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Riccieri V, Pellegrino G, Cipolletta E, Giuggioli D, Bajocchi G, Bellando-Randone S, Dagna L, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Lepri G, Girelli F, Zanatta E, Bosello SL, Cavazzana I, Ingegnoli F, De Santis M, Murdaca G, Abignano G, Romeo N, Della Rossa A, Caminiti M, Iuliano A, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Di Vico C, Gigante A, Saccon F, Grazia Lazzaroni M, Franceschini F, Generali E, Mennillo G, Barsotti S, Pagano Mariano G, Calabrese F, Furini F, Vultaggio L, Parisi S, Peroni CL, Bianchi G, Conti F, Cozzi F, D’Angelo S, Doria A, Fusaro E, Govoni M, Guiducci S, Iannone F, Salvarani C, Sebastiani GD, Ferri C, Matucci-Cerinic M, De Angelis R. Practice pattern for the use of intravenous iloprost for the treatment of peripheral vasculopathy in systemic sclerosis: A case-control study from the Italian national multicenter "SPRING" (Systemic Sclerosis Progression InvestiGation) Registry. J Scleroderma Relat Disord 2024; 9:38-49. [PMID: 38333531 PMCID: PMC10848931 DOI: 10.1177/23971983231209809] [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: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 02/10/2024]
Abstract
Background Intravenous iloprost has been widely used for the treatment of systemic sclerosis peripheral vasculopathy. No agreement has been found on the regimen and the dosage of intravenous iloprost in different scleroderma subset conditions. This study aimed to evaluate the modalities of intravenous iloprost administration within a large cohort of systemic sclerosis patients from the SPRING Registry and to identify any associated clinical-demographic, instrumental or therapeutic data. Patients and Methods Data of systemic sclerosis patients treated with intravenous iloprost for at least 1 year (case group) were retrospectively analyzed, including different timing and duration of intravenous iloprost session, and compared with those of untreated patients (control group). Results Out of 1895 analyzed patients, 937 (49%) received intravenous iloprost treatment, while 958 (51%) were assigned to the control group. Among cases, about 70% were treated every 4 weeks, 24% with an interval of more than 4 weeks, and only 6% of less than 4 weeks. Most patients receiving the treatment every 4 weeks, or less, underwent infusion cycle for 1 day only, while if it was scheduled with an interval of more than 4 weeks, a total number of 5 consecutive days of infusions was the preferred regimen. The comparison between the two groups revealed that patients treated with intravenous iloprost had a higher frequency of DUs (p < 0.001), pitting scars (p < 0.001), diffuse cutaneous involvement (p < 0.001), interstitial lung disease (p < 0.002), as well as higher rates of anti-topoisomerase I, "late" scleroderma pattern at nailfold videocapillaroscopy. These findings were confirmed by multivariate analysis. Conclusion Our data provide a picture on the Italian use of intravenous iloprost among systemic sclerosis patients and showed that it was usually employed in patients with a more aggressive spectrum of the disease. The disparity of intravenous iloprost treatment strategies in the different centers suggests the need of a rational therapeutical approach based on the clinical characteristics of different patients' subsets.
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Affiliation(s)
- Valeria Riccieri
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Greta Pellegrino
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of Rheumatology, IRCCS Ospedale Galeazzi–Sant’Ambrogio, Milan, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Rosario Foti
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy
| | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro,” Bari, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Francesco Girelli
- Department of Medicine, Rheumatology Unit, Ospedale GB Morgagni—L Pierantoni, Forlì, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Silvia Laura Bosello
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini, Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milan, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppina Abignano
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy
| | | | | | - Maurizio Caminiti
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | | | - Giovanni Ciano
- Hospital of Ariano Irpino, Local Health Department, Ariano Irpino, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ennio Lubrano
- Department of Rheumatology, University of Molise, Campobasso, Italy
| | - Ilenia De Andres
- Rheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale ed Alta Specializzazione “Garibaldi,” Catania, Italy
| | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Federica Lumetti
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Amelia Spinella
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Magnani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Veronica Codullo
- Department of Rheumatology, Policlinico San Matteo, Pavia, Italy
| | - Elisa Visalli
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy
| | - Claudio Di Vico
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia and University of Brescia, Brescia, Italy
| | - Elena Generali
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Gianna Mennillo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy
| | | | | | - Francesca Calabrese
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Federica Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Licia Vultaggio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Simone Parisi
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Clara Lisa Peroni
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gerolamo Bianchi
- Rheumatology Unit, Department of Musculoskeletal Sciences, Local Health Trust 3, La Colletta Hospital, Genoa, Italy
| | - Fabrizio Conti
- Department of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Franco Cozzi
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Salvatore D’Angelo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Enrico Fusaro
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari “Aldo Moro,” Bari, Italy
| | - Carlo Salvarani
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Clodoveo Ferri
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | - Rossella De Angelis
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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Di Battista M, Delle Sedie A, Romei C, Tavanti L, Da Rio M, Morganti R, Della Rossa A, Mosca M. Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2023:kead642. [PMID: 38048612 DOI: 10.1093/rheumatology/kead642] [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: 08/14/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes. METHODS SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software. RESULTS Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests. CONCLUSIONS We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | | | - Laura Tavanti
- Cardiovascular Thoracic Department, University of Pisa, Pisa, Italy
| | | | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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Di Battista M, Tavanti L, Pistelli F, Carrozzi L, Da Rio M, Rossi A, Puccetti L, Tavoni A, Romei C, Morganti R, Della Rossa A, Mosca M. Real life data on nintedanib safety: idiopathic pulmonary fibrosis versus systemic sclerosis-interstitial lung disease and strategies adopted to manage adverse effects. Inflammopharmacology 2023; 31:2445-2449. [PMID: 37535212 PMCID: PMC10518269 DOI: 10.1007/s10787-023-01286-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Nintedanib (NIN) is an antifibrotic drug approved to slow the progression of idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-related interstitial lung disease (SSc-ILD). NIN can frequently cause gastrointestinal adverse effects. We aimed to investigate the NIN safety profile in a real life setting, comparing IPF and SSc-ILD patients and evaluating the strategies adopted to manage NIN adverse effects. METHODS Patients taking NIN for IPF or SSc-ILD were enrolled. Alongside epidemiological and disease-specific data, the period of NIN use and the need for dosage reduction and/or interruption were investigated. Particular attention was paid to possible adverse effects and strategies adopted to manage them. RESULTS Twenty-seven SSc-ILD and 82 IPF patients were enrolled. No significant differences emerged between the two cohorts regarding the frequency of any possible adverse effect. Although the rates of NIN dosage reduction or interruption were similar between the two subgroups, SSc-ILD presented a mean period before NIN dosage reduction and NIN interruption significantly shorter than IPF (3 ± 2.6 vs 10.5 ± 8.9 months-p < 0.001 and 2.3 ± 0.5 vs 10.3 ± 9.9 months-p = 0.008, respectively). Several different strategies were tried to manage NIN adverse effects: especially in SSc-ILD, the variable combination of diet adjustment set by a nutritionist, probiotics and diosmectite was ultimately successful in maintaining patients on an adequate dose of NIN. CONCLUSION We presented data on the NIN safety profile in a real life setting, which was similar between SSc-ILD and IPF. A combination of multiple managing strategies and dose adjustment appears essential to cope optimally with NIN adverse effects.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, via Roma 67, 56123, Pisa, Italy.
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.
| | - Laura Tavanti
- Cardiovascular Thoracic Department, University of Pisa, Pisa, Italy
| | | | - Laura Carrozzi
- Cardiovascular Thoracic Department, University of Pisa, Pisa, Italy
| | - Mattia Da Rio
- Rheumatology Unit, University of Pisa, via Roma 67, 56123, Pisa, Italy
| | - Alessandra Rossi
- Rheumatology Unit, University of Pisa, via Roma 67, 56123, Pisa, Italy
| | - Lorenzo Puccetti
- Clinical Immunology and Allergy Unit, University of Pisa, Pisa, Italy
| | - Antonio Tavoni
- Clinical Immunology and Allergy Unit, University of Pisa, Pisa, Italy
| | | | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, via Roma 67, 56123, Pisa, Italy
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Di Battista M, Lepri G, Codullo V, Da Rio M, Fiorentini E, Della Rossa A, Guiducci S. Systemic sclerosis: one year in review 2023. Clin Exp Rheumatol 2023:19876. [PMID: 37199215 DOI: 10.55563/clinexprheumatol/ki76s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
Systemic sclerosis is a rare and chronic connective tissue disease resulting from an intricate pathogenesis and which is expressed in very heterogeneous clinical manifestations. Several studies try every year to unravel and shed a novel insight into the pathogenesis, organ involvement and treatment of this complex and severe disease. We herein provide an overview of the most relevant studies published in the literature in 2022.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Veronica Codullo
- Rheumatology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mattia Da Rio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Elisa Fiorentini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
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Di Battista M, Barsotti S, Vitali S, Palma M, Granieri G, Oranges T, Aringhieri G, Dini V, Della Rossa A, Neri E, Romanelli M, Mosca M. Multiparametric Skin Assessment in a Monocentric Cohort of Systemic Sclerosis Patients: Is There a Role for Ultra-High Frequency Ultrasound? Diagnostics (Basel) 2023; 13:diagnostics13081495. [PMID: 37189596 DOI: 10.3390/diagnostics13081495] [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: 03/30/2023] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023] Open
Abstract
Background: To assess skin involvement in a cohort of patients with systemic sclerosis (SSc) by comparing results obtained from modified Rodnan skin score (mRSS), durometry and ultra-high frequency ultrasound (UHFUS). Methods: SSc patients were enrolled along with healthy controls (HC), assessing disease-specific characteristics. Five regions of interest were investigated in the non-dominant upper limb. Each patient underwent a rheumatological evaluation of the mRSS, dermatological measurement with a durometer, and radiological UHFUS assessment with a 70 MHz probe calculating the mean grayscale value (MGV). Results: Forty-seven SSc patients (87.2% female, mean age 56.4 years) and 15 HC comparable for age and sex were enrolled. Durometry showed a positive correlation with mRSS in most regions of interest (p = 0.025, ρ = 0.34 in mean). When performing UHFUS, SSc patients had a significantly thicker epidermal layer (p < 0.001) and lower epidermal MGV (p = 0.01) than HC in almost all the different regions of interest. Lower values of dermal MGV were found at the distal and intermediate phalanx (p < 0.01). No relationships were found between UHFUS results either with mRSS or durometry. Conclusions: UHFUS is an emergent tool for skin assessment in SSc, showing significant alterations concerning skin thickness and echogenicity when compared with HC. The lack of correlations between UHFUS and both mRSS and durometry suggests that these are not equivalent techniques but may represent complementary methods for a full non-invasive skin evaluation in SSc.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, 56124 Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | | | | | - Marco Palma
- Radiology Unit, University of Pisa, 56124 Pisa, Italy
| | | | | | | | | | | | - Emanuele Neri
- Radiology Unit, University of Pisa, 56124 Pisa, Italy
| | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, 56124 Pisa, Italy
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Di Battista M, Della Rossa A, Da Rio M, De Mattia G, Morganti R, Mosca M. Clinical and LASCA preliminary data on selexipag efficacy for the treatment of digital vasculopathy in systemic sclerosis. J Rheumatol 2023:jrheum.221113. [PMID: 37003608 DOI: 10.3899/jrheum.221113] [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: 04/03/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is burdened by Raynaud's phenomenon (RP) and digital ulcers (DUs) and sometimes standard vasoactive therapies are ineffective or contraindicated. Selexipag is an oral selective IP prostacyclin receptor agonist approved for the treatment of SSc-related pulmonary arterial hypertension. We aimed to evaluate clinical and instrumental efficacy of selexipag in SSc digital vasculopathy. METHODS SSc patients with severe digital vasculopathy refractory or with contraindication to all other vasoactive therapies were administered selexipag, evaluating at baseline and after 3 months clinical outcomes regarding RP and DUs and digital perfusion assessed by laser speckle contrast analysis (LASCA). RESULTS Selexipag was administered to 9 SSc patients (66.6% female, mean age 52.3 ±16.6 years). One of them had to stop the drug for adverse effects. After three months selexipag determined a significant reduction of RP daily episodes (p=0.012) and RP mean duration (p=0.044). DUs decreased from 10 to 4 without reaching the statistical significance. A significant improvement in the mean perfusion of the fingers (p=0.016) was observed at LASCA. CONCLUSION Selexipag showed good potential for the treatment of SSc-digital vasculopathy. Our results are certainly preliminary but yet quite encouraging. New trials for the evaluation of selexipag efficacy in SSc-digital vasculopathy are needed.
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Affiliation(s)
- Marco Di Battista
- M. Di Battista, MD, Rheumatology Unit; University of Pisa, Pisa, Italy, Department of Medical Biotechnologies; University of Siena, Siena, Italy
| | - Alessandra Della Rossa
- A. Della Rossa, MD, PhD, Department of Medical Biotechnologies; University of Siena, Siena, Italy
| | - Mattia Da Rio
- M. Da Rio, MD, Department of Medical Biotechnologies; University of Siena, Siena, Italy
| | - Giammarco De Mattia
- G. De Mattia, MD, Department of Medical Biotechnologies; University of Siena, Siena, Italy
| | - Riccardo Morganti
- R. Morganti, ScD, PhD, Section of Statistics; University of Pisa, Pisa, Italy
| | - Marta Mosca
- M. Mosca, MD, PhD, Prof, Rheumatology Unit; University of Pisa, Pisa, Italy
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Di Battista M, Grosso M, Da Rio M, De Mattia G, Marciano A, Valevich A, Grosso A, Morganti R, Volterrani D, Della Rossa A, Mosca M. Is oropharyngoesophageal scintigraphy the method of choice for assessing dysphagia in systemic sclerosis? A single center experience. Esophagus 2023:10.1007/s10388-023-00995-0. [PMID: 36933137 DOI: 10.1007/s10388-023-00995-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To evaluate the performance of oropharyngoesophageal scintigraphy (OPES) in the assessment of dysphagia in patients with systemic sclerosis (SSc), and to compare OPES results with those of barium esophagogram. METHODS Adult SSc patients who underwent OPES for the assessment of dysphagia were enrolled. OPES was performed with both liquid and semisolid boluses and provided information regarding oropharyngeal transit time, esophageal transit time (ETT), oropharyngeal retention index (OPRI), esophageal retention index (ERI), and site of bolus retention. Barium esophagogram results were also collected. RESULTS Fifty-seven SSc patients (87.7% female, mean age 57.7 years) with dysphagia were enrolled. OPES identified at least one alteration in each patient and findings were generally worse for the semisolid bolus. Esophageal motility was widely impaired with 89.5% of patients with an increased semisolid ERI, and middle-lower esophagus was the most frequent site of bolus retention. However, oropharyngeal impairment was highlighted by widespread increased OPRI, especially in anti-topoisomerase I positivity. Older patients and with longer disease duration presented slower semisolid ETT (p = 0.029 and p = 0.002, respectively). Eleven patients with dysphagia had a negative barium esophagogram: all of them presented some alterations in OPES parameters. CONCLUSION OPES revealed a marked SSc esophageal impairment, in terms of both slowed transit time and increased bolus retention, but also shed light on oropharyngeal swallowing alterations. OPES showed high sensitivity, being able to detect swallowing alterations in dysphagic patients with negative barium esophagogram. Therefore, the use of OPES for the assessment of SSc-related dysphagia in clinical practice should be promoted.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, Via Roma 67, 56123, Pisa, Italy. .,Department of Medical Biotechnologies, University of Siena, Siena, Italy.
| | - Mariano Grosso
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | - Mattia Da Rio
- Rheumatology Unit, University of Pisa, Via Roma 67, 56123, Pisa, Italy
| | | | - Andrea Marciano
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | | | - Antonio Grosso
- Department of Translational Sciences and New Technologies in Medicine and Surgery, Gastrointestinal Unit, University of Pisa, Pisa, Italy
| | | | - Duccio Volterrani
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Via Roma 67, 56123, Pisa, Italy
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De Angelis R, Ferri C, Giuggioli D, Bajocchi G, Dagna L, Bellando-Randone S, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Lepri G, Girelli F, Riccieri V, Zanatta E, Bosello SL, Cavazzana I, Ingegnoli F, De Santis M, Murdaca G, Abignano G, Romeo N, Della Rossa A, Caminiti M, Iuliano AM, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Cipolletta E, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Di Vico C, Gigante A, Pellagrino G, Pigatto E, Lazzaroni MG, Franceschini F, Generali E, Mennillo G, Barsotti S, Mariano GP, Furini F, Vultaggio L, Parisi S, Peroni CL, Rozza D, Zanetti A, Carrara G, Landolfi G, Scirè CA, Bianchi G, Fusaro E, Sebastiani GD, Govoni M, D'Angelo S, Cozzi F, Guiducci S, Doria A, Salvarani C, Iannone F, Matucci-Cerinic M. Systemic sclerosis sine scleroderma: clinical and serological features and relationship with other cutaneous subsets in a large series of patients from the national registry 'SPRING' of the Italian Society for Rheumatology. RMD Open 2023; 9:rmdopen-2022-002890. [PMID: 36868782 PMCID: PMC9990652 DOI: 10.1136/rmdopen-2022-002890] [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] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/08/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVE To describe demographic, clinical and laboratory features of systemic sclerosis sine scleroderma (ssSSc) in a large multicentre systemic sclerosis (SSc) cohort. METHODS Data involving 1808 SSc patients from Italian Systemic sclerosis PRogression INvestiGation registry were collected. The ssSSc was defined by the absence of any cutaneous sclerosis and/or puffy fingers. Clinical and serological features of ssSSc were compared with limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets. RESULTS Among patients with SSc, only 61 (3.4%) were classified as having ssSSc (F/M=19/1). Time from Raynaud's phenomenon (RP) onset to diagnosis was longer in ssSSc (3 years, IQR 1-16.5) than lcSSc (2 years, IQR 0-7), and dcSSc (1 year, IQR 0-3) (p<0.001). Clinical ssSSc phenotype was comparable to lcSSc, except for digital pitting scars (DPS) (19.7% vs 42%, p=0.01), but significantly milder than dcSSc, particularly for digital ulcers (DU) (6.6% vs 35.7%, p<0.001), oesophagus (46.2% vs 63.5%, p=0.009), lung (mean diffusion capacity for carbon monoxide 72.2±19.6 vs 62.4±22.8, p=0.009; mean forced vital capacity 105.6±21.7 vs 89.2±20.9, p<0.001) and major videocapillaroscopic alterations (late pattern 8.6% vs 47.6%, p<0.001). Moreover, in ssSSc the percentages of anticentromere and antitopoisomerase were comparable to lcSSc (40% and 18.3% vs 36.7% and 26.6%), but divergent respect to dcSSc (8.6% and 67.4%, p<0.001). CONCLUSION The ssSSc is a quite rare disease variant characterised by clinico-serological features comparable to lcSSc, but significantly different from dcSSc. Overall, longer RP duration, low percentages of DPS and peripheral microvascular abnormalities, and increased anti-centromere seropositivity distinguish ssSSc. Further investigations based on national registries might provide useful insights on the actual relevance of the ssSSc within the scleroderma spectrum.
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Affiliation(s)
- Rossella De Angelis
- Rheumatology Unit - Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Gianluigi Bajocchi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy, Reggio Emilia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | | | - Rosario Foti
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy, Catania, Italy
| | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Giovanna Cuomo
- Department of Precision Medicine - University of Campania "Luigi Vanvitelli", Naples, Italy, Caserta, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy, Parma, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy, Roma, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Francesco Girelli
- Department of Medicine, Rheumatology Unit, Ospedale GB Morgagni - L Pierantoni, Forlì, Italy, Forlì, Italy
| | - Valeria Riccieri
- Department of Rheumatology, Sapienza University of Rome, Rome, Italy, Rome, Italy
| | | | - Silvia Laura Bosello
- Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy, Rome, Italy
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Brescia, Italy
| | - Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini, Dept. of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milan, Italy, Milano, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, and Humanitas University, Pieve Emanuele, Milan, Italy, Rozzano, Italy
| | - Giuseppe Murdaca
- Research Hospital San Martino, University of Genoa, Genoa, Italy, Genova, Italy
| | - Giuseppina Abignano
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy, Potenza, Italy
| | | | | | - Maurizio Caminiti
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy, Italy
| | | | - Giovanni Ciano
- Hospital of Ariano Irpino, Local Health Department, Ariano Irpino, Avellino, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ennio Lubrano
- Department of Rheumatology, University of Molise, Campobasso, Italy
| | - Ilenia De Andres
- Rheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale ed Alta Specializzazione "Garibaldi", Catania, Italy
| | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Marta Saracco
- Rheumatology Unit, Mauriziano-Umberto I Hospital, Torino, Italy
| | | | - Edoardo Cipolletta
- Rheumatology Unit - Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Federica Lumetti
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Amelia Spinella
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Luca Magnani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy, Reggio Emilia, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy
| | - Veronica Codullo
- Department of Rheumatology, Policlinico San Matteo, Pavia, Italy, Pavia, Italy
| | - Elisa Visalli
- Rheumatology Unit, A.O.U Policlinico S. Marco, Catania, Italy, Catania, Italy
| | - Claudio Di Vico
- Department of Precision Medicine - University of Campania "Luigi Vanvitelli", Naples, Italy, Caserta, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy, Roma, Italy
| | - Greta Pellagrino
- Department of Rheumatology, Sapienza University of Rome, Rome, Italy, Rome, Italy
| | - Erika Pigatto
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Maria-Grazia Lazzaroni
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Brescia, Italy
| | - Elena Generali
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, and Humanitas University, Pieve Emanuele, Milan, Italy, Rozzano, Italy
| | - Gianna Mennillo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy, Potenza, Italy
| | - Simone Barsotti
- Department of Rheumatology, University of Pisa, Pisa, Italy, Italy
| | - Giuseppa Pagano Mariano
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy, Italy
| | - Federica Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Licia Vultaggio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Simone Parisi
- Rheumatology Unit, Città della Salute e della Scienza, Turin, Italy
| | | | - Davide Rozza
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | | | - Carlo Alberto Scirè
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Gerolamo Bianchi
- Rheumatology Unit, Department of Musculoskeletal Sciences, Local Health Trust 3, La Colletta Hospital, Genoa, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Città della Salute e della Scienza, Turin, Italy
| | | | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara, Italy
| | - Salvatore D'Angelo
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital, Potenza, Italy, Potenza, Italy
| | - Franco Cozzi
- Department of Medicine, Villa Salus Hospital, Venice, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Andrea Doria
- Department of Rheumatology, University of Padua, Padua, Italy
| | - Carlo Salvarani
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy, Modena, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy, Milano, Italy.,Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence & Division of Rheumatology AOUC, University of Florence, Florence, Italy
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Di Battista M, Morganti R, Da Rio M, De Mattia G, Della Rossa A, Mosca M. Comparison of different forms of Raynaud's phenomenon by LASCA proximal-distal gradient perfusion. Microvasc Res 2023; 148:104509. [PMID: 36822366 DOI: 10.1016/j.mvr.2023.104509] [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: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To evaluate finger proximal-distal gradient (PDG) perfusion in subjects with primary Raynaud's phenomenon (PRP), then making comparisons with systemic sclerosis (SSc) patients and healthy controls (HC). METHODS Consecutive adult PRP subjects were enrolled, along with an equal number of SSc and HC. Peripheral blood perfusion of the hands was assessed by laser speckle contrast analysis (LASCA). PDG was then calculated applying a generalizable formula independent of both intra- and inter-personal factors. Non-specific anti-nuclear autoantibody (ANA) isolated positivity was assessed. RESULTS Fifty PRP patients (88 % female, mean age 45 ± 17.9 years) were enrolled, along with 50 SSc patients and 50 HC. After adjusting mean PDG results for age and sex, no significant differences emerged between PRP and SSc (1.80 ± 0.43 vs 1.76 ± 0.53; p = 0.294). Conversely, PRP values were significantly reduced when compared to HC (2.72 ± 0.37; p < 0.001). Among PRP subjects, no significant differences were found regarding isolated ANA positivity (1.86 ± 0.44 vs 1.74 ± 0.44; p = 0.42). CONCLUSION PRP and SSc seems to share the same basal PDG perfusion impairment assessed by LASCA. Isolated ANA positivity, in the absence of clinical and capillaroscopic suspicion for secondary causes, should not be considered an exclusion criterion for PRP classification.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Medical Biotechnologies, University of Siena, Siena, Italy.
| | | | | | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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Di Battista M, Vitali S, Barsotti S, Granieri G, Aringhieri G, Morganti R, Dini V, Della Rossa A, Romanelli M, Neri E, Mosca M. Ultra-high frequency ultrasound for digital arteries: improving the characterization of vasculopathy in systemic sclerosis. Semin Arthritis Rheum 2022; 57:152105. [DOI: 10.1016/j.semarthrit.2022.152105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022]
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Ferri C, De Angelis R, Giuggioli D, Bajocchi G, Dagna L, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Guiducci S, Girelli F, Riccieri V, Zanatta E, Bosello S, Cavazzana I, Ingegnoli F, De Santis M, Murdaca G, Abignano G, Romeo N, Rossa AD, Caminiti M, Iuliano A, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Masini F, Gigante A, Bellando-Randone S, Pellegrino G, Pigatto E, Lazzaroni MG, Franceschini F, Generali E, Mennillo G, Barsotti S, Mariano GP, Calabrese F, Furini F, Vultaggio L, Parisi S, Peroni CL, Rozza D, Zanetti A, Carrara G, Landolfi G, Scirè CA, Bianchi G, Fusaro E, Sebastiani GD, Govoni M, D'Angelo S, Cozzi F, Doria A, Iannone F, Salvarani C, Matucci-Cerinic M. Geographical heterogeneity of clinical and serological phenotypes of systemic sclerosis observed at tertiary referral centres. The experience of the Italian SIR-SPRING registry and review of the world literature. Autoimmun Rev 2022; 21:103159. [DOI: 10.1016/j.autrev.2022.103159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/24/2022] [Indexed: 12/18/2022]
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Lepri G, Orlandi M, Di Battista M, De Mattia G, Da Rio M, Codullo V, Guiducci S, Della Rossa A. Systemic sclerosis: one year in review 2022. Clin Exp Rheumatol 2022; 40:1911-1920. [DOI: 10.55563/clinexprheumatol/3401fl] [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: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, and Department of Medical Biotechnologies,
University of Siena, Italy
| | - Gianmarco De Mattia
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Mattia Da Rio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Veronica Codullo
- Rheumatology Unit, Fondazione IRCS Policlinico San Matteo, Pavia, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Di Battista M, Morganti R, Tani E, Da Rio M, Della Rossa A, Mosca M. Definition and application of proximal-distal gradient finger perfusion in systemic sclerosis by laser speckle contrast analysis. Microvasc Res 2021; 140:104307. [PMID: 34971696 DOI: 10.1016/j.mvr.2021.104307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In patients with systemic sclerosis (SSc) the perfusion of the fingers shows an alteration of the physiological proximal-distal gradient (PDG). The aim of this study is to provide a generalizable definition of PDG, applying it in a cohort of SSc patients and healthy controls (HC) using laser speckle contrast analysis (LASCA). METHODS Adult consecutive SSc patients and HC were enrolled. Peripheral blood perfusion of the hands was evaluated by LASCA, subsequently obtaining 3 different regions of interest: from the distal interphalangeal joint to the fingertip (DIST), from the metacarpophalangeal joint to the distal interphalangeal joint (PROX), and of the whole finger (TOT). A PDG formula independent of both intra- and inter-personal factors was then built. The PDG formula so obtained was: [(DIST × 2.63) - PROX]/TOT. RESULTS Ninety-four SSc patients (79.8% female, mean age 58.7 years) were enrolled. Applying the PDG formula, SSc patients revealed mean PDG values significantly lower than HC (1.82 ± 0.44 PU vs 2.70 ± 0.38 PU; p < 0.0001). Patients with a previous history of digital ulcers presented significant lower PDG values (p = 0.002). The ROC curve analysis identified in 2.28 PU the best PDG cut-off value between SSc and HC, with 86% sensibility and 90% specificity. CONCLUSION This study provided a PDG formula generalizable to all kind of subjects, applying it in SSc with great sensibility and specificity using LASCA, the best non-invasive imaging technique for the dynamical evaluation of peripheral perfusion. LASCA-PDG appears also as a tool able to identify a subclinical microangiopathic impairment.
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Affiliation(s)
| | | | - Eva Tani
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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De Angelis R, Giuggioli D, Bajocchi G, Dagna L, Zanframundo G, Foti R, Cacciapaglia F, Cuomo G, Ariani A, Rosato E, Guiducci S, Girelli F, Riccieri V, Zanatta E, Bosello S, Cavazzana I, Ingegnoli F, Santis MD, Murdaca G, Abignano G, Romeo N, Della Rossa A, Caminiti M, Iuliano A, Ciano G, Beretta L, Bagnato G, Lubrano E, De Andres I, Giollo A, Saracco M, Agnes C, Lumetti F, Spinella A, Magnani L, Campochiaro C, De Luca G, Codullo V, Visalli E, Masini F, Gigante A, Bellando-Randone S, Pellegrino G, Pigatto E, Dall'Ara F, Lazzaroni MG, Generali E, Mennillo G, Barsotti S, Mariano GP, Calabrese F, Furini F, Vultaggio L, Parisi S, Peroni CL, Risa AM, Rozza D, Zanetti A, Carrara G, Landolfi G, Scirè CA, Bianchi G, Fusaro E, Sebastiani GD, Govoni M, D'Angelo S, Cozzi F, Doria A, Iannone F, Salvarani C, Matucci-Cerinic M, Ferri C. Sex-related Differences in Systemic Sclerosis: A Multicenter Cross-sectional Study From the National Registry of the Italian Society for Rheumatology. J Rheumatol Suppl 2021; 49:176-185. [PMID: 34782448 DOI: 10.3899/jrheum.210794] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is still a great deal to learn about the influence of sex in systemic sclerosis (SSc). In this respect, national registries provide large and homogeneous patient cohorts for analytical studies. We therefore investigated a wide-ranging and well-characterized SSc series with the aim of identifying sex differences in disease expression, with a special focus on demographic, clinical, and serological characteristics. METHODS A multicenter SSc cohort of 2281 patients, including 247 men, was recruited in the Italian Systemic sclerosis PRogression INvestiGation (SPRING) registry. Demographic data, disease manifestations, serological profile, and internal organ involvement were compared. RESULTS The overall female/male ratio was 8.2:1. Female/male ratios for limited cutaneous SSc, diffuse cutaneous SSc, and SSc sine scleroderma subsets were 8.7:1, 4.9:1, and 10.7:1, respectively. A shorter time from onset of Raynaud phenomenon to SSc diagnosis, an increased prevalence of the diffuse cutaneous subset, renal crisis, and digital ulcers were found in males, whereas a significantly higher percentage of sicca syndrome, serum antinuclear antibodies, antiextractable nuclear antigens, anti-La/SSB, and anticentromere protein B was detected in the female group. Males exhibited lower left ventricular ejection fraction, as well as higher prevalence of conduction blocks, arrhythmias, ground glass, and honeycombing. Moreover, forced vital capacity and total lung capacity were medially lower in men than in women. Finally, males were more frequently treated with immunosuppressive drugs. CONCLUSION Our study further supports the presence of several sex-related differences in patients with SSc. These differences were pronounced in the severity of cutaneous, peripheral vascular, and cardiopulmonary involvement for male patients, whereas an increased prevalence of sicca syndrome and a specific autoantibody profile characterized the female sex.
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Affiliation(s)
- Rossella De Angelis
- R. De Angelis, MD, A.M. Risa, MD, Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona;
| | - Dilia Giuggioli
- D. Giuggioli, MD, F. Lumetti, MD, A. Spinella, MD, C. Ferri, MD, Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena
| | - Gianluigi Bajocchi
- G. Bajocchi, MD, L. Magnani, MD, C. Salvarani, MD, Rheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia
| | - Lorenzo Dagna
- L. Dagna, MD, C. Campochiaro, MD, G. De Luca, MD, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan
| | - Giovanni Zanframundo
- G. Zanframundo, MD, V. Codullo, MD, Department of Rheumatology, Policlinico San Matteo, Pavia
| | - Rosario Foti
- R. Foti, MD, E. Visalli, MD, AOU Policlinico Vittorio Emanuele, Catania
| | - Fabio Cacciapaglia
- F. Cacciapaglia, MD, F. Iannone, MD, Rheumatology Unit, Department of Emergency Surgery and Organ Transplantations, University of Bari, Bari
| | - Giovanna Cuomo
- G. Cuomo, MD, F. Masini, MD, Luigi Vanvitelli University, Naples
| | - Alarico Ariani
- A. Ariani, MD, Department of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria di Parma, Parma
| | - Edoardo Rosato
- E. Rosato, MD, A. Gigante, MD, Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Serena Guiducci
- S. Guiducci, MD, S. Bellando-Randone, MD, Department of Rheumatology, University of Florence, Florence
| | - Francesco Girelli
- F. Girelli, MD, Department of Medicine, Rheumatology Unit, Ospedale GB Morgagni-L Pierantoni, Forlì
| | - Valeria Riccieri
- V. Riccieri, MD, G. Pellegrino, MD, Department of Rheumatology, Sapienza University of Rome, Rome
| | - Elisabetta Zanatta
- E. Zanatta, MD, A. Doria, MD, Department of Rheumatology, University of Padua, Padova
| | - Silvia Bosello
- S. Bosello, MD, Institute of Rheumatology and Affine Sciences, Division of Rheumatology, Catholic University of the Sacred Heart, Rome
| | - Ilaria Cavazzana
- I. Cavazzana, MD, F. Dall'Ara, MD, M.G. Lazzaroni, MD, Department of Rheumatology, Spedali Civili di Brescia, Brescia
| | - Francesca Ingegnoli
- F. Ingegnoli, MD, Division of Clinical Rheumatology, ASST Pini, Dept. of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università degli Studi di Milano, Milan
| | - Maria De Santis
- M. De Santis, MD, E.Generali, MD, Humanitas Clinical and Research Center IRCCS, Milan
| | | | - Giuseppina Abignano
- G. Abignano, MD, G. Mennillo, MD, S. D'Angelo, MD, Department of Translational and Precision Medicine, Sapienza University of Rome
| | | | - Alessandra Della Rossa
- A. Della Rossa, MD, S. Barsotti, MD, Department of Rheumatology, University of Pisa, Pisa
| | - Maurizio Caminiti
- M. Caminiti, MD, G. Pagano Mariano, MD, F. Calabrese, MD, Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria
| | - Annamaria Iuliano
- A. Iuliano, MD, G.D. Sebastiani, MD, Rheumatology Unit, San Camillo-Forlanini Hospital, Rome
| | | | - Lorenzo Beretta
- L. Beretta, MD, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan
| | - Gianluca Bagnato
- G. Bagnato, MD, Department of Clinical and Experimental Medicine, University of Messina, Messina
| | - Ennio Lubrano
- E. Lubrano, MD, Department of Rheumatology, University of Molise, Campobasso
| | - Ilenia De Andres
- I. De Andres, MD, Rheumatology Unit, Azienda Ospedaliera di Rilievo Nazionale ed Alta Specializzazione Garibaldi, Catania
| | - Alessandro Giollo
- A. Giollo, MD, Rheumatology Section, Department of Medicine, University of Verona, Verona
| | - Marta Saracco
- M. Saracco, MD, Rheumatology Unit, Mauriziano-Umberto I Hospital, Turin
| | | | - Federica Lumetti
- D. Giuggioli, MD, F. Lumetti, MD, A. Spinella, MD, C. Ferri, MD, Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena
| | - Amelia Spinella
- D. Giuggioli, MD, F. Lumetti, MD, A. Spinella, MD, C. Ferri, MD, Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena
| | - Luca Magnani
- G. Bajocchi, MD, L. Magnani, MD, C. Salvarani, MD, Rheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia
| | - Corrado Campochiaro
- L. Dagna, MD, C. Campochiaro, MD, G. De Luca, MD, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan
| | - Giacomo De Luca
- L. Dagna, MD, C. Campochiaro, MD, G. De Luca, MD, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan
| | - Veronica Codullo
- G. Zanframundo, MD, V. Codullo, MD, Department of Rheumatology, Policlinico San Matteo, Pavia
| | - Elisa Visalli
- R. Foti, MD, E. Visalli, MD, AOU Policlinico Vittorio Emanuele, Catania
| | - Francesco Masini
- G. Cuomo, MD, F. Masini, MD, Luigi Vanvitelli University, Naples
| | - Antonietta Gigante
- E. Rosato, MD, A. Gigante, MD, Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Silvia Bellando-Randone
- S. Guiducci, MD, S. Bellando-Randone, MD, Department of Rheumatology, University of Florence, Florence
| | - Greta Pellegrino
- V. Riccieri, MD, G. Pellegrino, MD, Department of Rheumatology, Sapienza University of Rome, Rome
| | - Erika Pigatto
- E. Pigatto, MD, F. Cozzi, MD, Department of Medicine, Villa Salus Hospital, Venice
| | - Francesca Dall'Ara
- I. Cavazzana, MD, F. Dall'Ara, MD, M.G. Lazzaroni, MD, Department of Rheumatology, Spedali Civili di Brescia, Brescia
| | - Maria Grazia Lazzaroni
- I. Cavazzana, MD, F. Dall'Ara, MD, M.G. Lazzaroni, MD, Department of Rheumatology, Spedali Civili di Brescia, Brescia
| | - Elena Generali
- M. De Santis, MD, E.Generali, MD, Humanitas Clinical and Research Center IRCCS, Milan
| | - Gianna Mennillo
- G. Abignano, MD, G. Mennillo, MD, S. D'Angelo, MD, Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Simone Barsotti
- A. Della Rossa, MD, S. Barsotti, MD, Department of Rheumatology, University of Pisa, Pisa
| | - Giuseppa Pagano Mariano
- M. Caminiti, MD, G. Pagano Mariano, MD, F. Calabrese, MD, Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria
| | - Francesca Calabrese
- M. Caminiti, MD, G. Pagano Mariano, MD, F. Calabrese, MD, Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria
| | - Federica Furini
- F. Furini, MD, L. Vultaggio, MD, M. Govoni, MD, Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara
| | - Licia Vultaggio
- F. Furini, MD, L. Vultaggio, MD, M. Govoni, MD, Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara
| | - Simone Parisi
- S. Parisi, MD, C.L. Peroni, MD, E. Fusaro, MD, Rheumatology Unit, Città della Salute e della Scienza, Turin
| | - Clara Lisa Peroni
- S. Parisi, MD, C.L. Peroni, MD, E. Fusaro, MD, Rheumatology Unit, Città della Salute e della Scienza, Turin
| | - Anna Maria Risa
- R. De Angelis, MD, A.M. Risa, MD, Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona
| | - Davide Rozza
- D.Rozza, MS, A. Zanetti, MS, G. Carrara, MS, G. Landolfi, MS, Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Anna Zanetti
- D.Rozza, MS, A. Zanetti, MS, G. Carrara, MS, G. Landolfi, MS, Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Greta Carrara
- D.Rozza, MS, A. Zanetti, MS, G. Carrara, MS, G. Landolfi, MS, Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Giampiero Landolfi
- D.Rozza, MS, A. Zanetti, MS, G. Carrara, MS, G. Landolfi, MS, Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Carlo Alberto Scirè
- C.A. Scirè, MD, Epidemiology Unit, Italian Society for Rheumatology, Milan, and Rheumatology Unit, University of Ferrara-S. Anna Hospital, Ferrara
| | - Gerolamo Bianchi
- G. Bianchi, MD, Rheumatology Unit, Department of Musculoskeletal Sciences, Local Health Trust 3, La Colletta Hospital, Genoa
| | - Enrico Fusaro
- S. Parisi, MD, C.L. Peroni, MD, E. Fusaro, MD, Rheumatology Unit, Città della Salute e della Scienza, Turin
| | | | - Marcello Govoni
- F. Furini, MD, L. Vultaggio, MD, M. Govoni, MD, Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna di Ferrara, Ferrara
| | - Salvatore D'Angelo
- G. Abignano, MD, G. Mennillo, MD, S. D'Angelo, MD, Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Franco Cozzi
- E. Pigatto, MD, F. Cozzi, MD, Department of Medicine, Villa Salus Hospital, Venice
| | - Andrea Doria
- E. Zanatta, MD, A. Doria, MD, Department of Rheumatology, University of Padua, Padova
| | - Florenzo Iannone
- F. Cacciapaglia, MD, F. Iannone, MD, Rheumatology Unit, Department of Emergency Surgery and Organ Transplantations, University of Bari, Bari
| | - Carlo Salvarani
- G. Bajocchi, MD, L. Magnani, MD, C. Salvarani, MD, Rheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia
| | - Marco Matucci-Cerinic
- M. Matucci-Cerinic, MD, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, and Department of Rheumatology, University of Florence, Florence, Italy
| | - Clodoveo Ferri
- D. Giuggioli, MD, F. Lumetti, MD, A. Spinella, MD, C. Ferri, MD, Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena
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15
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Di Battista M, Barsotti S, Della Rossa A, Mosca M. Cardiovascular burden in systemic sclerosis: QRISK3 versus Framingham for risk estimation. Mod Rheumatol 2021; 32:584-588. [PMID: 34888692 DOI: 10.1093/mr/roab011] [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: 01/20/2021] [Revised: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To compare two algorithms for cardiovascular (CV) risk estimation in systemic sclerosis (SSc) patients, investigating correlations with disease characteristics. METHODS Traditional CV risk factors and SSc-specific characteristics were assessed in a cohort of SSc patients. Framingham and QRISK3 algorithms were used to estimate the risk of developing a CV disease over the next 10 years. RESULTS Seventy-two SSc patients were enrolled. Among those 56 without previous CV events, Framingham reported a median risk score of 9.6%, classifying 24 (42.9%) subjects at high risk. QRISK3 showed a median risk score of 15.8%, with 36 (64.3%) patients considered at high risk. Both algorithms revealed a significant role of some traditional risk factors and a noteworthy potential protective role of endothelin receptor antagonists (p = .003). QRISK3 was also significantly influenced by some SSc-specific characteristics, such as limited cutaneous subset (p = .01), interstitial lung disease (p = .04), and non-ischemic heart involvement (p = .03), with the first two maintaining statistical significance in the multivariate analysis (p = .02). CONCLUSIONS QRISK3 classifies more SSc patients at high risk to develop CV diseases than Framingham, reflecting the influence of some SSc-specific characteristics. If its predictive accuracy were prospectively verified, the use of QRISK3 as a tool in the early detection of SSc patients at high CV risk should be recommended.
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Affiliation(s)
| | | | | | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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16
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Ferri C, Giuggioli D, Raimondo V, L'Andolina M, Dagna L, Tavoni A, Caso F, Ursini F, Ruscitti P, Caminiti M, Foti R, Riccieri V, Guiducci S, Pellegrini R, Zanatta E, Varcasia G, Olivo D, Gigliotti P, Cuomo G, Murdaca G, Cecchetti R, De Angelis R, Romeo N, Ingegnoli F, Cozzi F, Codullo V, Cavazzana I, Colaci M, Abignano G, De Santis M, Lubrano E, Fusaro E, Rossa AD, Spinella A, Lumetti F, De Luca G, Bellando-Randone S, Visalli E, Dal Bosco Y, Amato G, Giannini D, Bilia S, Masini F, Pellegrino G, Pigatto E, Generali E, Mariano GP, Pettiti G, Zanframundo G, Brittelli R, Aiello V, Caminiti R, Scorpiniti D, Ferrari T, Campochiaro C, Brusi V, Fredi M, Moschetti L, Cacciapaglia F, Gragnani L, Monti M, Lorini S, Paparo SR, Ragusa F, Mazzi V, Elia G, Ferrari SM, Di Cola I, Vadacca M, Lorusso S, Barsotti S, Aprile ML, Marco T, Miccoli M, Bosello S, Matucci-Cerinic M, D'Angelo S, Doria A, Franceschini F, Meliconi R, Iannone F, Giacomelli R, Zignego AL, Fallahi P, Antonelli A. Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments. Curr Pharm Des 2021; 27:4245-4252. [PMID: 34477509 DOI: 10.2174/1381612827666210903103935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations. OBJECTIVE To investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic. METHOD Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in absence of a swab testing). RESULTS A significantly higher prevalence of definite plus highly suspected Covid-19 compared to Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed significantly lower rate of Covid-19 compared to those without (p=0.003). CONCLUSION The higher prevalence of Covid-19 in ASD patients along with the significant correlations with important clinical features and therapeutic regimens suggests the need to develop targeted prevention/management strategies during the current pandemic wave.
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Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy.,Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Vincenzo Raimondo
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Massimo L'Andolina
- Rheumatology Outpatient Clinic, ASP- Vibo Valentia-Tropea Hospital, Italy
| | | | | | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maurizio Caminiti
- UOD Reumatologia-Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Rosario Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | | | | | - Domenico Olivo
- Rheumatology Outpatient Clinic, San Giovanni di Dio Hospital, Crotone, Italy
| | | | | | - Giuseppe Murdaca
- Ospedale Policlinico S. Martino-University of Genova, Genova, Italy
| | | | - Rossella De Angelis
- Rheumatology Clinic, Department of Clinical & Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | | | | | | | | | - Ennio Lubrano
- Rheumatology, Università del Molise, Campobasso, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Amelia Spinella
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | - Federica Lumetti
- Rheumatology Unit, University of Modena and Reggio Emilia, School of Medicine, Modena, Italy
| | | | | | | | | | | | | | - Silvia Bilia
- Clinical Immunology, University of Pisa, Pisa, Italy
| | | | | | | | - Elena Generali
- Humanitas Clinical and Research Center IRCCS, Milano, Italy
| | | | | | | | | | - Vincenzo Aiello
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | - Rodolfo Caminiti
- Rheumatology Clinic 'Madonna dello Scoglio' Cotronei, Crotone, Italy
| | | | | | | | - Veronica Brusi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Micaela Fredi
- Rheumatology, Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | | | | | - Sabrina Rosaria Paparo
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Francesca Ragusa
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Valeria Mazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Giusy Elia
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
| | - Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological & Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marta Vadacca
- Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio Medico di Roma, Roma, Italy
| | - Sebastiano Lorusso
- Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio Medico di Roma, Roma, Italy
| | | | | | - Tasso Marco
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, School of Medicine, Pisa, Italy
| | - Silvia Bosello
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, and Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | - Andrea Doria
- Rheumatology, University of Padova, Padova, Italy
| | | | - Riccardo Meliconi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Roberto Giacomelli
- Unità Operativa di Immunoreumatologia - Area Medicina Clinica Policlinico Universitario Campus Bio Medico di Roma, Roma, Italy
| | - Anna Linda Zignego
- Department of Clinical Experimental Medicine, Interdepartmental Hepatology Center MASVE,
University of Florence, Firenze, Italy
| | - Poupak Fallahi
- Department of Translational Research & New Technologies in Medicine and Surgery, University of Pisa,
School of Medicine, Pisa, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, School of Medicine, Pisa, Italy
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17
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Di Battista M, Barsotti S, Orlandi M, Lepri G, Codullo V, Della Rossa A, Guiducci S, Del Galdo F. One year in review 2021: systemic sclerosis. Clin Exp Rheumatol 2021; 39 Suppl 131:3-12. [PMID: 34251323 DOI: 10.55563/clinexprheumatol/izadb8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022]
Abstract
Systemic sclerosis is a rare and chronic connective tissue disease with a multifaceted pathogenesis characterised by heterogeneous multi-organ clinical manifestations. Every year, many studies contribute to enrich the knowledge on the pathogenesis, organ involvement and treatment of this complex and severe disease. We herein provide an overview on the most relevant contributions published in the literature in 2020.
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Affiliation(s)
- Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Martina Orlandi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Gemma Lepri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Veronica Codullo
- Rheumatology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Francesco Del Galdo
- Scleroderma Programme, NIHR BRC and Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK
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18
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Ferri C, Giuggioli D, Raimondo V, Dagna L, Riccieri V, Zanatta E, Guiducci S, Tavoni A, Foti R, Cuomo G, De Angelis R, Cozzi F, Murdaca G, Cavazzana I, Romeo N, Codullo V, Ingegnoli F, Pellegrini R, Varcasia G, Rossa AD, De Santis M, Abignano G, Colaci M, Caminiti M, L'Andolina M, Lubrano E, Spinella A, Lumetti F, De Luca G, Bellando-Randone S, Visalli E, Bilia S, Giannini D, Masini F, Pellegrino G, Pigatto E, Generali E, Dall'Ara F, Mariano GP, Barsotti S, Pettiti G, Zanframundo G, Brittelli R, Aiello V, Scorpiniti D, Ferrari T, Caminiti R, Campochiaro C, D'Angelo S, Iannone F, Matucci-Cerinic M, Doria A, Miccoli M, Fallahi P, Antonelli A. COVID-19 and systemic sclerosis: clinicopathological implications from Italian nationwide survey study. Lancet Rheumatol 2021; 3:e166-e168. [PMID: 33521657 PMCID: PMC7836813 DOI: 10.1016/s2665-9913(21)00007-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Rheumatology Clinic Madonna dello Scoglio Cotronei, Crotone, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Valeria Riccieri
- Department of Rheumatology, Sapienza-University of Rome, Rome, Italy
| | | | - Serena Guiducci
- Department of Rheumatology, University of Florence, Florence, Italy
| | - Antonio Tavoni
- Department of Clinical Immunology, University of Pisa, Pisa, Italy
| | - Rosario Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Rossella De Angelis
- Rheumatology Clinic, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | | | - Giuseppe Murdaca
- Ospedale Policlinico S Martino-University of Genova, Genova, Italy
| | - Ilaria Cavazzana
- Department of Rheumatology, Spedali Civili di Brescia, Brescia, Italy
| | | | - Veronica Codullo
- Department of Rheumatology, Policlinico San Matteo, Pavia, Italy
| | | | - Roberta Pellegrini
- Rheumatology Complex Unit, Medicina Interna M Valentini PO Annunziata Cosenza, Cosenza, Italy
| | | | | | | | | | - Michele Colaci
- Department of Rheumatology, University of Catania, Catania, Italy
| | - Maurizio Caminiti
- Departmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Massimo L'Andolina
- Rheumatology Outpatient Clinic, Azienda Sanitaria Provinciale, Tropea Hospital, Vibo Valentia, Italy
| | - Ennio Lubrano
- Department of Rheumatology, Università del Molise, Campobasso, Italy
| | - Amelia Spinella
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Lumetti
- Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Silvia Bilia
- Department of Clinical Immunology, University of Pisa, Pisa, Italy
| | - Daiana Giannini
- Department of Clinical Immunology, University of Pisa, Pisa, Italy
| | | | - Greta Pellegrino
- Department of Rheumatology, Sapienza-University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | - Vincenzo Aiello
- Rheumatology Clinic Madonna dello Scoglio Cotronei, Crotone, Italy
| | | | - Tommaso Ferrari
- Rheumatology Section, Ospedale Castrovillari, Cosenza, Italy
| | - Rodolfo Caminiti
- Rheumatology Clinic Madonna dello Scoglio Cotronei, Crotone, Italy
| | | | | | - Florenzo Iannone
- Rheumatology Complex Unit, Dipartimento dell'Emergenza e Trapianti di Organi, Università di Bari, Bari, Italy
| | | | - Andrea Doria
- Department of Rheumatology, University of Padova, Padova, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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19
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Barsotti S, Venturini V, Di Battista M, Janowska A, Dini V, Della Rossa A, Mosca M. The impact of skin calcinosis on digital ulcers in patients with SSc: clinical and prognostic stratification using the "wound bed score". Int Wound J 2020; 17:1783-1790. [PMID: 32926570 PMCID: PMC7948997 DOI: 10.1111/iwj.13467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/04/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022] Open
Abstract
Digital ulcers (DUs) represent one of the major burdens for patients with systemic sclerosis (SSc), especially when associated with skin calcinosis (SC). The aim of this work is to evaluate the impact of SC in DUs of patients with SSc for clinical characteristics and prognosis assessed by the wound bed score (WBS). We prospectively enrolled 55 patients with DUs and SSc followed in our dedicated wound care clinic. For all the patients we collected clinical and anthropometric data and characteristics of the DU, and we calculated the WBS for each DU. Ninety-nine DUs were evaluated (24 with SC). SC was prevalent in limited cutaneous SSc (75%) and in patients with longer disease duration (P = 0.02). SC-DUs were prevalent at the fingertip (P = 0.04). The healing time was significantly higher in patients with SC (10.4 ± 7.9 weeks) compared with non-SC (7.0 ± 5.7 weeks) P = 0.03. The WBS negatively correlated with the time to achieve complete healing (r = -0.237 P = 0.023) and the correlation was maintained in the non-SC (r = -0.46, P = 0.033). DUs in SSc patients with SC are common and difficult to heal. When DUs are treated in dedicated centres, the prognosis is good. The WBS is fast and easy and maybe commonly applied in clinical practice.
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Affiliation(s)
- Simone Barsotti
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | - Marco Di Battista
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | | | | | - Marta Mosca
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
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20
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Di Battista M, Barsotti S, Monaco A, Rossi A, Della Rossa A, Mosca M. Bioelectrical Impedance Vector Analysis for Nutritional Status Assessment in Systemic Sclerosis and Association With Disease Characteristics. J Rheumatol 2020; 48:728-734. [PMID: 33060305 DOI: 10.3899/jrheum.200964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To use bioelectrical impedance vector analysis (BIVA) in a cohort of patients with systemic sclerosis (SSc) in order to assess their nutritional status in comparison to other groups of patients and to find any correlation with clinical characteristics and outcome of the disease. METHODS We retrospectively collected data from 50 SSc patients who underwent BIVA for clinical suspicion of malnutrition and compared them with patients affected by other chronic autoimmune rheumatic diseases (OCAD, n = 27) and those who were only symptomatic of malnutrition but without autoimmune features (n = 15), and with 50 healthy controls (HC). RESULTS Patients with SSc presented significantly lower values of phase angle (PhA), basal metabolic rate (BMR), and body cellular mass (BCM), and an increase in extracellular water (ECW; P < 0.01 for all) than HC; instead, there were no significant differences for BMI. No significant differences were found between SSc and OCAD. Among patients with SSc, age directly correlated with ECW (ρ = 0.342, P = 0.015) and inversely with PhA (ρ = -0.366, P = 0.009). Female sex, anemia, hypoalbuminemia, reflux, and early satiety/abdominal distension associated with relevant alterations in BIVA results. BIVA variables were significantly different when cardiopulmonary and microvascular involvement was present. Four patients died during the study: they had significantly (P ≤ 0.01) lower PhA, BMR, and BCM, with an increased ECW. CONCLUSION BIVA, unlike BMI, allowed an accurate characterization of SSc patients at risk of malnutrition, correlating with serological malnutrition markers, with SSc-specific organ manifestations (cardiopulmonary involvement and microvascular damage), and with mortality. BIVA variables might represent a surrogate marker of damage accrual that leads to malnutrition, thus playing a leading role in the prognostic stratification of SSc patients.
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Affiliation(s)
- Marco Di Battista
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Simone Barsotti
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Alessia Monaco
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Alessandra Rossi
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Alessandra Della Rossa
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy.
| | - Marta Mosca
- M. Di Battista, MD, S. Barsotti, MD, PhD, A. Monaco, MD, A. Rossi, MD, A. Della Rossa, MD, PhD, M. Mosca, MD, PhD, Professor, Rheumatology Unit, University of Pisa, Pisa, Italy
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21
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Orlandi M, Lepri G, Damiani A, Barsotti S, Di Battista M, Codullo V, Della Rossa A, Guiducci S, Allanore Y. One year in review 2020: systemic sclerosis. Clin Exp Rheumatol 2020; 38 Suppl 125:3-17. [PMID: 32662404] [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: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterised by diffuse microangiopathy and immune dysregulation which ultimately results in widespread fibrosis of the skin and internal organs. This complex autoimmune disease is characterised by heterogeneous clinical manifestations and variable disease course in which the severity of pathology dictates the disease prognosis and course. Every year novel insights into the pathogenesis, organ involvement and treatment of this severe disease are published. Herewith, we provide an overview of the most significant literature contributions published last year, with the aim of helping the clinician in the understanding and management of SSc patients.
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Affiliation(s)
- Martina Orlandi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Gemma Lepri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Arianna Damiani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Veronica Codullo
- Rheumatology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, Université de Paris, INSERM U1016, Paris, France
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22
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Ferri C, Giuggioli D, Guiducci S, Lumetti F, Bajocchi G, Magnani L, Codullo V, Ariani A, Girelli F, Riccieri V, Pellegrino G, Bosello S, Foti R, Visalli E, Amato G, Benenati A, Cuomo G, Iannone F, Cacciapaglia F, De Angelis R, Ingegnoli F, Talotta R, Campochiaro C, Dagna L, De Luca G, Bellando-Randone S, Spinella A, Murdaca G, Romeo N, De Santis M, Generali E, Barsotti S, Della Rossa A, Cavazzana I, Dall'Ara F, Lazzaroni MG, Cozzi F, Doria A, Pigatto E, Zanatta E, Ciano G, Beretta L, Abignano G, D'Angelo S, Mennillo G, Bagnato G, Calabrese F, Caminiti M, Pagano Mariano G, Battaglia E, Lubrano E, Zanframundo G, Iuliano A, Furini F, Zanetti A, Carrara G, Rumi F, Scirè CA, Matucci-Cerinic M. Systemic sclerosis Progression INvestiGation (SPRING) Italian registry: demographic and clinico-serological features of the scleroderma spectrum. Clin Exp Rheumatol 2020; 38 Suppl 125:40-47. [PMID: 32301427] [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: 09/13/2019] [Accepted: 12/03/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is a severe multiple-organ disease characterised by unpredictable clinical course, inadequate response to treatment, and poor prognosis. National SSc registries may provide large and representative patients cohorts required for descriptive and prognostic studies. Therefore, the Italian Society for Rheumatology promoted the registry SPRING (Systemic sclerosis Progression INvestiGation). METHODS The SPRING is a multi-centre rheumatological cohort study encompassing the wide scleroderma spectrum, namely the primary Raynaud's phenomenon (pRP), suspected secondary RP, Very Early Diagnosis of Systemic Sclerosis (VEDOSS), and definite SSc. Here we describe the demographic and clinical characteristics of a population of 2,028 Italian patients at the initial phase of enrolment, mainly focusing on the cohort of 1,538 patients with definite SSc. RESULTS Definite SSc showed a significantly higher prevalence of digital ulcers, capillaroscopic 'late' pattern, oesophageal and cardio-pulmonary involvement compared to VEDOSS, as expected on the basis of the followed classification criteria. The in-depth analysis of definite SSc revealed that male gender, diffuse cutaneous subset, and anti-Scl70 seropositivity were significantly associated with increased prevalence of the most harmful disease manifestations. Similarly, patients with very short RP duration (≤1 year) at SSc diagnosis showed a statistically increased prevalence of unfavourable clinico-serological features. CONCLUSIONS Nationwide registries with suitable subsetting of patients and follow-up studies since the prodromal phase of the disease may give us valuable insights into the SSc natural history and main prognostic factors.
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Affiliation(s)
| | | | | | | | | | - Luca Magnani
- Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | | | | | | | | | - Silvia Bosello
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, UOC di Reumatologia, Roma, Italy
| | - Rosario Foti
- AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | - Giovanna Cuomo
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesca Dall'Ara
- Spedali Civili di Brescia, and General Medicine Unit, Ospedale Maggiore di Lodi, Italy
| | | | | | | | | | | | | | - Lorenzo Beretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Federica Furini
- Department of Medical Sciences, University of Ferrara, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Federica Rumi
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Carlo Alberto Scirè
- Department of Medical Sciences, University of Ferrara, and Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
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Gargani L, Bruni C, Romei C, Frumento P, Moreo A, Agoston G, Guiducci S, Bellando-Randone S, Lepri G, Belloli L, Della Rossa A, Delle Sedie A, Stagnaro C, De Nes M, Salvadori S, Mosca M, Falaschi F, Epis O, Picano E, Matucci-Cerinic M. Prognostic Value of Lung Ultrasound B-Lines in Systemic Sclerosis. Chest 2020; 158:1515-1525. [PMID: 32360727 DOI: 10.1016/j.chest.2020.03.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 04/18/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A high percentage of systemic sclerosis (SSc) patients experience interstitial lung disease (ILD) during the disease course. Recent data have shown that lung ultrasound (LUS) can assess ILD by the evaluation of B-lines, the sonographic sign of pulmonary interstitial involvement. RESEARCH QUESTION To establish the prognostic value of B-lines in a large number of patients with SSc. STUDY DESIGN AND METHODS A total of 396 consecutive patients with SSc, who were enrolled at three Rheumatology Departments, underwent a comprehensive LUS examination on the anterolateral and posterior chest for a total of 58 scanning sites. All available clinical, imaging, and functional data were recorded. Patients were followed after enrolment to establish the prognostic role of LUS. RESULTS The median number of B-lines was higher in patients with the diffuse cutaneous subset (44 vs 17 B-lines; P < .0001), topoisomerase I autoantibodies (39 vs 16 B-lines; P < .0001), and the presence of ILD at chest high-resolution CT (45 vs 9 B-lines; P < .0001). At multivariable analysis, the number of posterior B-lines ≥5 was associated with new development or worsening ILD (hazard ratio, 3.378; 95% CI, 1.137-9.994; P = .028), with additional value over topoisomerase I positivity. The prognostic value was further confirmed in the subgroup of patients with known ILD at baseline (hazard ratio, 1.010; 95% CI, 1.003-1.018; P = .008). INTERPRETATION Lung ultrasound B-lines are associated with worsening or development of pulmonary deterioration. In the near future, LUS might become part of the diagnostic and prognostic armamentarium in patients with SSc, which would allow a more sustainable and user-friendly approach to this very fragile population.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Chiara Romei
- 2nd Radiology Unit, Azienda Ospedaliero Universitaria Pisa, Italy
| | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Antonella Moreo
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Gergely Agoston
- Cardiology and Rheumatology Department, Niguarda Hospital, Milan, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Laura Belloli
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Alessandra Della Rossa
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Andrea Delle Sedie
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Chiara Stagnaro
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Michele De Nes
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marta Mosca
- Department of Family Medicine, University of Szeged, Szeged, Hungary and Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Fabio Falaschi
- 2nd Radiology Unit, Azienda Ospedaliero Universitaria Pisa, Italy
| | - Oscar Epis
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
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24
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Barsotti S, Orlandi M, Codullo V, Di Battista M, Lepri G, Della Rossa A, Guiducci S. One year in review 2019: systemic sclerosis. Clin Exp Rheumatol 2019; 37 Suppl 119:3-14. [PMID: 31587697] [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: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Systemic sclerosis (SSc) is a complex disorder characterised by the involvement of small arteries, microvessels and connective tissue, with deposition of fibrotic tissue and microvascular obliteration in the skin and internal organs. Due to the multifaceted nature of the disease, several articles are published in the medical literature every year, aimed at exploring different aspects of the pathogenesis, internal organ involvement and clinical aspects, and possible therapeutic approaches. In this article we have reviewed the literature on SSc of the past year, with the aim of identifying novel approaches that may help the treating physician in the clinical management of patients.
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Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | | - Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gemma Lepri
- Rheumatology Unit, University of Florence, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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26
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Smith V, Scirè CA, Talarico R, Airo P, Alexander T, Allanore Y, Bruni C, Codullo V, Dalm V, De Vries-Bouwstra J, Della Rossa A, Distler O, Galetti I, Launay D, Lepri G, Mathian A, Mouthon L, Ruaro B, Sulli A, Tincani A, Vandecasteele E, Vanhaecke A, Vanthuyne M, Van den Hoogen F, Van Vollenhoven R, Voskuyl AE, Zanatta E, Bombardieri S, Burmester G, Eurico FJ, Frank C, Hachulla E, Houssiau F, Mueller-Ladner U, Schneider M, van Laar JM, Vieira A, Cutolo M, Mosca M, Matucci-Cerinic M. Systemic sclerosis: state of the art on clinical practice guidelines. RMD Open 2018; 4:e000782. [PMID: 30402270 PMCID: PMC6203100 DOI: 10.1136/rmdopen-2018-000782] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [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: 07/31/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Systemic sclerosis (SSc) is an orphan disease characterised by autoimmunity, fibrosis of the skin and internal organs, and vasculopathy. SSc may be associated with high morbidity and mortality. In this narrative review we summarise the results of a systematic literature research, which was performed as part of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases project, aimed at evaluating existing clinical practice guidelines or recommendations. Only in the domains ‘Vascular & Ulcers’ (ie, non-pharmacological approach to digital ulcer), ‘PAH’ (ie, screening and treatment), ‘Treatment’ and ‘Juveniles’ (ie, evaluation of juveniles with Raynaud’s phenomenon) evidence-based and consensus-based guidelines could be included. Hence there is a preponderance of unmet needs in SSc referring to the diagnosis and (non-)pharmacological treatment of several SSc-specific complications. Patients with SSc experience significant uncertainty concerning SSc-related taxonomy, management (both pharmacological and non-pharmacological) and education. Day-to-day impact of the disease (loss of self-esteem, fatigue, sexual dysfunction, and occupational, nutritional and relational problems) is underestimated and needs evaluation.
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Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Airo
- Rheumatology and Clinical Immunology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology Unit, Charité University Hospital Berlin, Berlin, Germany
| | - Yannick Allanore
- Service de Médicine Interne, Université Paris Descartes, Paris, France.,Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Veronica Codullo
- Department of Rheumatology, University of Pavia, Pavia, Italy.,Department of Rheumatology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Virgil Dalm
- Department of Internal Medicine and Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ilaria Galetti
- Federation of European Scleroderma Associations (FESCA), Brussels, Belgium
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France.,Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, CHU Lille, Lille, France
| | - Gemma Lepri
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
| | - Alexis Mathian
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Paris, France
| | - Luc Mouthon
- Service de Médicine Interne, Université Paris Descartes, Paris, France.,Centre de Référence Maladies systémiques Autoimmunes Rares d'Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Paris, France
| | - Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Els Vandecasteele
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Marie Vanthuyne
- Department of Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Louvain-la-Neuve, Belgium
| | - Frank Van den Hoogen
- Department of Rheumatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Ronald Van Vollenhoven
- Clinical Immunology & Rheumatology, Amsterdam Rheumatology & Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Infection & Immunity Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elisabetta Zanatta
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - Stefano Bombardieri
- Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Fonseca João Eurico
- Department of Rheumatology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Charissa Frank
- Flemish Patient Organization of Hereditary Collagen Disorders in Belgium, Koersel, Belgium
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France.,Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), LIRIC, INSERM, CHU Lille, Lille, France
| | - Frederic Houssiau
- Department of Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Louvain-la-Neuve, Belgium
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Giessen, Germany
| | - Matthias Schneider
- Institute for Rheumatology, Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ana Vieira
- Núcleo Síndrome de Sjögren of Liga Portuguesa Contra as Doenças Reumáticas (LPCDR, Portuguese League Against Rheumatic Diseases), Lisbon, Portugal
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.,Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence, Italy
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27
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Orlandi M, Barsotti S, Lepri G, Codullo V, Di Battista M, Guiducci S, Della Rossa A. One year in review 2018: systemic sclerosis. Clin Exp Rheumatol 2018; 36 Suppl 113:3-23. [PMID: 30277868] [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: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
Systemic sclerosis is a rare acquired systemic disease characterised by a complex pathogenesis and multi organ involvement. Every year the scientific world contributes to enrich the knowledge on the pathogenesis, clinical manifestations, diagnosis and treatment of this complex and severe disease. Herewith, we provide an overview of the most significant literature contributions published over the last year.
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Affiliation(s)
- Martina Orlandi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Simone Barsotti
- Department of Medical Biotechnologies, University of Siena; and Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gemma Lepri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | - Marco Di Battista
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
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Tripoli A, Barsotti S, Pollina LE, Della Rossa A, Neri R, d'Ascanio A, Baldini C, Mosca M. Muscular vasculitis confined to lower limbs: description of two case reports and a review of the literature. Rheumatol Int 2017; 37:2115-2121. [PMID: 29038907 DOI: 10.1007/s00296-017-3841-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/03/2017] [Indexed: 11/24/2022]
Abstract
Muscular involvement is common during systemic vasculitides, such as polyarteritis nodosa. However, in rare cases, muscular involvement can be the only clinically evident feature of the disease. The clinical pattern of isolated muscular vasculitis may mimic several other inflammatory muscle disorders, such as idiopathic inflammatory myositis, and may represent a challenge in differential diagnosis. Herewith, we present two clinical cases as examples of peculiar clinical and histopathological characteristics of isolated muscular vasculitis. Our patients were successfully treated with steroids and immunosuppressive agents. Moreover, we provide a review of the recent existing medical literature. Our cases suggest the importance of performing muscle biopsy in patients with muscular symptoms to guide the diagnosis and the treatment.
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Affiliation(s)
- Alessandra Tripoli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
- Department of Medical Biotechnologies, University of Siena, Siena, Italy.
| | | | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Rossella Neri
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Anna d'Ascanio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
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Barsotti S, Bruni C, Orlandi M, Della Rossa A, Marasco E, Codullo V, Guiducci S. One year in review 2017: systemic sclerosis. Clin Exp Rheumatol 2017; 35 Suppl 106:3-20. [PMID: 29035173] [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: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
Systemic sclerosis is a rare acquired systemic disease characterised by heterogeneous evolution and outcome. Each year novel insights into the pathogenesis, diagnosis and treatment of this severe disease have been published. We herewith provide our overview of the most significant literature contributions published over the last year.
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Affiliation(s)
- Simone Barsotti
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa; Department of Medical Biotechnologies, University of Siena, Italy
| | - Cosimo Bruni
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Italy
| | - Martina Orlandi
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Italy
| | - Alessandra Della Rossa
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy.
| | - Emiliano Marasco
- Division of Rheumatology, Hospital IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | - Veronica Codullo
- Division of Rheumatology, Hospital IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | - Serena Guiducci
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Florence, Italy
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Barsotti S, Stagnaro C, d'Ascanio A, Della Rossa A. One year in review 2016: systemic sclerosis. Clin Exp Rheumatol 2016; 34 Suppl 100:3-13. [PMID: 27463613] [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: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
Systemic sclerosis is a rare acquired systemic disease characterised by a complex pathogenesis and multi organ involvement. Every year, novel insights into the pathogenesis, diagnosis and treatment of this severe disease are published. Herewith, we provide an overview of the most significant literature contributions published over the last year.
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Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, University of Pisa; and Department of Medical Biotechnologies, University of Siena, Italy.
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Barsotti S, Stagnaro C, Della Rossa A. Systemic sclerosis: a critical digest of the recent literature. Clin Exp Rheumatol 2015; 33:S3-S14. [PMID: 26243174] [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: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 06/04/2023]
Abstract
Systemic sclerosis is a complex chronic disease characterised by chronic multisystem involvement of skin and internal organs. We reviewed all the articles published during the last 12 months on systemic sclerosis and in this article we provide a critical analysis of the most relevant studies regarding the pathogenesis, classification and management of the disease.
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Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Chiara Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Barsotti S, Mattaliano V, d'Ascanio A, Mosti G, Della Rossa A, Mattaliano C, Giuggioli D, Giraldi E, Ferri C, Mosca M. Systemic sclerosis chronic ulcers: preliminary results of treatment with allogenic skin grafting in a cohort of Italian patients. Int Wound J 2015; 13:1050-1. [PMID: 25648085 DOI: 10.1111/iwj.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/11/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Simone Barsotti
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | | | - Anna d'Ascanio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Mosti
- Angiology Department, Clinica MD Barbantini, Lucca, Italy
| | - Alessandra Della Rossa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Dilia Giuggioli
- Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Enzo Giraldi
- Day Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Clodoveo Ferri
- Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Rossa AD, Tavoni A, Bombardieri S. Cryoglobulinemia. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Della Rossa A, Cioffi E, Elefante E, Ferro F, Parma A, Vagelli R, Talarico R. Systemic vasculitis: an annual critical digest of the most recent literature. Clin Exp Rheumatol 2014; 32:S98-S105. [PMID: 24854379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
Herewith we provide our annual digest of the recent literature on systemic vasculitis in which we reviewed all the articles published during the last 12 months on large-, medium- and small-vessel vasculitis, and selected the most relevant studies regarding the epidemiology, pathogenesis and management of systemic vasculitis. In particular, we focused the attention on giant cell arteritis, ANCA-associated vasculitis and cryoglobulinaemia.
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Affiliation(s)
- Alessandra Della Rossa
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Mosca M, Tani C, Filice ME, Carli L, Delle Sedie A, Vagnani S, Della Rossa A, Baldini C, Bombardieri S. TNF-alpha inhibitors in Systemic Lupus Erythematosus. A case report and a systematic literature review. Mod Rheumatol 2013; 25:642-5. [DOI: 10.3109/14397595.2013.844306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mosca M, Tani C, Carli L, Della Rossa A, Talarico R, Baldini C, Bombardieri S. Analysis of the evolution of UCTD to defined CTD after a long term follow-up. Clin Exp Rheumatol 2013; 31:471. [PMID: 23075608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 06/01/2023]
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Tani C, Bellando Randone S, Guiducci S, Della Rossa A. Systemic sclerosis: a critical digest of the recent literature. Clin Exp Rheumatol 2013; 31:172-179. [PMID: 23910620] [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: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 06/02/2023]
Abstract
Herewith we provide a critical digest of the recent literature on systemic sclerosis. The most relevant studies published over the last two years have been reviewed, with particular focus on the diagnosis, pathogenesis and treatment of the disease.
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Affiliation(s)
- Chiara Tani
- Rhematology Unit, University of Pisa, Italy.
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Della Rossa A, Cazzato M, d'Ascanio A, Tavoni A, Bencivelli W, Pepe P, Mosca M, Baldini C, Rossi M, Bombardieri S. Alteration of microcirculation is a hallmark of very early systemic sclerosis patients: a laser speckle contrast analysis. Clin Exp Rheumatol 2013; 31:109-114. [PMID: 23073231] [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: 09/04/2012] [Accepted: 10/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate blood flow and microvascular reactivity by laser speckle perfusion imager (Perimed, Jarfalla) in consecutive patients affected by Raynaud's phenomenon at baseline and following dynamic stimulations. METHODS Skin blood flow in the dorsum of the hand was measured at baseline and after cold test and post-occlusive hyperemia test in 56 consecutive subjects affected by Raynaud's phenomenon (RP), 20 primary (PRP) and 36 secondary to systemic sclerosis (SSc). Twenty healthy subjects (HS) were studied as controls. RESULTS After cold test, SSc had a significant reduction of blood flow (-58%) as compared to HS (-19%) (p=0.01). Recovery time was significantly higher in SSc (58 minutes) as compared to HS (18 minutes) and PRP (19 minutes) (p=0.006 and 0.0016, respectively). Peak flow after ischaemic test was significantly reduced in SSc (+237%) as compared to PRP (+485%) (p=0.0068). Post-ischaemic hyperemic area under the curve (AUC) was blunted in SSc (79U/sec) compared to PRP (167 U/sec) (p=0.0126). Proximal distal gradient was noticed in 74% of HS, 45% of PRP and 36% of SSc (p=0.01). Homogeneous pattern of flux distribution was significantly different between HS (95%), PRP (80%), and SSc (16%) (p<0.0001). Among SSc patients, a significant difference in ischaemic challenge was shown between patients with early-SSc versus patients with definite-SSc. CONCLUSIONS Our preliminary results indicate a clearcut alteration of the dynamic of microcirculation in SSc-RP as compared to PRP and HS. Among SSc patients, early-SSc is a separate entity as compared to established disease.
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Affiliation(s)
- Alessandra Della Rossa
- Department of Musculoskeletal and Skin Diseases, Rheumatology Unit, University of Pisa, Italy.
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Baldini C, Mosca M, Della Rossa A, Pepe P, Notarstefano C, Ferro F, Luciano N, Talarico R, Tani C, Tavoni AG, Bombardieri S. Overlap of ACA-positive systemic sclerosis and Sjögren's syndrome: a distinct clinical entity with mild organ involvement but at high risk of lymphoma. Clin Exp Rheumatol 2013; 31:272-280. [PMID: 23343785] [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: 09/25/2012] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES We aimed to assess the prevalence of patients with either primary Sjögren's syndrome (pSS) and positive anticentromere antibodies (ACA) and secondary Sjögren's syndrome (sSS) and limited cutaneous ACA positive-systemic sclerosis (SSc) in two large cohorts of patients with pSS and SSc¸ and also to compare the clinical features of these two subsets with those of patients affected by 'ACA-positive SSc without sicca symptoms' and 'pSS'. METHODS In this retrospective monocentric study, the case records of 'overlap' patients fulfilling both the classification criteria for SS and the LeRoy criteria for early SSc were identified from two datasets of patients with limited cutaneous ACA positive SSc (209 subjects) and with pSS (402 subjects) who attended our Rheumatology Unit in the years between 1989 and 2011. Control groups were represented by SSc subjects without sicca symptoms ('SSc group') and ACA negative Pss patients ('pSS group'). SSc patients with sicca symptoms ('Sicca-SSc group') who did not complete the diagnostic algorithm for SS were excluded from the analysis. Demographic, clinical and immunological data of the patients enrolled were collected cumulatively over the entire follow up period. Statistical analysis was performed using SPSS 13 (SPSS Inc., Chicago IL, USA). RESULTS Out of the two datasets 41 'overlap' patients were selected. The control groups were represented by 102/209 SSc subjects without sicca symptoms ('SSc group') and 387/402 pSS patients ('pSS group'). Eighty-one 'sicca-SSc' with an incomplete work-up for SS were excluded from the analysis. The prevalence of ACA positive pSS patients among pSS was 3.7% (15/402), while the frequency of patients with definite sSS in the SSc cohort was 20% (26/128). No differences were detected between 'overlap' patients and control groups, relatively to demographic characteristics. 'Overlap patients' were characterised by a milder SSc disease (i.e. lower frequency of sclerodactily, negative evolution of the capillaroscopy pattern or absence of severe systemic involvement) whereas, as far as the SS-related manifestations were concerned, although often lacking in specific autoantibodies (i.e. rheumatoid factor, anti-Ro/SSA, anti-La/SSB), the 'overlap patients' displayed a full blown SS phenotype with recurrent salivary gland enlargement, purpura, fatigue, arthralgias, and leukocytopenia. It is noteworthy that the prevalence of non-Hodgkin's lymphoma in the 'overlap patients' was higher than in pSS. CONCLUSIONS Taken together, the results of our work emphasise the existence of a novel distinct clinical entity which might tentatively be called 'ACA-positive limited scleroderma/SS overlap syndrome' characterised by a benign SSc clinical course but at a high risk of non-Hodgkin's lymphoma.
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Martini D, Baldini C, Latorre M, Giorgerini V, Sernissi F, Della Rossa A, Mosca M. Future prospects for salivary proteomics in rheumatology: the example of eosinophil granulomatosis with polyangiitis. Clin Exp Rheumatol 2012; 30:810-811. [PMID: 23009806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/17/2012] [Indexed: 06/01/2023]
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Manetti M, Allanore Y, Saad M, Fatini C, Cohignac V, Guiducci S, Romano E, Airó P, Caramaschi P, Tinazzi I, Riccieri V, Della Rossa A, Abbate R, Caporali R, Cuomo G, Valesini G, Dieudé P, Hachulla E, Cracowski JL, Tiev K, Letenneur L, Amouyel P, Lambert JC, Chiocchia G, Martinez M, Ibba-Manneschi L, Matucci-Cerinic M. Evidence for caveolin-1 as a new susceptibility gene regulating tissue fibrosis in systemic sclerosis. Ann Rheum Dis 2012; 71:1034-41. [PMID: 22402147 DOI: 10.1136/annrheumdis-2011-200986] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Caveolin-1 (CAV1) is an inhibitor of tissue fibrosis and has been implicated in the pathogenesis of systemic sclerosis (SSc). The aim of the study was to analyse the possible association of CAV1 gene single nucleotide polymorphisms (SNP) with SSc. METHODS A total population of 3974 individuals (1355 SSc patients, 2619 controls) was studied. Genotype data for 23 SNP spanning the CAV1-CAV2 gene locus were obtained from a genome-wide scan conducted in a French population (564 SSc patients, 1776 controls). Three CAV1 SNP (rs926198, rs959173, rs9920) displaying the most significant associations with SSc and/or clinical phenotypes were then genotyped in an Italian population (791 SSc patients, 843 controls). CAV1 protein expression in skin biopsies was investigated by immunohistochemistry and western blotting. RESULTS In the French population, the CAV1 rs959173 C minor allele showed a significant protective association with susceptibility to SSc (OR 0.71, 95% CI 0.59 to 0.86, p(adjusted)=0.009), and with the subset of patients with limited cutaneous SSc (OR 0.71, 95% CI 0.56 to 0.89, p(adjusted)=0.018). The association was replicated in the Italian population and strengthened in the combined populations through Cochran-Mantel-Haenszel meta-analysis (SSc: pooled OR 0.81, 95% CI 0.71 to 0.92, p=0.0018; limited cutaneous SSc: pooled OR 0.80, 95% CI 0.69 to 0.93, p=0.0053). Genotype/protein expression correlations revealed that the rs959173 C protective allele was associated with increased CAV1 protein expression. CONCLUSIONS These results add CAV1 to the list of SSc susceptibility genes and provide further evidence for the contribution of this pathway in the fibrotic process that characterises SSc pathogenesis.
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Affiliation(s)
- Mirko Manetti
- Department of Anatomy, Histology and Forensic Medicine, University of Florence, Florence, Italy.
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Talarico R, Baldini C, Della Rossa A, Stagnaro C, Ferrari C, Luciano N, Bombardieri S. Large- and small-vessel vasculitis: a critical digest of the 2010-2011 literature. Clin Exp Rheumatol 2012; 30:S130-S138. [PMID: 22640656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 03/14/2012] [Indexed: 06/01/2023]
Abstract
The last two years have been marked by significant achievement in the identification of the basic mechanisms of systemic vasculitis and in the translation of these mechanisms into targeted therapies. More specifically, new insights into the environmental, cellular, and genetic factors involved in the pathogenesis of systemic vasculitis have been provided. Consequently, several studies focused on the development of novel strategies to achieve and maintain clinical remission in small- and large-vessel vascultis, including relevant large multicentre trials, have been promoted. The highlights of these studies, their potential clinical implications and the unmet needs, which are still to be addressed, are summarised in this review.
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Affiliation(s)
- Rosaria Talarico
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Italy.
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Rossa AD, Tavoni A, Bombardieri S. Cryoglobulinemia. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Baldini C, Talarico R, Della Rossa A, Bombardieri S. Clinical manifestations and treatment of Churg-Strauss syndrome. Rheum Dis Clin North Am 2010; 36:527-43. [PMID: 20688248 DOI: 10.1016/j.rdc.2010.05.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis affecting small to medium-sized vessels, and characterized by asthma, blood hypereosinophilia, and eosinophil-rich granulomatous inflammation of the respiratory tract. In the past few years the pathogenesis of the disease and its clinical manifestations have been clarified, fostering important advances in the treatment of CSS. Systemic corticosteroids are still considered the cornerstone of treatment. Many issues need to be addressed, such as how to maintain remission, prevent disease relapses, and treat refractory disease. This review provides a clinical overview of CSS and a summary of the current treatments and novel therapies.
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Affiliation(s)
- Chiara Baldini
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, 56126 Pisa, Italy
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Marchi F, Chimenti D, Tavoni A, Della Rossa A, Bombardieri S, Migliorini P. Endothelial progenitor cells in mixed cryoglobulinemia. J Rheumatol 2010; 37:1505-7. [PMID: 20516023 DOI: 10.3899/jrheum.100012] [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: 10/19/2022]
Abstract
OBJECTIVE Endothelial progenitor cells (EPC) are a rare population of circulating cells involved in vascular homeostasis. Our aim was to analyze EPC in patients with mixed cryoglobulinemia (MC). METHODS EPC were evaluated by cytometry according to guidelines of the International Society for Hematotherapy and Graft Engineering in 17 patients with MC and 36 controls. RESULTS Numbers of EPC were significantly increased in MC compared to controls and correlated with cryocrit, but not with clinical manifestations of the disease. CONCLUSION The high number of EPC might indicate an intact vascular repair ability. Alternatively, EPC might be defective in homing ability and their increase may represent the attempt to restore vascular integrity.
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Affiliation(s)
- Francesco Marchi
- Department of Internal Medicine, University of Pisa, Via Roma 67, Pisa, Italy
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Della Rossa A, Neri R, Talarico R, Doveri M, Consensi A, Salvadori S, Lorenzoni V, Turchetti G, Bellelli S, Cazzato M, Bazzichi L, Monicelli P, Moscardini S, Bombardieri S. Diagnosis and referral of rheumatoid arthritis by primary care physician: results of a pilot study on the city of Pisa, Italy. Clin Rheumatol 2009; 29:71-81. [PMID: 19806287 DOI: 10.1007/s10067-009-1285-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/01/2009] [Accepted: 09/16/2009] [Indexed: 11/28/2022]
Abstract
The aims of the present study were to evaluate, in the city of Pisa: (1) the prevalence of rheumatoid arthritis; (2) the reliability of the prevalence estimated by primary care physicians, using the rheumatologist's diagnosis as the "gold standard" and (3) the economic impact of the disease. The Tuscany registry of primary care physicians constituted the framework from which a sample of subjects was selected. The rheumatoid arthritis (RA) subjects >18 years followed by each primary care physician constituted the population studied. Each general practitioner (GP) was asked to fill out a questionnaire regarding their patients affected by RA and to send it to the tertiary rheumatologic centre, where the diagnosis was confirmed/discarded, the clinical and epidemiological data were collected in a standardized form and a number of data for the estimation of costs were gathered. The estimated prevalence of RA was 5.1 per thousand (CI, 4.4-5.7). The reliability of general practitioners in the diagnosis of rheumatoid arthritis was on the whole 69%. However, when an analysis of every physician was carried out, a high degree of heterogeneity in the prevalence of RA per physician was found. Overall, the mean annual cost per patient with RA was estimated at about 5,878 euro (euro; median, 6,434 euro; inter quartile range, 669-7,052 euro), with a high variability mainly dependent on the degree of patient disability. More than 90% of the overall annual cost per patient was due to the medical and non-medical direct components of costs. The prevalence of RA in Tuscany seems highly comparable with similar prevalence studies in Italy. The annual cost per patient with RA was highly variable and strictly dependent on the level of disability. More than 90% of the overall cost was due to the direct burden of costs.
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Affiliation(s)
- Alessandra Della Rossa
- Department of Internal Medicine, Rheumatology Unit, S. Chiara Hospital, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
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Mosca M, Giuliano T, Cuomo G, Doveri M, Tani C, Curcio M, Abignano G, De Feo F, Bazzichi L, Della Rossa A, Valentini G, Bombardieri S. Cell-free DNA in the plasma of patients with systemic sclerosis. Clin Rheumatol 2009; 28:1437-40. [PMID: 19669854 DOI: 10.1007/s10067-009-1245-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 07/13/2009] [Accepted: 07/23/2009] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to evaluate the concentration of cell-free DNA (cf-DNA) in the plasma of patients with systemic sclerosis (SSc) and to examine the correlation of cf-DNA with clinical variables of the disease. The study population consisted of 122 SSc patients and 16 healthy controls. Epidemiological and clinical data were collected by direct assessment. The beta-globin gene was used to determine the total amount of DNA in the plasma by real-time quantitative PCR analysis. cf-DNA was found in all patients (mean concentration 1,420.7 copies/ml) and controls (mean concentration 1,462.5), with no significant difference. In SSc patients, no correlation was found between cf-DNA and the type of organ involvement, but patients with active disease presented significantly higher cf-DNA concentrations than those with inactive disease (p < 0.05). Our data suggest that cf-DNA could provide a useful biomarker for the assessment of disease activity in SSc patients.
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Affiliation(s)
- Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Via Roma no. 67, 56126 Pisa, Italy.
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Della Rossa A, Bombardieri S, Valentini G. Comment on: Disease Activity Criteria in Scleroderma. Semin Arthritis Rheum 2008; 37:271-2; author reply 272. [PMID: 17889262 DOI: 10.1016/j.semarthrit.2007.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 07/17/2007] [Indexed: 10/22/2022]
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Abstract
The term cryoglobulinemia refers to the presence in the serum of proteins that precipitate at temperatures below 37 degrees C and redissolve on rewarming. The cryoglobulins can be divided into three categories: monoclonal, mixed, and polyclonal. Hyperviscosity syndrome is much more common in monoclonal than in mixed or polyclonal cryoglobulinemia. The clinical manifestations of cryoglobulinemia depend on the underlying disease and may involve various organs or systems. Mixed cryoglobulinemia (MC) is dominated by a vasculitic process, and the clinical manifestations can range from mild to life threatening in their severity. Another common feature of this disorder is the presence of a benign smoldering lymphoproliferative process that can evolve (in a limited number of cases) into non-Hodgkin's lymphoma. The elective treatment for hyperviscosity syndrome, whether associated with monoclonal, mixed, or polyclonal cryoglobulinemia, is plasma exchange. In monoclonal cryoglobulinemia, this procedure seems to act by removing large amounts of abnormal proteins, but its mechanism in MC is far from clear. Here it is possible that qualitative and quantitative variations in the circulating cryoglobulins, as well as hemodynamic changes, are at play. This article will focus on the hyperviscosity syndrome in cryoglobulinemia, beginning with a discussion of its clinical features and then examining the role of hemorheological parameters in the condition.
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Abstract
Mixed cryoglobulinemia is characterized by a wide spectrum of manifestations that may vary from mild symptoms (such as purpura, arthralgias, and Raynaud phenomenon) to life-threatening conditions (such as acute abdomen, hyperviscosity syndrome, and renal involvement). Hepatitis C virus infection is considered the principal trigger of the disease. Therefore, the treatment not only should be tailored to the prevailing symptom but also take into account the presence of a chronic, often smoldering infection. Symptomatic therapies are to be used in cases of minor clinical manifestations and aggressive modalities in cases of life-threatening conditions. The use of aggressive cytotoxic regimens should actually be stopped and every potentially immunosuppressive drug should be used with caution. Antiviral medications are used with growing frequency. To date, a few small trials with interferon-alpha alone or in combination with ribavirin in mixed cryoglobulinemia have been conducted. This overview deals with the current approach to the management of mixed cryoglobulinemia, focusing in particular on antiviral treatment in hepatitis C virus infection with or without mixed cryoglobulinemia.
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