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Andreoli L, Gerardi MC, Gerosa M, Rozza D, Crisafulli F, Erra R, Lini D, Trespidi L, Padovan M, Ruffilli F, Serale F, Cuomo G, Raffeiner B, Semeraro P, Tani C, Chimenti MS, Conigliaro P, Hoxha A, Nalli C, Fredi M, Lazzaroni MG, Filippini M, Taglietti M, Franceschini F, Zatti S, Loardi C, Orabona R, Ramazzotto F, Zanardini C, Fontana G, Gozzoli G, Barison C, Bizioli P, Caporali RF, Carrea G, Ossola MW, Maranini B, Silvagni E, Govoni M, Morano D, Verteramo R, Doria A, Del Ross T, Favaro M, Calligaro A, Tonello M, Larosa M, Zen M, Zambon A, Mosca M, Zucchi D, Elefante E, Gori S, Iannone F, Anelli MG, Lavista M, Abbruzzese A, Fasano CG, D'Angelo S, Cutro MS, Picerno V, Carbone T, Padula AA, Rovere-Querini P, Canti V, De Lorenzo R, Cavallo L, Ramoni V, Montecucco C, Codullo V, Milanesi A, Pazzola G, Comitini G, Marvisi C, Salvarani C, Epis OM, Benedetti S, Di Raimondo G, Gagliardi C, Lomater C, Crepaldi G, Bellis E, Bellisai F, Garcia Gonzalez E, Pata AP, Zerbinati M, Urban ML, Mattioli I, Iuliano A, Sebastiani G, Brucato AL, Bizzi E, Cutolo M, Santo L, Tonetta S, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A. Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study. RMD Open 2024; 10:e004091. [PMID: 38663885 PMCID: PMC11043763 DOI: 10.1136/rmdopen-2024-004091] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. METHODS Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database. RESULTS We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. CONCLUSIONS Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures.
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Affiliation(s)
- Laura Andreoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Chiara Gerardi
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Gerosa
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Davide Rozza
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Erra
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Lini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Melissa Padovan
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Giovanna Cuomo
- Precision Medicine Department, University of Campania L. Vanvitelli, Naples, Italy
| | - Bernd Raffeiner
- Department of Rheumatology, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Paolo Semeraro
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Sole Chimenti
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
| | - Ariela Hoxha
- General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Filippini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Taglietti
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sonia Zatti
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Chiara Loardi
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Rossana Orabona
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | | | - Cristina Zanardini
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Giulia Fontana
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giorgia Gozzoli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Barison
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paola Bizioli
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Felice Caporali
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Giulia Carrea
- Clinical Rheumatology Division, ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), University of Milan, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Maranini
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ettore Silvagni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Danila Morano
- Dipartimento Materno Infantile, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Ferrara, Italy
| | - Rosita Verteramo
- Dipartimento Cure Primarie, UO Servizi Sanitari 1- AUSL Ferrara, Ferrara, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Genoa, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandra Zambon
- Unit of Obstetrics and Gynecology, Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sabrina Gori
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Marlea Lavista
- Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
| | - Anna Abbruzzese
- Rheumatology Unit, DiMePRE-J, University of Bari, Bari, Italy
| | | | | | | | - Valentina Picerno
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Teresa Carbone
- Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
| | | | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Canti
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ludovica Cavallo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Véronique Ramoni
- Internal Medicine Department, ASST Lodi - Ospedale Maggiore di Lodi, Lodi, Italy
| | | | - Veronica Codullo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Milanesi
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- PhD Program in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Giulia Pazzola
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Department of Obstetrics and Gynecology, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Emilia-Romagna, Italy
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Benedetti
- Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Di Raimondo
- Obstetrics and Gynecology, Maternal Infant Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Clizia Gagliardi
- Division of Rheumatology, Multispecialist Medical Department, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudia Lomater
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gloria Crepaldi
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Center, A.O. Mauriziano di Torino; Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Bellisai
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Estrella Garcia Gonzalez
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Paola Pata
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Martina Zerbinati
- General Medicine and Thrombosis and Hemorrhagic Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Antonio Luca Brucato
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Emanuele Bizzi
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Leonardo Santo
- Rheumatology Unit, "Mons. Dimiccoli" Hospital, Barletta (BT), Italy
| | - Sara Tonetta
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Gianpiero Landolfi
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
| | - Alessandra Bortoluzzi
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Alberto Scirè
- Epidemiology Research Unit of the Italian Society for Rheumatology, Milan, Italy
- Rheumatology Unit, IRCCS San Gerardo dei Tintori Foundation, Milan, Italy
- School of Medicine, Bicocca University, Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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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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Parodis I, Moroni G, Calatroni M, Bellis E, Gatto M. Is per-protocol kidney biopsy required in lupus nephritis? Autoimmun Rev 2024; 23:103422. [PMID: 37633351 DOI: 10.1016/j.autrev.2023.103422] [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: 08/06/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
Baseline kidney biopsy is recommended in lupus nephritis (LN). Biopsy allows to classify different forms of LN and differentiate other forms of renal involvement, such as tubulo-interstitial nephritis or thrombotic microangiopathy. The indications for repeat biopsy are more controversial. Some authors feel that good clinical monitoring is sufficient to assess prognosis and make therapeutic decisions. Based on the recently demonstrated discordance between clinical and histological response, some physicians recommend per-protocol biopsies either at 6 months in stable patients to verify the response to induction therapy, or after one-to-two years to assess treatment efficacy and tune the duration of maintenance therapy. Others recommend repeating kidney biopsy in case of incomplete response or to discriminate between active and chronic lesions. By definition, a per-protocol kidney biopsy differs from a repeat biopsy in that the former is foreseen at fixed timepoints, regardless of the clinical response. Although any decision should always consider the patient's overall clinical condition, there are no doubts that repeat kidney biopsy represents a useful tool in difficult cases to evaluate treatment response, modulate treatment intensity, and predict long-term renal outcome both in quiescent lupus and during flares. How to harmonize per-protocol biopsies in the LN course remains challenging.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Medical Unit of Gastroenterology, Dermatology, and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele Milan, Italy; Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele Milan, Italy; Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Elisa Bellis
- Unit of Rheumatology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Mariele Gatto
- Unit of Rheumatology, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy; Unit of Rheumatology, Department of Medicine, University of Padua, Padua, 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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Ruscitti P, Sota J, Vitale A, Lopalco G, Iannone F, Morrone M, Giardini HAM, D'Agostin MA, Antonelli IPDB, Almaghlouth I, Asfina KN, Khalil N, Sfikakis PP, Laskari K, Tektonidou M, Ciccia F, Iacono D, Riccio F, Ragab G, Hussein MA, Govoni M, Ruffilli F, Direskeneli H, Alibaz-Oner F, Giacomelli R, Navarini L, Bartoloni E, Riccucci I, Martín-Nares E, Torres-Ruiz J, Cipriani P, Di Cola I, Hernández-Rodríguez J, Gómez-Caverzaschi V, Dagna L, Tomelleri A, Makowska J, Brzezinska O, Iagnocco A, Bellis E, Caggiano V, Gaggiano C, Tarsia M, Mormile I, Emmi G, Sfriso P, Monti S, Erten Ş, Del Giudice E, Lubrano R, Conti G, Olivieri AN, Lo Gullo A, Tharwat S, Karamanakos A, Gidaro A, Maggio MC, La Torre F, Cardinale F, Ogunjimi B, Maier A, Sebastiani GD, Opris-Belinski D, Frassi M, Viapiana O, Bizzi E, Carubbi F, Fotis L, Tufan A, Kardas RC, Więsik-Szewczyk E, Jahnz-Różyk K, Fabiani C, Frediani B, Balistreri A, Rigante D, Cantarini L. The administration of methotrexate in patients with Still's disease, "real-life" findings from AIDA Network Still Disease Registry. Semin Arthritis Rheum 2023; 62:152244. [PMID: 37517110 DOI: 10.1016/j.semarthrit.2023.152244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To describe clinical characteristics of patients with Still's disease treated with methotrexate (MTX) and to assess drug effectiveness evaluating change in disease activity, reduction of inflammatory markers, and glucocorticoid (GC)-sparing effect. METHODS Patients with Still's disease treated with MTX were assessed among those included in AIDA Network Still Disease Registry. RESULTS In this registry, 171 patients with Still's disease were treated with MTX (males 43.3%, age 37.1 ± 16.0 years). They were mainly characterised by joint features and fever without a prominent multiorgan involvement. MTX was administered with GCs in 68.4% of patients, with other conventional synthetic DMARDs in 6.4%, and with biologic DMARDs in 25.1%. A significant reduction of the modified systemic score was observed, and 38.6% patients were codified as being in clinical remission at the end of follow-up. The concomitant administration of a biologic DMARD resulted a predictor of the clinical remission. Furthermore, a reduction of inflammatory markers and ferritin levels was observed following the administration of MTX. Additionally, a marked reduction of the dosage of concomitant GCs was identified, while 36.7% discontinued such drugs. Male gender appeared as a predictor of GC discontinuation. MTX was discontinued in 12.3% of patients because of adverse effects, and in 12.3% for lack of efficacy. CONCLUSIONS Clinical characteristics of patients with Still's disease treated with MTX were described, mainly joint features and fever without a prominent multiorgan involvement. The clinical usefulness of MTX was reported in reducing the disease activity, decreasing the inflammatory markers, and as GC-sparing agent.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Morrone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Marília Ambuel D'Agostin
- Rheumatology Division, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kazi Nur Asfina
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Najma Khalil
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Laskari
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tektonidou
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesco Ciccia
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Daniela Iacono
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Flavia Riccio
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Gaafar Ragab
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Egypt; Faculty of Medicine, Newgiza University, Egypt
| | - Mohamed A Hussein
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Egypt
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Luca Navarini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eduardo Martín-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, 14080, Mexico
| | - Jiram Torres-Ruiz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, 14080, Mexico
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - José Hernández-Rodríguez
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Verónica Gómez-Caverzaschi
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Łódz, Poland
| | - Olga Brzezinska
- Department of Rheumatology, Medical University of Lodz, Łódz, Poland
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Turin, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Maria Tarsia
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Ilaria Mormile
- Department of Translational Medical Sciences (DiSMeT) and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Centre for Inflammatory Diseases, Monash Medical Centre, Monash University Department of Medicine, Melbourne, VIC, Australia
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Sara Monti
- Rheumatology Department, Istituto di ricovero e cura a carattere scientifico Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Şükran Erten
- Department of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Emanuela Del Giudice
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy
| | - Riccardo Lubrano
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU), "G. Martino" Messina, Italy
| | - Alma Nunzia Olivieri
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Samar Tharwat
- Internal Medicine Department, Rheumatology and Immunology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Anastasios Karamanakos
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Maria Cristina Maggio
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco La Torre
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Benson Ogunjimi
- Division of Paediatric Rheumatology, Department of Paediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Center for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Belgium; Antwerp Center for Pediatric Rheumatology and Autoinflammatory Diseases, Antwerp, Belgium
| | - Armin Maier
- Rheumatology Unit, Department of Medicine, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Daniela Opris-Belinski
- Rheumatology and Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Micol Frassi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuele Bizzi
- Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lampros Fotis
- Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Riza Can Kardas
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Unit of Rheumatology, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alberto Balistreri
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Rare Diseases and Periodic Fevers Research Centre, Università Cattolica Sacro Cuore, Rome, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
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Tani C, Zucchi D, Bellis E, Birru Talabi M, Frise C, de Jesús GR, Koksvik HS, Lledó GM, Mekinian A, Marinello D, Palla I, Mehta P, Sáez Comet L, Shaimaa S, Smeele HTW, Talarico R, Brucato A, Khamashta M, Shoenfeld Y, Tincani A, Mosca M. Patient Care Pathways for Pregnancy in Rare and Complex Rheumatic Diseases: Results From an International Survey. J Rheumatol 2023:jrheum.220773. [PMID: 36642433 DOI: 10.3899/jrheum.220773] [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: 01/16/2023]
Abstract
OBJECTIVE To map existing organizational care pathways in clinical centers of expertise that care for pregnant women affected by rare and complex connective tissue diseases (rcCTDs). METHODS An international working group composed of experts in the field of pregnancy in rcCTDs co-designed a survey focused on organizational aspects related to the patient's pathway before, during, and after pregnancy. The survey was distributed to subject experts through referral sampling. RESULTS Answers were collected from 69 centers in 21 countries. Patients with systemic lupus erythematosus and/or antiphospholipid syndrome were followed by more than 90% of centers, whereas those with disorders such as IgG4-related diseases were rarely covered. In the majority of centers, a multidisciplinary team was involved, including an obstetrician/gynecologist in 91.3% of cases and other healthcare professionals less frequently. Respondents indicated that 96% of the centers provided routine pre-pregnancy care, whereas the number of patient visits during pregnancy varied across centers. A formalized care pathway was described in 49.2% of centers, and 20.3% of centers had a predefined protocol for the monitoring of pregnant patients. Access to therapies during pregnancy also was heterogeneous among different centers. CONCLUSION In international referral centers, a high level of care is provided to patients with rcCTDs before, during, and after pregnancy. No significant discrepancies were found between European and non-European countries. However, this work highlights a potential benefit to streamlining the care approaches across countries to optimize pregnancy and perinatal outcomes among patients with rcCTDs.
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Affiliation(s)
- Chiara Tani
- C. Tani, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- D. Zucchi, MD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Bellis
- E. Bellis, MD, Rheumatology Unit, Mauriziano Umberto I Hospital, Turin Italy, and Rheumatology Unit, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Mehret Birru Talabi
- M. Birru Talabi, MD, PhD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charlotte Frise
- C. Frise, MD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Hege Svean Koksvik
- H.S. Koksvik, MD, Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gema Maria Lledó
- G.M. Lledó, MD, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Arsène Mekinian
- A. Mekinian, MD, Sorbonne University, Internal Medicine Department, Saint Antoine Hospital, Paris, France
| | - Diana Marinello
- D. Marinello, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Ilaria Palla
- I. Palla, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Puja Mehta
- P. Mehta, MD, Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Luis Sáez Comet
- L.S. Comet, MD, Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Shoela Shaimaa
- S. Shaimaa, MD, Internal Medicine & Rheumatology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Hieronymus T W Smeele
- H.T.W. Smeele, MD, Department of Rheumatology, Erasmus MC, Rotterdam, the Netherlands
| | - Rosaria Talarico
- R. Talarico, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Brucato
- A. Brucato, MD, Università di Milano, Department of Biomedical and Clinical Sciences, Milan, Italy
| | - Munther Khamashta
- M. Khamashta, MD, PhD, Department of Women and Children's Health, King's College London, London, UK, and Gulf Medical Expert-Lupus, GSK, Dubai, UAE
| | | | - Angela Tincani
- A. Tincani, MD, Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marta Mosca
- M. Mosca, MD, PhD, Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Biglia A, Dourado E, Palterer B, Parronchi P, Pellico MR, Zanframundo G, Rivera Matias PA, Martins P, Miranda A, Cabral Da Fonseca JE, DI Agosta E, Cammelli D, Emmi G, Rosi E, Bixio R, Conticini E, Bellis E, Bruni C, Montecucco C, Matucci-Cerinic M, Rojas-Serrano J, Cavagna L. POS0863 ANTI-NOR90 ANTIBODIES IN THE SETTING OF CONNECTIVE TISSUE DISEASE: CLINICAL SIGNIFICANCE AND COMPARISON WITH A COHORT OF PATIENTS WITH SYSTEMIC SCLEROSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1636] [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
BackgroundAnti-NOR90 antibodies are directed against a 90-kD nucleolar protein located in the nucleolus organizing regions (NORs), mainly described in systemic sclerosis (SSc) [1, 2, 3] but reported also in other rheumatologic and oncologic diseases [4, 5, 6]. The clinical correlates of anti-NOR90 antibodies are still to be defined because the cohorts described thus far include a low number of patients.ObjectivesTo describe the characteristics of a large cohort of anti-NOR90 antibodies positive patients and compare them with a matched cohort of SSc patients negative for anti-NOR90 antibodies.MethodsA retrospective analysis was performed on patients positive for anti-NOR90 antibodies referring to participating centres. The concomitant positivity for anti-RNA polymerase III, Th/To, PM-Scl, Ku, and PDGFR antibodies was an exclusion criterion. In all cases the diagnoses, the different organ involvement and related clinical, instrumental and laboratory characteristics were evaluated. The EUROLINE SystemicSclerosisProfile kit from Euroimmun (Lübeck, Germany) was used to detect anti-NOR90 antibodies.ResultsWe included 101 patients positive for anti-NOR90 (M/F=13/88, mean age 52.5 years). They were mainly classified as SSc (n=38), undifferentiated connective tissue disease (UCTD) (n=21), interstitial pneumonia with autoimmune features (IPAF) (n=11) (graph 1). The most frequent clinical manifestations were arthralgias (n=72), Raynaud’s phenomenon (RP) (n=58), sicca syndrome (n=49), ILD (n=40), puffy fingers (n=32), arthritis (n=30), and limited skin sclerosis (n=24). Anti-NOR90 antibodies were associated with anti-Ro52 antibodies in the 16% of cases, with anticentromere antibodies in the 7% of cases, and with anti-Scl70 in the 5% of cases. After excluding these patients, and considering the isolated anti-NOR90 positivity, 12 patients had SSc, 35 UCTD, and 11 IPAF. The most frequent clinical manifestations were arthralgias (n=40), RP (n=37), and sicca syndrome (n=21). Compared to 242 matched SSc without anti-NOR90 antibodies, patients with anti-NOR90 had more frequently joint manifestations and sicca syndrome and less frequently all vasculopathic manifestations (RP, telangiectasias, pitting scars, acral ulcers), dysphagia and fibromyalgia.ConclusionOur study shows that anti-NOR90 antibodies are more commonly observed in females, and clinically associated with the occurrence of arthritis/arthralgias, sicca syndrome and RP. In more than the 50% of cases they may be found with other autoantibodies, such as the anti-Ro52, the anticentromere, and the anti-Scl70 antibodies. Anti-NOR90 seems to play an accompanying role in the context of CTDs, without strong influence on the clinical phenotype expression of the underlying CTD.References[1]Rodriguez-Sanchez et al., Anti-NOR 90. A new autoantibody in scleroderma that recognizes a 90-kDa component of the nucleolus-organizing region of chromatin, 1987.[2]Hamaguchi et al., Clinical and immunologic predictors of scleroderma renal crisis in Japanese systemic sclerosis patients with anti-RNA polymerase III autoantibodies, 2015.[3]Liaskos et al., Disease-related autoantibody profile in patients with systemic sclerosis, 2017.[4]Imai et al., Immunocytochemical characterization of human NOR-90 (upstream binding factor) and associated antigens reactive with autoimmune sera. Two MR forms of NOR-90/hUBF autoantigens, 1994.[5]Fujii et al., Detection of autoantibodies to nucleolar transcription factor NOR 90/hUBF in sera of patients with rheumatic diseases, by recombinant autoantigen-based assays, 1996.[6]Yamashita et al., Clinical significance of anti-NOR90 antibodies in systemic sclerosis and idiopathic interstitial pneumonia, 2021.Figure 1.Disclosure of InterestsNone declared
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Bellis E, Codullo V, Palermo BL, Bottazzi F, Biglia A, Bellingeri C, Beneventi F, Spinillo A, Montecucco C, Zanframundo G, Cavagna L. POS0924 THE ROLE OF RAYNAUD’S PHENOMENON ON MATERNAL AND FETAL OBSTETRICAL OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5048] [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
BackgroundIt is established that Raynaud’s phenomenon (RP) may influence pregnancy outcomes when secondary to rheumatic conditions (1,2). Data on the impact of primary RP (pRP) on pregnancy are very limited.ObjectivesTo retrospectively evaluate the impact of pRP on pregnancy outcomes.MethodsWomen with pRP were included in the study. They were compared with a group of women affected by UCTD with RP, and by UCTD without RP. These women were assessed and followed at our outpatient clinic from January 2011 to October 2020 and they did not exhibit an evolution to a UCTD or to a definite CTD during at least one-year follow-up. Antiphospholipid antibody positivity, twin pregnancies and voluntary termination of pregnancy were exclusion criteria. Women with pRP were also compared with a group of healthy pregnant women enrolled by our gynaecologist during the first trimester of pregnancy. Maternal and foetal outcomes were retrospectively recorded. ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi2 test or the Fischer exact test for categorical were performed (level of significance. P<0.050). In the post-hoc analysis we used the Mann-Whitney test (quantitative variables) or with the Chi2 test/Fischer exact test (qualitative variables), applying the Bonferroni correction with pRP women as a reference group (level of significance: p<0.0167).ResultsThe analysis included 188 women with a total of 375 pregnancies divided in 4 groups:-Group “pRP”: 46 women with RP without secondary causes, and a total of 106 pregnancies (reference group),-Group “RP-UCTD”: 48 UCTD women with RP and a total of 88 pregnancies,-Group “UCTD”: 37 UCTD women without RP and a total of 88 pregnancies,-Group “HC”: 57 healthy women with a total of 93 pregnancies.The reference group did not differ from the others regarding age at conception.Prophylactic acetylsalicylic acid was administered during pregnancy to 9% of patients with pRP compared to 1% in HC (p=0.010). In contrast, in the RP-UCTD this percentage was significantly higher (32%, p<0,001) than in pRP.pRP group showed an increased rate of 1st trimester miscarriages (33% vs 16%, p=0.006, OR 2.05 and 95%CI 1.05-3.98), a lower median birth weights (3038 g vs 3358 g, p=0.002), a higher rate of infants with a birth weight <10th percentile (21% vs 3%, p=<0.001, OR 8.36 and 95% CI 1.85 - 37.84) with respect to HC. There was no statistically significant difference between the reference and the UCTD groups.No statistically significant differences were observed when considering obstetrical outcomes (eg: mode of delivery, median gestation duration, gestational diabetes mellitus, hypertensive disorder of pregnancy, premature rupture of membranes, oligo-anhydramnios).ConclusionOur study shows that pRP in a retrospective cohort has an impact on pregnancy outcomes, with significantly more miscarriages and lower birth weight infants compared to HC. Importantly, pregnancy outcome in pRP women did not differ with respect to UCTD with and without RP, conditions generally associated to maternal morbidity, but in the RP-UCTD group prophylactic acetylsalicylic acid was more commonly prescribed.Further prospective studies aiming at evaluating these differences and at identifying the appropriate follow-up and the possible benefit from the use of prophylactic acetylsalicylic acid during pregnancy in RP are necessary.References[1]Liu E et al. Arch Rheumatol., 2017.[2]Al Arfaj A et al. Lupus. 2010.Table 1.Analysis of obstetrical outcomesPrimary RP (pRP)RP-UCTDUCTDHCp-valueMiscarriagesN. (%)35 (33%)17 (19%)30 (31%)15 (16%)p=0,017vs pRPreferencep=0,051p=0,750p=0,006Median weight at birth(IQR), gr3038 (2710-3500)3180 (2935 - 3465)3157 (2910 - 3610)3358 (3195 - 3583)p=0,02vs pRPreferencep=0,3473p=0,1542p=0,0002Birthweight < 10th percentileN. (%)15 (21%)7 (10%)5 (8%)2 (3%)p=0,002vs pRPreferencep=0,087p=0,03p=<0,001Disclosure of InterestsNone declared
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Tani C, Zucchi D, Haase I, Gerosa M, Larosa M, Cavagna L, Bortoluzzi A, Crisafulli F, Mucke J, Strigini FAL, Baglietto L, Fornili M, Monacci F, Elefante E, Erra R, Bellis E, Padovan M, Andreoli L, Coletto LA, Zanframundo G, Govoni M, Iaccarino L, Tincani A, Doria A, Fischer-Betz R, Mosca M. Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: results from a multicentre study. Lupus Sci Med 2022; 9:9/1/e000714. [PMID: 35701044 PMCID: PMC9198794 DOI: 10.1136/lupus-2022-000714] [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: 04/15/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022]
Abstract
Objective It is still a matter of debate whether low-dose acetylsalicylic acid (LDASA) should be prescribed to all patients with SLE during pregnancy. This study aimed at investigating the impact of LDASA on pregnancy outcomes in patients with SLE without history of renal involvement and without antiphospholipid antibodies (aPL). Methods This is a retrospective analysis of prospectively monitored pregnancies at seven rheumatology centres. Previous/current renal involvement and aPL positivity were the exclusion criteria. Adverse pregnancy outcome (APO) is the composite outcome of the study and included proteinuric pre-eclampsia, preterm delivery <37 weeks, small-for-gestational age infant, low birth weight <2500 g, intrauterine growth restriction and intrauterine fetal death after 12 weeks of gestation of a morphologically normal fetus. Results 216 pregnancies in 187 patients were included; 82 pregnancies (38.0%) were exposed to LDASA treatment. No differences in terms of age at conception, disease duration, clinical manifestations, comorbidities and disease flare during pregnancy were observed between patients taking LDASA and those who did not take LDASA during pregnancy. APO was observed in 65 cases (30.1%), including 13 cases (6.1%) of pre-eclampsia. The incidence of all complications was similar in the two groups. However, it is interesting to note that pre-eclampsia had lower frequency in patients taking LDASA versus those not taking LDASA (2.4% vs 8.3%, p=0.14). Conclusions In pregnant patients with SLE without renal involvement and were aPL-negative, there is a low risk of severe obstetric complications, such as early pre-eclampsia. LDASA treatment does not provide a statistically significant advantage over these complications. However, a careful individual risk–benefit balance is warranted.
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Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dina Zucchi
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Isabell Haase
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Maria Gerosa
- Division of Clinical Rheumatology, ASST Pini-CTO, Research Centre for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Lorenzo Cavagna
- Rheumatology Unit, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Francesca Crisafulli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Francesca A L Strigini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Monacci
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Elena Elefante
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Erra
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Bellis
- Rheumatology Unit, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Melissa Padovan
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, ASST Pini-CTO, Research Centre for Adult and Pediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Zanframundo
- Rheumatology Unit, University and IRCCS Policlinico S Matteo Foundation, Pavia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Angela Tincani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Rebecca Fischer-Betz
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana and Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Bozzalla-Cassione E, Zanframundo G, Biglia A, Bellis E, Bozzini S, Codullo V, Vertui V, Alpini C, Valentini A, Preda L, Montecucco C, Meloni F, Cavagna L. Anti-Ro52 antibodies positivity in antisynthetase syndrome: a single centre cohort study. Clin Exp Rheumatol 2022; 40 Suppl 134:27-31. [DOI: 10.55563/clinexprheumatol/bjb2gf] [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: 11/07/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Emanuele Bozzalla-Cassione
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET.
| | - Giovanni Zanframundo
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
| | - Alessandro Biglia
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
| | - Elisa Bellis
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
| | - Sara Bozzini
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
| | - Veronica Codullo
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
| | - Valentina Vertui
- Lung Transplant Centre Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Claudia Alpini
- Laboratory of Biochemical-Clinical Analyses, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Adele Valentini
- Radiology Unit, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Lorenzo Preda
- Radiology Unit, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
| | - Federica Meloni
- Lung Transplant Centre Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, IRCCS Policlinico S. Matteo Foundation, Pavia; Chair of Rheumatology, Department of Internal Medics and Therapeutics, University of Pavia, Italy. European Reference Network ReCONNET
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Chighizola CB, Crisafulli F, Hoxha A, Carubbi F, Bellan M, Monti S, Costa L, Baldi C, Radin M, Praino E, Coletto LA, Pregnolato F, Sciascia S, Sainaghi PP, Bellis E, Ramoni V, Quartuccio L, Alunno A, Gerosa M, Andreoli L. Psychosocial burden in young patients with primary anti-phospholipid syndrome: an Italian nationwide survey (The AQUEOUS study). Clin Exp Rheumatol 2021; 39:938-946. [PMID: 32940209 DOI: 10.55563/clinexprheumatol/2b73dn] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The AQUEOUS (Anti-phospholipid syndrome: a QUEstionnaire for yOUng patientS) study aimed to assess how the diagnosis of primary anti-phospholipid syndrome (PAPS) affects the psychosocial status of young patients. METHODS Subjects with PAPS aged 18-45 years were invited to compile an ad hoc designed questionnaire and the Short Form-12 to assess quality of life (QoL). RESULTS Ninety-two patients (83.7% females) were recruited in 10 Italian centres. Vascular and obstetric manifestations were equally represented. Nearly half of the patients perceived the need for psychological support, 89.2% when considering women after pregnancy complications. Social activities and working efficiency were reduced in APS patients, also intimacy was threatened. In all cases, fatigue appeared to be the main determinant. PAPS affected family planning, due to fears of treatment side-effects, disease hereditariness, inability to care for the newborn child. Fertility appeared to be conserved: the median time to pregnancy was 2 months; assisted reproduction techniques were pursued by 5 women. Our survey documented significantly lower rates of hospitalisation and learning disabilities in 51 children born after APS diagnosis as compared to 48 children born before. PAPS patients displayed lower QoL in physical and, to a greater extent, mental scores compared to the general Italian population. Both components were significantly lower in women and in patients with fatigue. CONCLUSIONS The AQUEOUS study assessed for the first time the unmet needs of young PAPS patients, enabling the development of a future "youth-focused" strategy to reduce disease burden.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Ariela Hoxha
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, and Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila; Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Mattia Bellan
- Center for Translational Research on Autoimmune and Allergic Disease-CAAD, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Siena University Hospital, Italy
| | - Massimo Radin
- Centre of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Emanuela Praino
- Rheumatology Unit, D.S.S.4 Barletta, ASL BT, Barletta, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Research Center for Adult and Paediatric Rheumatic Diseases, ASST G. Pini & CTO, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Francesca Pregnolato
- Experimental Laboratory of Immunological and Rheumatologic Researches, Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Pier Paolo Sainaghi
- Center for Translational Research on Autoimmune and Allergic Disease-CAAD, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisa Bellis
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Veronique Ramoni
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, ASUFC, Santa Maria della Misericordia Hospital, Department of Medicine, University of Udine, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maria Gerosa
- Division of Clinical Rheumatology, Research Center for Adult and Paediatric Rheumatic Diseases, ASST G. Pini & CTO, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Maranini B, Chiodin T, Scirè CA, Govoni M, Lucioni E, Chiarello S, Scabbia F, Marchi I, Zanframundo G, Cavagna L, Bellis E, Silva M, Tringali G, Carnevale A. POS1406 DEVELOPMENT OF A DIAGNOSTIC ALGORITHM FOR THE DIFFERENTIAL DIAGNOSIS OF INTERSTITIAL LUNG DISEASE: PRELIMINARY DATA FROM A MULTICENTER RETROSPECTIVE CASE-CONTROL STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Interstitial lung diseases (ILDs) represent a heterogeneous group of disorders with different treatment and prognosis. ILD may be the presenting or the dominant manifestation of a connective tissue disease (CTD). Multidisciplinary team (MDT) discussion is currently the diagnostic standard. However, there is no consensus on how MDT diagnosis is validated and on the core elements of discussion.Objectives:To explore the performance of a diagnostic algorithm for the differential diagnosis of ILD based on clinical, serological and radiological data, supporting clinician decision-making.Methods:In this retrospective study, analysis was performed on clinical, serological and radiological features at diagnosis and 1-year follow-up in 71 patients, including 41 with CTD-ILD and 30 with idiopathic interstitial pneumonias (IIPs). In order to identify robust hallmarks, we conducted the Receiver Operating Characteristic (ROC) curve analyses in logistic regression, to discriminate significantly different features between CTD-ILD and non-CTD-ILD groups.Results:Out of 71 patients 46% were women, with a mean age of 66±11 years. History of smoking (8.8% current and 39.8% former smokers), was more associated with IIPs. 54% of patients had dyspnea on exertion and 39% dry cough, both more frequently associated with IIPs (p = 0.016). Among radiological features, NSIP pattern was more frequent in CTD-ILD, while UIP was associated with IIP. Lung fibrosis extent was greater in IIP (p = 0.063), in which CT is generally performed in symptomatic patients at diagnosis and rarely for screening purpose. Baseline features with good performance (OR p-value ≤ 0.05) were eligible as potential candidate discriminators: age, sex, smoking habit, rheumatological signs and symptoms, autoantibodies, ILD patterns were selected, to build a multivariate model with high discrimination accuracy (AUC 0.971). The model has a sensitivity of 100% and specificity of 89.7%. The most relevant correlations between population features and CTD-ILD are presented in Table 1.Table 1.Correlation analysis of the most significant discriminative
features.FeaturesOdds ratioP valueArea under ROC curveSex (female)3.290.019*0.643Age0.910.001*0.736Smoke0.12<0.001*0.738Respiratory symptoms (dyspnea and/or dry cough)0.260.016*0.644Rheumatological symptoms (any)28.8<0.001*0.839 • Raynaud’s phenomenon15.040.0110.654 • Cutaneous manifestations8.160.0530.593Autoantibodies (ANA, ENA, RF, ACPA, myositis-specific antibodies or aPL) positivity33.68<0.001*0.792Lung function test • Forced vital capacity (%FVC)0.970.1750.638 • Diffusing capacity of carbon monoxide (%DLCO)0.960.0720.665High-resolution computed tomography (HRCT) imaging • Honeycombing0.340.0680.593 • Emphysema0.140.005*0.647 • Extent of lung involvement (%)0.970.0630.668HRCT pattern • NSIP vs UIP30.033*0.625Abbreviations: ANA, antinuclear antibody; ENA, extractable nuclear antigen; RF, rheumatoid factor; ACPA, anti-citrullinated peptide antibody; aPL, antiphospholipid antibody; NSIP, nonspecific interstitial pneumonia; UIP, usual interstitial pneumonia.Conclusion:Our study shows that the most important variables in the differential diagnosis between CTD-ILD versus IIPs include, as expected, autoimmune features (rheumatological symptoms and serological data). Questionnaire tool containing these specific hallmarks may be relevant during MDT discussion, limiting the number of misdiagnosed CTD-ILDs and potentially avoiding further unnecessary investigations. However, only prospective cohort studies of early onset ILD are needed to fully validate the relative importance of clinical, serological, functional and radiological data.References:[1]Furini F. et al, The Role of the Multidisciplinary Evaluation of Interstitial Lung Diseases: Systematic Literature Review of the Current Evidence and Future Perspectives. Front Med (Lausanne). 2019; 6: 246.Disclosure of Interests:None declared
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Biglia A, Monti S, Morandi V, Delvino P, Bellis E, Rossi S, Cavagna L, Mugellini A, Canino C, Bogliolo L, Montecucco C. Is it really infective endocarditis? Distinguishing systemic vasculitis from its mimics. Scand J Rheumatol 2021; 51:76-77. [PMID: 33682580 DOI: 10.1080/03009742.2021.1881157] [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] [Indexed: 10/22/2022]
Affiliation(s)
- A Biglia
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - S Monti
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy.,PhD School of Experimental Medicine, University of Pavia, Pavia, Italy
| | - V Morandi
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - P Delvino
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy.,PhD School of Experimental Medicine, University of Pavia, Pavia, Italy
| | - E Bellis
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - S Rossi
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - L Cavagna
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - A Mugellini
- Department of Internal Medicine, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - C Canino
- Department of Traslational Oncology, Scientific Institute of Pavia Maugeri ICS, Pavia, Italy
| | - L Bogliolo
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - C Montecucco
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
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Delvino P, Biglia A, Bellis E, Monti S, Bozzalla Cassione E, Zanframundo G, Montecucco C, Cavagna L. Lumbar spondylolisthesis associated with systemic sclerosis-related spinal calcinosis: an unusual clinical case. Rheumatology (Oxford) 2021; 59:3999. [PMID: 32556288 DOI: 10.1093/rheumatology/keaa293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paolo Delvino
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation
| | | | - Elisa Bellis
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation
| | - Sara Monti
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation.,Experimental Medicine, University of Pavia, Pavia, Italy
| | | | | | | | - Lorenzo Cavagna
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation
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Monti S, Bartoletti A, Bellis E, Delvino P, Montecucco C. Fast-Track Ultrasound Clinic for the Diagnosis of Giant Cell Arteritis Changes the Prognosis of the Disease but Not the Risk of Future Relapse. Front Med (Lausanne) 2020; 7:589794. [PMID: 33364248 PMCID: PMC7753207 DOI: 10.3389/fmed.2020.589794] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Color Duplex sonography (CDS) of temporal arteries and large vessels (LV) is a recently validated diagnostic methodology for Giant Cell Arteritis (GCA). CDS combined with a fast-track approach (FTA) has improved the early diagnosis of the disease. Objectives: To assess FTA effects on the prevention of permanent visual loss (PVL), relapse and late complications of GCA compared to conventional practice. To assess the impact of COVID-19 pandemic on outcomes of GCA patients assessed with FTA. Methods: GCA patients diagnosed up to June 2020 at the Rheumatology Department, University of Pavia, were included. FTA was implemented since October 2016. FTA consists in the referral within 1 working day of a suspected GCA case to an expert rheumatologist who performs clinical evaluation and CDS. Results: One hundred sixty patients were recruited [female 120 (75%), mean age 72.4 ± 8.2 years]. Sixty-three (39.4%) evaluated with FTA, 97 (60.6%) with conventional approach. FTA patients were older (75.1 ± 7.6 vs. 70.6 ± 8.2 years old; p < 0.001). Median follow-up duration was shorter in the FTA group compared to the conventional one (0.9 vs. 5.0 years; p < 0.001). There was no difference between the two cohorts regarding major vessel district involvement (LV-GCA 17.5% vs. 22.7%; p = 0.4). PVL occurred in 8 (12.7%) FTA patients and 26 (26.8%) conventional ones (p = 0.03). The relative risk of blindness in the conventional group was 2.11 (95% C.I. 1.02–4.36; P = 0.04) as compared to FTA. Median symptom latency of patients experiencing PVL was higher in the conventional group (23 days IQR 12–96 vs. 7 days IQR 4–10, p = 0.02). During COVID-19 there was a significant increase in the occurrence of PVL (40%) including bilateral blindness despite a regularly operating FTA clinic. Cumulative incidence of relapses and time to first relapse did not change after FTA introduction (P = 0.2). No difference in late complications (stenosis/aneurysms) was detected. Conclusions: FTA including CDS evaluation contributed to a substantial reduction of PVL in GCA by shortening the time to diagnosis and treatment initiation. Relapse rate did not change upon FTA introduction, highlighting the need for better disease activity monitoring and treatment strategies optimization based on risk stratification that would predict the occurrence of relapse during glucocorticoid de-escalation.
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Affiliation(s)
- Sara Monti
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy.,PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Alice Bartoletti
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Elisa Bellis
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Paolo Delvino
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy.,PhD in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Rheumatology Department, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
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Caffetti C, Bogliolo L, Giuffrè G, Sozzi A, Degli Esposti L, Bellis E, Montecucco C, Reitano F, Triarico A, Silva S, Bejor M, Muzzi A, Mirabile P, Ramaioli N, Brait M. Multidisciplinary model for hospital-territory integrated management of patient with bone fragility: primary and secondary prevention of fractures according to severity and complexity. Reumatismo 2020; 72:75-85. [PMID: 32700873 DOI: 10.4081/reumatismo.2020.1271] [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] [Received: 02/08/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to promote the construction of a real network and a shared diagnostic and therapeutic management model between hospitals and out-of-hospital healthcare services to capture as many patients with bone fragility as possible. Starting from the analysis of the clinical competences present in the province of Pavia, the bone specialists (BSs) organized some educational events involving both general practitioners (GPs) and hospital specialists. The Fracture Liaison Service (FLS) model, the revision of Note 79, the national plan for chronicity and the health reform of the Lombardy Regional Authority supported the structure of our model, in which the roles of clinicians are well defined and based on the complexity and severity of patients. In our method the GP has a central role as clinical manager, facilitating patient management and communication between the specialists and the BS. In January 2019, the Therapeutic Care Diagnostic Path (PDTA) shared between 2 bone specialists (BSs), 9 GPs, as reference treaters, and a multidisciplinary group of 25 specialists of the Province of Pavia was defined. The strategic directions of the two largest public hospitals in Pavia have supported the PDTA, which was validated by the quality departments of the hospitals themselves. Finally, sixty GPs belonging to the network have joined the PDTA. This model is the first example of integrated management between hospitals and out-of-hospital healthcare services for the primary and secondary prevention of fragility fractures (FF), where the GPs play a pivotal role as managers and supervisors to ensure proper care to chronic patients according to their levels of severity.
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Affiliation(s)
- C Caffetti
- U.O.C. Riabilitazione Specialistica di Voghera, ASST Pavia.
| | - L Bogliolo
- U.O.C. Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - G Giuffrè
- Medico di Medicina Generale, ATS Pavia.
| | - A Sozzi
- Fondazione Don Carlo Gnocchi, ONLUS Centro Santa Maria alle Fonti, Salice Terme, Pavia.
| | - L Degli Esposti
- CliCon S.r.l. - Health, Economics and Outcomes Research, Pavia.
| | - E Bellis
- U.O.C. Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - C Montecucco
- U.O.C. Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - F Reitano
- Direzione Sanitaria Aziendale, ASST Pavia.
| | - A Triarico
- Direzione Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - S Silva
- Direzione Sanitaria, ATS Pavia.
| | - M Bejor
- U.O.C. Riabilitazione Specialistica di Voghera, ASST Pavia.
| | - A Muzzi
- Software developer, freelance.
| | - P Mirabile
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - N Ramaioli
- UOS Accreditamento e Qualità, ASST Pavia.
| | - M Brait
- Direzione Generale, ASST Pavia.
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Bellis E, Monti S, Balduzzi S, Delvino P, Biglia A, Montecucco C. AB0462 BEHCET’S DISEASE: CLINICAL FEATURES AND OFF-LABEL BIOLOGIC TREATMENT STRATEGIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The treatment of Behçet’s disease (BD) is still mainly based on the evidence derived from case reports, case series, retrospective analyses, and few clinical trials suggesting the safety and potential efficacy of off-label use of biologic agents in refractory cases.1Objectives:To describe clinical manifestations and their management, with particular focus on treatment indications, outcomes and safety of biologic therapy, in a cohort of patients with BD.Methods:Patients with a diagnosis of BD who visited our outpatient clinic until December 2019 were included in the study. Clinical data were recorded since diagnosis until the latest follow-up visit, analyzing clinical features, flares and therapeutic strategies adopted.Results:A total of 95 patients were included in the study with a medium follow-up of 108.54 ± 169.59 months. 20 of them (21. 05%) were treated with biologic agents. Patients treated with biologic therapy compared to those on conventional non-biologic therapies had a higher proportion of musculoskeletal (80% vs 46.67%, p = 0.008), neurological (30% vs 10.67%, p = 0.031), intestinal involvement (40% vs 12%, p = 0.004), and they were treated with a higher dose of glucocorticoids at diagnosis (16.84 mg ±14.01 vs 8.89 mg ± 11.76, p = 0.012). The most frequent indications for biologic step-up therapy were musculoskeletal involvement (40%), eye involvement (25%), neurological involvement (15%) and intestinal involvement (10%). Most patients initiated a biologic treatment within the first year of follow-up. TNF-inhibitor (TNFi) were more frequently prescribed (95%) and one patient was treated with 8 therapeutic cycles of Rituximab (500 mg/weekly for 4 infusions to be repeated after at least 6 months) because of recurrent pancytopenia. All patients experienced non-biologic therapy before starting a TNFi. The preferred first-line TNFi was infliximab (50%), followed by adalimumab (40%) and etanercept (5%). As second line treatment were also prescribed certolizumab (10%) and golimumab (5%). 10 patients switched to a second line treatment because of inefficacy of the first biologic agent, mainly because of refractory arthritis, intestinal and mucocutaneous involvement. One patient switched from infliximab to certolizumab during pregnancy with subsequent worsening of arthritis.85% of patients treated with biologic agents reached a clinical remission by the time of the latest follow up visit without any safety or tolerability issues.Conclusion:A relevant proportion of patients in our BD cohort were treated with biologic therapy, because of severe or refractory manifestations. The most frequent indications were musculoskeletal, neurological or intestinal involvement. Biologic agents were a generally effective and safe therapeutic approach.References:[1]F. Alibaz-Oner, M. H. Sawalha, H. Direskeneli. Management of Behçet disease, Curr. Opin. Rheumatol, 2018Table 1.General characteristics and disease involvement at diagnosisBiologic therapyNo biologic therapyp value20 (21.05%)75 (78.95%)General characteristicsMediaSDMediaSDAge at disease onset(years ± SD)34.5± 10.4938.64± 13.18p = 0.1976Diagnostic delay(months ± SD)45.28± 67.4828.09± 48.42p = 0.1996Glucocorticoids at diagnosis (mg prednisone ± SD)16.84± 14.018.89± 11.76p = 0.0115Glucocorticoids at latest follow up visit (mg prednisone ± SD)6.38± 7.763.83± 4.81p = 0.0707N%N%F / M12 / 860 / 4054 / 4172 / 28p = 0.3030Disease involvement at diagnosisOral ulcers2010075100Genital ulcers11553749,33p = 0.6540Cutaneous lesions15755066,67p = 0.4787Eye involvement6302736p = 0.6184Musculoskeletal involvement16803546,67p = 0.0082Neurological involvement630810,67p = 0.0311Intestinal involvement840912p = 0.0039Thrombosis2101824p = 0.1747Disclosure of Interests:None declared
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Delvino P, Monti S, Bartoletti A, Bellis E, Brandolino F, Milanesi A, Montecucco C. SAT0256 THE ROLE OF FAST-TRACK ULTRASOUND IN PREVENTING EARLY COMPLICATIONS AND RELAPSES IN GIANT CELL ARTERITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Giant Cell Arteritis (GCA) is the most common form of primary systemic vasculitis, mainly affecting adults over 50 years old. Permanent visual loss (PVL) is one of the most feared complications, occurring in about 20% of cases, typically prior to initiation of high-dose glucocorticoid (GC) therapy. Color-duplex sonography (CDS) of temporal arteries (TAs) and large vessels (LVs) is recognized as a first-line diagnostic tool for patients with suspected GCA. A fast track approach (FTA), incorporating CDS has been associated to a significant reduction of PVL in two retrospective studies1,2.Objectives:To assess the impact of FTA on PVL and risk of relapses during follow-up compared to conventional care prior to the introduction of the FTA in our rheumatology clinic.Methods:Patients with new-onset GCA evaluated in our department from January 1998 to September 2019 were included in the study. The FTA approach for GCA was implemented since October 2016. The diagnosis of GCA was based on positive TAs and/or LVs CDS and/or a positive TA biopsy and clinical signs and symptoms of GCA. All patients were clinically examined by the same rheumatologist who performed the CDS. PVL was defined as total visual impairment in one or both eyes. Data on baseline clinical features and later outcomes were collected.Results:153 patients were included: 115 females (75.2%), mean age at diagnosis 71.6±8.2 years. Of these, 112 patients (73%) were evaluated conventionally and 41 (27%) with FTA. Patients in the FTA group were older (P=0.0002), presented more frequently with polymyalgia rheumatica symptoms, weight loss, jaw or tongue claudication and scalp tenderness (P<0.05 for all comparisons). The median duration of follow-up in the FTA group was shorter compared with the conventional group (1.5 vs 5.8 years). PVL occurred in 22 (19.6%) patients in the conventional group compared to 5 patient (12.2%) in the FTA, leading to a reduction of 37.9% in the relative risk of PVL with the FTA approach. Cumulative incidence of relapses and time to first relapse did not change after FTA introduction (P>0.05) (Fig. 1).Conclusion:The application of a FTA in GCA resulted in a significant reduction of PVL. However, the relapse rate did not seem to be influenced by the FTA, highlighting the need to implement further management strategies, besides earlier diagnosis and prompt initiation of GC, that would impact the course of the disease during long-term follow-upReferences:[1]Patil P, Williams M, Maw WW et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. Clin Exp Rheumatol 2015;33(Suppl 89):S-103-6.[2]Diamantopoulos AP, Haugeberg G, Lindland A, Myklebust G. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? Rheumatology 2016;55:66_70.Fig. 1.Time to first relapse in patients with GCA and evaluated with a FTA compared to conventionally approached patients.Disclosure of Interests:None declared
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Gerosa M, Fredi M, Andreoli L, Chighizola C, Argolini LM, Donzelli D, Vojinovic T, Ramoni V, Bellis E, Trespidi L, Gazzola F, Ferrazzi E, Zatti S, Benvenuti F, Meroni PL, Franceschini F, Montecucco C, Cimaz R, Caporali R, Tincani A. SAT0207 ANTI-SSA/RO POSITIVITY AND CONGENITAL HEART BLOCK: OBSTETRIC AND FETAL OUTCOME IN A COHORT OF ANTI-SSA/RO POSITIVE PREGNANT WOMEN WITH AND WITHOUT AUTO-IMMUNE DISEASES FROM THREE ITALIAN TERTIARY REFERRAL CENTERS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:neonatal lupus syndrome (NLS) is an acquired disease caused by the trasplacental passage of anti-SSA antibodies. Congenital heart block (CHB) represents the most serious manifestation of NLS. The rate of CHB in Anti-SSA positive pregnant women ranges from 1 to 5% in different studiesObjectives:to retrospectively assess the prevalence of CHB in a cohort of anti-SSA positive pregnant women followed in 3 Italian tertiary centersMethods:pregnancies of anti-SSA positive women attending the pregnancy clinic of ASST Pini CTO/Policlinico Mangiagalli, Rheumatology Division of Spedali Civili, Brescia and Rheumatology Division of Ospedale S Matteo, Pavia from 2009 to 2019 were included. Patients underwent monthly clinical examination. Fetal heart rate was assessed weekly by Doppler ultrasound from 14thto 26thgestational week. On week 14 and 26, a fetal echocardiography was performed. A EKG was performed at birthResults:351 prospectively followed pregnancies in 292 anti-SSA/Ro positive women were included. Table 1 reports diagnosis. None of the prospectively followed pregnancies were complicated by complete CHB. Seven additional patients were referred to our clinics after diagnosis of CHB and were subsequently found to be anti-SSA positive, reporting no symptoms of diseases. Considering the 7 additional pregnancies, the incidence of CHB was 1.9%. We observed 3 neonates (0.8%) with cutaneous NLS and 1 case of transient increase of liver enzymes. In another neonate, a 1thdegree A-V block was found after birth. A complete analysis of maternal and fetal outcome was possible in 244 cases (Table 2) and compared with 3158 unselected healthy controls. Among these 244 cases, 65% were taking hydroxychloroquineTable 1.patients diagnosisn%Sjogren’s Syndrome58`20Systemic lupus erythematosus7626UCTD7425Asymptomatic Ro carriers5619Other2810292100Table 2.maternal and fetal outcomehealthy controls N=3158Anti-SSA/Ro ptsN=244P valuePrevious CHB n (%)2 (0.8)Anti-SSB pos n (%)46 (18.8)aPL pos n (%)49 (20)PregnancyLive births3158241Preeclampsia, n (%)43 (1.1)2 (0.8)nsDeliveryDelivery <37 wks, n (%) / < 34 wks n (%)401 (12.6) /201 (6)35 (15.6) / 14 (6)ns / nsCesarean Section, n (%)897 (29.3)115 (47.5)<0.001Conclusion:none of the patients prospectively followed in our centers before and during pregnancy developed complete CHB. If the 7 cases of anti-SSA positivity diagnosed after CHB detection were included in the analysis, the incidence of CHB was comparable to previous reports. Our data suggest that a strict follow up and proper treatment of anti-SSA positive patients with or without an autoimmune disease before and during pregnancy can reduce the risk of NLS. Further studies are warranted to confirm a possible protective role of anti-rheumatic treatments, including HCQReferences:[1]Fredi M. Front Cardiovasc Med. 2019Disclosure of Interests:Maria Gerosa: None declared, Micaela Fredi: None declared, Laura Andreoli: None declared, Cecilia Chighizola: None declared, Lorenza Maria Argolini: None declared, Davide Donzelli: None declared, Tamara Vojinovic: None declared, Véronique Ramoni: None declared, Elisa Bellis: None declared, Laura Trespidi: None declared, Federica Gazzola: None declared, Enrico Ferrazzi: None declared, Sonia Zatti: None declared, Fausta Benvenuti: None declared, Pier Luigi Meroni: None declared, Franco Franceschini: None declared, Carlomaurizio Montecucco: None declared, Rolando Cimaz: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Angela Tincani: None declared
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Monti S, Delvino P, Bellis E, Milanesi A, Brandolino F, Montecucco C. Impact of delayed diagnoses at the time of COVID-19: increased rate of preventable bilateral blindness in giant cell arteritis. Ann Rheum Dis 2020; 79:1658-1659. [PMID: 32448783 DOI: 10.1136/annrheumdis-2020-217915] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Sara Monti
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Paolo Delvino
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Elisa Bellis
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Alessandra Milanesi
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
| | - Fabio Brandolino
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy
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Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis 2020; 79:667-668. [PMID: 32241793 PMCID: PMC7211079 DOI: 10.1136/annrheumdis-2020-217424] [Citation(s) in RCA: 348] [Impact Index Per Article: 87.0] [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: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Sara Monti
- Rheumatology Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Silvia Balduzzi
- Rheumatology Department, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Delvino
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Bellis
- Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Sakellariou G, Bellis E, Scirè C, Carrara G, Adinolfi A, Bortoluzzi A, Batticciotto A, Cagnotto G, Caprioli M, Canzoni M, Cavatorta F, De Lucia O, Di Sabatino V, Draghessi A, Filippou G, Farina I, Focherini M, Gabba A, Gutierrez M, Idolazzi L, Luccioli F, Macchioni P, Massarotti M, Mastaglio C, Menza L, Muratore M, Parisi S, Picerno V, Piga M, Ramonda R, Raffeiner B, Rossi D, Rossi S, Rossini P, Scioscia C, Venditti C, Volpe A, Matucci-Cerinic M, Iagnocco A. SAT0061 Concurrent Ultrasound-Detected Synovitis and Tenosynovitis Predict Flare in Patients with Rheumatoid Arthritis in Clinical Remission. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bellis E, Scirè C, Carrara G, Adinolfi A, Batticciotto A, Bortoluzzi A, Cagnotto G, Caprioli M, Canzoni M, Cavatorta F, De Lucia O, Di Sabatino V, Draghessi A, Filippou G, Farina I, Focherini M, Gabba A, Gutierrez M, Idolazzi L, Luccioli F, Macchioni P, Massarotti M, Mastaglio C, Menza L, Muratore M, Parisi S, Picerno V, Piga M, Ramonda R, Raffeiner B, Rossi D, Rossi S, Rossini P, Sakellariou G, Scioscia C, Venditti C, Volpe A, Matucci-Cerinic M, Iagnocco A. OP0217 Ultrasound-Detected Synovitis and Tenosynovitis Independently Associate with Flare in Patients with Rheumatoid Arthritis in Clinical Remission. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bellis E, Hajba L, Kovács B, Sándor K, Kollár L, Kokotos G. Three generations of alpha,gamma-diaminobutyric acid modified poly(propyleneimine) dendrimers and their cisplatin-type platinum complexes. ACTA ACUST UNITED AC 2006; 69:151-61. [PMID: 16624417 DOI: 10.1016/j.jbbm.2006.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Revised: 02/01/2006] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
Three generations of alpha,gamma-diaminobutyric acid modified poly(propyleneimine) dendrimers [DAB(AM)n, n = 4, 8, 16] containing 4, 8, 16 free amino groups were coupled with Boc-protected alpha,gamma-diaminobutyric acid (DABA) moieties in high yields. These modified dendrimers were deprotected and the chiral dendritic amines with 8, 16 and 32 amino groups on the surface were isolated in excellent yields. Dendrimers with cisplatin moieties at the periphery were obtained in the reaction of the free amine dendrimers and potassium tetrachloroplatinate(II). The highly insoluble complexes were isolated as hydrates and characterized by means of IR, TGA and elemental analysis.
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Affiliation(s)
- E Bellis
- University of Athens, Laboratory of Organic Chemistry, 15771 Athens, Greece
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Randle MJ, Wolf A, Levi L, Rigamonti D, Mirvis S, Robinson W, Bellis E, Greenberg J, Salcman M. The use of anterior Caspar plate fixation in acute cervical spine injury. Surg Neurol 1991; 36:181-9. [PMID: 1876968 DOI: 10.1016/0090-3019(91)90110-u] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Optimal management of cervical cord injury in the presence of documented instability and/or compression of neural elements remains a controversial topic. Surgery and internal stabilization of cervical spine fracture/dislocations are effective and well accepted, but controversy exists on the relative merits of the anterior versus the posterior approach as well as the optimal timing of surgical intervention. We report our experience with the Caspar technique and instrumentation for anterior stabilization in 54 patients for acute cervical spine injury. Our series consists of 38 male and 16 female patients whose ages ranged from 16 to 68 years, with a mean age of 29.2 years. Thirty-two of these patients had complete neurological sensory/motor deficits at the time of presentation, eight were neurologically intact, and 14 had preservation of some motor and sensory function. All 54 patients had radiographic evidence of posterior instability as well as anterior disruption of either a vertebral body or intervertebral disk. We found that "early" intervention (less than 24 hours after injury) was performed frequently in the neurologically compromised patients. Twelve of the 22 patients undergoing surgery less than 24 hours after admission regained significant neurological function, with 13 of 22 developing postoperative complications. In the "delayed" group (surgery more than 24 hours after injury, mean 14.3 days), 14 patients experienced postoperative complications, with 15 of 24 demonstrating neurological improvement. The eight patients who were intact did uniformly well. There was no mortality during the follow-up. All 54 patients showed a solid fusion (clinically and radiologically) within 6 months of surgery. In two cases the plates had to be removed, without risking the fusion. Our experience suggests that although anterior cervical fusion and Caspar plating remain appropriate for patients with documented anterior compromise of the canal, it should not substitute for more traditional posterior stabilization procedures. Because this route has the potential for more serious complications, it should be reserved for the cases in which anterior decompression is deemed necessary or posterior fusion was unsuccessful. With appropriate selection of patients, no adverse effect of early surgery was demonstrated. In fact, neurologically compromised patients had the benefits of increased ease of patient care and early transfer to rehabilitation.
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Affiliation(s)
- M J Randle
- Neuro-Trauma Service, University of Maryland Medical Center, Baltimore
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Salcman M, Botero E, Bellis E. Giant posttraumatic aneurysm of the intracranial carotid artery: evolution and regression documented by computed tomography. Neurosurgery 1985; 16:218-21. [PMID: 3974833 DOI: 10.1227/00006123-198502000-00016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Posttraumatic aneurysms of the proximal intracranial internal carotid artery are rare. A case is presented in which the evolution and regression of such an aneurysm is documented by computed tomography as well as by arteriography. The coexistence of a proximal dissection of the cervical carotid artery probably contributed to the growth of the aneurysm.
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Agnisola C, Bellis E, Foti L, Lampo A, Russo G, Trara Genoino I. [Influence of the age on 5'-nucleotidase activity associated with the rat liver plasma membrane]. Boll Soc Ital Biol Sper 1978; 54:2595-601. [PMID: 756282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The influence of age on the isothermic and temperature-induced kinetics of the plasma membrane 5'-nucleotidase was studied in rat liver. The apparent Km values increased with age, while the Vmax, the temperature discontinuity and the Ex above and below the max break were unaffected.
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Bellis P, Bellis E, Pellegrino G. [Study on the relationship between meteorological-seasonal factors and acute vascular accidents]. Minerva Med 1977; 68:1735-54. [PMID: 865714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mortality from acute cardiovascular accidents has been studied in relation to the seasons in Naples, Milan and the rest of Italy. A constant parallel was noted between such deaths and the winter season. It is concluded that the meteoric-seasonal factor most responsible consists of the drop in temperature which could cause vascular spasm followed by an increase in systemic arterial pressure. It is personally considered that this is the most important pathogenetic mechanism in the majority of cases of acute cardiovascular accidents.
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Bellis E, Del Guercio R, Valva M, Conti G. [Behavior of serum beta-lipoproteins in pulmonary emphysema, pneumothorax and severe pulmonary destructive processes of tubercular origin]. Rass Int Clin Ter 1968; 48:715-22. [PMID: 5736047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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31
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Del Guercio R, Conti G, Valva M, Pinto R, Bellis E. [Peripheral rheographic changes following hypertensin infusion]. Rass Int Clin Ter 1967; 47:1105-8. [PMID: 4306724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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32
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Bellis E. [Clinical experimentation with a new nitrofuran: 2-acetamide-495-nitro-2-furyl)-thiazole]. Clin Ter 1965; 34:515-20. [PMID: 5322253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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33
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Bellis E, Sabatini C. [Study of in vitro antibacterial activity of 2-acetamido-4-(5-nitro-2-furyl)-thiazol on some pathogenic bacteria]. Clin Ter 1965; 34:308-12. [PMID: 5849442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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34
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Miller SM, Mishler EG, Hollingshead AB, Redlich FC, Star S, Cumming E, Cumming J, Stouffer S, Riessman F, Haase W, Miller SM, Lee RI, Jones LW, Redlich FC, Hollingshead AB, Bellis E, Barabee P, von Mering O, Singer JL, Opler MK, Gruenberg EM. Social Class, Mental Illness, and American Psychiatry: An Expository Review. ACTA ACUST UNITED AC 1959. [DOI: 10.2307/3348592] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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