Kinase/Signal Transduction Activator of Transcription Pathway in the Pathogenesis of Vasculitis: A Possible Treatment Target in the Upcoming Future. Front Pharmacol 2021; 12:635663. [PMID: 33854436 PMCID: PMC8039124 DOI: 10.3389/fphar.2021.635663] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/30/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Janus-kinase (JAK) and signal transduction activator of transcription (STAT) signal transduction pathway is involved in a wide range of physiological and pathological processes, including in the pathogenesis of several autoimmune diseases. Data supporting the role of JAK/STAT in the development of vasculitis are limited and mostly focused on large vessel vasculitis and Behçet's disease. In this review, we provide a thorough picture of currently available evidence on the topic, gathered from in vitro experiments, animal models and human real-life data, analyzing the rationale for the use of JAK inhibitors for the management of vasculitis. Overall, despite a very strong biological and pathogenic basis, data are too few to recommend this therapeutic approach, beyond very severe and refractory forms of vasculitis. However, for the same reasons, a strong scientific effort in this direction is indeed worthwhile.
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Affiliation(s)
- Roberto Bursi
- 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
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Santina Calvacchi
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Cafaro G, Perricone C, Carubbi F, Baldini C, Quartuccio L, Priori R, Berardicurti O, Ferro F, Gandolfo S, Gattamelata A, Giacomelli R, De Vita S, Gerli R, Bartoloni E. Peripheral Nervous System Involvement in Sjögren's Syndrome: Analysis of a Cohort From the Italian Research Group on Sjögren's Syndrome. Front Immunol 2021; 12:615656. [PMID: 33841398 PMCID: PMC8024688 DOI: 10.3389/fimmu.2021.615656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/08/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose The prevalence of peripheral nervous system (PNS) involvement in primary Sjögren's syndrome (pSS) has been reported to range from 2% to over 50%. Bias in study designs, including low number of patients and unclearly defined rheumatological and neurological diagnosis could explain such variability. Consequently, the exact depiction of PNS involvement in pSS is still lacking. This study aimed at analyzing the prevalence and the clinical and laboratory factors associated with PNS involvement in a very large cohort of well-characterized pSS patients with a clearly defined neurological diagnosis. Methods Clinical and serological data of 1,695 pSS patients with specific and accurate information on PNS involvement were analyzed. Comparisons between patients with and without PNS involvement and between patients with distinct subsets of PNS manifestations were performed. Results Prevalence of PNS involvement was 3.7%. The most frequent types observed were pure sensory neuropathies and axonal sensorimotor polyneuropathies (SMP). Patients with PNS involvement exhibited a more active disease profile and were more frequently treated with immunosuppressants. Intriguingly, clinical and serological negative prognostic factors, including purpura, extra-glandular manifestations, leukopenia, low complement and cryoglobulinemia, principally characterized patients with SMP, while subjects with pure sensory neuropathy displayed a milder phenotype. Conclusion Our results highlight that PNS involvement is rather rare, but prognostically relevant in pSS. Main adverse prognostic features characterize patients with SMP, while pure sensory neuropathies are usually associated with a mild clinical picture. These findings, useful for patient stratification, may suggest protean pathogenic pathways underlying different types of PNS manifestations in pSS.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Francesco Carubbi
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Roberta Priori
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Onorina Berardicurti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Saviana Gandolfo
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Angelica Gattamelata
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Roberto Giacomelli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
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Garcia-Melchor E, Cafaro G, MacDonald L, Crowe LAN, Sood S, McLean M, Fazzi UG, McInnes IB, Akbar M, Millar NL. Novel self-amplificatory loop between T cells and tenocytes as a driver of chronicity in tendon disease. Ann Rheum Dis 2021; 80:1075-1085. [PMID: 33692018 PMCID: PMC8292554 DOI: 10.1136/annrheumdis-2020-219335] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 10/17/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Increasing evidence suggests that inflammatory mechanisms play a key role in chronic tendon disease. After observing T cell signatures in human tendinopathy, we explored the interaction between T cells and tendon stromal cells or tenocytes to define their functional contribution to tissue remodelling and inflammation amplification and hence disease perpetuation. METHODS T cells were quantified and characterised in healthy and tendinopathic tissues by flow cytometry (FACS), imaging mass cytometry (IMC) and single cell RNA-seq. Tenocyte activation induced by conditioned media from primary damaged tendon or interleukin-1β was evaluated by qPCR. The role of tenocytes in regulating T cell migration was interrogated in a standard transwell membrane system. T cell activation (cell surface markers by FACS and cytokine release by ELISA) and changes in gene expression in tenocytes (qPCR) were assessed in cocultures of T cells and explanted tenocytes. RESULTS Significant quantitative differences were observed in healthy compared with tendinopathic tissues. IMC showed T cells in close proximity to tenocytes, suggesting tenocyte-T cell interactions. On activation, tenocytes upregulated inflammatory cytokines, chemokines and adhesion molecules implicated in T cell recruitment and activation. Conditioned media from activated tenocytes induced T cell migration and coculture of tenocytes with T cells resulted in reciprocal activation of T cells. In turn, these activated T cells upregulated production of inflammatory mediators in tenocytes, while increasing the pathogenic collagen 3/collagen 1 ratio. CONCLUSIONS Interaction between T cells and tenocytes induces the expression of inflammatory cytokines/chemokines in tenocytes, alters collagen composition favouring collagen 3 and self-amplifies T cell activation via an auto-regulatory feedback loop. Selectively targeting this adaptive/stromal interface may provide novel translational strategies in the management of human tendon disorders.
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Affiliation(s)
- Emma Garcia-Melchor
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Giacomo Cafaro
- Rheumatology Unit - Department of Medicine, University of Perugia, Perugia, Italy
| | - Lucy MacDonald
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Lindsay A N Crowe
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Shatakshi Sood
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Michael McLean
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Umberto G Fazzi
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Moeed Akbar
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK .,Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Perricone C, Triggianese P, Bursi R, Cafaro G, Bartoloni E, Chimenti MS, Gerli R, Perricone R. Intravenous Immunoglobulins at the Crossroad of Autoimmunity and Viral Infections. Microorganisms 2021; 9:microorganisms9010121. [PMID: 33430200 PMCID: PMC7825648 DOI: 10.3390/microorganisms9010121] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
Intravenous immunoglobulins (IVIG) are blood preparations pooled from the plasma of donors that have been first employed as replacement therapy in immunodeficiency. IVIG interact at multiple levels with the different components of the immune system and exert their activity against infections. Passive immunotherapy includes convalescent plasma from subjects who have recovered from infection, hyperimmune globulin formulations with a high titer of neutralizing antibodies, and monoclonal antibodies (mAbs). IVIG are used for the prevention and treatment of several infections, especially in immunocompromised patients, or in case of a poorly responsive immune system. The evolution of IVIG from a source of passive immunity to a powerful immunomodulatory/anti-inflammatory agent results in extensive applications in autoimmune diseases. IVIG composition depends on the antibodies of the donor population and the alterations of protein structure due to the processing of plasma. The anti-viral and anti-inflammatory activity of IVIG has led us to think that they may represent a useful therapeutic tool even in COVID-19. The human origin of IVIG carries specific criticalities including risks of blood products, supply, and elevated costs. IVIG can be useful in critically ill patients, as well as early empirical treatment. To date, the need for further well-designed studies stating protocols and the efficacy/tolerability profile of IVIG and convalescent plasma in selected situations are awaited.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome, 00133 Rome, Italy; (M.S.C.); (R.P.)
- Correspondence: ; Tel.: +39-062-090-4444; Fax: +39-062-090-3749
| | - Roberto Bursi
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Elena Bartoloni
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome, 00133 Rome, Italy; (M.S.C.); (R.P.)
| | - Roberto Gerli
- Rheumatology, Department of Medicine, University of Perugia, 06129 Perugia, Italy; (C.P.); (R.B.); (G.C.); (E.B.); (R.G.)
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome, 00133 Rome, Italy; (M.S.C.); (R.P.)
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Zabotti A, Zandonella Callegher S, Tullio A, Vukicevic A, Hocevar A, Milic V, Cafaro G, Carotti M, Delli K, De Lucia O, Ernst D, Ferro F, Gattamelata A, Germanò G, Giovannini I, Hammenfors D, Jonsson MV, Jousse-Joulin S, Macchioni P, Parisi S, Perricone C, Stradner MH, Filipovic N, Tzioufas AG, Valent F, De Vita S. Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project. Front Med (Lausanne) 2020; 7:581248. [PMID: 33330537 PMCID: PMC7719819 DOI: 10.3389/fmed.2020.581248] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience. Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring. Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience. Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Annarita Tullio
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Arso Vukicevic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vera Milic
- Institute of Rheumatology, Belgrade, Serbia
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Orazio De Lucia
- Unit of Clinical Rheumatology, Department of Rheumatology and Medical Sciences, Aziende Socio Sanitarie Territoriali (ASST) Centro Traumatologico Ortopedico G. Pini-Centri Traumatologici Ortopedici (CTO), Milan, Italy
| | - Diana Ernst
- Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Germanò
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Daniel Hammenfors
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Malin V Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Centre Hospitalier Universitaire (CHU) de Brest, Univ Brest, Brest, France.,UMR 1227, Lymphocytes B et Autoimmunité (LBAI), Inserm, Univ Brest, Brest, France
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Simone Parisi
- Unit of Rheumatology, Department of General and Specialty Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Nenad Filipovic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, 06129 Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, 06129 Perugia, Italy
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Cafaro G, Gerli R, Bartoloni E. Association Between Glandular Infiltrate and Leukopenia in Sjögren Syndrome (SS): Data From the Italian Research Group on SS (GRISS). J Rheumatol 2020; 47:1840-1841. [DOI: 10.3899/jrheum.200328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
SARS-CoV-2 infection is characterized by a protean clinical picture that can range from asymptomatic patients to life-threatening conditions. Severe COVID-19 patients often display a severe pulmonary involvement and develop neutrophilia, lymphopenia, and strikingly elevated levels of IL-6. There is an over-exuberant cytokine release with hyperferritinemia leading to the idea that COVID-19 is part of the hyperferritinemic syndrome spectrum. Indeed, very high levels of ferritin can occur in other diseases including hemophagocytic lymphohistiocytosis, macrophage activation syndrome, adult-onset Still's disease, catastrophic antiphospholipid syndrome and septic shock. Numerous studies have demonstrated the immunomodulatory effects of ferritin and its association with mortality and sustained inflammatory process. High levels of free iron are harmful in tissues, especially through the redox damage that can lead to fibrosis. Iron chelation represents a pillar in the treatment of iron overload. In addition, it was proven to have an anti-viral and anti-fibrotic activity. Herein, we analyse the pathogenic role of ferritin and iron during SARS-CoV-2 infection and propose iron depletion therapy as a novel therapeutic approach in the COVID-19 pandemic.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Bursi
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | | | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, 5265601, Tel-Hashomer, Israel
- The Mosaic of Autoimmunity Project, Saint Petersburg University, Saint Petersburg, Russia
- Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Roberto Gerli
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy.
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Abstract
SARS-CoV-2 infection is characterized by a protean clinical picture that can range from asymptomatic patients to life-threatening conditions. Severe COVID-19 patients often display a severe pulmonary involvement and develop neutrophilia, lymphopenia, and strikingly elevated levels of IL-6. There is an over-exuberant cytokine release with hyperferritinemia leading to the idea that COVID-19 is part of the hyperferritinemic syndrome spectrum. Indeed, very high levels of ferritin can occur in other diseases including hemophagocytic lymphohistiocytosis, macrophage activation syndrome, adult-onset Still's disease, catastrophic antiphospholipid syndrome and septic shock. Numerous studies have demonstrated the immunomodulatory effects of ferritin and its association with mortality and sustained inflammatory process. High levels of free iron are harmful in tissues, especially through the redox damage that can lead to fibrosis. Iron chelation represents a pillar in the treatment of iron overload. In addition, it was proven to have an anti-viral and anti-fibrotic activity. Herein, we analyse the pathogenic role of ferritin and iron during SARS-CoV-2 infection and propose iron depletion therapy as a novel therapeutic approach in the COVID-19 pandemic.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Bursi
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | | | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, 5265601, Tel-Hashomer, Israel
- The Mosaic of Autoimmunity Project, Saint Petersburg University, Saint Petersburg, Russia
- Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Roberto Gerli
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy.
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Perricone C, Triggianese P, Bartoloni E, Cafaro G, Bonifacio AF, Bursi R, Perricone R, Gerli R. The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19. J Autoimmun 2020; 111:102468. [PMID: 32317220 PMCID: PMC7164894 DOI: 10.1016/j.jaut.2020.102468] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [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] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has posed the world at a pandemic risk. Coronavirus-19 disease (COVID-19) is an infectious disease caused by SARS-CoV-2, which causes pneumonia, requires intensive care unit hospitalization in about 10% of cases and can lead to a fatal outcome. Several efforts are currently made to find a treatment for COVID-19 patients. So far, several anti-viral and immunosuppressive or immunomodulating drugs have demonstrated some efficacy on COVID-19 both in vitro and in animal models as well as in cases series. In COVID-19 patients a pro-inflammatory status with high levels of interleukin (IL)-1B, IL-1 receptor (R)A and tumor necrosis factor (TNF)-α has been demonstrated. Moreover, high levels of IL-6 and TNF-α have been observed in patients requiring intensive-care-unit hospitalization. This provided rationale for the use of anti-rheumatic drugs as potential treatments for this severe viral infection. Other agents, such as hydroxychloroquine and chloroquine might have a direct anti-viral effect. The anti-viral aspect of immunosuppressants towards a variety of viruses has been known since long time and it is herein discussed in the view of searching for a potential treatment for SARS-CoV-2 infection.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Elena Bartoloni
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Angelo F Bonifacio
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Bursi
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Roberto Gerli
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy.
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Cafaro G, Perricone C, Baldini C, Quartuccio L, Priori R, Carubbi F, Ferro F, Colafrancesco S, Bini V, De Vita S, Giacomelli R, Gerli R, Bartoloni E. Significance of anti-La/SSB antibodies in primary Sjögren's syndrome patients with combined positivity for anti-Ro/SSA and salivary gland biopsy. Clin Exp Rheumatol 2020; 38 Suppl 126:53-56. [PMID: 33095137] [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: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Immunological parameters exert a relevant diagnostic and prognostic role in primary Sjögren's syndrome (pSS) and may identify specific disease phenotypes. Among disease-associated immunological features, anti-La/SSB are rarely found without concomitant anti-Ro/SSA and their clinical significance in patients with pSS has been poorly investigated. Thus, we aimed to characterise the value of anti-La/SSB analysing clinical and serologic features of a wide cohort of pSS patients with both circulating anti-Ro/SSA and positive salivary gland biopsy (SGB). METHODS Clinical and serological data of 600 pSS patients with both anti-Ro/SSA and SGB positivity and categorised according to anti-La/SSB status were retrospectively analysed. Comparisons between patients with and without circulating anti-La/SSB were performed. RESULTS Among the whole cohort, 319 (53%) of patients were anti-La/SSB negative and 281 (47%) were anti-La/SSB positive. Anti-La/SSB positive patients were younger at disease diagnosis and had a longer disease duration. Moreover, anti-La/SSB positive patients had a higher prevalence of hypergammaglobulinaemia and circulating rheumatoid factor and of lymphoproliferative disorders in comparison to seronegative group. At multivariate analysis, hypergammaglobulinaemia (OR=1,7; 95% CI 1.17, 2.43), rheumatoid factor (OR=2.3; 95% CI 1.6, 3.3) and lymphoma (OR=2.6; 95% CI 1.12, 5.96) were identified as independent variables significantly associated with anti-La/SSB positivity. CONCLUSIONS In patients with pSS and concomitant anti-Ro/SSA and SGB positivity, the presence of anti-La/SSB may help in identifying a disease subset with distinct prognostic features, especially in terms of higher risk of lymphoproliferative complications.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Roberta Priori
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - Francesco Carubbi
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Serena Colafrancesco
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - Vittorio Bini
- Internal Medicine, Endocrine and Metabolic Science Section, University of Perugia, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Roberto Giacomelli
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
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Gatto M, Perricone C, Tonello M, Bistoni O, Cattelan AM, Bursi R, Cafaro G, De Robertis E, Mencacci A, Bozza S, Vianello A, Iaccarino L, Gerli R, Doria A, Bartoloni E. Frequency and clinical correlates of antiphospholipid antibodies arising in patients with SARS-CoV-2 infection: findings from a multicentre study on 122 cases. Clin Exp Rheumatol 2020; 38:754-759. [PMID: 32723434] [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: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES COVID-19 features include disseminated intravascular coagulation and thrombotic microangiopathy indicating a hypercoagulable state. We aimed to investigate antiphospholipid antibodies (aPL) prevalence and clinical relationships in a large cohort of COVID-19 patients. METHODS We analysed the prevalence and titres of serum aPL in 122 patients with COVID-19 and 157 with primary antiphospholipid syndrome (PAPS) and 91 with other autoimmune rheumatic diseases (oARD) for comparison. IgG/IgM anticardiolipin (aCL) and IgG/IgM anti-beta2glycoprotein I (β2GPI) were assayed using homemade ELISA, IgA aCL and anti-β2GPI by commercial ELISA kits and lupus anticoagulant (LAC) by multiple coagulation tests following updated international guidelines. RESULTS Prevalence of IgG and IgM aCL and of IgG and IgM anti-β2GPI across COVID-19 patients were 13.4%, 2.7%, 6.3% and 7.1%, being significantly lower than in PAPS (p<0.0001 for all). Frequency of IgG aCL and IgM anti-β2GPI was comparable to oARD (13.4% vs. 13.2% and 7.1% vs. 11%, respectively), while IgG anti-β2GPI and IgM aCL were lower (p<0.01). IgA aCL and IgA anti-β2GPI were retrieved in 1.7% and 3.3% of COVID-19 patients, respectively. Positive LAC was observed in 22.2% COVID-19 vs. 54.1% of PAPS (p<0.0001) and 14.6% of oARD (p=0.21). Venous or arterial thromboses occurred in 18/46 (39.1%) COVID-19 patients and were not associated with positive aPL (p=0.09). CONCLUSIONS Thrombosis is a frequent manifestation during COVID-19 infection. However, prevalence and titres of aPL antibodies or LAC were neither consistently increased nor associated with thrombosis when measured at a single timepoint, therefore not representing a suitable screening tool in the acute stage of disease.
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Affiliation(s)
- Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | - Roberto Bursi
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Edoardo De Robertis
- Section of Anesthesia, Intensive Care and Pain, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Antonella Mencacci
- Medical Microbiology Unit, Department of Medicine, University of Perugia, Italy
| | - Silvia Bozza
- Medical Microbiology Unit, Department of Medicine, University of Perugia, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
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Manfrè V, Cafaro G, Riccucci I, Zabotti A, Perricone C, Bootsma H, De Vita S, Bartoloni E. One year in review 2020: comorbidities, diagnosis and treatment of primary Sjögren's syndrome. Clin Exp Rheumatol 2020; 38 Suppl 126:10-22. [PMID: 32940212] [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: 06/29/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
Primary Sjögren's syndrome (pSS) is a complex and heterogeneous disorder characterised by a wide spectrum of glandular and extra-glandular features. The discovery of novel biomarkers allowed to characterise the disease not only phenotypically on the basis of clinical presentation, but also on the basis of the endotype. Moreover, a better stratification of patients has important value in the evaluation of mechanisms underlying the risk of lymphoproliferative disorders in these patients. Finally, novel targeted therapies may open new possibilities for the application of personalised medicine in pSS.
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Affiliation(s)
- Valeria Manfrè
- Clinic of Rheumatology, DAME, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Alen Zabotti
- Clinic of Rheumatology, DAME, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Salvatore De Vita
- Clinic of Rheumatology, DAME, University Hospital S. Maria della Misericordia, Udine, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
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Cacciapaglia F, Manfredi A, Erre G, Bartoloni Bocci E, Sakellariou G, Viapiana O, Colella S, Abbruzzese A, Fornaro M, Cafaro G, Fenu MA, Palermo BL, Dessì M, Palermo A, Giollo A, Gremese E, Spinelli FR, Atzeni F, Piga M. THU0257 ESTIMATED 10-YEARS CARDIOVASCULAR RISK IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: PRELIMINARY RESULTS FROM THE “CARDIOVASCULAR OBESITY AND RHEUMATIC DISEASE (CORDIS)” STUDY GROUP OF THE ITALIAN SOCIETY OF RHEUMATOLOGY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6187] [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:Systemic lupus erythematosus (SLE) patients are at high risk for CV events, and EULAR recommends assessing the 10-year CV-risk using the Systematic Coronary Risk Evaluation (SCORE) [1]. The QRISK3, another score to assess CV-risk in UK population, considers different factors among which also SLE. The Progetto Cuore score (PCS) is validated to estimate CV risk in Italian people and largely replicates the SCORE project [2].Objectives:This cross-sectional study aimed to estimate CV-risk using SCORE, QRISK3 and, for the first time, PCS in a multicentric cohort of Italian SLE patients.Methods:During 2019 we evaluated 173 SLE patients (87.7% female; age 40±16 years; disease duration 138±105 months), fulfilling the 1997 ACR classification criteria. Clinical and laboratory data were registered, and individual CV-risk was calculated using suitable algorithms for the SCORE, QRISK3 and PCS. Statistical analysis was performed using Graphpad Instat 8.0 (San Diego, CA-USA).Results:In 13 (7%) SLE patients a previous CV event was recorded. Hypertension was present in 60 (37.5%) and diabetes in 27 (16.9%) patients. Mean total cholesterol was 184±39 mg/dL, HDLc 58±18 mg/dL, LDLc 124±37 mg/dL, triglycerides 105±63 mg/dL; dyslipidaemia was reported in 58 (36.2%) patients and 29 (18.1%) were on statin. Mean BMI was 24.9±5.3 Kg/sm, 60 (37.5%) and 23 (14.3%) patients were overweight and obese, while 25 (15.6%) patients were smokers. 87 (54.3%) SLE patients had a SLEDAI<4, 91% of patients were taken HCQ and 65% were on prednisone (mean dose 5.4±5.9 mg/day), but only 7.5% took >7.5 mg/day. The CV-risk of SLE patients according to SCORE, QRISK3 and PCS was 1.1±2.1%, 10.5±12.3% and 3.7±5.4%, respectively. Stratifying patients at low, moderate or high CV risk according to the PCS and SCORE a double proportion of patients was at moderate (8% vs 3.9%) or high (1.9% vs 0.9%) CV risk (p=0.03). Finally, CV-risk according to QRISK3 was higher than 20% (high risk) in 32/160 (20%) patients.Conclusion:This multicentre study demonstrated that the mean estimated CV-risk in SLE patients is globally low using the SCORE, QRISK3 and PCS. The PCS seems to better intercept those patients at moderate/high risk, at least in Italian SLE patients, while QRISK3 predicts the highest CV risk. The lack of disease-specific CV-risk factors (such as autoantibodies profile or organ involvement) probably account for the underestimation of CV risk using the SCORE and PCS.References:[1]ARD 2019;78(6):736-745.[2]ARD 2019;0:1–2.doi:10.1136/annrheumdis-2019-215715Disclosure of Interests:Fabio Cacciapaglia Speakers bureau: BMS; Roche; Pfizer; Abbvie, Andreina Manfredi: None declared, Gianluca Erre: None declared, Elena Bartoloni Bocci: None declared, Garifallia Sakellariou Speakers bureau: Abbvie, Novartis, MSD, Ombretta Viapiana: None declared, Sergio Colella: None declared, Anna Abbruzzese: None declared, Marco Fornaro: None declared, Giacomo Cafaro: None declared, Maria Antonietta Fenu: None declared, Bianca Lucia Palermo: None declared, Martina Dessì: None declared, Adalgisa Palermo: None declared, Alessandro Giollo: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Francesca Romana Spinelli Grant/research support from: Pfizer, Speakers bureau: Lilly, BMS, Celgene, Fabiola Atzeni: None declared, Matteo Piga: None declared
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Cacciapaglia F, Piga M, Erre G, Manfredi A, Bartoloni Bocci E, Sakellariou G, Viapiana O, Colella S, Abbruzzese A, Dessì M, Vacchi C, Castagna F, Cafaro G, Palermo BL, Giollo A, Fornaro M, Gremese E, Spinelli FR, Atzeni F. THU0127 Estimated cardiovascular risk in a large cohort of rheumatoid arthritis patients from the “Cardiovascular Obesity and Rheumatic DISease (CORDIS)” Study Group of the Italian Society of Rheumatology. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:Rheumatoid arthritis (RA) patients present high cardiovascular (CV) morbidity and mortality and EULAR recommends estimating their CV-risk [1]. The Systematic Coronary Risk Evaluation (SCORE) algorithm is suggested if National Guidelines are lack, but few data are available about different strategies.Objectives:To estimate the 10-years CV-risk using different algorithms in RA compared to osteoarthritis (OA) patients, as control group.Methods:A total of 1467 RA patients (78.3% female; mean age 59.8±11.5 years; mean disease duration 131±109 months), fulfilling the 2010 EULAR/ACR classification criteria, and 342 age and sex matched patients with OA (79.8% female; mean age 58.7±11.5 years) were enrolled in this multicentre cross-sectional study during 2019. Clinical and laboratory data were registered, and individual CV-risk was calculated using: SCORE chart, “Progetto Cuore” model (PCM), QRisk3, Reynolds Risk Scores (RRS) and Expanded Risk Score in RA (ERS-RA), as stated by suitable algorithms. Statistical analysis was performed using the Statistical System Graphpad Instat 8.0 (San Diego, CA-USA).Results:In 46 (3%) RA patients a previous CV event was observed. Among traditional CV-risk factors, RA patients presented higher frequency of diabetes (9.9% vs 6.4%; p=0.04) and lower prevalence of dyslipidaemia (21.7% vs 32.5%; p<0.0001) compared to OA patients. Prevalence of hypertension was similar in both groups (40% vs 39.2%). Mean BMI (25.6±4.8 vs 26.6±4.4; p<0.0001) and prevalence of obesity (15% vs 21%; p=0.003) were significantly lower in RA patients. Finally, RA patients were more frequently smokers (20.4% vs 12.5% - p=0.002). 441 (30%) RA patients were in CDAI remission, 998 (68%) patients were on csDMARDs while a biologic agent was used in 617 (42%) patients. About 43% of RA patients were on a mean prednisone-dose of 4.5±3.5 mg/day. The 10-years CV-risk resulted 2 to 3-fold higher in RA compared to OA patients using the different algorithms. The QRisk3 estimated the highest CV risk in our cohort of patients, while the ERS-RA and RRS were significantly higher than PCM and SCORE.Conclusion:Our study demonstrates a higher estimated CV-risk in RA compared to OA patients. The commonly used algorithms to estimate CV-risk in clinical practice perform differently, evaluating different traditional CV-risk factors and disease specific characteristic, as for QRisk3 or ERS-RA. Rheumatologist should impact on both traditional and RA related modifiable CV-risk factors.References:[1]Agca R, et al. Ann Rheum Dis 2017;76:17–28.Disclosure of Interests:Fabio Cacciapaglia Speakers bureau: BMS; Roche; Pfizer; Abbvie, Matteo Piga: None declared, Gianluca Erre: None declared, Andreina Manfredi: None declared, Elena Bartoloni Bocci: None declared, Garifallia Sakellariou Speakers bureau: Abbvie, Novartis, MSD, Ombretta Viapiana: None declared, Sergio Colella: None declared, Anna Abbruzzese: None declared, Martina Dessì: None declared, Caterina Vacchi: None declared, Floriana Castagna: None declared, Giacomo Cafaro: None declared, Bianca Lucia Palermo: None declared, Alessandro GIollo: None declared, Marco Fornaro: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Francesca Romana Spinelli Grant/research support from: Pfizer, Speakers bureau: Lilly, BMS, Celgene, Fabiola Atzeni: None declared
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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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Garcia-Melchor E, Cafaro G, Sood S, Crowe LAN, McLean M, McInnes IB, Akbar M, Millar NL. O22 Assessing the role of tendon T cell interactions in the development of chronicity in PsA. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa110.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Mechanical stress or damage is a well-known inducer of inflammation in both psoriasis and psoriatic arthritis (PsA). The occurrence of microtrauma at enthesial sites, areas subjected to high mechanic stress, could explain the development of local inflammation (enthesitis) that further extends to the synovial tissue through what it is known synovio-entheseal complex. Current treatment strategies mainly target the immune compartment, however there is growing evidence for the role of the stroma in the development of chronic inflammation. Increasing attention has focused on the interaction between the stroma and immune system and its role in the initiation/development of tissue inflammatory chronicity. Our hypothesis is that stromal cells in the tendon or tenocytes, once activated, are able to recruit and activate T cells into the tendon, which in turn may have an effect on the stroma, altogether leading to chronicity.
Methods
We assessed the effect of damage on healthy tenocytes after stimulation with conditioned media from tendon explants or IL-1β by qPCR and ELISA. A transwell membrane system was used to test the impact of conditioned media from tenocytes on T cell migration. T cells and tenocytes were co-cultured with or without the presence of a transwell membrane to quantify T cell activation (CD69 by FACS and IFN-γ by ELISA). Changes in gene expression on tenocytes after co-culture with activated T cells were analysed by qPCR.
Results
In the presence of damage, tenocytes upregulated inflammatory cytokines (IL-1β, IL-6), chemokines (IL-8, CCL2, CCL5, CXCL10) and adhesion molecules (ICAM-1). Of interest, we observed an upregulation of CCL20, both at transcript and protein level. Conditioned media from tenocytes induced T cell migration, especially after stimulation. Co-culture of tenocytes and T cells resulted in contact dependant activation of T cells. These activated T cells also had an effect on tenocytes, further upregulating the production of inflammatory mediators.
Conclusion
These results support the role of the tendon stromal compartment in the recruitment and activation of T cells, creating a feedback loop that could be involved in the maintenance of the inflammatory process and the development of chronicity in the context of PsA. Moreover, the production of CCL20 by tenocytes after damage could explain the preferential recruitment of Th17 or gamma delta T cells into the tendon. We are further investigating the mechanisms that govern this relationship that could be targeted therapeutically in the future.
Disclosures
E. Garcia-Melchor None. G. Cafaro None. S. Sood None. L.A.N. Crowe None. M. McLean None. I.B. McInnes None. M. Akbar None. N.L. Millar None.
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Affiliation(s)
- Emma Garcia-Melchor
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
| | - Giacomo Cafaro
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
| | - Shatakshi Sood
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
| | - Lindsay A. N Crowe
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
| | - Michael McLean
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UNITED KINGDOM
| | - Iain B McInnes
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
| | - Moeed Akbar
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
| | - Neal L Millar
- University of Glasgow, Institute of Infection, Immunity and Inflammation, Glasgow, UNITED KINGDOM
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UNITED KINGDOM
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45
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Cafaro G, Bartoloni E, Alunno A, Bistoni O, Cipriani S, Topini F, Gerli R. A Platelet's Guide to Synovitis. Isr Med Assoc J 2019; 21:454-459. [PMID: 31507120] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Platelets have the ability to influence the immune system and the inflammatory process and may be strongly involved in the whole pathogenic process of chronic inflammatory joint diseases, such as rheumatoid arthritis. They may play a significant role even before the clinical onset of the disease, contributing to the loss of tolerance of the immune system and the induction of autoimmunity. Subsequently, they can interact with the most important cellular players involved in autoimmunity and inflammation, namely innate immunity cells and T cells and eventually contribute to the building of inflammation in the synovium, thus inducing the activation, migration, and proliferation of fibroblasts that eventually lead to joint damage. Due to their peculiar features, studying the behavior of platelets is a challenging task; however, platelets may prove to be valuable therapeutic targets in the future.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Sabrina Cipriani
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Fabiana Topini
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
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46
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Bartoloni E, Baldini C, Ferro F, Alunno A, Carubbi F, Cafaro G, Bombardieri S, Gerli R, Grossi E. Application of artificial neural network analysis in the evaluation of cardiovascular risk in primary Sjögren's syndrome: a novel pathogenetic scenario? Clin Exp Rheumatol 2019; 37 Suppl 118:133-139. [PMID: 31464678 DOI: pmid/31464678] [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: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim of the present study was to verify whether artificial neural networks (ANNs) might help to elucidate the mechanisms underlying the increased prevalence of cardiovascular events (CV) in primary Sjögren's syndrome (pSS). METHODS 408 pSS patients (395 F: 13 M), with a mean age of 61 (±14) years and mean disease duration of 8.8 (±7.8) years were retrospectively included. CV risk factors and events were analysed and correlated with the other pSS clinical and serological manifestations by using both a traditional statistical approach (i.e. Agglomerative Hierarchical Clustering (AHC)) and Auto-CM, a data mining tool based on ANNs. RESULTS Five percent of pSS patients experienced one or more CV events, including heart failure (8/408), transient ischaemic attack (6/408), stroke (4/408), angina (4/408), myocardial infarction (3/408) and peripheral obliterative arteriopathy (2/408). The AHC provided a dendrogram with at least three clusters that did not allow us to infer specific differential associations among variables (i.e. CV comorbidity and pSS manifestations). On the other hand, Auto-CM identified two different patterns of distributions in CV risk factors, pSS-related features, and CV events. The first pattern, centered on "non-ischaemic CV events/generic condition of HF", was characterised by the presence of traditional CV risk factors and by a closer link with pSS glandular features rather than to pSS extra-glandular manifestations. The second pattern included "ischaemic neurological, cardiac events and peripheral obliterative arteriopathy" and appeared to be strictly associated with extra-glandular disease activity and longer disease duration. CONCLUSIONS This study represents the first application of ANNs to the analysis of factors contributing to CV events in pSS. When compared to AHC, ANNs had the advantage of better stratifying CV risk in pSS, opening new avenues for planning specific interventions to prevent long-term CV complications in pSS patients.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | | | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Stefano Bombardieri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Enzo Grossi
- Villa Santa Maria Foundation, Tavernerio, Italy
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47
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Cafaro G, Croia C, Argyropoulou OD, Leone MC, Orlandi M, Finamore F, Cecchettini A, Ferro F, Baldini C, Bartoloni E. One year in review 2019: Sjögren's syndrome. Clin Exp Rheumatol 2019; 37 Suppl 118:3-15. [PMID: 31464675] [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: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
Primary Sjögren's syndrome (pSS) is a complex and heterogeneous disorder characterised by a wide spectrum of glandular and extra-glandular features. Novel insights into disease pathogenesis and the discovery of novel biomarkers are allowing us to characterise the disease not only phenotypically on the basis of clinical presentation, but also on the basis of the endotype. Ultimately, a better stratification of patients may pave new avenues for novel targeted therapies, opening new possibilities for the application of personalised medicine in pSS.
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Affiliation(s)
- Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Cristina Croia
- Immuno-Allergology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Ourania D Argyropoulou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Martina Orlandi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | | | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
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48
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Bartoloni E, Alunno A, Cafaro G, Valentini V, Bistoni O, Bonifacio AF, Gerli R. Subclinical Atherosclerosis in Primary Sjögren's Syndrome: Does Inflammation Matter? Front Immunol 2019; 10:817. [PMID: 31110500 PMCID: PMC6499202 DOI: 10.3389/fimmu.2019.00817] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease mainly characterized by inflammatory involvement of exocrine gland. Atherosclerosis is a complex process leading to plaque formation in arterial wall with subsequent cardiovascular (CV) events. Recently, numerous studies demonstrated that SS patients bear an increased CV risk. Since activation of immune system is a key element in atherosclerosis, it is interesting to analyze whether and how the autoimmune and inflammatory events characterizing SS pathogenesis directly or indirectly contribute to atherosclerosis risk in these patients. An increase in circulating endothelial microparticles and integrins, which may be a consequence of endothelial damage and impaired repair mechanisms, has been demonstrated in SS. Increased endothelial expression of adhesion molecules with subsequent infiltration of inflammatory cells into arterial wall is also a critical event in atherosclerosis. The early inflammatory events taking place in the atherosclerotic plaque cause an increase in alarmins, such as S100A8/A9, which seems to be associated with SS disease activity and, in turn, induce up-regulation of interleukin (IL)-1β and other pro-atherogenic cytokines. Interestingly, increased IL-1β levels were also detected in tertiary lymphoid structures developing in vessel adventitia adjacent to the atherosclerotic plaque, suggesting a direct role of IL-1β in this process. Similar to these structures, germinal center-like structures arising in SS exocrine glands are also tertiary lymphoid systems where T-helper (Th) cell subsets govern the adaptive immune response. Th1 cells are the most prevalent subtype and have been shown to be strongly involved in both SS pathogenesis and atherosclerosis. Th17 cells are attracting great interest and few studies showed its importance in SS development. Albeit in low amounts, a Th17 signature was also detected in atherosclerotic plaques and some animal models demonstrated a significant pro-atherogenic role and positive effects of IL-17A blockade. Despite the fact that T cells have a pivotal role in the inflammatory process that ultimately leads to atherosclerosis, B cells have also been detected in atherosclerotic plaques, although their exact role is still mostly unknown with studies showing contrasting results. In this scenario, the role of inflammation in atherosclerosis pathogenesis in patients with SS needs to be further explored.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Valentina Valentini
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
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49
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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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50
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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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