Anti-Interleukin-17s for successful management of pustular psoriasis

Generalised pustular psoriasis (GPP) and acrodermatitis continua of Hallopeau (ACH) are two rare entities included in the spectrum of pustular psoriasis (PP). Due to the lack of randomised controlled clinical trials and standardized guidelines, their treatment remains a challenge for clinicians. Thus, herein we report our centre experience with the successful use of interleukin (IL)-17 inhibitors in three patients affected by PP. We also provide a brief overview of the current knowledge concerning the role of IL-17 in PP pathogenesis and of the use of IL-17 inhibitors in the treatment of PP. Based on our experience, anti-IL-17 molecules may represent a valuable therapeutical option for patients affected by different PP subtypes.

Pso-Reg: a web registry for psoriasis in real life

BACKGROUND

Psoriasis (PsO) is a common immune mediated inflammatory disease, affecting about 60 million people worldwide. Although current therapies have dramatically changed the therapeutic approach to the disease, the heterogeneity of responses often results in an essential unmet clinical need. This study describes the design and development of the Psoriasis Registry (Pso-Reg), an Italian electronic-based-registry, aimed to collect real life data of patients with psoriasis.

METHODS

Pso-Reg is a multicenter, retrospective and observational cohort study based on the Research Electronic Data Capture (REDcap) tool. Five Italian medical centres were part of the network and all patients affected by PsO were included in the study. Socio-demographic, clinical characteristics, laboratory findings and therapies were collected, and descriptive analysis was carried out.

RESULTS

Among the 768 patients analyzed, 446 were men (58.1%), with a mean age of 55.5 years. The first more frequent comorbidity was psoriatic arthritis (26.8%), followed by hypertension (25.3%), diabetes (10%) and dyslipidemia (11.7%). Of the entire cohort, 240 patients (38.2%) had a positive family history for PsO. Vulgar type was the most common phenotype (85.5%), with a major involvement of the scalp (13.8%). The mean PASI (Psoriasis Area Severity Index) score at the baseline was 7.5 (7.8). At the enrolment, 107 patients were treated with topic treatments (13.9%), 5 with phototherapy (0.7%), 92 with cDMARDs (conventional disease-modifying anti-rheumatic drugs) (12.0%) and 471 with biologic therapies (61.3%).

CONCLUSIONS

Real-life data from Pso-Reg could contribute providing the rationale for an individual-based strategy and a more tailored approach for the management of psoriasis.

Consistency of Bacterial Triggers in the Pathogenesis of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is an inflammatory skin disease whose pathogenesis remains poorly defined. Over the past decades, the bacterial role in HS patients has been a focus of research. According to the literature, the HS skin (and probably gut) bacterial composition is different to that of healthy controls. To date, a key question is whether compositional changes in the microbial populations are responsible for the development of HS (primum movens), or only secondarily reflect the ongoing inflammatory process. The great diversity of methodologies that have been used to study microbial role in HS have led to an accumulation of conflicting results. Thus, in view of these considerations, the aim of this article is to provide the reader with an overview about different hypotheses proposed to explain the bacterial role in HS pathogenesis.

AB0551 CLINICAL SIGNIFICANCE OF COGNITIVE IMPAIRMENT AND MALNUTRITION IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Previous studies reported a high prevalence of cognitive dysfunction in systemic sclerosis (SSc). Cognitive impairment was estimated to involve 60% to 80% of SSC patients and to be correlated with older age, disease severity, diffuse cutaneous subset and poor quality of life.

Objectives:

The aim of our study was to evaluate the association between cognitive impairment, nutritional status and the quality of life of SSc patients.

Methods:

Sixty-eight consecutive SSc patients followed at our Institution were evaluated for cognitive impairment using the validated Italian version of the Montreal Cognitive Assessment (MoCA). Scores <26 were considered abnormal. We also assessed other domains and quality of life measures such as UCLA SCTC GIT 2.0 for gastrointestinal involvement, BDI-II and PHQ-9 for anxiety and depression, EAT-10 for dysphagia symptoms, SHAQ and SF-36 for function and quality of life (QoL). The risk and the presence of overt malnutrition were assessed using the MUST questionnaire and the GLIM criteria, respectively. Clinical and demographic parameters such as age, sex, BMI, disease subset, organ involvement, autoantibody profile and modified Rodnan Skin Score were also recorded for each patient. Data were analysed by Student t-test or chi-square test and regression analyses were used to assess the association between variables.

Results:

A total of 68 SSc patients [47 (69.1%) limited SSc (lSSc) and 21 (30.9%) with diffuse SSc (dSSc), 59 female; mean age 60.2 (±13.4) years; mean disease duration 9 (±8.2) years; mean mRSS 8.1 (±7.6)] were included in the study.

Cognitive impairment was identified in 30 (44.1%) SSc patients; the mean MoCA score was 24.7 (±4.3). According to GLIM criteria, 16 (23.5%) patients were malnourished. Compared to patients with a MoCA≥26, patients with cognitive impairment were older (p<0.001), had more comorbidities (p<0.0001) and a worse QoL as assessed by the physical and general health domains of the Sf-36 (p<0.05). Malnourished patients were significantly more dysphagic (p<0.01) and had a worse HAQ (p<0.01) compared to well-fed patients. On regression analyses, cognitive impairment was related to increasing age (OR 1.08, 95%CI 1.03 to 1.14, p=0.001), but not to malnutrition, disease subset or symptoms. Malnutrition was associated with dysphagia (OR 1.10, 95%CI 1.01 to 1.20, p=0.01) and HAQ score (OR 2.69, 95%CI 1.24 to 5.82, p=0.01), but was not predicted by cognitive impairment.

Conclusion:

Cognitive dysfunction is frequently observed in SSc patients and mostly associated with increasing age and number of comorbidities. Malnutrition and cognitive impairment are both associated to QoL but seem to be unrelated.

Disclosure of Interests:

None declared

Long-term chikungunya infection clinical manifestations after an outbreak in Italy: a prognostic cohort study

OBJECTIVES

Following a Chikungunya (CHIKV) outbreak in Italy, a cohort study was conducted to describe the infection long-term clinical course and outcome.

METHODS

Persons identified through active and passive surveillance as confirmed or possible CHIKV cases during the outbreak were enrolled and interviewed by trained public health nurses, between 4-5 and 12-13 months following the acute stage. Patients reporting persistent clinical symptoms were evaluated by rheumatologists. Serum samples were obtained and anti-CHIKV specific IgG and IgM immune responses detected. Only confirmed cases who completed the follow-up were analysed.

RESULTS

Out of 250 patients, 66.5% still reported myalgia, asthenia or arthralgia (most frequent sign) after 12 months. Functional ability, measured by the ROAD index, was more impaired for lower extremities (3.75; Inter Quartile Range - IQR 4.4), and the activities of daily living (average 4.2; IQR 5). Variables independently associated with the presence of joint pain at 12-13 months were increasing age, and history of rheumatologic diseases). Elderly, females, and persons with history of rheumatologic diseases had higher anti-CHIKV IgG titres at 12-13 months.

CONCLUSIONS

This study confirms, in an unselected population, that the long-lasting burden of CHIKV infection is significant.

Infection with chikungunya virus in Italy: an outbreak in a temperate region

BACKGROUND

Chikungunya virus (CHIKV), which is transmitted by Aedes spp mosquitoes, has recently caused several outbreaks on islands in the Indian Ocean and on the Indian subcontinent. We report on an outbreak in Italy.

METHODS

After reports of a large number of cases of febrile illness of unknown origin in two contiguous villages in northeastern Italy, an outbreak investigation was done to identify the primary source of infection and modes of transmission. An active surveillance system was also implemented. The clinical case definition was presentation with fever and joint pain. Blood samples were gathered and analysed by PCR and serological assays to identify the causal agent. Locally captured mosquitoes were also tested by PCR. Phylogenetic analysis of the CHIKV E1 region was done.

FINDINGS

Analysis of samples from human beings and from mosquitoes showed that the outbreak was caused by CHIKV. We identified 205 cases of infection with CHIKV between July 4 and Sept 27, 2007. The presumed index case was a man from India who developed symptoms while visiting relatives in one of the villages. Phylogenetic analysis showed a high similarity between the strains found in Italy and those identified during an earlier outbreak on islands in the Indian Ocean. The disease was fairly mild in nearly all cases, with only one reported death.

INTERPRETATION

This outbreak of CHIKV disease in a non-tropical area was to some extent unexpected and emphasises the need for preparedness and response to emerging infectious threats in the era of globalisation.