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Romozzi M, Amorelli G, Savastano MC, Fedele AL, Amorelli F, Rizzo S, Lucchini M, Mirabella M, Nociti V. COVID-19 presenting as a non-arteritic anterior ischemic optic neuropathy. Eur J Ophthalmol 2023; 33:NP133-NP136. [PMID: 36624618 PMCID: PMC9834612 DOI: 10.1177/11206721221149762] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
We present a case of a 61-year-old woman with an atypical non-arteritic anterior ischemic optic neuropathy (NA-AION) as a unique manifestation of COVID-19. Furthermore, the patient worsened after Pfizer-BioNTech COVID-19 vaccine administration. Our findings suggest that NA-AION could result from microangiopathic/thrombotic events that may occur during SARS-CoV-2 infection and/or vaccination against COVID-19. This report sheds light on possible ophthalmologic complications of COVID-19.
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Affiliation(s)
- Marina Romozzi
- UOC di Neurologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro
Cuore, Rome, Italy
| | - Giulia Amorelli
- UOC di Oftalmologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Anna Laura Fedele
- UOC di Reumatologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Amorelli
- Centro Oculistico Amorelli, Corso
Italia 35, Gaeta, Italy
| | - Stanislao Rizzo
- UOC di Oftalmologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Matteo Lucchini
- UOC di Neurologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro
Cuore, Rome, Italy
| | - Massimiliano Mirabella
- UOC di Neurologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro
Cuore, Rome, Italy
| | - Viviana Nociti
- UOC di Neurologia, Fondazione
Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro
Cuore, Rome, Italy
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2
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Pollio Benvenuto C, Simonini C, Vaccarella M, Fedele AL, Ierardi C, Leone AM. [Development of coronary artery disease in a young adult with Takayasu's arteritis: the lesser, the better]. G Ital Cardiol (Rome) 2023; 24:475-477. [PMID: 37227207 DOI: 10.1714/4041.40207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Large vessel vasculitis, such as Takayasu's arteritis (TA), is a rare inflammatory disease affecting multiple vascular districts including the coronary arteries, producing either stenosis and/or aneurysms: these lesions can be found in the same patient and also in the same vessel, with potentially devastating effects. Moreover, TA often affects young people, in the midst of their work and social activity. Ischemic heart disease is the leading cause of cardiovascular mortality in Western countries and is mainly due to coronary atherosclerosis, whose etiopathogenesis is multifactorial and is closely related to the concomitant presence of classic cardiovascular risk factors and inflammation of the vessel wall. We report the case of a young, physically active adult with multivessel coronary artery disease developed in the context of a TA bursted 7 years before and currently in clinical remission. This complex case required a careful literature review and a multidisciplinary approach, since the best treatment option for coronary lesions induced by TA has not been established: a "watchful waiting" strategy was eventually adopted, considering the poor outcome of both percutaneous and surgical revascularization in this group of patients.
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Affiliation(s)
| | | | - Marcello Vaccarella
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Anna Laura Fedele
- U.O. Reumatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Carolina Ierardi
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
| | - Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma
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3
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Vitali F, Sciarrone MA, Frisullo G, Fedele AL, Torchia E, Tasca G, Luigetti M. ANCA-negative microscopic polyangiitis with neuromuscular involvement: When pathology could make the difference. Clin Neurol Neurosurg 2023; 225:107573. [PMID: 36608469 DOI: 10.1016/j.clineuro.2022.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
Microscopic polyangiitis (MPA) is a necrotizing small vessel vasculitis with little or absent immune deposits (pauci-immune vasculitis), usually associated with the presence of antineutrophil cytoplasmic autoantibodies (ANCA) and a wide spectrum of organ manifestations. In our report we describe the case of a 74-year-old Asian man, who rapidly developed lower limb weakness and impaired renal and pulmonary functions. ANCA detection remained borderline throughout the disease course. Electrophysiological and instrumental studies revealed a picture of neuromuscular involvement; renal and muscle biopsies disclosed a small vessel vasculitis. He was started on a targeted immunosuppressive combination therapy and his clinical status progressively improved. In the framework of a multi-organ disease, microscopic polyangiitis should be considered as a differential diagnosis in case of acute/subacute onset of muscle weakness, even in the absence of ANCA detection.
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Affiliation(s)
- Francesca Vitali
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, L.go A. Gemelli 8, Roma, Lazio 00168, Italy.
| | - Maria Ausilia Sciarrone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, L.go A. Gemelli 8, Roma, Lazio 00168, Italy
| | - Giovanni Frisullo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, L.go A. Gemelli 8, Roma, Lazio 00168, Italy
| | - Anna Laura Fedele
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Reumatologia, L.go A Gemelli 8, Roma, Lazio 00168, Italy
| | - Eleonora Torchia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, L.go A. Gemelli 8, Roma, Lazio 00168, Italy
| | - Giorgio Tasca
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, L.go A. Gemelli 8, Roma, Lazio 00168, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, L.go A. Gemelli 8, Roma, Lazio 00168, Italy
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4
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Seguiti C, Salvo PF, Di Stasio E, Lamonica S, Fedele AL, Manfrida S, Ciccarelli N, Corvari B, De Luca C, Tartaglione L, Pitocco D, Cauda R, Cingolani A. Health-related quality of life (HRQoL) from HIV patients' perspective: comparison of patient-reported outcome (PRO) measures among people living with hiv (PLWH) and other chronic clinical conditions. J Patient Rep Outcomes 2022; 6:27. [PMID: 35347476 PMCID: PMC8960483 DOI: 10.1186/s41687-022-00423-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background People living with HIV (PLWH) are generally known to suffer from a lower quality of life compared to the one of general population, but still very few is known about the self-perception of quality of life when comparing HIV to non-communicable diseases. We performed a comprehensive assessment of patient’s reported outcomes measures (PROMs) among PLWH and patients affected by other chronic conditions (OC) such as diabetes mellitus type 1, rheumatoid arthritis, breast cancer in hormonal therapy, in order to investigate differences in PROMs outcomes between PLWH and other pathologies. Methods A cross-sectional observational study was performed by using questionnaires investigating health-related quality of life (Medical Outcomes Study Short Form 36-item Health Survey), work productivity (WPI), and global health status (EQ-5D-3L). They were administered to patients affected by chronic diseases consecutively observed at a single University Hospital during a 10 months period, with comparable disease related aspects. Logistic regression analysis was used to analyze the association between disease group (HIV vs OC) and PROMs. Results 230 patients were enrolled (89 PLWH, 143 OC). Mean age: 49 years (SD 10), mean time of disease 12 years (10), 96% were Caucasian, 35% assumed polypharmacy, 42% of male were PLWH versus 16% OC (p < 0.001), 19% PLWH versus 6% OC had clinical complications (p < 0.001). HIV infection was independently associated to a better health-related quality of life in several domains compared with the other conditions, except in mental health, whereas a worst health-related quality of life in most domains was reported by older patients and those experiencing polypharmacy. Conclusions In this cohort of patients with chronic conditions followed within the same health setting, PLWH showed better self-reported health outcomes compared to other chronic conditions with comparable characteristics of chronicity. The potential detrimental role of older age and polypharmacy in most outcomes suggests the need of longitudinal assessment of PROMs in clinical practice.
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Affiliation(s)
- C Seguiti
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - P F Salvo
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Di Stasio
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Lamonica
- UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A L Fedele
- Divisione Reumatologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - S Manfrida
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - N Ciccarelli
- Dipartimento di Psicologia, Università Cattolica, Milan, Italy
| | - B Corvari
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - C De Luca
- UOC Chimica, Biochimica e Biologia Molecolare Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Tartaglione
- UOS Diabetologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - D Pitocco
- UOS Diabetologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - R Cauda
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - A Cingolani
- Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy. .,UOC Malattie Infettive, Infectious Disease Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
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5
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De Lorenzis E, Crudo F, Fedele AL, Fiorita A, Bruno D, Paludetti G, Alivernini S, Giraldi L, Picciotti PM, Zoli A, Cadoni G. Postural control and disability in patients with early rheumatoid arthritis. Clin Exp Rheumatol 2021; 39:1369-1377. [DOI: 10.55563/clinexprheumatol/hkfeur] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Enrico De Lorenzis
- Biomolecular Medicine PhD Program - cycle XXXV, University of Verona, and Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Fabrizio Crudo
- Department of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Fiorita
- Department of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Bruno
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Department of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Alivernini
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Giraldi
- Sections of Hygiene, Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Angelo Zoli
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Gabriella Cadoni
- Department of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy
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6
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Mangoni AA, Woodman RJ, Piga M, Cauli A, Fedele AL, Gremese E, Erre GL. Patterns of Anti-Inflammatory and Immunomodulating Drug Usage and Microvascular Endothelial Function in Rheumatoid Arthritis. Front Cardiovasc Med 2021; 8:681327. [PMID: 34350216 PMCID: PMC8326370 DOI: 10.3389/fcvm.2021.681327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/22/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives: Specific anti-inflammatory and/or immunomodulating drugs (AIDs) can influence endothelial function which is often impaired in patients with rheumatoid arthritis (RA). We sought to determine whether overall patterns of AID usage are similarly associated with endothelial function. Methods: The reactive hyperaemia index (RHI), a marker of microvascular endothelial function, was measured in 868 RA patients reporting their intake of seven AIDs known to affect endothelial function. Latent class analysis (LCA) was performed to characterise patterns of AID usage. Models for 2-6 classes were compared using the AIC and BIC statistics and Lo-Mendell-Rubin likelihood ratio tests. Associations between the classes and RHI were adjusted for age, gender, body mass index, diabetes, HDL-cholesterol, LDL-cholesterol, family history of ischaemic heart disease, smoking status, RA duration, DAS28 score, steroid dose, existing hypertension, and C-reactive protein. Results: LCA identified five distinct AID usage classes: Class 1, generally low medication usage; Class 2, using either sulfasalazine or non-tumour necrosis factor (TNF) inhibitors; Class 3, methotrexate users; Class 4, TNF-inhibitor users; and Class 5, hydroxychloroquine users. The geometric mean for the RHI for subjects in classes 1 to 5 was 1.92, 1.81, 1.94, 2.10, and 2.07, respectively, with subjects in classes 4 and 5 having better endothelial function than subjects in class 2 (p = 0.003 for each). The glucocorticoid dosage did not influence the classes formed or the association between the classes and the RHI in sensitivity analyses. Conclusion: There were five broad patterns (classes) of AID usage in RA patients. The RHI was relatively lower in users of either sulfasalazine or non-TNF inhibitors. TNF inhibitors or hydroxychloroquine may counteract the negative effects of RA on endothelial function.
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Affiliation(s)
- Arduino A Mangoni
- Discipline of Clinical Pharmacology, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard J Woodman
- Centre of Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Matteo Piga
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy.,Unità Operativa Complessa (UOC) di Reumatologia, Policlinico Universitario Azienda Ospedaliero-Universitaria (AOU) Cagliari, Cagliari, Italy
| | - Alberto Cauli
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy.,Unità Operativa Complessa (UOC) di Reumatologia, Policlinico Universitario Azienda Ospedaliero-Universitaria (AOU) Cagliari, Cagliari, Italy
| | - Anna Laura Fedele
- Fondazione Policlinico Gemelli-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Gremese
- Fondazione Policlinico Gemelli-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Luca Erre
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy.,Dipartimento di Specialità Mediche, Unità Operativa Complessa (UOC) Reumatologia, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
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7
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Giorgio V, Blasi E, Rigante D, Guerriero C, De Simone C, Fedele AL, Stella G, Gasbarrini A, Scaldaferri F. Anti-TNF-Related Leukocytoclastic Vasculitis in Ulcerative Colitis: A Case Report. Int J Environ Res Public Health 2021; 18:ijerph18136711. [PMID: 34206410 PMCID: PMC8297360 DOI: 10.3390/ijerph18136711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 01/13/2023]
Abstract
Background: The development of drugs directed against tumor necrosis factor (TNF)-α has dramatically modified the therapeutic approach to inflammatory bowel diseases: a larger use of such drugs has also led to a major knowledge about their adverse effects, especially on skin. The aim of this report was to describe a rare steroid-dependent form of leukocytoclastic vasculitis induced by an anti-TNF-α agent in a young woman with ulcerative colitis. Case presentation: A young girl with ulcerative colitis developed a form of leukocytoclastic vasculitis induced by an anti-TNF-α agent. Recurrent palpable purpuric lesions on her legs were the main cutaneous manifestation. Skin lesions were steroid-dependent, but improved after withdrawal of the anti-TNF-α agent and second-line immunosuppressant therapy. Conclusions: The need to develop specific recommendations to guide the use of medications for managing skin reactions induced by anti-TNF-α drugs is herein emphasized.
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Affiliation(s)
- Valentina Giorgio
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.B.); (D.R.); (G.S.)
- Correspondence:
| | - Elisa Blasi
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.B.); (D.R.); (G.S.)
| | - Donato Rigante
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.B.); (D.R.); (G.S.)
- Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.D.S.); (A.G.)
| | - Cristina Guerriero
- Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Clara De Simone
- Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.D.S.); (A.G.)
- Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Anna Laura Fedele
- Institute of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Giuseppe Stella
- Department of Life Sciences and Global Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (E.B.); (D.R.); (G.S.)
| | - Antonio Gasbarrini
- Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.D.S.); (A.G.)
- Department of Internal Medicine, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Franco Scaldaferri
- Department of Internal Medicine, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
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8
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Alivernini S, Tolusso B, Gessi M, Gigante MR, Mannocci A, Petricca L, Perniola S, Di Mario C, Bui L, Fedele AL, Capacci A, Bruno D, Peluso G, La Torre G, Federico F, Ferraccioli G, Gremese E. Inclusion of Synovial Tissue-Derived Characteristics in a Nomogram for the Prediction of Treatment Response in Treatment-Naive Rheumatoid Arthritis Patients. Arthritis Rheumatol 2021; 73:1601-1613. [PMID: 33750008 PMCID: PMC8457106 DOI: 10.1002/art.41726] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
Objective This study applied a synovitis score obtained during routine care from ultrasound (US)–guided biopsies of synovial tissue (ST) in patients with rheumatoid arthritis (RA) and patients with other inflammatory and noninflammatory joint diseases to identify pretreatment synovial biomarkers associated with disease characteristics, and to integrate the findings into a multiparameter nomogram for use in baseline prediction of diagnosis and treatment response in treatment‐naive rheumatoid arthritis (RA) patients. Methods The study enrolled a total of 1,015 patients with various autoimmune diseases (545 patients with RA, 167 patients with psoriatic arthritis [PsA], 199 patients with undifferentiated peripheral inflammatory arthritis [UPIA], 18 patients with crystal‐induced arthritis, 26 patients with connective tissue diseases, and 60 patients with osteoarthritis [OA] [as part of the SYNGem cohort]). All patients underwent a US‐guided ST biopsy at baseline, and patients were then stratified according to disease phase. The KSS, along with disease characteristics and clinical outcomes, were incorporated into a nomogram for prediction of achievement of clinical remission in RA patients who were previously naive to treatment. In patients in whom a treat‐to‐target strategy was applied, remission was defined as change in the Disease Activity Score in 28 joints (DAS28) at 6 months after treatment initiation. Results The KSS significantly differed among RA patients, as well as PsA patients and UPIA patients, when compared to OA patients. In RA, the KSS directly correlated with the DAS28 and was related to autoantibody positivity in treatment‐naive RA patients. Moreover, at baseline, treatment‐naive RA patients achieving 6‐month remission according to DAS28 had a lower KSS, shorter duration of symptoms (very early RA [VERA]), and lower disease activity than treatment‐naive RA patients not achieving remission according to DAS28. Results of logistic regression analysis identified the following synergistic predictive factors of achievement of DAS28‐based disease remission at 6 months: having a short disease duration (VERA), not having high disease activity, and having a KSS of <5 at baseline. A nomogram integrating these baseline clinical and histologic characteristics in treatment‐naive RA patients yielded an up to 81.7% probability of achieving 6‐month remission according to the DAS28. Conclusion The KSS is a reliable tool for synovitis assessment on US‐guided ST biopsy, contingent on the phase of the disease and the autoimmune profile of each patient. This tool could be integrated within a therapeutic response–predictive nomogram for the prediction of treatment response in RA patients who were previously naive to treatment.
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Affiliation(s)
- Stefano Alivernini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Marco Gessi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Maria Rita Gigante
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Luca Petricca
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Simone Perniola
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy, and University of Verona, Verona, Italy
| | | | - Laura Bui
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Annunziata Capacci
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Dario Bruno
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giusy Peluso
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Francesco Federico
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Elisa Gremese
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Bruno D, Fedele AL, Tolusso B, Barini A, Petricca L, Di Mario C, Barini A, Mirone L, Ferraccioli G, Alivernini S, Gremese E. Systemic Bone Density at Disease Onset Is Associated With Joint Erosion Progression in Early Naive to Treatment Rheumatoid Arthritis: A Prospective 12-Month Follow-Up Open-Label Study. Front Med (Lausanne) 2021; 8:613889. [PMID: 33732715 PMCID: PMC7959810 DOI: 10.3389/fmed.2021.613889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/18/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives: Osteoporosis and bone erosions are hallmarks of rheumatoid arthritis (RA) since disease onset is underpinned by the inflammatory burden. In this observational study, we aimed to dissect the putative RA-related parameters and bone-derived biomarkers associated with systemic and focal bone loss at disease onset and with their progression. Methods: One-hundred twenty-eight patients with early rheumatoid arthritis (ERA) were recruited at disease onset. At study entry, demographic, clinical, and immunological parameters were recorded. Each ERA patient underwent plain X-rays of the hands and feet at study entry and after 12 months to assess the presence of erosions. After enrollment, each patient was treated according to the recommendations for RA management and followed up based on a treat-to-target (T2T) strategy. At baseline, blood samples for soluble biomarkers were collected from each patient, and plasma levels of osteoprotegerin (OPG), receptor activator of nuclear factor κB ligand (RANKL), Dickkopf-1 (DKK1), and interleukin 6 (IL-6) were assessed by enzyme-linked immunosorbent assay (ELISA). Seventy-one ERA patients underwent bone mineral density (BMD) measurement at the left femoral neck and second to fourth lumbar spine vertebrae (L2–L4) by dual-energy X-ray absorptiometry (DXA). Results: Among the whole cohort, 34 (26.6%) ERA patients with bone erosions at study entry had a higher disease activity (p = 0.02) and IL-6 plasma levels (p = 0.03) than non-erosive ones. Moreover, at DXA, 33 (46.5%) ERA patients had osteopenia, and 16 (22.5%) had osteoporosis; patients with baseline bone erosions were more likely osteopenic/osteoporotic than non-erosive ones (p = 0.03), regardless of OPG, RANKL, and DKK1 plasma levels. Obese ERA patients were less likely osteopenic/osteoporotic than normal weight ones (p = 0.002), whereas anti-citrullinated protein antibodies (ACPA) positive ERA patients were more likely osteopenic/osteoporotic than ACPA negative ones (p = 0.034). At logistic regression analysis, baseline Disease Activity Score measured on 44 joints (DAS44) [OR: 2.46 (1.11–5.44)] and osteopenic/osteoporosis status [OR: 7.13 (1.27–39.94)] arose as independent factors of erosiveness. Baseline osteopenic/osteoporotic status and ACPA positivity were associated with bone damage progression during the follow-up. Conclusions: Bone erosions presence is associated with systemic bone loss since the earliest phases of RA, suggesting that the inflammatory burden and autoimmune biology, underpinning RA, represent crucial enhancers of bone remodeling either locally as at systemic level.
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Affiliation(s)
- Dario Bruno
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelina Barini
- Istituto di Biochimica e Biochimica Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clara Di Mario
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Barini
- Istituto di Biochimica e Biochimica Clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Mirone
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Stefano Alivernini
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Gremese E, Cingolani A, Bosello SL, Alivernini S, Tolusso B, Perniola S, Landi F, Pompili M, Murri R, Santoliquido A, Garcovich M, Sali M, De Pascale G, Gabrielli M, Biscetti F, Montalto M, Tosoni A, Gambassi G, Rapaccini GL, Iaconelli A, Zileri Del Verme L, Petricca L, Fedele AL, Lizzio MM, Tamburrini E, Natalello G, Gigante L, Bruno D, Verardi L, Taddei E, Calabrese A, Lombardi F, Bernabei R, Cauda R, Franceschi F, Landolfi R, Richeldi L, Sanguinetti M, Fantoni M, Antonelli M, Gasbarrini A. Sarilumab use in severe SARS-CoV-2 pneumonia. EClinicalMedicine 2020; 27:100553. [PMID: 33043284 PMCID: PMC7531933 DOI: 10.1016/j.eclinm.2020.100553] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Interleukin-6 signal blockade showed preliminary beneficial effects in treating inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the outcomes of off-label intravenous use of Sarilumab in severe SARS-CoV-2-related pneumonia. METHODS 53 patients with SARS-CoV-2 severe pneumonia received intravenous Sarilumab; pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards, live discharge rate in ICU treated patients and safety profile were recorded. Sarilumab 400 mg was administered intravenously on day 1, with eventual additional infusion based on clinical judgement, and patients were followed for at least 14 days, unless previously discharged or dead. FINDINGS Of the 53 SARS-CoV-2pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO2/FiO2:146(IQR:120-212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO2/FiO2: 112(IQR:100-141.5)].Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5-8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 h, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7%. INTERPRETATION IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical outcome and good safety.
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Affiliation(s)
- Elisa Gremese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Silvia Laura Bosello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Stefano Alivernini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Barbara Tolusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Simone Perniola
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
| | - Maurizio Pompili
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
| | - Rita Murri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Angelo Santoliquido
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
| | - Matteo Garcovich
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Michela Sali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Rome, Italy
| | - Gennaro De Pascale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
| | - Maurizio Gabrielli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Emergency Medicine, Rome, Italy
| | - Federico Biscetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
| | - Massimo Montalto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
| | - Alberto Tosoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Giovanni Gambassi
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Medicina Generale, Rome, Italy
| | - Gian Ludovico Rapaccini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
| | - Amerigo Iaconelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Lorenzo Zileri Del Verme
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
| | - Luca Petricca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Anna Laura Fedele
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Marco Maria Lizzio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
| | - Enrica Tamburrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Gerlando Natalello
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Laura Gigante
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Dario Bruno
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Lucrezia Verardi
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
| | - Eleonora Taddei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
| | - Angelo Calabrese
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
| | - Francesco Lombardi
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
| | - Roberto Bernabei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Francesco Franceschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Emergency Medicine, Rome, Italy
- Università Cattolica del Sacro Cuore, Emergency Medicine, Rome, Italy
| | - Raffaele Landolfi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
| | - Maurizio Sanguinetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Rome, Italy
| | - Massimo Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
| | - Massimo Antonelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
| | - GEMELLI AGAINST COVID-19 Group
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Reumatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Divisione di Reumatologia, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Sicurezza e Bioetica, Sez. Malattie Infettive, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Università Cattolica del Sacro Cuore, Institute of Internal Medicine and Geriatrics, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Clinic Medica e Malattie Cardiovascolari, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie – Sezione di Microbiologia, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Emergency Medicine, Rome, Italy
- Università Cattolica del Sacro Cuore, Division of Internal Medicine, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Medicina Generale, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCC, Division of Pulmonary Medicine, Rome, Italy
- Università Cattolica del Sacro Cuore, Emergency Medicine, Rome, Italy
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11
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Alivernini S, Petricca L, Perniola S, Fedele AL, Gigante MR, Capacci A, Paglionico A, Varriano V, De Lorenzis E, Lanzo L, Melpignano F, Rubortone P, Tanti G, Tur C, Bruno D, Gigante L, Natalello G, Verardi L, Di Mario C, Tolusso B, Mirone L, Lizzio MM, Zoli A, Peluso G, Bosello SL, Gremese E. No higher risk of respiratory symptoms in Italian rheumatological patients under IL-6R-inhibitor therapy in SARS-CoV-2 pandemic. Rheumatology (Oxford) 2020; 59:2644-2646. [PMID: 32728733 PMCID: PMC7454831 DOI: 10.1093/rheumatology/keaa388] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/12/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Simone Perniola
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Annunziata Capacci
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Valentina Varriano
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico De Lorenzis
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Lanzo
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Melpignano
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Rubortone
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Tanti
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Tur
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Bruno
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Gigante
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gerlando Natalello
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucrezia Verardi
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Luisa Mirone
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Maria Lizzio
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Angelo Zoli
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giusy Peluso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Alivernini S, MacDonald L, Elmesmari A, Finlay S, Tolusso B, Gigante MR, Petricca L, Di Mario C, Bui L, Perniola S, Attar M, Gessi M, Fedele AL, Chilaka S, Somma D, Sansom SN, Filer A, McSharry C, Millar NL, Kirschner K, Nerviani A, Lewis MJ, Pitzalis C, Clark AR, Ferraccioli G, Udalova I, Buckley CD, Gremese E, McInnes IB, Otto TD, Kurowska-Stolarska M. Distinct synovial tissue macrophage subsets regulate inflammation and remission in rheumatoid arthritis. Nat Med 2020; 26:1295-1306. [PMID: 32601335 DOI: 10.1038/s41591-020-0939-8] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/12/2020] [Indexed: 12/28/2022]
Abstract
Immune-regulatory mechanisms of drug-free remission in rheumatoid arthritis (RA) are unknown. We hypothesized that synovial tissue macrophages (STM), which persist in remission, contribute to joint homeostasis. We used single-cell transcriptomics to profile 32,000 STMs and identified phenotypic changes in patients with early/active RA, treatment-refractory/active RA and RA in sustained remission. Each clinical state was characterized by different frequencies of nine discrete phenotypic clusters within four distinct STM subpopulations with diverse homeostatic, regulatory and inflammatory functions. This cellular atlas, combined with deep-phenotypic, spatial and functional analyses of synovial biopsy fluorescent activated cell sorted STMs, revealed two STM subpopulations (MerTKposTREM2high and MerTKposLYVE1pos) with unique remission transcriptomic signatures enriched in negative regulators of inflammation. These STMs were potent producers of inflammation-resolving lipid mediators and induced the repair response of synovial fibroblasts in vitro. A low proportion of MerTKpos STMs in remission was associated with increased risk of disease flare after treatment cessation. Therapeutic modulation of MerTKpos STM subpopulations could therefore be a potential treatment strategy for RA.
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MESH Headings
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Arthritis, Rheumatoid/pathology
- Biopsy
- Cell Lineage/genetics
- Humans
- Inflammation/genetics
- Inflammation/immunology
- Inflammation/metabolism
- Inflammation/pathology
- Joints/immunology
- Joints/metabolism
- Joints/pathology
- Lectins, C-Type/genetics
- Lectins, C-Type/immunology
- Macrophages/immunology
- Macrophages/metabolism
- Mannose Receptor
- Mannose-Binding Lectins/genetics
- Mannose-Binding Lectins/immunology
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/immunology
- Receptors, Immunologic/genetics
- Receptors, Immunologic/immunology
- Synovial Fluid/immunology
- Synovial Fluid/metabolism
- Synovial Membrane
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Affiliation(s)
- Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
| | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Aziza Elmesmari
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Samuel Finlay
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Bui
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simone Perniola
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Moustafa Attar
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Marco Gessi
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sabarinadh Chilaka
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Domenico Somma
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Stephen N Sansom
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Andrew Filer
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Charles McSharry
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Alessandra Nerviani
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Andrew R Clark
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Irina Udalova
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Christopher D Buckley
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Elisa Gremese
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Iain B McInnes
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE)
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK
| | - Thomas D Otto
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
| | - Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), .
- Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, UK.
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13
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Alivernini S, Tolusso B, Gessi M, Gigante MR, Petricca L, Mario CD, Perniola S, Fedele AL, Peluso G, Bui L, Capacci A, Federico F, Ferraccioli G, Gremese E. O14 Semi-quantitative assessment of synovial inflammation on US guided synovial membrane biopsy is contingent to disease phase, autoimmune profile and treatment response in RA: a large single center experience. Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa110.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ultrasound (US)-guided minimally-invasive synovial tissue (ST) biopsy is a well-tolerated procedure for basic and translational studies on chronic inflammatory joint diseases as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA). The aim of the study was to evaluate the utility of histopathologic criteria to differentiate US-guided ST biopsies in daily clinical care in relation to diagnosis, disease characteristics, US parameters and treatment response in a large single center ST biopsy unit.
Methods
1,064 patients [545 RA, 167 PsA, 75 SpA, 199 undifferentiated peripheral inflammatory arthritis (UPIA), 18 crystal arthritis, 26 connective tissue diseases and 34 osteoarthritis (OA) respectively] who underwent US-guided ST biopsy were enrolled. US parameters (Synovial Hyperthrophy and Power Doppler signal respectively) were recorded for each biopsied joint. RA, PsA and SpA patients were stratified based on disease activity phase (naive to DMARDs, DMARDs resistant and in sustained remission, respectively). Clinical, demographic and immunological characteristics were recorded for each patient. All ST FFPE specimens were routinely processed and stained with H&E and classified by a pathologist, blinded to clinical characteristics, using the Krenn score to assess the degree of ST inflammation. Moreover, the presence/absence of lymphocytes, plasmacells, granulocytes and oedema was assessed for each ST. All naive to treatment RA were treated according to the T2T scheme and followed for at least 12 months and DAS remission rate was recorded.
Results
In the cohort, the distribution of synovitis score was significantly different among patients with inflammatory chronic diseases (RA, PsA, SpA and UPIA respectively) compared to OA (ANOVA Test p < 0.001). Moreover, Krenn score directly correlated with synovial hyperthrophy (R = 0.36; p < 0.001) and Power Doppler signal (R = 0.40;p<0.001) of the biopsied joint. Considering the RA cohort, naive RA showed a higher Krenn score compared to resistant RA (p < 0.001) and RA in sustained clinical and US remission (p < 0.001), directly correlating with DAS28 (R = 0.51; p < 0.001). Moreover, ACPA and RF positivity was related to the Krenn score and to ST plasmacells presence at RA onset (p < 0.05 and p < 0.001, respectively) but not at the time of DMARDs-failure or sustained remission achievement (p > 0.05 for both). Stratifying naive RA based on disease duration at ST biopsy, naive RA with symptoms duration >1 year, showed higher Krenn score compared to those with symptoms duration <3 months (p < 0.001). Finally, logistic regression analysis revealed that Krenn score higher or equal to 4.5 at baseline is an independent factor of no DAS remission achievement within 12 months [OR(95%CI):0.37(0.20-0.67)p<0.001] in naive RA.
Conclusion
Krenn score is a reliable tool for the semi-quantitative assessment of ST inflammation on US-guided ST biopsies being differentially distributed among various chronic inflammatory joint diseases and contingent to disease phase, autoimmune profile and therapeutic response in RA.
Disclosures
S. Alivernini None. B. Tolusso None. M. Gessi None. M. Gigante None. L. Petricca None. C. Di Mario None. S. Perniola None. A. Fedele None. G. Peluso None. L. Bui None. A. Capacci None. F. Federico None. G. Ferraccioli None. E. Gremese None.
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Affiliation(s)
- Stefano Alivernini
- Fondazione Policlinico Universitario A.Gemelli IRCCS - Università Cattolica del Sacro Cuore, Institute of Rheumatology, Rome, ITALY
| | - Barbara Tolusso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Marco Gessi
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Pathology, Rome, ITALY
| | - Maria Rita Gigante
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Luca Petricca
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Clara Di Mario
- Università Cattolica del Sacro Cuore, Institute of Rheumatology, Rome, ITALY
| | - Simone Perniola
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Anna Laura Fedele
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Giusy Peluso
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Laura Bui
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Pathology, Rome, ITALY
| | - Annunziata Capacci
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Division of Rheumatology, Rome, ITALY
| | - Francesco Federico
- Fondazione Policlinico Universitario A.Gemelli IRCCS - Università Cattolica del Sacro Cuore, Division of Pathology, Rome, ITALY
| | | | - Elisa Gremese
- Fondazione Policlinico Universitario A.Gemelli IRCCS - Università Cattolica del Sacro Cuore, Institute of Rheumatology, Rome, ITALY
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14
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Benucci M, Grossi V, Manfredi M, Damiani A, Infantino M, Moscato P, Cinquanta L, Gremese E, Tolusso B, Petricca L, Fedele AL, Alivernini S, Atzeni F, Minisola G, Verna R. Laboratory Monitoring of Biological Therapies in Rheumatology: The Role of Immunogenicity. Ann Lab Med 2020; 40:101-113. [PMID: 31650726 PMCID: PMC6822010 DOI: 10.3343/alm.2020.40.2.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/04/2019] [Revised: 06/09/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022] Open
Abstract
Biological drugs, such as proteins and immunogens, are increasingly used to treat various diseases, including tumors and autoimmune diseases, and biological molecules have almost completely replaced synthetic drugs in rheumatology. Although biological treatments such as anti-tumor necrosis factor (TNF) drugs seem to be quite safe, they cause some undesirable effects, such as the onset of infections due to weakening of the immune system. Given the biological nature of these drugs, they might be recognized as extraneous; this would induce an immune reaction that neutralizes their effectiveness or lead to more serious consequences. Laboratories play a pivotal role in appropriate therapeutic management. The aim of this review was to underline the production of anti-drug antibodies during treatment with biological drugs and highlight the role of laboratories in ensuring appropriate use of these drugs.
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Affiliation(s)
| | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, S.Giovanni di Dio Hospital, Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, S.Giovanni di Dio Hospital, Florence, Italy
| | - Arianna Damiani
- Rheumatology Unit, S.Giovanni di Dio Hospital, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, S.Giovanni di Dio Hospital, Florence, Italy
| | - Paolo Moscato
- Department of Medicine, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | | | - Roberto Verna
- World Association of Societies of Pathology and Laboratory Medicine, Milan, Italy.,Department of Experimental Medicine Sapienza University of Rome, Rome, Italy.
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15
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Cassone G, Manfredi A, Atzeni F, Venerito V, Vacchi C, Picerno V, Furini F, Erre GL, Tomietto P, Fedele AL, Della Casa G, Nucera V, Giannitti C, Salvarani C, Sebastiani M. Safety of Abatacept in Italian Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Multicenter Retrospective Study. J Clin Med 2020; 9:jcm9010277. [PMID: 31963908 PMCID: PMC7019755 DOI: 10.3390/jcm9010277] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 12/31/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Treatment of rheumatoid arthritis (RA)-related interstitial lung disease (ILD) is challenging, and many conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) have been associated with ILD development or progression. The aim of this multicentric retrospective study was to analyze the evolution of ILD in Italian RA-ILD patients treated with abatacept (ABA). Methods: All RA-ILD patients treated with ABA for at least six months were retrospectively evaluated. Serology, previous and concurrent therapies, chest high-resolution computer tomography (HRCT), forced vital capacity (FVC), and lung diffusion of carbon monoxide (CO, DLCO) were collected. Results: Forty-four patients were included; HRCT, FVC, and DLCO were analyzed at baseline, at one year, and at the end of follow-up. A remission or a low disease activity of RA was reached in 41/44 patients. Overall, FVC and DLCO remained stable or increased in 86.1% and 91.7% of patients, respectively, while HRCT was stable or improved in 81.4% of them. Previous and concurrent treatments, in particular, methotrexate, serology, age, sex, joint and lung disease duration were not associated with the outcome at univariate analysis. Conclusion: The management of RA-ILD patients remains a critical unmet medical need. Waiting for prospective controlled studies, ABA has shown a good safety profile in our cohort of Italian RA-ILD patients.
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Affiliation(s)
- Giulia Cassone
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.C.); (C.V.)
| | - Andreina Manfredi
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
| | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, 98121 Messina, Italy; (F.A.)
| | - Vincenzo Venerito
- Rheumatology Unit, Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy;
| | - Caterina Vacchi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.C.); (C.V.)
| | - Valentina Picerno
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, 85100 Potenza, Italy;
| | - Federica Furini
- Department of Medical Sciences, Division of Rheumatology, Santa Anna University Hospital, 44100 Ferrara, Italy;
| | - Gian Luca Erre
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07010 Sassari, Italy;
| | - Paola Tomietto
- Department of Clinical Medicine, Rheumatology Unit, Azienda Sanitaria Universitaria Integrata di Trieste, 34121 Trieste, Italy;
| | - Anna Laura Fedele
- Rheumatology Unit, Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanni Della Casa
- Radiology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, 98121 Messina, Italy; (F.A.)
| | | | - Carlo Salvarani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
| | - Marco Sebastiani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
- Correspondence: ; Tel.: +39-059-4225636; Fax: +39-059-4223007
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16
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Alivernini S, Tolusso B, Fedele AL, Di Mario C, Ferraccioli G, Gremese E. The B side of rheumatoid arthritis pathogenesis. Pharmacol Res 2019; 149:104465. [PMID: 31574298 DOI: 10.1016/j.phrs.2019.104465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 01/01/2023]
Abstract
In the last years, a dramatic amount of research has been performedincreasing the knowledge about the biological mechanism underpinning Rheumatoid Arthritis (RA) inflammation, putting B lymphocytes in the center of RA pathogenesis. Nowadays, B cell phenotypes and autoantibodies positivity arose as important biomarkers in early and long-standing disease. Moreover, comparative analysis of peripheral blood and synovial tissue compartments enables the identification of novel physiopathological mechanisms promoting inflammation. In this narrative review we will discuss the biological relevance of B cell derived autoimmunity and in RA course, from disease onset to remission achievement.
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Affiliation(s)
- Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Clara Di Mario
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
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17
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Manfredi A, Cassone G, Cerri S, Venerito V, Fedele AL, Trevisani M, Furini F, Addimanda O, Pancaldi F, Della Casa G, D'Amico R, Vicini R, Sandri G, Torricelli P, Celentano I, Bortoluzzi A, Malavolta N, Meliconi R, Iannone F, Gremese E, Luppi F, Salvarani C, Sebastiani M. Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device). BMC Pulm Med 2019; 19:111. [PMID: 31221137 PMCID: PMC6587236 DOI: 10.1186/s12890-019-0875-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High-resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients. The aim of the present investigation was to validate the diagnostic accuracy of VECTOR in a larger population of RA patients, compared with that of the reference standard of HRCT, from a multicentre study. Methods To avoid X-ray exposure, we enrolled 137 consecutive RA patients who had recently undergone HRCT. Lung sounds of all patients were recorded in 4 pulmonary fields bilaterally with a commercial electronic stethoscope (ES); subsequently, all HRCT images were blindly evaluated by a radiologist, and audio data were analysed by means of VECTOR. Results Fifty-nine of 137 patients showed ILD (43.1%). VECTOR correctly classified 115/137 patients, showing a diagnostic accuracy of 83.9% and a sensitivity and specificity of 93.2 and 76.9%, respectively. Conclusions VECTOR may represent the first validated tool for the screening of RA patients who are suspected for ILD and who should be directed to HRCT for the diagnosis. Moreover, early identification of RA-ILD could contribute to the design of prospective studies aimed at elucidating unclear aspects of the disease.
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Affiliation(s)
- A Manfredi
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy.
| | - G Cassone
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy
| | - S Cerri
- Respiratory Disease Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - V Venerito
- Rheumatology Unit, Dipartimento Interdisciplinare di Medicina, University of Bari, 70124, Bari, Italy
| | - A L Fedele
- Rheumatology Unit, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - M Trevisani
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola-Malpighi, 40121, Bologna, Italy
| | - F Furini
- Rheumatology Unit, Clinical and experimental Medicine, Sant'Anna Hospital, 44121, Ferrara, Italy
| | - O Addimanda
- Rheumatology Unit, Department of Biomedical and Neuromotor Sciences, Rizzoli Orthopaedic Institute and University of Bologna, 40136, Bologna, Italy
| | - F Pancaldi
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Della Casa
- Radiology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - R D'Amico
- Unit of Statistics in Medicine, Department of Oncology and Hematology, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - R Vicini
- Unit of Statistics in Medicine, Department of Oncology and Hematology, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Sandri
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy
| | - P Torricelli
- Radiology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - I Celentano
- Radiology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - A Bortoluzzi
- Rheumatology Unit, Clinical and experimental Medicine, Sant'Anna Hospital, 44121, Ferrara, Italy
| | - N Malavolta
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola-Malpighi, 40121, Bologna, Italy
| | - R Meliconi
- Rheumatology Unit, Department of Biomedical and Neuromotor Sciences, Rizzoli Orthopaedic Institute and University of Bologna, 40136, Bologna, Italy
| | - F Iannone
- Rheumatology Unit, Dipartimento Interdisciplinare di Medicina, University of Bari, 70124, Bari, Italy
| | - E Gremese
- Rheumatology Unit, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - F Luppi
- Respiratory Disease Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - C Salvarani
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy.,Rheumatology Unit, Santa Maria Hospital, IRCCS, 42121, Reggio Emilia, Italy
| | - M Sebastiani
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy
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18
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Alivernini S, Bruno D, Tolusso B, Bui L, Petricca L, Gigante MR, Birra D, Fedele AL, Peluso G, Federico F, Ferraccioli G, Gremese E. Differential synovial tissue biomarkers among psoriatic arthritis and rheumatoid factor/anti-citrulline antibody-negative rheumatoid arthritis. Arthritis Res Ther 2019; 21:116. [PMID: 31072400 PMCID: PMC6509792 DOI: 10.1186/s13075-019-1898-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/24/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Differential diagnosis among psoriatic arthritis (PsA) and seronegative rheumatoid arthritis (Abneg RA) can be challenging particularly in the clinical setting of peripheral phenotype and autoantibodies seronegativity. The aim of the study was to identify synovial tissue (ST) biomarkers differentially expressed in PsA and Abneg RA and test their predictive value of therapeutic response. Methods Thirty-four PsA patients [12 DMARD naive and 22 non-responder to methotrexate (MTX-IR)] with peripheral joint involvement and 55 Abneg RA (27 DMARD naive and 28 MTX-IR) underwent US-guided ST biopsy and immunohistochemistry (IHC) for CD68+, CD3+, CD20+, CD21+, CD117+, and CD138+ cells. After study entry, each DMARD-naive patient started MTX therapy and was followed in an outpatient setting for at least 6 months to define the achievement of Minimal Disease Activity (PsA) and DAS remission (Abneg RA) status respectively. Each IR-MTX patient was treated according to EULAR recommendations. Results At study entry, IHC analysis revealed that PsA patients had comparable levels of lining and sublining CD68+ and sublining CD21+, CD20+, and CD3+ cells than Abneg RA, despite the therapeutic regimen. Moreover, regardless of the therapeutic scheme, PsA patients showed higher IHC score of CD117+ cells (p = 0.0004 and p = 0.0005 for naive and MTX-IR patients respectively) compared to Abneg RA patients. Conversely, Abneg RA patients showed higher IHC score of CD138+ cells, irrespective to the therapeutic scheme (p = 0.04 and p = 0.002 for naive and MTX-IR patients respectively). Analyzing the response rate to the therapeutic scheme, naive PsA patients reaching MDA status at 6 months follow-up, showed, at the study entry, lower IHC score of CD3+ cells compared to PsA patients not reaching this outcome (p = 0.02); conversely, naive Abneg RA patients reaching DAS remission status at 6 months follow-up, showed, at the study entry, lower IHC score of sublining CD68+ cells compared to Abneg RA patients not reaching this outcome (p < 0.001). Conclusions CD117+ and CD138+ cells are differentially distributed among PsA and Abneg RA. Histological analysis of ST may help to solve the clinical overlap between the two diseases and provides prognostic data about the therapy success. Electronic supplementary material The online version of this article (10.1186/s13075-019-1898-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Bruno
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Bui
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Birra
- Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giusy Peluso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Federico
- Institute of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Institute of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Musto A, Fedele AL, Gessi M, Pallini R, Cocciolillo F, Zoli A. Hypertrophic pachymeningitis IgG4-related with antineutrophil cytoplasmic antibody positivity and aortitis. Rheumatol Adv Pract 2019; 3:rkz006. [PMID: 31431994 PMCID: PMC6649927 DOI: 10.1093/rap/rkz006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/11/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alessia Musto
- UOC of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- UOC of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Gessi
- UOC of Histopathology, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Roberto Pallini
- UOC of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Fabrizio Cocciolillo
- UOC of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy
| | - Angelo Zoli
- UOC of Rheumatology, Fondazione Policlinico Universitario A. Gemelli - Catholic University of the Sacred Heart, Rome, Italy
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Tolusso B, Gigante MR, Alivernini S, Petricca L, Fedele AL, Di Mario C, Aquilanti B, Magurano MR, Ferraccioli G, Gremese E. Chemerin and PEDF Are Metaflammation-Related Biomarkers of Disease Activity and Obesity in Rheumatoid Arthritis. Front Med (Lausanne) 2018; 5:207. [PMID: 30123797 PMCID: PMC6085446 DOI: 10.3389/fmed.2018.00207] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 04/26/2018] [Accepted: 07/02/2018] [Indexed: 12/14/2022] Open
Abstract
Objective: Obesity is a risk factor for Rheumatoid Arthritis (RA) being associated to low grade inflammation. This study aimed to determine whether PEDF and Chemerin are biomarkers of inflammation related to fat accumulation in RA and to investigate whether weight loss associates with clinical disease improvement through the modification of fat-related biomarkers in overweight/obese RA with low-moderate disease. Participants and Methods: Two-hundred and thirty RA patients were enrolled, of whom 176 at disease onset treated according to a treat-to-target strategy (T2T) and 54 overweight/obese RA in stable therapy and low-moderate disease activity. Gene expression of adipokines, interleukin-6 and their receptors were examined in adipose tissue from obese RA. Obese RA with low-moderate disease activity underwent low-calories diet aiming to Body Mass Index (BMI) reduction >5%, maintaining RA therapy unchanged. Chemerin, PEDF and Interleukin-6 plasma values were assessed by ELISA and disease activity was evaluated. Results: At RA onset, PEDF and Chemerin plasma values correlated with BMI (p < 0.001) but only Chemerin plasma values correlated with disease activity (p < 0.001). After adopting a T2T strategy, Chemerin arose as an independent factor associated with remission in early RA [OR(95%CIs):0.49(0.25–0.97)]. Moreover, after low-calories diet, RA with low-moderate disease activity reaching BMI reduction ≥5% (62.6%) at 6 months had significant decrease of PEDF (p < 0.05) and Chemerin (p < 0.05) plasma values, in parallel with the improvement in disease activity. Conclusions: PEDF and Chemerin arose as biomarkers of obesity and metaflammation respectively, providing a link between chronic inflammation and excess of body weight in RA. Therefore, BMI reduction of at least 5% in obese RA allowed better disease control without modifying RA treatment.
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Affiliation(s)
- Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Clara Di Mario
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Aquilanti
- Service of Dietary and Human Nutrition, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Rosaria Magurano
- Service of Psychology and Psychotherapy, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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Gremese E, Fedele AL, Alivernini S, Ferraccioli G. Ultrasound assessment as predictor of disease relapse in children and adults with arthritis in clinical stable remission: new findings but still unmet needs. Ann Rheum Dis 2018; 77:1391-1393. [PMID: 29860230 PMCID: PMC6161664 DOI: 10.1136/annrheumdis-2018-212941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Elisa Gremese
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, IRCCS-Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy
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22
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Fedele AL, Petricca L, Tolusso B, Alivernini S, Canestri S, Di Mario C, Bosello SL, Ferraccioli G, Gremese E. Interleukin-6 and IgA-rheumatoid factor are crucial for baseline erosiveness, and anti-citrullinated peptide antibodies for radiographic progression in early rheumatoid arthritis treated according to a treat-to-target strategy. Scand J Rheumatol 2018. [PMID: 29542372 DOI: 10.1080/03009742.2017.1416668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To define baseline clinical and immunological characteristics [anti-citrullinated peptide antibodies (ACPAs), immunoglobulin M (IgM)- and IgA-rheumatoid factor (RF), and interleukin-6 (IL-6) levels] involved in determining baseline erosiveness, outcome, and radiographic progression among seropositive and seronegative early rheumatoid arthritis (ERA) patients. METHOD The 408 ERA patients enrolled in the study were monitored every 3 months according to the treat-to-target strategy. At baseline and after 12 months, hand and foot radiographs were evaluated using the Sharp/van der Heijde erosion score. RESULTS At diagnosis, seronegative patients were older and had higher Disease Activity Scores (DASs) than seropositive patients. A higher risk of erosiveness at baseline was conferred by IgA-RF positivity and IL-6 plasma levels ≥7.6 pg/mL, particularly when simultaneously present. In multivariate analysis, disease duration and IL-6 plasma levels ≥7.6 pg/mL arose as independent variables associated with presence of erosions at onset. Radiographic progression at 1 year follow-up, which occurred in 11.1% of ERA patients, was predicted by ACPA positivity, together with higher age at diagnosis. Despite similar percentages of good European League Against Rheumatism response, DAS and Boolean remission being observed over time among seropositive and seronegative patients and between erosive and non-erosive subjects, ERA patients who were erosive at onset, IgA-RF seropositive, and simultaneously having high baseline IL-6 plasma levels (≥7.6 pg/mL) were treated to a greater extent with tumour necrosis factor blockers after 12 months. CONCLUSION IgA-RF positivity and IL-6 plasma levels are crucial for baseline erosiveness, while ACPA positivity represents the strongest risk factor for developing radiographic progression in ERA.
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Affiliation(s)
- A L Fedele
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - L Petricca
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - B Tolusso
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - S Alivernini
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - S Canestri
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - C Di Mario
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - S L Bosello
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - G Ferraccioli
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
| | - E Gremese
- a Division of Rheumatology , Catholic University of the Sacred Heart, Agostino Gemelli University Polyclinic , Rome , Italy
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Salaffi F, Di Carlo M, Iannone F, Fedele AL, Epis OM, Pellerito R, Foti R, Passiu G, Punzi L, Furini F, Sarzi-Puttini P, Carletto A, Gremese E, Lapadula G, Ferraccioli G. The UltraSound-CLinical ARthritis Activity (US-CLARA) index: Properties of a new composite disease activity index for rheumatoid arthritis. Semin Arthritis Rheum 2017; 47:619-629. [PMID: 29102157 DOI: 10.1016/j.semarthrit.2017.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/04/2017] [Accepted: 09/25/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess validity, responsiveness and interpretability of the UltraSound-CLinical ARthritis Activity (US-CLARA) index in patients with rheumatoid arthritis (RA). METHODS In this longitudinal study were involved RA patients starting treatment with abatacept. Subjects were followed along three visits in the first 6 months of therapy and underwent a comprehensive clinimetric evaluation. Validity was explored correlating the baseline scores and the cumulative inflammatory burden of the US-CLARA with the other composite indices applied. Sensitivity to change was assessed after 6 months of treatment in terms of internal and external responsiveness. Interpretability was defined in terms of determination of cutoffs against external criteria for remission (REM), low disease activity (LDA), moderate disease activity (MDA), and high disease activity (HDA) of SDAI. RESULTS One-hundred and thirty patients completed the study. VALIDITY moderate correlations were observed between US-CLARA and both DAS28-CRP and DAS28-ESR. Higher correlations were also found between US-CLARA and both SDAI and CDAI scores. Responsiveness: internal responsiveness was wide, with SRM and ES ranging from 0.91 to 1.51. US-CLARA responsiveness was similar to that of DAS28, SDAI, or CDAI. Similarly, the area under ROC curve (AUC-ROC) of US-CLARA gives identical results. The AUC of cumulative inflammatory burden, calculated during the 6-months follow-up of all combinations were highly correlated (p < 0.0001). Interpretability: cutoff values for REM, US-CLARA <2.0; for LDA, 2.0 ≤US-CLARA <3; for MDA, 3 ≤US-CLARA ≤4.8; for HDA, US-CLARA >4.8. CONCLUSION The US-CLARA is valid and sensitive tool to assess disease activity in RA.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Unit, Università Politecnica delle Marche, Via Aldo Moro, 25-60035, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Unit, Università Politecnica delle Marche, Via Aldo Moro, 25-60035, Jesi (Ancona), Italy.
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, Università di Bari, Bari, Italy
| | - Anna Laura Fedele
- Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Rosario Foti
- Rheumatology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Giuseppe Passiu
- Department of Clinical and Experimental Medicine, Rheumatology Unit, Azienda Ospedaliero Universitaria, Sassari, Italy
| | - Leonardo Punzi
- Department of Medicine-DIMED, Rheumatology Unit, University of Padova, Padova, Italy
| | - Federica Furini
- Department of Medical Sciences, Rheumatology Unit, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Ferrara, Italy
| | | | - Antonio Carletto
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy
| | - Elisa Gremese
- Rheumatology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Lapadula
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, Università di Bari, Bari, Italy
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Alivernini S, Tolusso B, Petricca L, Bui L, Di Sante G, Peluso G, Benvenuto R, Fedele AL, Federico F, Ferraccioli G, Gremese E. Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission? Ann Rheum Dis 2017; 76:1228-1236. [PMID: 28119289 PMCID: PMC5530352 DOI: 10.1136/annrheumdis-2016-210424] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/14/2016] [Accepted: 12/17/2016] [Indexed: 12/22/2022]
Abstract
Objective To define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockers. Methods Patients with RA in remission (n=25) (disease activity score (DAS)<1.6 for at least 6 months), patients with RA in low disease activity (LDA) (n=10) (1.6<DAS<2.4 for at least 6 months) and patients with PsA in remission (n=18) (DAS<1.6 and Psoriasis Area Severity Index (PASI)=0 for at least 6 months) achieved by MTX+anti-TNF (adalimumab 40 mg or etanercept 50 mg) with power Doppler (PDUS)-negative synovial hypertrophy underwent synovial tissue biopsy. Patients with RA with high/moderate disease naïve to treatment (n=50) were included as a comparison group. Immunostaining for cluster designation (CD)68, CD21, CD20, CD3, CD31 and collagen was performed. Results PDUS-negative patients with RA in remission showed lower histological scores for synovial CD68+, CD20+, CD3+ cells and CD31+ vessels and collagen deposition (p<0.05 for both lining and sublining) compared with PDUS-positive patients with RA with high/moderate disease. In addition, there was no significant difference in terms of lining and sublining CD68+, CD20+, CD3+, CD31+ cells and collagen comparing PDUS-negative patients with RA in remission and in LDA, respectively. On the contrary, PDUS-negative patients with PsA in remission showed higher histological scores for sublining CD68+ (p=0.02) and CD3+ cells (p=0.04) as well as CD31+ vessels (p<0.001) than PDUS-negative patients with RA in remission. Conclusions PDUS-negative patients with RA in remission have comparable synovial histological features than PDUS-negative patients with RA in LDA. However, patients with PsA in remission are characterised by a higher degree of residual synovial inflammation than patients with RA in remission, despite PDUS negativity under TNF inhibition.
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Affiliation(s)
- Stefano Alivernini
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Tolusso
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Petricca
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Laura Bui
- Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Di Sante
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Giusy Peluso
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Benvenuto
- Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Franco Federico
- Institute of Pathology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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Alivernini S, Kurowska-Stolarska M, Tolusso B, Benvenuto R, Elmesmari A, Canestri S, Petricca L, Mangoni A, Fedele AL, Di Mario C, Gigante MR, Gremese E, McInnes IB, Ferraccioli G. MicroRNA-155 influences B-cell function through PU.1 in rheumatoid arthritis. Nat Commun 2016; 7:12970. [PMID: 27671860 PMCID: PMC5052655 DOI: 10.1038/ncomms12970] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022] Open
Abstract
MicroRNA-155 (miR-155) is an important regulator of B cells in mice. B cells have a critical role in the pathogenesis of rheumatoid arthritis (RA). Here we show that miR-155 is highly expressed in peripheral blood B cells from RA patients compared with healthy individuals, particularly in the IgD-CD27- memory B-cell population in ACPA+ RA. MiR-155 is highly expressed in RA B cells from patients with synovial tissue containing ectopic germinal centres compared with diffuse synovial tissue. MiR-155 expression is associated reciprocally with lower expression of PU.1 at B-cell level in the synovial compartment. Stimulation of healthy donor B cells with CD40L, anti-IgM, IL-21, CpG, IFN-α, IL-6 or BAFF induces miR-155 and decreases PU.1 expression. Finally, inhibition of endogenous miR-155 in B cells of RA patients restores PU.1 and reduces production of antibodies. Our data suggest that miR-155 is an important regulator of B-cell activation in RA. MiR-155 is thought to inhibit PU.1 and thereby drive antigen-induced B-cell maturation. Here the authors show that patients with rheumatoid arthritis have high B-cell miR-155 expression and that an antagomir can rescue PU.1 expression, suggesting potential therapeutic avenues to treat rheumatoid arthritis.
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Affiliation(s)
- Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Mariola Kurowska-Stolarska
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Barbara Tolusso
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Roberta Benvenuto
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Aziza Elmesmari
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Silvia Canestri
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Antonella Mangoni
- Division of Pathology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Anna Laura Fedele
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Clara Di Mario
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy.,Division of Pathology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Maria Rita Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome 00168, Italy
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Ferraccioli G, Tolusso B, Fedele AL, Gremese E. Do we need to apply a T2T strategy even in ACPA-negative early rheumatoid arthritis? YES. RMD Open 2016; 2:e000263. [PMID: 27099779 PMCID: PMC4823584 DOI: 10.1136/rmdopen-2016-000263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
- Gianfranco Ferraccioli
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
| | - Barbara Tolusso
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
| | - Anna Laura Fedele
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
| | - Elisa Gremese
- Division of Rheumatology-Fondazione Gemelli , Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart , Rome , Italy
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27
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Carbonella A, Berardi G, Petricca L, Biscetti F, Alivernini S, Bosello SL, Fedele AL, Ferraccioli G, Gremese E. Immunosuppressive Therapy (Methotrexate or Cyclophosphamide) in Combination with Corticosteroids in the Treatment of Giant Cell Arteritis: Comparison with Corticosteroids Alone. J Am Geriatr Soc 2016; 64:672-374. [DOI: 10.1111/jgs.14004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Angela Carbonella
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Giorgia Berardi
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Luca Petricca
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Federico Biscetti
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Stefano Alivernini
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Silvia Laura Bosello
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Anna Laura Fedele
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
| | - Elisa Gremese
- Division of Rheumatology; Institute of Rheumatology and Affine Sciences; School of Medicine; Catholic University of the Sacred Heart; Rome Italy
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Di Sante G, Tolusso B, Ria F, Laura Fedele A, Gremese E, Ferraccioli G. Is Citrullination Required for the Presence of Restricted Clonotypes Reacting With Type II Collagen? Comment on the Article by Chemin et al. Arthritis Rheumatol 2016; 68:2052-3. [PMID: 26946074 DOI: 10.1002/art.39661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Francesco Ria
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - Elisa Gremese
- Catholic University of the Sacred Heart, Rome, Italy
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Fedele AL, Alivernini S, Gremese E, Ferraccioli G. CTLA-4 Ig as an effective treatment in a patient with type I diabetes mellitus and seropositive rheumatoid arthritis. Clin Exp Rheumatol 2016; 34:315-317. [PMID: 26575162] [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: 03/11/2015] [Accepted: 07/23/2015] [Indexed: 06/05/2023]
Abstract
We describe a patient suffering from seropositive rheumatoid arthritis (RA) and type I diabetes mellitus (T1DM), who achieved a good EULAR response together with an improvement of the glycemic profile under treatment with CTLA-4 Ig. A close association is known to exist between T1DM and RA, and CTLA-4 exon 1 polymorphism has been associated to RA with coexisting autoimmune endocrinopathies. The possible common genetic background and the potential role of CTLA-4 Ig in the early phases of T1DM, could be considered in the therapeutic interventions in RA patients with type 1 diabetes.
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Affiliation(s)
- Anna Laura Fedele
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
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Di Sante G, Tolusso B, Fedele AL, Gremese E, Alivernini S, Nicolò C, Ria F, Ferraccioli G. Collagen Specific T-Cell Repertoire and HLA-DR Alleles: Biomarkers of Active Refractory Rheumatoid Arthritis. EBioMedicine 2015; 2:2037-45. [PMID: 26844284 PMCID: PMC4703746 DOI: 10.1016/j.ebiom.2015.11.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is characterized by chronic joint inflammation and associates with HLA-DRB1*04. The Collagen IIp261-273-specific T cell repertoire in the peripheral blood of DR4 + patients at the onset of the disease shows a restricted TCR-beta chain usage among which the most frequent is TRBV25. To define whether this group of DR4-restricted collagen-specific shared T cell could represent markers of active-severe disease and response to therapy, 90 subjects affected by early-RA were enrolled in the study; peripheral blood mononuclear cells were cultured with or without the human collagen II peptide p261-273 and were examined by immunoscope analysis for the usage of the previously identified shared TCR-beta chains. We report that the presence of T cells carrying rearrangement TRBV25 associated with HLA-DR haplotype and disease activity. HLA-DRB1* haplotypes 04–04, 04–01 and 04–11 were significantly associated with usage of TRBV25, higher disease activity at the onset of disease and poor response to DMARDs. Finally, the HLA-DRB1* haplotype appeared complementary with current serologic tools to predict good and poor responders in a treat to target strategy. The data reported here offer clues to predict the course of the disease and to foresee personalized treatments in RA patients. In DR4 + RA patients disease activity is associated with detection of Collagen261-273-specific T cells carrying TRBV25. HLA-DR 04/04, 04/01 and 04/11 alleles were associated with TRBV25, DAS at the onset, and poor response to DMARDs. These findings could lead to tailor the treatment in the subgroup of patients with an active refractory disease.
In the era of costly medical care with monoclonal antibodies and new molecules, and of an increasing request of a personalized medicine, a relevant socio-economic problem in the management of Rheumatoid Arthritis patients is the possible identification of the subgroups of poor responders to treatment. Our study aimed to detect the refractory active patients using an HLA-DR test (available in most hospital centers) combined with a relatively new biomarker of active disease expressed on the cell surface of autoreactive T cells. These tests appear complementary tools to identify the best and the poor responders to a “treat to target strategy”.
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Key Words
- ACPA
- ACPA, anti-cyclic citrullinated peptide antibodies
- APCs, antigen presenting cells
- CDR3, complementarity-determining region 3
- CRP, C-reactive protein
- Clonotypes
- Coll261-273, human collagen derived peptide
- DAS, disease activity score
- Disease activity
- ERA, early rheumatoid arthritis
- ESR, erythrocyte sedimentation rate
- GWAS, genome wide association studies
- HAQ, Health Assessment Questionnaire
- HLA, histocompatibility leucocyte antigen
- HLA-DRB1
- MHC, major histocompatibility complex
- PBMC, peripheral blood mononuclear cells
- RF, rheumatoid factor
- RT-PCR, reverse transcription polymerase chain reaction
- SJC, swollen joint count
- SNP, single nucleotide polymorphism
- TCR, T cell receptor
- TJC, tender joint count
- TRBJ, junctional beta chain gene of TCR
- TRBV 25
- TRBV, variable beta chain gene of TCR
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Affiliation(s)
- Gabriele Di Sante
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Tolusso
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Laura Fedele
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Alivernini
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Nicolò
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Ria
- Institute of General Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
- Corresponding author.
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Sebastiani M, Anelli MG, Atzeni F, Bazzani C, Farina I, Fedele AL, Favalli EG, Fineschi I, Cino N, Dal Forno I, Gasparini S, Cassarà E, Giardina R, Bruschi E, Addimanda O, Cassone G, Lopriore S, Sarzi-Puttini P, Filippini M, Pignatti F, Gremese E, Biggioggero M, Manganelli S, Amato G, Caimmi C, Salaffi F, Iannone F, Ferri C, Sandri G, Lapadula G, Gorla R, Govoni M, Ferraccioli G, Marchesoni A, Galeazzi M, Foti R, Carletto A, Cantini F, Triolo G, Epis OM, Salvarani C. Efficacy and safety of rituximab with and without methotrexate in the treatment of rheumatoid arthritis patients: Results from the GISEA register. Joint Bone Spine 2014; 81:508-12. [DOI: 10.1016/j.jbspin.2014.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/24/2014] [Indexed: 01/23/2023]
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Fedele AL, Tolusso B, Gremese E, Bosello SL, Carbonella A, Canestri S, Ferraccioli G. Memory B cell subsets and plasmablasts are lower in early than in long-standing rheumatoid arthritis. BMC Immunol 2014; 15:28. [PMID: 25187226 PMCID: PMC4168163 DOI: 10.1186/s12865-014-0028-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/11/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Alterations of B cell subset distribution have been described in the peripheral blood (PB) of rheumatoid arthritis (RA) patients, but no data are available on differences between the onset and the established phases of the disease. The purpose of the study was to clarify whether a peculiar distribution of B cell subsets characterizes RA onset, thus leading to a more favorable clinical response to treatment, and to evaluate the possible association of a particular B cell subpopulation with response to therapy. RESULTS 122 RA patients were enrolled: 25 had symptom duration less than 3 months and were defined as having "very early RA" (VERA), and 43 had symptom duration from more than 3 months up to one year (early-RA: ERA). The other 54 RA patients had long-standing RA (LSRA). At baseline and at 6-month follow-up visit peripheral blood samples were collected and analyzed by flow cytometry for the distribution of circulating B cell subsets by staining with surface markers CD45, CD19, CD38, CD27 and IgD and intracellular marker ZAP70.VERA and ERA patients showed higher percentages and absolute counts of circulating antigen inexperienced naïve B cells (IgD + CD27-) and lower percentages and absolute numbers of double negative (IgD-CD27-) memory B cells and plasmablasts (CD38 + CD27+) compared to LSRA patients. At the multivariate analysis, a higher frequency of naïve B cells (IgD + CD27-) at baseline arose as significant predictor of CDAI remission, together with "having VERA disease" and a low disease activity at baseline. CONCLUSIONS The onset of RA is characterized by higher percentages and absolute numbers of naïve B cells and lower numbers of plasmablasts and double negative memory B cells compared to established RA. Naïve B cells could represent a promising biomarker of outcome.
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Affiliation(s)
| | | | | | | | | | | | - Gianfranco Ferraccioli
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, Via Moscati 31, Rome, 00168, Italy.
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Totaro MC, Cattani P, Ria F, Tolusso B, Gremese E, Fedele AL, D'Onghia S, Marchetti S, Di Sante G, Canestri S, Ferraccioli G. Porphyromonas gingivalis and the pathogenesis of rheumatoid arthritis: analysis of various compartments including the synovial tissue. Arthritis Res Ther 2013; 15:R66. [PMID: 23777892 PMCID: PMC4060366 DOI: 10.1186/ar4243] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 06/18/2013] [Indexed: 01/02/2023] Open
Abstract
Introduction We evaluated the presence of Porphyromonas gingivalis (Pg) DNA in the synovial tissue through synovial biopsy and in other compartments of rheumatoid arthritis (RA) patients in comparison with patients affected by other arthritides. Possible links with clinical, immunologic and genetic features were assessed. Methods Peripheral blood (PB), sub-gingival dental plaque, synovial fluid (SF) and synovial tissue samples were collected from 69 patients with active knee arthritis (32 with RA and 37 with other arthritides, of which 14 had undifferentiated peripheral inflammatory arthritis - UPIA). Demographic, clinical, laboratory and immunological data were recorded. The presence of Pg DNA was evaluated through PCR. The HLA-DR haplotype was assessed for 45 patients with RA and UPIA. Results No differences arose in the positivity for Pg DNA in the sub-gingival plaque, PB and SF samples between RA and the cohort of other arthritides. Full PB samples showed a higher positivity for Pg DNA than plasma samples (11.8% vs. 1.5%, P = 0.04). Patients with RA showed a higher positivity for Pg DNA in the synovial tissue compared to controls (33.3% vs. 5.9%, P <0.01). UPIA and RA patients carrying the HLA DRB1*04 allele showed a higher positivity for Pg DNA in the synovial tissue compared to patients negative for the allele (57.1% vs. 16.7%, P = 0.04). RA patients positive for Pg DNA in the sub-gingival plaque had a lower disease duration and a higher peripheral blood leucocyte and neutrophil count. The presence of Pg DNA did not influence disease activity, disease disability or positivity for autoantibodies. Conclusions The presence of Pg DNA in the synovial tissue of RA patients suggests a pathogenic role of the bacterium. The higher positivity of Pg DNA in full peripheral blood and synovial tissue samples compared to plasma and synovial fluid suggests a possible intracellular localization of Pg, in particular in patients positive for HLA-DR4.
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Gremese E, Tolusso B, Fedele AL, Canestri S, Alivernini S, Ferraccioli G. ZAP-70+ B cell subset influences response to B cell depletion therapy and early repopulation in rheumatoid arthritis. J Rheumatol 2012; 39:2276-85. [PMID: 22984268 DOI: 10.3899/jrheum.120153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To define the role of ZAP-70+ B cells (CD19+/ZAP-70+) as a biomarker of response to B cell depletion therapy (BCDT), their relationship with clinical outcome, and their behavior during repopulation of peripheral blood in patients with rheumatoid arthritis (RA). METHODS Thirty-one patients with RA underwent BCDT and were followed for 12 months. Disease activity was assessed with the European League Against Rheumatism (EULAR) criteria. Cytofluorimetric analysis of peripheral blood B cell subsets at baseline and at 6- and 12-month intervals after BCDT was performed using surface markers (CD45, CD3, CD56, CD19, IgD, CD38, CD27) and intracellular ZAP-70. RESULTS A moderate/good EULAR response was achieved in 66.6% of the RA cohort. The baseline percentage of CD19+/ZAP-70+ cells was lower in good responder patients (1.8% ± 1.7%) compared to poor responders (5.6% ± 4.9%; p = 0.02). A decrease of plasmablasts (IgD-CD27+CD38+) and pre-switch memory (IgD+CD27+) B cells occurred after BCDT. Recovery of B cells in peripheral blood after the first course of BCDT was characterized by the reappearance of B cell subtypes that showed a naive, activated phenotype, coupled with a decrease in memory cells. B cells carrying intracytoplasmic ZAP-70 increased significantly from the baseline value of 4.4% ± 4.5% to 12.4% ± 9.2% (p = 0.001) at the 6-month and to 9.4% ± 6.4% (p = 0.002) at the 12-month followup. CONCLUSION Baseline percentage of CD19+/ZAP-70+ cells is associated with the clinical outcome after BCDT in patients with RA. Depletion of plasmablasts and pre-switch memory B cells and increase of CD19+/ZAP-70+ cells are features of the recovery of the B cell pool after BCDT.
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Affiliation(s)
- Elisa Gremese
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences (IRSA), School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Bosello S, Fedele AL, Peluso G, Gremese E, Tolusso B, Ferraccioli G. Very early rheumatoid arthritis is the major predictor of major outcomes: clinical ACR remission and radiographic non-progression. Ann Rheum Dis 2011; 70:1292-5. [PMID: 21515600 PMCID: PMC3103665 DOI: 10.1136/ard.2010.142729] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives To identify predictors of clinical remission as well as of no x-ray progression in a cohort of early rheumatoid arthritis (ERA) treated with a tight-control protocol. Methods A total of 121 consecutive patients with ERA were treated to reach European League Against Rheumatism (EULAR) and/or American College of Rheumatology (ACR) clinical remission with methotrexate (MTX) for 3 months, then with a combination with anti-tumour necrosis factor if the patient did not achieve a 44-joint Disease Activity Score (DAS44) ≤2.4. At baseline and after 12 months all the patients had hand and foot joint radiographs. Very early rheumatoid arthritis (VERA) was defined as a disease with symptoms of less than 12 weeks. Results In all, 46.3% of the patients reached DAS remission and 24.8% achieved ACR remission. More than 60% of patients reached remission with MTX. Male sex and an erythrocyte sedimentation rate <35 mm/h at onset arose as significant predictors of EULAR remission, while VERA disease was the only predictor of ACR remission. At baseline, 28.1% of the patients were erosive. Multivariate analysis demonstrated that the only independent predictor of erosiveness was ‘not having VERA disease’. After 12 months, VERA was the only factor predicting a lack of new erosions. Conclusions VERA represents the best therapeutic opportunity in clinical practice to achieve a complete remission and to stop the erosive course of rheumatoid arthritis.
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Affiliation(s)
- Silvia Bosello
- Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Zizzo G, De Santis M, Bosello SL, Fedele AL, Peluso G, Gremese E, Tolusso B, Ferraccioli G. Synovial fluid-derived T helper 17 cells correlate with inflammatory activity in arthritis, irrespectively of diagnosis. Clin Immunol 2010; 138:107-16. [PMID: 21056009 DOI: 10.1016/j.clim.2010.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 06/29/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
We analyzed peripheral blood (PB) and synovial fluid (SF) mononuclear cells from 16 rheumatoid arthritis (RA), 9 spondyloarthritis (SpA), 3 microcrystal arthritis patients, to define the presence of Th17 and Th1 and their relationship with inflammatory activity, and TCR-zeta chain and ZAP-70 levels. Th17 were significantly higher in SF than in PB and more abundant in microcrystal arthritis patients compared to the other groups. Irrespectively of the diagnosis, SF Th17 percentages correlated with joint (SF total leukocyte count, neutrophil percentage) and systemic (C reactive protein [CRP], fibrinogen, erythrocyte sedimentation rate) inflammation markers. SF Th1 percentages directly correlated with inflammation and disease activity (CRP, swollen joint count [SJC]) indices in SpA, but not in RA patients. These observations support the role of Th17 in the pathogenesis of inflammatory arthritides. The TCR-zeta(dim) lymphocytes in SF were found to produce the highest amounts of cytokines including IL-17, whereas no ZAP-70 impairment was associated to Th17.
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Affiliation(s)
- Gaetano Zizzo
- Department of Rheumatology, Catholic University of the Sacred Heart, CIC, Via Moscati 31, 00168, Rome, Italy
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Pietrapertosa D, Tolusso B, Gremese E, Papalia MC, Bosello SL, Peluso G, Petricca L, Michelutti A, Faustini F, Fedele AL, Ferraccioli G. Diagnostic performance of anti-citrullinated peptide antibodies for the diagnosis of rheumatoid arthritis: the relevance of likelihood ratios. Clin Chem Lab Med 2010; 48:829-34. [DOI: 10.1515/cclm.2010.152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Alivernini S, Fedele AL, Cuoghi I, Tolusso B, Ferraccioli G. Citrullination: the loss of tolerance and development of autoimmunity in rheumatoid arthritis. Reumatismo 2008; 60:85-94. [PMID: 18651051 DOI: 10.4081/reumatismo.2008.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rheumatoid arthritis is a chronic inflammatory disease characterized by synovial inflammation and pannus formation leading to destruction of cartilage and bone. Several self proteins have been suggested to be disease-driving autoantigens. Proteins are encoded by a limited number of genes in our genome. Post-translational modifications such as citrullination of the arginine residues, can increase the morphological and the functional diversity of the proteome. The positivity of anti-citrullinated peptides autoantibodies occurs then at an early stage of the disease development. Several factors, among which the synovial tissue inflammatory and the nitric oxide reaction, are involved in the regulation of the citrullination reaction. All of them have to be analysed and considered to understand the loss of tolerance and the development of autoimmunity leading to the disease.
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Affiliation(s)
- S Alivernini
- Cattedra e Clinica di Reumatologia, Università Cattolica del Sacro Cuore, Via Moscati 31, Rome, Italy
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Tolusso B, Frezza D, Mattioli C, Fedele AL, Bosello S, Faustini F, Peluso G, Giambra V, Pietrapertosa D, Morelli A, Gremese E, De Santis M, Ferraccioli GF. Allele *2 of the HS1,2A enhancer of the Ig regulatory region associates with rheumatoid arthritis. Ann Rheum Dis 2008; 68:416-9. [PMID: 18952640 PMCID: PMC2633630 DOI: 10.1136/ard.2008.095414] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To investigate the role of the HS1,2 enhancer polymorphisms as a new candidate marker for rheumatoid arthritis (RA) and to define the possible association with autoantibody positivity and clinical outcome. Methods: Genomic DNA was obtained from two cohorts of patients with RA (100 with early RA (ERA) and 114 with longstanding RA (LSRA)) and from 248 gender-matched controls from the same geographical area. Clinical and immunological characteristics were recorded for all the patients. Results: The percentage of the 2/2 genotype was higher in patients with ERA (27.0%), and in patients with LSRA (34.2%), than in controls (14.9%) (ERA: OR = 2.11 (95% CI 1.20 to 3.70) vs controls; LSRA: OR = 2.96 (95% CI 1.76 to 5.00) vs controls). A lower representation of allele *3 was present in patients with ERA (2.0%) than in controls (6.0%; OR = 0.32 (95% CI 0.11 to 0.91)). No significant associations were found between polymorphisms and autoantibodies positivity. Conclusion: The HS1,2A allele *2 associates with early and longstanding RA.
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Affiliation(s)
- B Tolusso
- Division of Rheumatology, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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