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Donzella D, Bellis E, Campisi P, Crepaldi G, Data V, Dapavo P, Lomater C, Marucco E, Saracco M, Gatto M, Iagnocco A. New onset sarcoidosis following biologic treatment in patients with seronegative inflammatory arthritis: A case series and systematic literature review. Autoimmun Rev 2024; 23:103481. [PMID: 38008299 DOI: 10.1016/j.autrev.2023.103481] [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: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To report cases of new onset sarcoidosis upon biologic (bDMARDs) treatment administration in patients with seronegative inflammatory arthritis in a real-life cohort, alongside a systematic literature review (SLR) on this topic. METHODS We performed a retrospective analysis on clinical records of patients with seronegative arthritis followed up in a monocentric cohort who underwent bDMARDs treatment due to the underlying rheumatic disease and described any newly diagnosed sarcoidosis in this cohort. Only ascertained cases with available radiological and/or histological documentation were considered. A SLR on new-onset sarcoidosis in seronegative arthritis receiving bDMARDs was performed across MEDLINE (through PubMed), Scopus and Ovid (Cochrane, Embase) electronic databases using appropriate strings. RESULTS In our cohort, 4 new-onset cases of sarcoidosis were reported among patients with seronegative inflammatory arthritis receiving biologics. Three out of 4 patients were receiving anti-tumor necrosis factor alpha (TNFα) while 1 patient was on secukinumab (anti-IL17A) prior to sarcoidosis onset. The SLR disclosed 46 new-onset sarcoidosis cases upon biological treatment for seronegative arthritis, of whom 43 occurred during treatment with anti-TNFα, while 3 during anti-IL-17A therapy. In our cohort as well as in the majority of cases reported in the SLR, sarcoidosis presented with lymph nodal and lung involvement and displayed a benign course with spontaneous resolution in about 1 fourth of the cases. CONCLUSION The use of biologics may relate to the onset of sarcoidosis; hence, clinicians must remain aware of the potential occurrence or reactivation of sarcoidosis when starting biologic treatment in patients with inflammatory arthritis, performing adequate patient assessment and surveillance. Since TNFα inhibitors may represent a therapeutic option for sarcoidosis, further evaluation on larger cohorts is needed to investigate any causal link with the development of sarcoidosis.
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Affiliation(s)
- Denise Donzella
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | | | - Gloria Crepaldi
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Valeria Data
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudia Lomater
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Elena Marucco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Marta Saracco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Mariele Gatto
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy.
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Rizzo C, La Barbera L, Barletta G, Camarda F, Donzella D, Romano G, Agrusa A, Bonventre S, Guggino G. Characterising oesophageal motility disorders by high-resolution impedance manometry in dermatomyositis patients. Clin Exp Rheumatol 2024; 42:344-350. [PMID: 37812480 DOI: 10.55563/clinexprheumatol/h4drr2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/24/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES We studied high-resolution impedance manometry (HRiM) findings in dermatomyositis (DM) to detect oesophageal dysmotility, even in asymptomatic patients, and correlated the alterations to clinical and serological disease domains. METHODS We performed a cross-sectional study of DM patients, enrolled between December 2021 and December 2022. All patients underwent rheumatological, laboratory and HRiM assessment. HRiM findings were compared with different clinical and serological profiles. RESULTS The study population consisted of 15 DM patients (13 women and 2 men, age 54±15.2 years). The mean disease duration was 6.6 years. According to HRiM findings, three different groups of oesophageal disease severity were identified (in order of severity G0, G1 and G>1, 5 patients per group). G>1 group was significantly associated with MDA5 antibodies (80% vs. 20%, p<0.05). Interstitial lung disease (ILD) did not show any significant association with HRiM findings. However, a diffusing lung capacity for carbon oxide (DLCO) < 80% was present in 100% of G>1 (p<0.05). No associations between dysphagia, creatine kinase (CK) level, muscle weakness, skin, articular involvement and treatment were found. CONCLUSIONS Oesophageal involvement is frequent and should be evaluated in the comprehensive work-up of DM. We used for the first time HRiM in DM, which proved to be an accurate and objective technique in assessing oesophageal disease, even in the subclinical stage. Interestingly, the MDA5-positive group had a higher burden of HRiM pathological findings, suggesting a greater severity of oesophageal involvement, often asymptomatic.
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Affiliation(s)
- Chiara Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Italy
| | - Lidia La Barbera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Italy
| | - Gabriele Barletta
- Department of General Emergency and Transplant Surgery, General and Emergency Surgery Unit, Oesophageal Motility Disorder Section, P. Giaccone University Hospital, University of Palermo, Italy
| | - Federica Camarda
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Italy
| | - Denise Donzella
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Italy
| | - Giorgio Romano
- Department of General Emergency and Transplant Surgery, General and Emergency Surgery Unit, Oesophageal Motility Disorder Section, P. Giaccone University Hospital, University of Palermo, Italy
| | - Antonino Agrusa
- Department of General Emergency and Transplant Surgery, General and Emergency Surgery Unit, Oesophageal Motility Disorder Section, P. Giaccone University Hospital, University of Palermo, Italy
| | - Sebastiano Bonventre
- Department of General Emergency and Transplant Surgery, General and Emergency Surgery Unit, Oesophageal Motility Disorder Section, P. Giaccone University Hospital, University of Palermo, Italy
| | - Giuliana Guggino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Unit, P. Giaccone University Hospital, University of Palermo, Italy.
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Bellis E, Donzella D, Navarini L, Giacomelli R, Iagnocco A. Has colour Doppler ultrasonography modified the diagnostic approach for giant cell arteritis? A comparison with temporal artery biopsy. Joint Bone Spine 2023; 90:105612. [PMID: 37437876 DOI: 10.1016/j.jbspin.2023.105612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Elisa Bellis
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Regione Gonzole 10, Orbassano, 10043 Torino, Italy
| | - Denise Donzella
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Regione Gonzole 10, Orbassano, 10043 Torino, Italy
| | - Luca Navarini
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policiclinico Campus Biomedico, Via Alvaro del Portillo 200, 00128 Rome, Italy; Department of Medicine, Rheumatology and Clinical Immunology, University of Rome "Campus Biomedico", School of Medicine, Rome, Italy
| | - Roberto Giacomelli
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policiclinico Campus Biomedico, Via Alvaro del Portillo 200, 00128 Rome, Italy; Department of Medicine, Rheumatology and Clinical Immunology, University of Rome "Campus Biomedico", School of Medicine, Rome, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Regione Gonzole 10, Orbassano, 10043 Torino, Italy.
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Rizzo C, La Barbera L, Lo Pizzo M, Mohammadnezhad L, Lentini VL, Donzella D, Ciccia F, Fasano S, Guggino G. POS0101 POTENTIAL INVOLVEMENT OF IL-40 AND IL-40 PRODUCING CELLS IN SYSTEMIC LUPUS ERYTHEMATOSUS AND LUPUS ASSOCIATED NEPHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disorder, characterized by a remarkable heterogeneity of clinical presentations. Glomerulonephritis (GN) remains a leading cause of morbidity and mortality in SLE, influencing long-term prognosis. The alteration of both innate and adaptive immune responses plays a pivotal role in SLE pathophysiology [1]. B lymphocytes are mainly involved in SLE through the production of autoantibodies but recent evidence suggests an effector role of these cells in cytokine production. IL-40 is a recently discovered cytokine, produced by B cells and involved in their homeostasis, that may participate in the pathogenesis of B-mediated autoimmune diseases, such as SLE [2].ObjectivesThe purpose of this study was to evaluate the role of IL-40 in the pathogenesis of SLE, with a specific focus on renal involvement.MethodsPeripheral blood and urine samples were collected from 10 consecutive SLE patients and 10 healthy controls; kidney biopsy specimens were obtained from 3 SLE patients and 3 controls. The concentration of IL-40 in serum and urine samples was evaluated by ELISA. IL-40 production by monocytes, B cells and T cells was assessed by flow cytometry at day 0 and after in vitro stimulation. Immunohistochemistry on kidney tissue was also performed to evaluate IL-40 expression.ResultsIL-40 levels were reduced in the serum of patients with active GN. This reduction was further observed in the serum of patients with previous GN. In the serum of active SLE patients, without renal involvement, the concentration of IL-40 did not change significantly compared to controls. Urinary levels of IL-40 showed no significant changes compared to controls. Consistently, immunohistochemistry on kidney showed the expression of IL-40 only in SLE patients (Figure 1). Flow cytometric analysis on T cells, B cells and monocytes isolated from peripheral blood of SLE patients with active GN did not show production of IL-40.Figure 1.IL-40 overexpression in lupus nephritis at tissue level. Kidney biopsies stained for IL-40 in controls (A), Class III lupus nephritis (B) and Class V lupus nephritis (C) showed intense IL-40 positivity in lupus nephritis (B, C) compared to controls (A).ConclusionTo the best of our knowledge this is the first demonstration of IL-40 expression at kidney level in SLE associated nephritis. These preliminary data suggest an active role of IL-40 in SLE, with specific focus on active kidney disease. Our results highlight a potential use of IL-40 as a marker of active GN, although its specific mechanism of action needs to be further elucidated.References[1]Tsokos GC, Lo MS, Costa Reis P, Sullivan KE. New insights into the immunopathogenesis of systemic lupus erythematosus. Nat Rev Rheumatol. 2016;12(12):716-730.[2]Catalan-Dibene J, Vazquez MI, Luu VP, Nuccio SP, Karimzadeh A, Kastenschmidt JM, et al. Identification of IL-40, a Novel B Cell-Associated Cytokine. J Immunol. 2017;199(9):3326-35.Disclosure of InterestsChiara Rizzo: None declared, Lidia La Barbera: None declared, Marianna Lo Pizzo: None declared, Leila Mohammadnezhad: None declared, Vincenzo Luca Lentini: None declared, DENISE DONZELLA: None declared, Francesco Ciccia Speakers bureau: lilly, pfizer, novartis, celgene, abbvie, roche, janssen, UCB, SERENA FASANO: None declared, Giuliana Guggino Speakers bureau: pfizer, novartis, celgene, abbvie, roche, lilly, janssen, UCB
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