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Treppo E, Isola M, De Martino M, Padoan R, Giollo A, Urban ML, Monti S, Sartorelli S, Fassio A, Argolini LM, Marvisi C, Gattamelata A, Regola F, Ferro F, Cassone G, Motta F, Berti A, Conticini E, Guiducci S, Matucci-Cerinic M, Lo Gullo A, Manfredi A, Frediani B, Bortolotti R, Selmi C, Baldini C, Franceschini F, Conti F, Caporali R, Rossini M, Dagna L, Montecucco C, Emmi G, Schiavon F, Salvarani C, Quartuccio L. Validation of the Italian version of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire. Rheumatol Adv Pract 2024; 8:rkae001. [PMID: 38515585 PMCID: PMC10956719 DOI: 10.1093/rap/rkae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives The primary objective of this study was the translation and validation of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire into Italian, denoted as AAV-PRO_ita. The secondary objective was to evaluate the impact of ANCA-associated vasculitis (AAV) on quality of life (QoL) and work impairment in a large cohort of Italian patients. Methods The study design took a prospective cohort study approach. First, the AAV-PRO was translated into Italian following the step guidelines for translations. The new AAV-PRO_ita questionnaire covered three disease domains: organ-specific and systemic symptoms and signs; physical function; and social and emotional impact. Second, Italian-speaking AAV patients were recruited from 17 Italian centres belonging to the Italian Vasculitis Study Group. Participants completed the AAV-PRO_ita questionnaire at three time points. Participants were also requested to complete the work productivity and activity impairment: general health questionnaire. Results A total of 276 AAV patients (56.5% women) completed the questionnaires. The AAV-PRO_ita questionnaire demonstrated a good internal consistency and test-retest reliability. Female AAV patients scored higher (i.e. worse) in all thee domains, especially in the social and emotional impact domain (P < 0.001). Patients on glucocorticoid therapy (n = 199) had higher scores in all domains, especially in the physical function domain (P < 0.001), compared with patients not on glucocorticoid therapy (n = 77). Furthermore, patients who had at least one relapse of disease (n = 114) had higher scores compared with those who had never had one (n = 161) in any domain (P < 0.05). Finally, nearly 30% of the patients reported work impairment. Conclusion The AAV-PRO_ita questionnaire is a new 29-item, disease-specific patient-reported outcome measuring tool that can be used in AAV research in the Italian language. Sex, glucocorticoids and relapsing disease showed the greatest impact on QoL.
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Affiliation(s)
- Elena Treppo
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
| | - Miriam Isola
- Institute of Statistics, Department of Medicine, University of Udine, Udine, Italy
| | - Maria De Martino
- Institute of Statistics, Department of Medicine, University of Udine, Udine, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Sartorelli
- IRCCS San Raffaele Scientific Institute, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), Milano, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | - Chiara Marvisi
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Angelica Gattamelata
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Motta
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milano, Italy
| | - Alvise Berti
- Center for Medical Sciences (CISMed), University of Trento, and Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Serena Guiducci
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Marco Matucci-Cerinic
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | | | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Roberto Bortolotti
- Center for Medical Sciences (CISMed), University of Trento, and Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Italy
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabrizio Conti
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Istituto Gaetano Pini—CTO, Milano, Italy
| | | | - Lorenzo Dagna
- IRCCS San Raffaele Scientific Institute, Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), Milano, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
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Monti S, Milanesi A, Klersy C, Tomelleri A, Dagna L, Campochiaro C, Farina N, Muratore F, Galli E, Marvisi C, Bond M, Berti A, Bortolotti R, Padoan R, Schiavon F, Felicetti M, Nannini C, Cantini F, Giollo A, Rossini M, Conticini E, Frediani B, Conti F, Priori R, Sebastiani M, Cassone G, Quartuccio L, Treppo E, Bettio S, Hoxha A, Lovisotto M, Emmi G, Mattioli I, Leccese P, Caporali R, Argolini LM, Foti R, Visalli E, Colaci M, Salvarani C, Montecucco C. Age at diagnosis influences the clinical phenotype, treatment strategies and outcomes in patients with giant cell arteritis: results from the observational GCAGE study on a large cohort of 1004 patients. Ann Rheum Dis 2023; 82:1098-1106. [PMID: 37188498 DOI: 10.1136/ard-2023-223895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/14/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Immune and vascular ageing are proposed risk factors for giant cell arteritis (GCA). Data on the impact of age at diagnosis of GCA on the clinical presentation and course of the disease are scarce. METHODS Patients with GCA followed at referral centres within the Italian Society of Rheumatology Vasculitis Study Group were enrolled up to November 2021. Patients were grouped according to age at diagnosis: ≤64, 65-79 and ≥80 years old. RESULTS The study included 1004 patients, mean age 72.1±8.4, female 70.82%. Median follow-up duration was 49 (IQR 23-91) months. Patients in the oldest group (≥80 years) had significantly more cranial symptoms, ischaemic complications and risk for blindness compared with the groups 65-79 and ≤64 years (blindness: 36.98% vs 18.21% vs 6.19%; p<0.0001). Large-vessel-GCA was more frequent in the youngest group (65% of patients). Relapses occurred in 47% of patients. Age did not influence the time to first relapse, nor the number of relapses. Older age was negatively associated with the number of adjunctive immunosuppressants. Patients >65 years old had 2-3 fold increased risk for aortic aneurysm/dissection up to 60 months follow-up. Serious infections, but not other treatment-related complications (hypertension, diabetes, osteoporotic fractures), were significantly associated with older age. Mortality occurred in 5.8% of the population with age >65, cranial and systemic symptoms as independent risk factors. CONCLUSIONS The highest risk of ischaemic complications, aneurysm development, serious infections and the possible undertreatment make of GCA a very challenging disease in the oldest patients.
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Affiliation(s)
- Sara Monti
- Dipartimento di medicina interna e terapia medica, Universita degli Studi di Pavia, Pavia, Italy
- Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Milanesi
- Dipartimento di medicina interna e terapia medica, Universita degli Studi di Pavia, Pavia, Italy
- Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- UOS Epidemiologia Clinica e Biometria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Nicola Farina
- Unit of Immunology, Allergology and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesco Muratore
- Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Galli
- Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Marvisi
- University of Modena and Reggio Emilia, Modena, Italy
- Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Milena Bond
- Rheumatology, Santa Chiara Hospital of Trento, Trento, Italy
- Rheumatology, Brunico Hospital, Brunico, Italy
| | - Alvise Berti
- Center for Medical Sciences (CISMed), Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, and Division of Rheumatology, Santa Chiara Hospital, APSS, Trento, Italy
| | | | - Roberto Padoan
- Department of Medicine DIMED, Division of Rheumatology, University of Padua, Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Mara Felicetti
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Padova, Italy
| | - Carlotta Nannini
- UOC Reumatologia ASl Toscana Centro, Santo Stefano Hospital Prato, Prato, Italy
| | - Fabrizio Cantini
- UOC Reumatologia ASl Toscana Centro, Santo Stefano Hospital Prato, Prato, Italy
| | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine, University of Verona Faculty of Medicine and Surgery, Verona, Italy
- Rheumatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | | | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | - Roberta Priori
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Marco Sebastiani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Modena, Italy
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
- Division of Rheumatology, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elena Treppo
- Division of Rheumatology, Department of Medicine, University of Udine, Udine, Italy
- Division of Rheumatology, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Ariela Hoxha
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital of Vicenza, Vicenza, Italy
- General Internal Medicine Unit and Thrombotic and Hemorragic Unit, Department of Medicine-DIMED, University of Padua, Padova, Italy
| | - Marco Lovisotto
- General Internal Medicine Unit and Thrombotic and Hemorragic Unit, Department of Medicine-DIMED, University of Padua, Padova, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, Università degli Studi di Firenze, Firenze, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania/IReL, Regional Hospital San Carlo, Potenza, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini, Milano, Italy
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milano, Italy
| | | | - Rosario Foti
- Rheumatology Unit, AOU San Marco, Catania, Catania, Italy
| | - Elisa Visalli
- Rheumatology Unit, AOU San Marco, Catania, Catania, Italy
| | - Michele Colaci
- Clinical and Experimental Medicine, Rheumatolgy Unit, University of Catania, Catania, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Carlomaurizio Montecucco
- Dipartimento di medicina interna e terapia medica, Universita degli Studi di Pavia, Pavia, Italy
- Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, Craven A, Khalid S, Hutchings A, Danda D, Luqmani RA, Watts RA, Merkel PA, Hill C, Ranganathan D, Kronbichler A, Blockmans D, Barra L, Carette S, Pagnoux C, Dhindsa N, Fifi‐Mah A, Khalidi N, Liang P, Milman N, Pineau C, Tian X, Wang G, Wang T, Zhao M, Tesar V, Baslund B, Hammam N, Shahin A, Pirila L, Putaala J, Hellmich B, Henes J, Holle J, Lamprecht P, Moosig F, Neumann T, Schmidt W, Sunderkoettey C, Szekanecz Z, Danda D, Das S, Gupta R, Rajasekhar L, Sharma A, Wagh S, Clarkson M, Molloy E, Salvarani C, Schiavon F, Tombetti E, Vaglio A, Amano K, Arimura Y, Dobashi H, Fujimoto S, Harigai M, Hirano F, Hirahashi J, Honma S, Kawakami T, Kobayashi S, Kono H, Makino H, Matsui K, Muso E, Suzuki K, Ikeda K, Takeuchi T, Tsukamoto T, Uchida S, Wada T, Yamada H, Yamagata K, Yumura W, Lai KS, Flores‐Suarez LF, Hinojosa‐Azaola A, Rutgers B, Tak P, Grainger R, Quincey V, Stamp L, Suppiah R, Besada E, Diamantopoulos A, Sznajd J, Azevedo E, Geraldes R, Rodrigues M, Santos E, Song Y, Moiseev S, Hočevar A, Cid MC, Moreno XS, Atukorala I, Berglin E, Mohammed A, Segelmark M, Daikeler T, Direskeneli H, Hatemi G, Kamali S, Karadağ Ö, Pehlevan S, Adler M, Basu N, Bruce I, Chakravarty K, Dasgupta B, Flossmann O, Gendi N, Hassan A, Hoyles R, Jayne D, Jones C, Klocke R, Lanyon P, Laversuch C, Luqmani R, Robson J, Magliano M, Mason J, Maw WW, McInnes I, Mclaren J, Morgan M, Morgan A, Mukhtyar C, O'Riordan E, Patel S, Peall A, Robson J, Venkatachalam S, Vermaak E, Menon A, Watts R, Yee C, Albert D, Calabrese L, Chung S, Forbess L, Gaffo A, Gewurz‐Singer O, Grayson P, Liang K, Matteson E, Merkel PA, Rhee R, Springer J, Sreih A. 2022 American College of Rheumatology/EULAR Classification Criteria for Takayasu Arteritis. Arthritis Rheumatol 2022; 74:1872-1880. [PMID: 36349501 DOI: 10.1002/art.42324] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 07/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for Takayasu arteritis (TAK). METHODS Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 6 phases: 1) identification of candidate criteria items, 2) collection of candidate items present at diagnosis, 3) expert panel review of cases, 4) data-driven reduction of candidate items, 5) derivation of a points-based classification score in a development data set, and 6) validation in an independent data set. RESULTS The development data set consisted of 316 cases of TAK and 323 comparators. The validation data set consisted of an additional 146 cases of TAK and 127 comparators. Age ≤60 years at diagnosis and imaging evidence of large-vessel vasculitis were absolute requirements to classify a patient as having TAK. The final criteria items and weights were as follows: female sex (+1), angina (+2), limb claudication (+2), arterial bruit (+2), reduced upper extremity pulse (+2), reduced pulse or tenderness of a carotid artery (+2), blood pressure difference between arms of ≥20 mm Hg (+1), number of affected arterial territories (+1 to +3), paired artery involvement (+1), and abdominal aorta plus renal or mesenteric involvement (+3). A patient could be classified as having TAK with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the model area under the curve was 0.97 (95% confidence interval [95% CI] 0.94-0.99) with a sensitivity of 93.8% (95% CI 88.6-97.1%) and specificity of 99.2% (95% CI 96.7-100.0%). CONCLUSION The 2022 American College of Rheumatology/EULAR classification criteria for TAK are now validated for use in research.
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Affiliation(s)
- Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Acadámico de Medicina de Lisboa, Lisbon, Portugal
| | - Ravi Suppiah
- Te Whatu Ora - Health New Zealand, Auckland, New Zealand
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, and Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Katherine Bates Gribbons
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | - Andrew Judge
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Anthea Craven
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sara Khalid
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Hutchings
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Richard A Watts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK, and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
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Padoan R, Zorzi M, Battagello J, Zagonel V, Emmi G, Baldini C, Monti S, Quartuccio L, Doria A, Schiavon F. POS0838 INCIDENCE OF CANCER IS SIGNIFICANTLY INCREASED IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS PATIENTS: RESULTS FROM A MULTICENTRE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4824] [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
BackgroundNo large assessment of the general cancer occurrence in eosinophilic granulomatosis with polyangiitis (EGPA) has been reported.ObjectivesThe aim is to investigate the incidence of malignancies in EGPA patients and to examine the effect of immunosuppressive therapy on malignancy risk in these patients.MethodsThe occurrence of cancers was assessed in a cohort of 303 incident EGPA patients (54.8% female, 44% MPO-ANCA positive, 53 [41-61] years old at diagnosis), diagnosed between 1987 and 2019. Demographic, clinical and laboratory data, and the use of immunosuppressive drugs were assessed. Through linkage with Regional Italian Cancer Registries, information about any malignancy occurring before and after EGPA diagnosis was collected. For each patient, the person-years (PY) of follow-up was calculated till the first event: cancer occurrence, last follow-up or death. The PY was stratified by sex, age (in 5-year groups) and calendar-decades (2000-2009 and 2010-2019). Standardized incidence ratios (SIR) between observed and expected numbers (retrieved from the AIRTUM-AIOM database) of cancers were calculated with exact Poisson regression analysis and used as a measure of risk difference.ResultsThirty patients developed a total of 42 malignancies during a median follow-up of 4.4 [2.1-8.5] years. After excluding patients with a diagnosis of cancer before EGPA onset, 20 first malignancies were observed in 1276 PY observation period. The SIR (95% Poisson CI) malignancy risk was 1.99 (1.22-3.08; p=0.007) for all cancers at all sites, and 1.86 (0.98-2.75; p= 0.025) for all cancers excluding non-melanoma skin cancers. Incidence rates were significantly higher in ANCA positive patients (SIR 2.43 [1.30-4.16]; p=0.007) when compared to ANCA negative, and in those treated with cyclophosphamide (SIR 2.42 [1.11-4.60]; p=0.030) when compared to other immunosuppressive agents. Median latency from EGPA onset and first cancer diagnosis was 5 (2-11) years, with 63.3% of patients developing cancer within 1 and 5 years. Malignancy-free survival at 2, 5, and 10 years of follow-up was 96%, 91%, and 70%, respectively. Of these malignancies, 30% were skin cancers, 25% prostate cancers and 20% breast cancers. Comparing patients who developed malignancies with those who did not, any significant difference was noted regarding sex, ANCA status, age at diagnosis, clinical manifestations, BVAS, FFS, environmental exposure, smoking habit and cancer familiarity. Type of treatment and cumulative doses of cyclophosphamide were not associated with higher incidence of cancers.ConclusionEGPA patients have a two-fold risk of overall malignancy than the general population. This cancer excess might be driven by a combination of already known treatment-associated factors and other unknown disease-associated factors, which should be further investigatedReferencesNAFigure 1.Disclosure of InterestsNone declared
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Iorio L, Campaniello D, Zucchetta P, Cecchin D, Doria A, Schiavon F, Padoan R. POS0813 GLUCOCORTICOIDS, CONVENTIONAL DMARDs AND TOCILIZUMAB DIFFERENTLY AFFECT 18F-FDG PET METABOLIC ACTIVITY IN GIANT CELL ARTERITIS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3781] [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
BackgroundImaging role in large vessel vasculitis (LVV) patients is tremendously increased in recent years. However, the role of 18F-FDG PET in evaluating treatment response is still an unmet need.ObjectivesThe aim of the present study is to evaluate the effect of different treatment regimens, namely glucocorticoids (GC), conventional disease modifying anti-rheumatic drugs (cDMARDs) and tocilizumab (TCZ), on clinical and metabolic activity of giant cell arteritis (GCA) with extra-cranial involvement.MethodsConsecutive LVV inpatients and outpatients, classified as GCA, were prospectively enrolled. We included all patients who underwent to at least 2 consecutive 18F-FDG PET-CT or MR scan between October 2010 and October 2021. Demographic and clinical data as well as disease activity were assessed before every PET scan. Remission was defined absence of signs and symptoms attributable to GCA and normalization of ESR (<30 mm/Hr) and CRP (<1 mg/dL) [1].GCA patients were compared according to current treatment regimen: GC monotherapy versus cDMARDs (methotrexate, azathiopirine) and versus TCZ (administered both subcutaneous and intravenous). For each PET scan the vessel’s metabolic activity was evaluated using the Meller’s grading [2] and the PETVAS score [3].ResultsThe study included 47 patients (age 66 [60-70], 72.3% female) exposed to a total of 77 treatment regimens (n=37 GC monotherapy, n=26 cDMARDs, n=14 TCZ). A total of 181 PET scan were conducted (min 2 – max 6). Overall clinical remission rate during the follow-up was 75.7% in GC-treated patients, 69.2% in cDMARDs-treated and 85.7% in TCZ-treated (p=0.513).Persistence was comparable among the different treatment regimens (GC 19±10 months vs cDMARDs 22±16 months vs TCZ 23±11 months, p=0.445).All the treatment led to significant reduction of acute phase reactants (GC-treated: ESR 50vs20 mmh, p<0.001, ΔESR= -43.3%, CRP 13.6vs5.3 mg/L, p=0.001, ΔCRP= -87.7%; cDMARDs-treated: ESR 36vs27 mmh, p=0.134, ΔESR= -152%, CRP 13.6vs5.3 mg/L, p=0.038, ΔCRP= -66.3% and TCZ-treated: ESR 27vs3 mmh, p=0.017, ΔESR= -86.7%, CRP 11.4vs2.7 mg/L, p=0.023, ΔCRP= -80.2%).Significant improvement in PETVAS was observed only in TCZ-treated patients (12vs4, p=0.002, ΔPETVAS -66.7%), while the other treatment approaches resulted not significant (GC treated 12vs5, p=0.052, ΔPETVAS= -50%; cDMARDs 11vs4, p=0.124, ΔPETVAS -52.4%).Daily prednisone dose at last examination was 4.5 [0-5] mg/d in the cDMARDs group vs 1.25 [0-5] mg/d in the TCZ group (p=0.057). Interestingly, at last PET examination low-grade inflammation (Meller 1-2) was observed in 56.8% of GC-treated patients, 57.7% of cDMARDs-treated patients and 64.3% of TCZ-treated patients (p=0.884).Conclusion18F-FDG PET may be useful in assessing disease activity and monitoring response to therapy. Tocilizumab treatment significantly reduce vessel’s metabolic activity over time, when compared to conventional treatment. A persistent low-grade uptake during remission is common features in LVV patients, irrespectively of treatment regimens.References[1]Stone JH, Tuckwell K, Dimonaco S, Klearman M, Aringer M, Blockmans D, Brouwer E, Cid MC, Dasgupta B, Rech J, Salvarani C, Schett G, Schulze-Koops H, Spiera R, Unizony SH, Collinson N. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med. 2017 Jul 27;377(4):317-328. doi: 10.1056/NEJMoa1613849. PMID: 28745999.[2]Meller J, Grabbe E, Becker W, Vosshenrich R. Value of F-18 FDG hybrid camera PET and MRI in early takayasu aortitis. Eur Radiol. 2003 Feb;13(2):400-5. doi: 10.1007/s00330-002-1518-8. Epub 2002 Jun 29. PMID: 12599007.[3]Grayson PC, Alehashemi S, Bagheri AA, Civelek AC, Cupps TR, Kaplan MJ, Malayeri AA, Merkel PA, Novakovich E, Bluemke DA, Ahlman MA. 18 F-Fluorodeoxyglucose-Positron Emission Tomography As an Imaging Biomarker in a Prospective, Longitudinal Cohort of Patients With Large Vessel Vasculitis. Arthritis Rheumatol. 2018 Mar;70(3):439-449. doi: 10.1002/art.40379. Epub 2018 Feb 6. PMID: 29145713; PMCID: PMC5882488Figure 1.Disclosure of InterestsNone declared
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Treppo E, Isola M, De Martino M, Padoan R, Urban ML, Monti S, Sartorelli S, Giollo A, Argolini LM, Marvisi C, Ferro F, Cassone G, Motta F, Berti A, Conticini E, Manfredi A, Frediani B, Bortolotti R, Selmi C, Baldini C, Emmi G, Caporali R, Rossini M, Dagna L, Montecucco C, Schiavon F, Salvarani C, De Vita S, Quartuccio L. AB0627 Evaluation of internal consistency, feasibility, and reliability of the Italian version of ANCA-associated vasculitis patient-reported outcome (AAV-PRO_ita) questionnaire: preliminary results from a multicenter study on a large cohort of Italian patients. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3164] [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
BackgroundThe ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire is a 29-item disease-specific PRO measure for AAV[1]. The Italian version of the AAV-PRO questionnaire (AAV-PRO_ita) was translated in collaboration with Oxford and Bristol University (UK) and was preliminarily tested on a single-center Italian cohort[2].ObjectivesThe main objective of this multicentric study was to assess the internal consistency, feasibility, and reliability of the AAV-PRO_ita in a large cohort of Italian AAV patients. The secondary objective was to investigate the clinical characteristics of AAV patients associated with AAV-PRO_ita domains.MethodsThe AAV-PRO_ita is describes the following disease domains: (1) organ-specific and systemic symptoms and signs (SSS); (2) physical function (PF); (3) social and emotional impact (SEI). In this study, Italian-speaking AAV patients were recruited from Italian Centres (N=13) with a large experience in the diagnosis and treatment of systemic vasculitis, belonging to the Vasculitis Study Group of the Italian Society of Rheumatology. Inclusion criteria were: a confirmed diagnosis of GPA, MPA, or EGPA; ANCA positivity in at least once occasion or biopsy-proven AAV; and age ≥18 years old. Participants completed the AAV-PRO_ita at three different time-points: baseline, after 5-7 days, and at month 3.Results229 AAV-patients (56.3% women) with a median age of 61 (IQR 51-72) were recruited and completed the questionnaires. The subtype of AAV was mainly GPA (131, 57.2%), followed by EGPA (58, 25.3%), and MPA (40, 17.5%). Median BVASv3 at baseline was 0 (IQR 0-3), whereas the median BVASv3 at the onset of disease was 14 (IQR 9-20). Participants had a median duration of disease of 67 (IQR 24-126) months. Patients who experienced at least one relapse, one hospitalization, and one severe infection were 40.2%, 53.3%, and 24%, respectively. 83% of the patients were on immunosuppressant therapy and 71.6% were still receiving glucocorticoids (GC).AAV-PRO_ita questionnaire had good internal consistency (Cronbach’s Alpha range 0.81-0.93) and good test-retest reliability (ICCs range 0.93-0.96). Item response rates were high overall (maximum 0.87% missing data), supporting the feasibility of the questionnaire.Concerning the domains of the questionnaire, female AAV patients scored higher (i.e. worse) in all three domains, especially in the SEI domain (p-value<0.001). Older participants (≥65 years) scored higher in the PF domain (p-value<0.05) in all three times of self-completions of the questionnaire. The ongoing treatment also influenced the results. In fact, patients on GC showed higher scores in the PF domain (p-value=0.003) and SEI domain (p-value=0.021). The VDI value seemed to be related to AAV-PRO_ita scores more than disease duration or disease activity, especially in the SSS domain (ρ>0.3, p-value<0.001). Conversely, subtype of AAV did not influence the item scores.ConclusionThe AAV-PRO_ita questionnaire is a new 29-item, disease-specific PRO measure for use in AAV in the Italian language. It is a self-administered Italian questionnaire with good internal consistency, feasibility, and reliability. AAV-PRO_ita proved to be a useful tool to explore the AAV patient’s perception of quality of life, and it could become an important way of measuring the unmet needs of AAV patients.References[1]Robson, J.C. et al. Validation of the ANCA-Associated Vasculitis Patient-Reported Outcomes (AAV-PRO) Questionnaire. Ann. Rheum. Dis.2018, 77, 1157–1164, doi:10.1136/annrheumdis-2017-212713.[2]Treppo, E.; Palese, A.; Vita, S.D.; Quartuccio, L. AB0392 PRELIMINARY VALIDATION OF THE ITALIAN VERSION OF ANCA-ASSOCIATED VASCULITIS PATIENT-REPORTED OUTCOME (AAV-PRO_ita) QUESTIONNAIRE: FATIGUE AND CHRONIC PAIN AS UNMET NEEDS BY CURRENT TREATMENTS. Ann. Rheum. Dis.2021, 80, 1224–1224, doi:10.1136/annrheumdis-2021-eular.2123.AcknowledgementsWe thank the Italian Study Group on Systemic Vasculitis.Disclosure of InterestsNone declared
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Campaniello D, Treppo E, D’onofrio B, Franchi G, Berti A, Iorio L, Bortolotti R, Montecucco C, Monti S, Quartuccio L, Doria A, Schiavon F, Padoan R. POS0837 EFFICACY OF ULTRA-LOW DOSE RITUXIMAB FOR REMISSION MAINTENANCE THERAPY IN ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4795] [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
BackgroundRituximab (RTX) achieved high remission-induction and sustained maintenance rates for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [1], [2]. However, RTX is an expensive medication, which may potentially lead to serious side effects. Defining the best dose regimen for maintenance in AAV is still an unmet need.ObjectivesThe aim of the present study is to compare the effects of ultra-low dose RTX (500 mg or 1000 mg once per year) to standard low dose RTX (500 or 1000 mg twice per year) as remission-maintenance therapy in AAV patients.MethodsWe included consecutive AAV patients (classified as GPA and MPA [3]) referring to four different Rheumatology centers in Italy. We assessed all AAV patients who successfully achieved disease remission (BVASv3=0) with conventional RTX or cyclophosphamide regimens and have been subsequently treated with RTX for maintenance of remission. All included patients received at least three maintenance infusions with either 1000 mg or 500 mg, twice per year (standard low dose) or once per year (ultra-low dose). After a period of 18 months, we assessed the remission rate, damage (VDI), glucocorticoids intake, ANCA status, B-cells depletion and serum IgG levels.ResultsFrom January 2011 to December 2021, 83 AAV patients (mean age 51±16, 49.4% female, 95.2% ANCA positive, 65.8% anti PR3, 34.2% anti MPO), 61 classified as GPA and 22 MPA, achieved complete disease remission with conventional RTX induction regimen. After 7 [6-9] months, 29.9% patients started maintenance treatment with ultra-low dose RTX (once per year), while 70.1% patients with standard low dose (twice per year), for 18 months. No significant differences at baseline were noted between patients receiving ultra-low dose when compared to those treated with conventional low-dose.At the end of observation period, a disease flare was observed in 22.7% of the low-dose group, and 21.2% in those treated with the standard dose (p=0.881). Relapse-free survival was comparable between the two group (log-rank p=0.818, Figure 1).Figure 1.When comparing AAV patients treated with ultra-low dose regimen to those treated with low-dose, no differences were noted in negative ANCA rate (72.2% vs 67.1%, p=0.262), ANCA titer (0 [0-7.8] vs 0 [0-50] UI/mL, p=0.232), B-cells depletion rate (70.6% vs 75%, p=0.725), mean serum IgG (811 [146-922] vs 680 [429-861] mg/dL, p=0.367), mean daily glucocorticoid dosage (2.5 [0-5] vs 3.75 [0-5] mg/d, p=0.647), VDI (4 [1-5] vs 2 [1-4], p=0.098), hypogammaglobulinaemia rate (31.8% vs 36.5%, p=0.697) and deaths (4.5% vs 5.8%, p=0.831).Although not significant, patients treated with ultra-low dose had lower severe infection rate (10.5% vs 26.8%, p=0.154). Notably, in the all cohort 5 deaths were related to COVID19 pneumonia.ConclusionReduced exposure to RTX was not associated with an impaired efficacy of maintenance therapy in patients with AAV. Remission maintenance with ultra-low dose RTX is a safe and more cost-effective option.References[1]B. Terrier et al., “ANCA-associated vasculitides: Recommendations of the French Vasculitis Study Group on the use of immunosuppressants and biotherapies for remission induction and maintenance,” Press. Medicale, vol. 49, no. 3, 2020, doi: 10.1016/j.lpm.2020.104031.[2]S. V. Moiseev, N. M. Bulanov, A. S. Zykova, and P. I. Novikov, “Rituximab in ANCA-associated vasculitis: Fewer infusions or ultra low-dose maintenance therapy,” Ann. Rheum. Dis., vol. 78, no. 9, pp. 1–2, 2019, doi: 10.1136/annrheumdis-2018-213873.[3]J. C. Jennette et al., “2012 Revised International Chapel Hill consensus conference nomenclature of vasculitides,” Arthritis Rheum., vol. 65, no. 1, pp. 1–11, 2013, doi: 10.1002/art.37715.Disclosure of InterestsNone declared
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Abstract
INTRODUCTION Relapsing polychondritis (RP) is a rare systemic inflammatory disease of unknown etiology, primarily affecting cartilaginous tissue and proteoglycan-rich structures. Clinical manifestations vary from mild symptoms to occasional organ or life-threatening complications. Treatment can be challenging and is mostly based on experience or case reports/series. AREAS COVERED There is growing literature investigating the role of biologics in the management of RP. TNFα antagonists, abatacept, tocilizumab, rituximab, anakinra and tofacitinib have been prescribed in several RP patients, mainly as second-line treatment, after conventional immunosuppressive agents' failure. EXPERT OPINION : Glucocorticoids represent the gold standard treatment of RP. Conventional immunosuppressants should be administered in refractory patients or when a glucocorticoid-sparing effect is needed. Biologic therapy should be used after failure of conventional treatments or in severe manifestations. TNFα inhibitors are the most prescribed biologic agent, with partial or complete response in several cases; but loss of efficacy may occur over time. Infliximab and adalimumab should be preferred among TNFα antagonists. Abatacept and tocilizumab proved to be effective as second-line biologic agents, but frequent infections are reported with the former. Data on anakinra and rituximab are controversial, therefore they are not recommended as first-line biologic drugs. The use of JAK inhibitors is still anecdotal.
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Affiliation(s)
- Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Debora Campaniello
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Luca Iorio
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
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Cazzador D, Padoan R, Colangeli R, Pendolino AL, Felicetti M, Zanoletti E, Emanuelli E, Martini A, Doria A, Nicolai P, Schiavon F. Health-Related Quality of Life in Patients With ANCA-Associated Vasculitis and Sinonasal Involvement: A Single-Center Cross-Sectional Study. J Clin Rheumatol 2022; 28:e89-e94. [PMID: 33136696 PMCID: PMC10836782 DOI: 10.1097/rhu.0000000000001630] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to assess the impact of sinonasal morbidity on quality of life (QoL) in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS This cross-sectional case-control study enrolled 71 patients-44 AAV cases with (ear, nose, and throat [ENT]-AAV) or without ENT involvement (non-ENT-AAV) undergoing multidisciplinary evaluations and 27 chronic rhinosinusitis (CRS) cases. Three validated QoL questionnaires (Sino-Nasal Outcomes Test-22 [SNOT-22], Nasal Obstruction Symptom Evaluation [NOSE], and Short-Form 36) were administered, and the 3 groups were compared. RESULTS The ENT-AAV patients were significantly younger (p = 0.01), with less antineutrophil cytoplasmic antibody positivity frequency (p = 0.035) and lower renal involvement (p = 0.003) than the non-ENT-AAV patients.The SNOT-22 questionnaire demonstrated significantly greater sinonasal morbidity in ENT-AAV patients compared with CRS patients (p < 0.001). The NOSE score of ENT-AAV patients was comparable to those of CRS patients, but higher than that of non-ENT-AAV patients (p < 0.001). The SNOT-22 and NOSE scores positively correlated with disease activity (p = 0.037; p = 0.004, respectively). Short-Form 36 domain-by-domain analysis revealed a significantly poorer QoL in ENT-AAV patients, especially with physical functioning being progressively impaired in CRS, non-ENT-AAV, and ENT-AAV patients (p < 0.001). No significant differences in QoL came to light when AAV patients were stratified according to current systemic o local treatments. CONCLUSIONS The QoL in AAV patients is significantly reduced, especially in the presence of ENT involvement. The AAV-related nasal morbidity is consistent and comparable to that reported by CRS patients. It significantly affects patients' QoL and in particular social functioning, leading to limitation in daily/work activities. Organ-focused questionnaires and multidisciplinary management are warranted to pursue a treat-to-target approach in these patients.
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Affiliation(s)
- Diego Cazzador
- From the Otorhinolaryngology Unit
- Section of Human Anatomy, Department of Neurosciences
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | | | | | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | | | | | | | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | | | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
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Gasparotto M, Bindoli S, Padoan R, Cozzi G, Depascale R, Zanatta E, Giollo A, Gatto M, Zen M, Schiavon F, Ramonda R, Sfriso P, Doria A, Iaccarino L. New onset and flare of rheumatic diseases following COVID-19 vaccination are mild and respond well to treatment: 9-month follow-up data from a single centre cohort. Clin Exp Rheumatol 2021; 41:642-648. [PMID: 35930472 DOI: 10.55563/clinexprheumatol/vx44zn] [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: 12/13/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Anti-COVID-19 vaccines have proved to be effective and well tolerated. Great attention is now being paid to the characterisation of possible adverse events associated to their administration. We report a case series of suspected rheumatic diseases (RDs) following anti-COVID-19 vaccination. METHODS We included patients evaluated at first-aid rheumatologic consultancy and at rheumatologic outpatient and inpatient clinic at Padova University Hospital between May and September 2021 presenting with a RD within 30 days after an anti-COVID-19 vaccine dose. Our selection was in accordance with the World Health Organisation guidelines for adverse event following immunisation (AEFI) surveillance. Patients were regularly re-evaluated by telemedicine or face-to-face visit. RESULTS We identified 30 cases of RD following vaccination: 24 (80.0%) new onsets and 6 (20.0%) flares. Most of patients (76.6%) received the BNT162b2 vaccine. The mean time to RD onset/flare was 12±9 days. The most common manifestations were inflammatory arthritis (40.0%), rheumatic polymyalgia (33.3%) and adult-onset Still's disease (13.3%). At the last FU visit (9.6±2.2 months), 83.3% of patients showed complete response to first- or second-line therapy, 13.3% a partial response and one patient (3.3%) was still experiencing an active disease. CONCLUSIONS Considering the amount of vaccine doses administered during the evaluation period we overall detected a limited number of cases. We noted a clear prevalence of autoinflammatory conditions and seronegative manifestations. The great majority of patients had mild features and showed a good response to therapy.
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Affiliation(s)
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Roberto Depascale
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | | | - Alessandro Giollo
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Margherita Zen
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Italy
| | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Italy.
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Padoan R, Campaniello D, Gatto M, Schiavon F, Doria A. Current clinical and therapeutic approach to tumour-like mass lesions in granulomatosis with polyangiitis. Autoimmun Rev 2021; 21:103018. [PMID: 34902605 DOI: 10.1016/j.autrev.2021.103018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic autoimmune disorder classified among the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and characterized by a triad of upper and lower respiratory tract disease, systemic vasculitis involving small-to-medium vessels and renal manifestations. Mass lesions, also described as inflammatory lesions, pseudotumor or tumour-like masses, are uncommon manifestations of GPA and are often called granuloma since histology examination shows granulomatous inflammation and rarely vasculitis. Masses could represent a localized manifestation of GPA or develop as part of a systemic disease. Unusual clinical presentation together with nonspecific radiological and histological features may delay the correct diagnosis leading to disease progression and organ damage. Diagnosis of GPA in such cases may be challenging and malignancy or infections must be considered as alternative diagnostic options. Here we reviewed all the different sites where mass lesions were reported in GPA, focusing on atypical localization, and summarized current therapeutic options and their different outcomes. We retrieved and discussed the cases reported since 2010, bearing in mind the advances in the therapeutic management of AAV patients in the last decade, namely biological therapy such as rituximab. Despite treatment regimens with glucocorticoids and immunosuppressive agents, mass lesions have a refractory course in a high proportion of patients. Invasive surgical procedures may be considered only when drug therapy fails.
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Affiliation(s)
- Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Debora Campaniello
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Mariele Gatto
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy.
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Papo M, Martinot P, Sinico R, Teixeira V, Urban M, Mahrhold J, Monti S, Cassone G, Schiavon F, Seeliger B, Neumann T, Kroegel C, Jayne D, Hellmich B, Kahn J, Durel C, Emmi G, Vaglio A, Porcher R, Terrier B. Prédiction de l’évolution à long terme de la granulomatose éosinophilique avec polyangéite à partir d’une cohorte rétrospective européenne de 809 patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Padoan R, Gatto M, Ghirardello A, Tonello M, Franco C, Felicetti M, Schiavon F, Doria A. IgG anti-Pentraxin 3 antibodies are a novel biomarker of ANCA-associated vasculitis and better identify patients with eosinophilic granulomatosis with polyangiitis. J Autoimmun 2021; 124:102725. [PMID: 34534841 DOI: 10.1016/j.jaut.2021.102725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate prevalence of anti-Pentraxin 3 (PTX3) antibodies in sera of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) patients. METHODS Anti-PTX3 and PTX3 levels were analysed by enzyme-linked immunosorbent assays in sera from unselected patients with AAV and compared with patients with systemic lupus erythematosus (SLE, n = 130), other connective tissue diseases (CTDs, n = 97) and matched healthy controls (n = 97). Optical density (OD) cut-off for positive anti-PTX3 antibodies was determined by ROC curve analysis and set as 0.234. Indirect immunofluorescence (IIF) on fixed human granulocytes was used to analyze the fluorescence pattern of anti-PTX3 antibodies. Liquid-phase inhibition tests were conducted to assess potential interferences. RESULTS We included 101 AAV patients (females 58%, median age 60[51-69] years) affected either with granulomatosis with polyangiitis (GPA, n = 51), microscopic polyangiitis (MPA, n = 12) or eosinophilic granulomatosis with polyangiitis (EGPA, n = 38). Anti-PTX3 antibodies were detected in 29.7% AAV patients, being significantly higher than in healthy controls (p < 0.001) and CTDs (p = 0.030) but lower than in SLE (p = 0.004). Anti-PTX3 antibody prevalence was 44.7% in EGPA, 25% in MPA and 19% in GPA (p = 0.034). Among ANCA negative patients, 35.7% displayed positive anti-PTX3 antibodies. Anti-PTX3 were associated with a lower prevalence of systemic (p = 0.002), ear-nose-throat (p = 0.006) and renal manifestations (p = 0.016). Anti-PTX3 antibodies were characterized by a specific IIF pattern on fixed granulocytes. PTX3 serum levels resulted lower in AAV than healthy controls (p < 0.001). PTX3 inhibited anti-PTX3 binding in a dose-dependent manner. CONCLUSIONS Anti-PTX3 autoantibodies appear a promising novel biomarker of AAV, especially EGPA.
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Affiliation(s)
- Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Mariele Gatto
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Anna Ghirardello
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Marta Tonello
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Chiara Franco
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Mara Felicetti
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy.
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14
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Bettiol A, Urban ML, Dagna L, Cottin V, Franceschini F, Del Giacco S, Schiavon F, Neumann T, Lopalco G, Novikov P, Baldini C, Lombardi C, Berti A, Alberici F, Folci M, Negrini S, Sinico RA, Quartuccio L, Lunardi C, Parronchi P, Moosig F, Espígol-Frigolé G, Schroeder J, Kernder AL, Monti S, Silvagni E, Crimi C, Cinetto F, Fraticelli P, Roccatello D, Vacca A, Mohammad AJ, Hellmich B, Samson M, Bargagli E, Cohen Tervaert JW, Ribi C, Fiori D, Bello F, Fagni F, Moroni L, Ramirez GA, Nasser M, Marvisi C, Toniati P, Firinu D, Padoan R, Egan A, Seeliger B, Iannone F, Salvarani C, Jayne D, Prisco D, Vaglio A, Emmi G. Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis (EGPA): a European multicenter observational study. Arthritis Rheumatol 2021; 74:295-306. [PMID: 34347947 PMCID: PMC9305132 DOI: 10.1002/art.41943] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/18/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Mepolizumab proved efficacious for eosinophilic granulomatosis with polyangiitis (EGPA, former Churg-Strauss) at the dosage of 300mg/4 weeks in the randomized controlled MIRRA trial. Few successful real-life experiences with the dosage approved for severe eosinophilic asthma (100mg/4 weeks) were recently reported. We retrospectively assessed the effectiveness and safety of mepolizumab 100 and 300mg/4 weeks in a large European EGPA cohort. METHODS We included all EGPA patients treated with mepolizumab at the recruiting centres in 2015-2020. Treatment response was evaluated from month 3 through 24 (T3-T24) after mepolizumab starting. Complete response (CR) was defined as no disease activity (Birmingham Vasculitis Activity Score, BVAS=0) and a prednisone dose ≤4mg/day. Respiratory outcomes included asthma and ear-nose-throat (ENT) exacerbations. RESULTS We included 203 patients, of whom 191 at stable dosage (158 mepolizumab 100mg/4 weeks, 33 300mg/4 weeks). At T3, 25 patients (12.3%) had a CR. CR rates increased to 30.4% and 35.7% at T12 and T24 and were comparable between mepolizumab 100 and 300mg/4 weeks. Mepolizumab led to a significant reduction in BVAS, prednisone dose, eosinophil counts from T3 through T24, with no significant differences between 100 and 300 mg/4weeks. Eighty-two patients (40.4%) experienced asthma exacerbations [57/158 (36%) on 100mg/4 weeks; 17/33 (52%) on 300mg/4 weeks]. Thirty-one (15.3%) experienced ENT exacerbations. Forty-four patients (21.7%) experienced adverse events, most being non-serious (38/44). CONCLUSION Mepolizumab both at 100 and 300mg/4 weeks is effective for EGPA. The two dosages should be compared in the setting of a controlled trial.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincent Cottin
- Department of Respiratory Medicine, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Schiavon
- Unit of Rheumatology, Department of Systems Medicine, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Thomas Neumann
- Department of Rheumatology and Immunology, Cantonal Hospital St, Gallen St, Gallen Switzerland.,Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Carlo Lombardi
- Departmental Unit of Allergology-Clinical Immunology & Pneumology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | - Alvise Berti
- Santa Chiara Hospital, Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Trento, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Folci
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Simone Negrini
- Internal Medicine, Clinical Immunology and Translational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Luca Quartuccio
- Department of Medicine, Rheumatology Clinic, University of Udine, ASUFC Udine, Udine, Italy
| | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jan Schroeder
- Unit of Allergy and Immunology, ASST GOM Niguarda, Milan, Italy
| | | | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Ettore Silvagni
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Paolo Fraticelli
- Department of Internal Medicine, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Unit (ERKnet Member)-CMID, Center of Research of Immunopathology and Rare Diseases, San Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Angelo Vacca
- Guido Baccelli Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, School of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Aladdin J Mohammad
- Lund University, Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitiszentrum Süd, Medius Kliniken, University of Tübingen, Kirchheim unter Teck, Germany
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Maastricht University, Maastricht, Netherlands
| | - Camillo Ribi
- Division of Immunology and Allergy, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Davide Fiori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Fagni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Moroni
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mouhamad Nasser
- Department of Respiratory Medicine, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia.,Università di Modena e Reggio Emilia, Reggio Emilia and Modena, Italy
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberto Padoan
- Unit of Rheumatology, Department of Systems Medicine, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Allyson Egan
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia.,Università di Modena e Reggio Emilia, Reggio Emilia and Modena, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Florence, Italy.,Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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15
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Monti S, Felicetti M, Delvino P, Padoan R, Berti A, Paolazzi G, Brunori G, Schiavon F, Caporali R, Montecucco C. Anti-neutrophil cytoplasmic antibody specificity determines a different clinical subset in granulomatosis with polyangiitis. Clin Exp Rheumatol 2021; 39 Suppl 129:107-113. [DOI: 10.55563/clinexprheumatol/50919f] [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: 02/03/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, and PhD in Experimental Medicine, University of Pavia, Italy.
| | - Mara Felicetti
- Operative Unit of Rheumatology, Department of Medicine DIMED, University of Padova, and Department of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | - Paolo Delvino
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, and PhD in Experimental Medicine, University of Pavia, Italy
| | - Roberto Padoan
- Operative Unit of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Alvise Berti
- Department of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | | | | | - Franco Schiavon
- Operative Unit of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
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16
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Bettiol A, Sinico RA, Schiavon F, Monti S, Bozzolo EP, Franceschini F, Govoni M, Lunardi C, Guida G, Lopalco G, Paolazzi G, Vacca A, Gregorini G, Leccese P, Piga M, Conti F, Fraticelli P, Quartuccio L, Alberici F, Salvarani C, Bettio S, Negrini S, Selmi C, Sciascia S, Moroni G, Colla L, Manno C, Urban ML, Vannacci A, Pozzi MR, Fabbrini P, Polti S, Felicetti M, Marchi MR, Padoan R, Delvino P, Caporali R, Montecucco C, Dagna L, Cariddi A, Toniati P, Tamanini S, Furini F, Bortoluzzi A, Tinazzi E, Delfino L, Badiu I, Rolla G, Venerito V, Iannone F, Berti A, Bortolotti R, Racanelli V, Jeannin G, Padula A, Cauli A, Priori R, Gabrielli A, Bond M, Tedesco M, Pazzola G, Tomietto P, Pellecchio M, Marvisi C, Maritati F, Palmisano A, Dejaco C, Willeit J, Kiechl S, Olivotto I, Willeit P, Prisco D, Vaglio A, Emmi G. Risk of acute arterial and venous thromboembolic events in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Eur Respir J 2021; 57:13993003.04158-2020. [PMID: 33833031 DOI: 10.1183/13993003.04158-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandra Bettiol
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Dept of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Renato Alberto Sinico
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Franco Schiavon
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Sara Monti
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Enrica Paola Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Marcello Govoni
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | | | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O.S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | | | - Angelo Vacca
- Dept of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | | | - Pietro Leccese
- Rheumatology Dept of Lucania, San Carlo Hospital, Potenza, Italy
| | - Matteo Piga
- Rheumatology, Dept of Medical Sciences and Public Health, University Clinic, Cagliari, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Dept of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Fraticelli
- Dept of Internal Medicine, Clinica Medica, Ospedali Riuniti, Ancona, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Dept of Medicine (DAME), University of Udine, Udine, Italy
| | - Federico Alberici
- Dept of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvano Bettio
- Rheumatology Unit, Internal Medicine Dept, Cattinara Teaching Hospital (ASUITS), Trieste, Italy
| | - Simone Negrini
- Internal Medicine, Clinical Immunology and Translational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research and Dept of Internal Medicine, University of Genoa, Genoa, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Dept of Clinical and Biological Sciences, University of Turin, Turin, Italy.,SCU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Dept of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gabriella Moroni
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Loredana Colla
- Nephrology, Dialysis and Renal Transplant Division, Dept of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Carlo Manno
- Dept of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplant Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Letizia Urban
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Alfredo Vannacci
- Dept of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Maria Rosa Pozzi
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Paolo Fabbrini
- Nephrology Unit, Hospital San Gerardo Monza, University of Milano Bicocca, Milan, Italy
| | - Stefano Polti
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Mara Felicetti
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Maria Rita Marchi
- Respiratory Pathophysiology Division, University Hospital of Padova, Padova, Italy
| | - Roberto Padoan
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Paolo Delvino
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy.,Dept of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Paola Toniati
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Silvia Tamanini
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Federica Furini
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Alessandra Bortoluzzi
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Elisa Tinazzi
- Dept of Medicine, University of Verona, Verona, Italy
| | | | - Iuliana Badiu
- Allergy and Pneumology Unit, A.O.S. Croce e Carle, Cuneo, Italy
| | - Giovanni Rolla
- Dept of Medical Science, Allergy and Clinical Immunology, University of Torino and AO Ordine Mauriziano Umberto I, Turin, Italy
| | - Vincenzo Venerito
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Alvise Berti
- Dept of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | | | - Vito Racanelli
- Dept of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Guido Jeannin
- Nephrology Unit, ASST Spedali Civili, Brescia, Italy
| | - Angela Padula
- Rheumatology Dept of Lucania, San Carlo Hospital, Potenza, Italy
| | - Alberto Cauli
- Rheumatology, Dept of Medical Sciences and Public Health, University Clinic, Cagliari, Italy
| | - Roberta Priori
- Rheumatology Unit, Dept of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Armando Gabrielli
- Dept of Internal Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Milena Bond
- Dept of Rheumatology, Santa Chiara Hospital, Trento, Italy.,Rheumatology Clinic, Dept of Medicine (DAME), University of Udine, Udine, Italy
| | - Martina Tedesco
- Nephrology Unit, ASST Spedali Civili, Brescia, Italy.,Dept of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paola Tomietto
- Rheumatology Unit, Internal Medicine Dept, Cattinara Teaching Hospital (ASUITS), Trieste, Italy
| | - Marco Pellecchio
- Struttura Complessa Medicina Interna 1 P.O. Levante, ASL 2 Savona, Savona, Italy
| | - Chiara Marvisi
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Nephrology Unit, University Hospital, Parma, Italy
| | - Federica Maritati
- Dept of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Christian Dejaco
- Hospital of Brunico (SABES-ASDAA), Dept of Rheumatology, Brunico, Italy.,Dept of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Johann Willeit
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iacopo Olivotto
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Peter Willeit
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,These authors contributed equally to this manuscript
| | - Domenico Prisco
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,These authors contributed equally to this manuscript
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.,Dept of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Firenze, Florence, Italy.,These authors contributed equally to this manuscript
| | - Giacomo Emmi
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,These authors contributed equally to this manuscript
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17
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Ferranti M, Cama E, Cacciavillani M, Schiavon F, Felicetti M, Briani C, Alaibac M. Leukocytoclastic vasculitis associated with multifocal sensory neuropathy responsive to intravenous immunoglobulins: a case report. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021022. [PMID: 34744418 PMCID: PMC8552574 DOI: 10.36141/svdld.v38i3.10883] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
Leukocytoclastic vasculitis (LCV) is a common form of small-vessel vasculitis, which commonly presents as palpable purpura or petechiae, caused by deposition of circulating immune complexes on vessels walls that attracts granulocytes which damage the vascular endothelium and leading to erythrocytes extravasation. The skin is the most commonly involved organ, but also renal, gastrointestinal, pulmonary, cardiovascular and neurological systems may be affected. Skin lesions may be the initial signs of systemic vasculitis. Systemic symptoms may be present, such us fever, myalgia, abdominal pain and arthralgia. The presence of neuropathy/mononeuritis multiplex is expression of severe vasculitic involvement. Herein, we describe the case of a patient with leucocytoclastic vasculitis associated to sensitive neuropathy, responsive to intravenous immunoglobulins (IVIg) therapy, after the failure of classic systemic treatments.
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Affiliation(s)
- Martina Ferranti
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Elena Cama
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | | | - Franco Schiavon
- Unit of Rheumatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Mara Felicetti
- Unit of Rheumatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Chiara Briani
- Unit of Neurology, Department of Neurosciences, University of Padua, Padua, Italy
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18
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Papo M, Sinico RA, Teixeira V, Venhoff N, Urban ML, Iudici M, Mahrhold J, Locatelli F, Cassone G, Schiavon F, Seeliger B, Neumann T, Kroegel C, Groh M, Marvisi C, Samson M, Barba T, Jayne D, Troilo A, Thiel J, Hellmich B, Monti S, Montecucco C, Salvarani C, Kahn JE, Bonnotte B, Durel CA, Puéchal X, Mouthon L, Guillevin L, Emmi G, Vaglio A, Terrier B. Significance of PR3-ANCA positivity in eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Rheumatology (Oxford) 2020; 60:4355-4360. [PMID: 33347592 DOI: 10.1093/rheumatology/keaa805] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Only a third of patients with eosinophilic granulomatosis with polyangiitis (EGPA) are ANCA-positive, mainly directed against MPO. ANCA directed against PR3 are rarely found in EGPA. We aimed to examine the significance of PR3-ANCA in EGPA. METHODS We set up a retrospective European multicentre cohort including 845 patients. Baseline characteristics and outcomes were analysed and compared according to ANCA status. RESULTS ANCA status was available for 734 patients: 508 (69.2%) ANCA-negative, 210 (28.6%) MPO-ANCA and 16 (2.2%) PR3-ANCA. At baseline, PR3-ANCA patients, compared with those with MPO-ANCA and ANCA-negative, less frequently had active asthma (69% vs 91% and 93%, P = 0.003, respectively) and peripheral neuropathy (31% vs 71% and 47%, P < 0.0001), more frequently had cutaneous manifestations (63% vs 38% and 34%, P = 0.03) and pulmonary nodules (25% vs 10% and 8%, P = 0.046), and lower median eosinophil count (1450 vs 5400 and 3224/mm3, P < 0.0001). Vasculitis relapse-free survival was shorter for PR3-ANCA (hazard ratio 6.05, P = 0.005) and MPO-ANCA patients (hazard ratio 1.88, P = 0.0002) compared with ANCA-negative patients. CONCLUSION PR3-ANCA EGPA patients differ from those with MPO-ANCA and negative ANCA, and share clinical features with granulomatosis with polyangiitis. This suggests that PR3-ANCA EGPA could be a particular form of PR3-ANCA-associated vasculitis.
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Affiliation(s)
- Matthias Papo
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Renato A Sinico
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milano/Monza, Italy
| | - Vítor Teixeira
- Department of Medicine, University of Cambridge, Cambridge, UK.,Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Portugal
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Maria-Letizia Urban
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Michele Iudici
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France.,Rheumatology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Juliane Mahrhold
- Department of Internal Medicine, Rheumatology and Immunology, Vasculitis-Center Tübingen-Kirchheim, Medius Klinik Kirchheim, University of Tübingen, Kirchheim-Teck, Germany
| | - Francesco Locatelli
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Giulia Cassone
- Clinical and Experimental Medicine PhD Program, Azienda USL-IRCCS di Reggio Emilia and Università di Modena and Reggio Emilia, Italy
| | - Franco Schiavon
- Operative Unit of Rheumatology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Thomas Neumann
- Department of Rheumatology, Clinic of Internal Medicine II I, Jena University Hospital, Jena, Germany.,Division of Rheumatology, Immunology and Rehabilitation, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Claus Kroegel
- Department of Pneumology and Allergology, Clinic of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Matthieu Groh
- Service de Médecine Interne, Centre de Référence des Syndromes Hyperéosinophiliques-CEREO, Hôpital Foch, Université Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Chiara Marvisi
- Rheumatology Unit Università di Modena and Reggio Emilia, Modena, Italy
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | - Thomas Barba
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - David Jayne
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Portugal
| | - Arianna Troilo
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia, Università di Modena and Reggio Emilia
| | - Jean-Emmanuel Kahn
- Service de Médecine Interne, Centre de Référence des Syndromes Hyperéosinophiliques-CEREO, Hôpital Foch, Université Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | | | - Xavier Puéchal
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Augusto Vaglio
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France.,Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milano/Monza, Italy
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
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Papo M, Sinico R, Teixeira V, Urban M, Mahrhold J, Monti S, Cassone G, Schiavon F, Seeliger B, Neumann T, Kroegel C, Jayne D, Hellmich B, Salvarani C, Kahn J, Durel C, Vaglio A, Emmi G, Guillevin L, Terrier B. Séquelles à long terme au cours de la granulomatose éosinophilique avec polyangéite : données issues d’une étude rétrospective multicentrique de 845 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Berti A, Felicetti M, Monti S, Ortolan A, Padoan R, Brunori G, Bortolotti R, Caporali R, Montecucco C, Schiavon F, Paolazzi G. Disease and treatment-related morbidity in young and elderly patients with granulomatosis with polyangiitis and microscopic polyangiitis. Semin Arthritis Rheum 2020; 50:1441-1448. [DOI: 10.1016/j.semarthrit.2020.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/26/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
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Brescia G, Padoan R, Schiavon F, Contro G, Parrino D, Tealdo G, Felicetti M, Frigo AC, Alessandrini L, Marioni G. Nasal polyps in eosinophilic granulomatosis with polyangiitis: Structured histopathology and CD105 expression. Am J Otolaryngol 2020; 41:102661. [PMID: 32810787 DOI: 10.1016/j.amjoto.2020.102661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Distinguishing the prodromal nasal polyposis of eosinophilic granulomatosis with polyangiitis (EGPA) from chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenge for rhinologists and rheumatologists. It has recently been reported that angiogenesis and CD105 expressed on vascular endothelial cells could have a role in the pathogenesis and development of nasal polyps. This exploratory study examined the structured histopathology of nasal polyps in patients with EGPA and CRSwNP, comparing CD105 expression in their nasal tissue with that of a control group with no chronic sinonasal inflammation. METHODS A structured histopathological study was performed on surgical specimens of nasal tissue from 32 adults (13 with EGPA, 14 with CRSwNP, 5 controls), considering CD105 as a marker to determine microvessel density (MVD). RESULTS The mean eosinophil count was higher in EGPA patients with tissue inflammation (p = .002), and in CRSwNP patients with sub-epithelial edema (p = .009). Neutrophil infiltration was significantly associated with severe tissue inflammation in EGPA patients (p = .04), but with the absence of fibrosis in CRSwNP patients (p = .04). In the EGPA group, CD105-MVD correlated with tissue eosinophil count (p = .05). Mean CD105-MVD was significantly higher in EGPA patients with mucosal ulceration (p = .004). In the CRSwNP group, a CD105-MVD correlated positively and significantly with tissue eosinophil count (p = .01). CONCLUSION Alongside the known abundance of eosinophils, other cells might contribute to inflammatory processes. Neutrophils may amplify inflammation, eosinophil recruitment and tissue damage. CD105 expression in CRSwNP and EGPA nasal polyps supports the hypothesized involvement of angiogenesis in the pathogenesis and development of nasal polyps.
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Affiliation(s)
- Giuseppe Brescia
- Department of Neuroscience - DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine - DIMED, Rheumatology Division, Padova University, Italy
| | - Franco Schiavon
- Department of Medicine - DIMED, Rheumatology Division, Padova University, Italy
| | - Giacomo Contro
- Department of Neuroscience - DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128 Padova, Italy
| | - Daniela Parrino
- Department of Neuroscience - DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128 Padova, Italy
| | - Giulia Tealdo
- Department of Neuroscience - DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine - DIMED, Rheumatology Division, Padova University, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Padova University, Padova, Italy
| | | | - Gino Marioni
- Department of Neuroscience - DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128 Padova, Italy.
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22
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Contro G, Brescia G, Alessandrini L, Barion U, Padoan R, Frigo AC, Schiavon F, Marioni G. Neutrophil infiltrates and eosinophil aggregates in chronic rhinosinusitis with nasal polyps and EGPA. Clin Rheumatol 2020; 40:1949-1957. [PMID: 33094393 DOI: 10.1007/s10067-020-05474-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVES The histopathological study of inflammatory cells and their tendency to form aggregates in chronic rhinosinusitis with nasal polyps (CRSwNP) has shown promising results in determining the pathogenesis and predicting clinical outcome. Bilateral nasal polyps also occur in over 70% of patients with eosinophilic granulomatosis with polyangiitis (EGPA). The study aim was to investigate neutrophil infiltrates and eosinophil aggregates in CRSwNP and EGPA tissues of Caucasian patients. METHOD A histopathological study was performed on surgical specimens of nasal polyps from 144 adults (15 with allergic fungal rhinosinusitis; 19 with nonsteroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD); 16 with intrinsic asthma; 21 with extrinsic asthma; 21 with allergy; 22 with eosinophil CRSwNP (ECRSwNP); 17 with non-ECRSwNP; 13 with EGPA). RESULTS Focusing on the presence of tissue eosinophil aggregates, NERD and ECRSwNP were the sub-cohorts with the highest rate. Neutrophil infiltrate rate was significantly higher in EGPA sub-cohort than in all CRSwNP sub-cohorts apart from non-ECRSwNP. CONCLUSIONS Structured histopathology is increasingly identifying the different histotypes of CRSwNP. This analysis can be used to better understand CRSwNP endotypes and develop targeted therapies. The response to therapy and therefore control of CRSwNP relapses definitely depends on our ability to act on the underlying inflammatory pattern. Key points • Systematic analysis of how neutrophil infiltrates and eosinophilic aggregates are distributed in the different phenotypes of CRSwNP and EGPA. • Neutrophil infiltrates and eosinophil aggregates are strong risk factors for nasal polyps' refractoriness. • NERD and ECRSwNP are the sub-cohorts of CRSwNP with the highest rate of tissue eosinophil aggregates. • Neutrophil infiltrates are significantly higher in EGPA.
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Affiliation(s)
- Giacomo Contro
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy
| | - Giuseppe Brescia
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy
| | | | - Umberto Barion
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy
| | - Roberto Padoan
- Department of Medicine-DIMED, Rheumatology Division, Padova University, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Padova University, Padova, Italy
| | - Franco Schiavon
- Department of Medicine-DIMED, Rheumatology Division, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neuroscience-DNS, Otolaryngology Section, Padova University, Via Giustiniani 2, 35128, Padova, Italy.
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23
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Zen M, Fuzzi E, Astorri D, Saccon F, Padoan R, Ienna L, Cozzi G, Depascale R, Zanatta E, Gasparotto M, Benvenuti F, Bindoli S, Gatto M, Felicetti M, Ortolan A, Campaniello D, Larosa M, Lorenzin M, Ramonda R, Sfriso P, Schiavon F, Iaccarino L, Doria A. SARS-CoV-2 infection in patients with autoimmune rheumatic diseases in northeast Italy: A cross-sectional study on 916 patients. J Autoimmun 2020; 112:102502. [PMID: 32527675 PMCID: PMC7832807 DOI: 10.1016/j.jaut.2020.102502] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/22/2022]
Abstract
Background Whether patients with autoimmune rheumatic diseases (ARD) have a higher risk for SARS-CoV-2 infection (COVID-19) and how SARS-CoV-2 pandemic impacts on adherence to therapy has not been fully elucidated. We assessed the rate and clinical presentation of COVID-19, and adherence to therapy in a large cohort of patients with ARD followed-up in a tertiary University-Hospital in Northeast Italy. Methods Between April 9th and April 25th, 2020, after SARS-CoV-2 infection peak, a telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), ANCA-associated vasculitis (AAV), and idiopathic inflammatory myopathies (IIM) was administered. Demographics, disease activity status, therapy, occupational exposure, and adherence to social distancing advise were also collected. Results 916 patients (397 SLE, 182 AAV, 176 SSc, 111 RA, 50 IIM) completed the survey. 148 patients developed at least one symptom compatible with COVID-19 (cough 96, sore throat 64, fever 64, arthromyalgias 59, diarrhea 26, conjunctivitis 18, ageusia/hyposmia, 18). Among the 916 patients, 65 (7.1%) underwent SARS-CoV-2 nasopharyngeal swab (18 symptomatic and 47 asymptomatic), 2 (0.21%) tested positive, a proportion similar to that observed in the general population of the Veneto region. No deaths occurred. 31 patients (3.4%) withdrew ≥1 medication, mainly immunosuppressants or biologics. Adoption of social distancing was observed by 860 patients (93.9%), including 335 (36.6%) who adopted it before official lockdown. Conclusions COVID-19 incidence seems to be similar in our cohort compared to the general population. Adherence to therapy and to social distancing advise was high. SARS-CoV-2 infection rate in ARDs seems to be similar to that of the general population. Adoption of social distancing measures was prevalent among different ARD groups. Earlier social distancing was more common in unremitted patients, treated with multiple drugs. Therapy discontinuation due to COVID-related concerns was rare, but undertaken even by active patients. Therapeutic regimens based on ≥3 drugs were associated with therapy discontinuation in our cohort.
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Affiliation(s)
- M Zen
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - E Fuzzi
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - D Astorri
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - F Saccon
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - R Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - L Ienna
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - G Cozzi
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - R Depascale
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - E Zanatta
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - M Gasparotto
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - F Benvenuti
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - S Bindoli
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - M Gatto
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - M Felicetti
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - A Ortolan
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - D Campaniello
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - M Larosa
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - M Lorenzin
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - R Ramonda
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - P Sfriso
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - F Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - L Iaccarino
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy
| | - A Doria
- Division of Rheumatology, Department of Medicine DIMED, University of Padua, Italy.
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Padoan R, Chieco Bianchi F, Marchi MR, Cazzador D, Felicetti M, Emanuelli E, Vianello A, Nicolai P, Doria A, Schiavon F. Benralizumab as a glucocorticoid-sparing treatment option for severe asthma in eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol Pract 2020; 8:3225-3227.e2. [PMID: 32505716 DOI: 10.1016/j.jaip.2020.05.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Fulvia Chieco Bianchi
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic-Vascular Sciences, University of Padova, Padova, Italy
| | - Maria Rita Marchi
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic-Vascular Sciences, University of Padova, Padova, Italy
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy; Section of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Enzo Emanuelli
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic-Vascular Sciences, University of Padova, Padova, Italy
| | - Piero Nicolai
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
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25
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Padoan R, Tomelleri A, Felicetti M, Campochiaro C, Baldissera E, Crimì F, Zucchetta P, Cecchin D, Picchio M, Dagna L, Doria A, Schiavon F. FRI0214 PERSISTENT LOW-GRADE FDG-PET VASCULAR INFLAMMATION IN REMITTED LVV-GCA PATIENTS IS ASSOCIATED TO A SIGNIFICANT HIGH RISK OF RELAPSE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6478] [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:Persistent low-grade vascular inflammation in giant cell arteritis (GCA) with large vessel involvement (LVV) treated patients could represent the expression of persistent subclinical disease activity or post-inflammatory vascular remodelling. Whether these findings have any impact on future vascular outcomes is still an unmet need.Objectives:To evaluate the frequency and evolution of FDG-PET low-grade vascular inflammation in remitted LVV-GCA patients.Methods:We included all consecutive patients classified as GCA with LVV involvement, with a minimum disease duration of 12 months and clinically remitted, who underwent to at least one PET/MR scan between January 2015 and January 2020. For each scan vessel’s metabolic activity was assessed using the Meller’s grading1. Low-grade inflammation was defined as Meller 1 and 2 (inferior or equal to liver), as reported in previous studies. Demographic and clinical data, as well as disease remission or flares, were recorded and compared to vascular metabolic activity.Results:In total 88 PET scans were performed in 54 LVV-GCA patients, predominantly female (77.8%), aged 68[7,8] years, with a regular BMI (23.9[2.8]) and with a long-standing disease (27[32.6] months). A subsequent PET/MR scan was available in 34 patients (median time between the two scans 9[6.3] months).At first PET examination, low-grade metabolic activity was reported in 68,5% of the cases, while complete remission in 15% and high metabolic activity in 25%. Comparing patients with low-grade vascular inflammation to those with complete remission (Meller 0), they had lower disease duration (28[25.9] vs 73[68] months, but without significance) and they were treated with higher daily prednisone dosage (5[3.8] vs 0[2.2], p=0.042). No significant differences were noted in age, acute phase reactants and type of treatment. Moreover, when compared to those with high metabolic activity (Meller 3), the latter had only significantly higher CRP levels (8.3[13.8] vs 4.1[3.9], p=0.03) and lower disease duration (19[20.6] vs 28[25.9] months, but without significance). While no significant differences were noted in age and type of treatment (both glucocorticoids and immunosuppressants).Among all patients with low-grade vascular inflammation, 81% of them underwent to steroids or immunosuppressants tapering due to clinical remission. At the subsequent PET examination, a worsening of metabolic activity (Meller 3) was found in 4/20 patients, with 1 clinical flare. While in 14/20 patients the subsequent PET revealed a persistent metabolic activity. Only in 2/20 there was a complete metabolic remission. Change or increase of the treatment regimen led to an improvement (Meller 0 or 1) in all the cases. Low-grade metabolic activity was associated with a significant increased risk of worsening/flare at the subsequent PET examination (RR 5.29[1.87-16.11], p=0.002).Conclusion:Low-grade vascular inflammation at PET examination is a common feature in remitted patients. It is associated with older age, lower disease duration and clinical remission. Treatment tapering is associated with an increased risk of worsening/flare. Further research is urgently needed to address this issue.References:[1]J. Meller et al., “Early diagnosis and follow-up of aortitis with [(18)F]FDG PET and MRI.,” Eur. J. Nucl. Med. Mol. Imaging, vol. 30, no. 5, pp. 730–6, May 2003.Disclosure of Interests:Roberto Padoan: None declared, Alessandro Tomelleri: None declared, Mara Felicetti: None declared, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Elena Baldissera Speakers bureau: Novartis, Pfizer, Roche, Alpha Sigma, Sanofi, Filippo Crimì: None declared, Pietro Zucchetta: None declared, Diego Cecchin: None declared, Maria Picchio: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Franco Schiavon: None declared
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Felicetti M, Ortolan A, Frigo AC, Padoan R, Gasparotto M, Lorenzin M, Doria A, Ramonda R, Schiavon F. SAT0245 RENAL INVOLVEMENT AT ONSET IN ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)-ASSOCIATED VASCULITIS: A MAJOR INDEPENDENT RISK FACTOR FOR RENAL RELAPSE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5830] [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:In ANCA-associated vasculitis (AAV), renal relapses are cause for concern as they are unpredictable and predictors of end-stage renal disease (ESRD).Objectives:We aimed to assess the frequency of major renal (MR) relapses in AAV in our cohort and identify independent predictors of the first MR relapse at diagnosis.Methods:We performed a retrospective monocentric observational study in our Vasculitis clinic from January 2000 to August 2019. Inclusion criteria were: 1) granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and limited kidney disease (LKD) diagnosis fulfilling EMA algorithm criteria; 2) achievement of a stable remission, defined as absence of vasculitis symptoms or signs and adherence to the prednisone taper during remission-induction treatment. We excluded patients who developed ESRD before remission and those with incomplete data during the follow-up. Major renal (MR) relapses were defined as occurrence of at least one major item of renal Birmingham Vasculitis Activity Score version 3 (BVASv3).All remitted patients were allocated in two subgroups: patients without MR relapse and patients with MR relapse. Univariate and multivariable analysis of first MR relapse predictors was performed with Fine and Gray (F&G) sub distribution hazards model to assess all competitive risks (progression to ESRD without MR relapse and death before MR relapse). Due to the relatively low frequency of events and the risk of overfitting, we performed several multivariable models with three variables, as recommended by Peduzzi e al1. The best multivariable model was selected accordingly to the Akaike information criterion (AIC).Results:96 (53% females) patients met the inclusion criteria: 74 GPA, 21 MPA and 1 LKD. Median age at diagnosis was 54 (44-64) years. ANCA testing was present in 94 patients, 85 were ANCA positive: 56 c-ANCA/PR3, 28 p-ANCA/MPO and 1 double positivity.During a median follow-up (FU) of 54.5 months (29.3-96.5), we observed 19 MR relapses in 17 patients while 2 patients progressed to ESRD, 3 died without events and 76 reported no MR relapse. Density-incidence of MR relapses since remission was 3.6/100 person-year (CI 95% 2.2-5.6). Median time to first MR relapse after remission was 33 months (14-67.5).At first MR relapse, 8 (53.3%) patients were on steroids while 10 (66.7%) were on immunosuppressant (5 azathioprine, 5 mycophenolate). In 2 cases, data about remission-maintenance treatment was not available.MR relapses were observed only in ANCA positive patients with a significantly higher frequency of skin, kidney and nerve involvement at diagnosis (41.2% vs 17.7%, p=0.034, 94.1% vs 57.0% p=0.004, and 52.9% vs 25.3% p=0.024, respectively); while Ear, Nose and Throat (ENT) involvement was significantly lower (35.3% vs 62.0% p=0.043). Mean BVASv3 at diagnosis scored significantly higher in MR relapse group (24.1±6.2 vs 18.1±8.1. p=0.007).At multivariable analysis with F&G model, renal involvement and induction treatment without cyclophosphamide and/or Rituximab at diagnosis were independent predictors of MR relapse (sHR 20.4 (2.6-158.2), p=0.004 and sHR 4.2 (1.5-12.0), p=0.007, respectively). Moreover, there was a trend of higher risk of MR relapse in PR3-ANCA (sHR 2.5 (0.9-7.1), p=0.091).Conclusion:Renal involvement at diagnosis and milder remission-induction treatment regimens resulted in a significantly higher risk of MR relapse during the FU in our cohort. PR3-ANCA specificity was not an independent predictor of MR relapse, even if we observed a trend of higher MR relapse risk with this covariate.References:[1]Peduzzi P et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373-9.Disclosure of Interests:Mara Felicetti: None declared, Augusta Ortolan: None declared, Anna Chiara Frigo: None declared, Roberto Padoan: None declared, Michela Gasparotto: None declared, Mariagrazia Lorenzin: None declared, Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Roberta Ramonda Speakers bureau: Novartis, Celgene, Janssen, Pfizer, Abbvie, Lilly, Franco Schiavon: None declared
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Karadag O, Bolek EC, Furuta S, Emmi G, Hocevar A, Hinojosa-Azaola A, Mohammad AJ, Ugurlu S, Alibaz-Oner F, Yazici A, Quartuccio L, Bozzolo E, Dagna L, Ramirez GA, Cantarini L, Gregorini G, Guido J, Monti S, Martin-Nares E, Schiavon F, Padoan R, Kono H, Vaglio A, Kiliçkap S, Ertenli Aİ, Direskeneli H, Özen S, Jayne D. SAT0243 SUBPHENOTYPES IN POLYARTERITIS NODOSA (PAN): TARGET ORGAN ASSOCIATIONS OF A WORLDWIDE COLLABORATION STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4635] [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:There is a paucity of information on the current phenotypes, ethnic and geographic differences of PAN. A global PAN study group has been working for clinical subphenotype and GWAS studies.Objectives:This study is aimed to look for target organ associations in PAN.Methods:PAN patients fulfilling the EMA vasculitis classification algorithm were recruited. In addition to baseline characteristics, treatment and outcome data, occurrence of any of the clinical manifestations related to PAN during disease course was recorded.Factor analysis was used to analyse target organ associations of 306 patients. Five factors were identified by factor analysis of variables sex, paediatric-onset, HBV, monogenic disease relationship, cutaneous features, musculoskeletal symptoms, constitutional symptoms and involved areas (abdominal, renal, neurologic, ENT, cardiac, pulmonary).Results:PAN cohort from 7 countries were used (Italy: n=59, Japan: n=39, Mexico: n=29, Slovenia: n=14, Sweden:11, TUR: n=106, UK: n=48). 306 (M/F: 171/135 and Caucasian 77.1%, Asian 13.4%, and Hispanic 9.5%) patients were included. 8 were HBV-related, and 22 of TUR patients had a monogenic form of disease (FMF n=15, DADA2 n=7). 21.8% of patients were cutaneous-only PAN patients. 48.4% of patients had radiologic, 64% had biopsy-proven PAN. Median age at disease onset was 40 (IQR 27.0-57.5) years. During a median 57 (16-120) months follow-up, 39 (13%) patients died.Factor analysis revealed 5 factors that explained 54.1% of the original information on the matrix as follows:Factor 1,represented the association between gastrointestinal and renal involvement, male gender and negatively associated with cutaneous features;Factor 2,the association between monogenic relationship with paediatric onset disease;Factor 3,any of musculoskeletal findings with positive constitutional symptoms;Factor 4any neurologic involvement was associated with ENT and pulmonary findings;Factor 5cardiac involvement in non-HBV patients (Table).The eigenvalues of the 5 factors were 2.034, 1.470, 1.427, 1.079 and 1.030, in decreasing order, i.e., the highest contribution to the overall variance in the matrix came from the togetherness of the 4 clinical and demographic characteristics that made up Factor 1.Conclusion:Target organ associations could support distinctive subphenotypes in PAN. Factor 1 seems the most severe form. Patients with FMF or DADA2 have distinct target organ associations. The jury is out to decide whether these patients should be classified as ‘vasculitis associated with probable etiology’ just as HBV-related-PAN. Factor 4 might define a different subphenotype (ANCA- medium vessel vasculitis?).Disclosure of Interests:Omer Karadag: None declared, Ertugrul Cagri Bolek: None declared, Shunsuke Furuta: None declared, Giacomo Emmi: None declared, ALOJZIJA HOCEVAR: None declared, Andrea Hinojosa-Azaola: None declared, Aladdin J Mohammad Speakers bureau: lecture fees from Roche and Elli Lilly Sweden, PI (GiACTA study), Serdal Ugurlu: None declared, Fatma Alibaz-Oner: None declared, Ayten Yazici: None declared, Luca Quartuccio: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Giuseppe Alvise Ramirez: None declared, Luca Cantarini: None declared, Gina Gregorini: None declared, Jeannin Guido: None declared, Sara Monti: None declared, Eduardo Martin-Nares: None declared, Franco Schiavon: None declared, Roberto Padoan: None declared, Hajime Kono: None declared, Augusto Vaglio: None declared, Saadettin Kiliçkap: None declared, Ali İhsan Ertenli: None declared, Haner Direskeneli: None declared, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim
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Felicetti M, Gasparotto M, Frigo AC, Ortolan A, Padoan R, Lorenzin M, Ramonda R, Doria A, Schiavon F. Renal involvement at baseline can predict major renal relapse in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Clin Exp Rheumatol 2020; 38 Suppl 124:201-206. [PMID: 32441648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES In ANCA-associated vasculitis (AAV), renal relapses are cause of concern as they are unpredictable and predictors of end-stage renal disease (ESRD). We aimed to assess the frequency of major renal (MR) relapses in AAV and to identify independent base-line predictors. METHODS We performed a retrospective monocentric observational cohort study of patients affected by granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and renal limited vasculitis (RLV), diagnosed from 2000 to 2019, and who achieved clinical remission defined as Birmingham Vasculitis Activity Index version 3 (BVASv3)=0 and/or clinical judgment. MR relapse was defined as the occurrence of major items of renal BVASv3. Univariate and multivariable analysis was performed with competitive risk analysis. RESULTS We included 96 patients: 73 GPA, 21 MPA and 2 RLV. Eighty-five (90%) patients were ANCA-positive: 56 c-ANCA/PR3, 28 p-ANCA/MPO and 1 double positive. During the follow-up, 17/96 patients developed at least one MR relapse, 2/96 progressed to ESRD and 3/96 died without events; 74 did not develop MR relapse. Patients with MR relapse were all ANCA positive and had higher frequency of skin (p=0.034), kidney (p=0.004) and nervous system (p=0.024) involvement and lower fre¬quency of ear, nose and throat (ENT) manifestations (p=0.043). At multivariable analysis, renal involvement at baseline (sHR 20.4, 95% confidence interval (95% CI) 2.6-158.2, p=0.004) and remission-induction treatment without cyclophosphamide and/or rituximab (sHR 4.2, 95% CI 1.5-12.0, p=0.007) were independent predictors of MR relapses. CONCLUSIONS Baseline renal involvement predicts MR relapse in AAV while intense initial treatment seems to be protective.
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Affiliation(s)
- Mara Felicetti
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Michela Gasparotto
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital, Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy.
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine-DIMED, University Hospital, Padova, Italy
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Padoan R, Felicetti M, Gatto M, Polito P, Doria A, Schiavon F. Rituximab-associated hypogammaglobulinaemia in ANCA-associated vasculitis and connective tissue diseases: a longitudinal observational study. Clin Exp Rheumatol 2020; 38 Suppl 124:188-194. [PMID: 32441645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The burden of hypogammaglobulinaemia following rituximab (RTX) treatment in rheumatic diseases has not been fully elucidated yet. Our aim was to evaluate the frequency and predictors of hypogammaglobulinaemia in patients affected by ANCA-associated vasculitis (AAV) and connective tissue diseases (CTD). METHODS We retrospectively reviewed prospectively collected data of patients receiving RTX. Immunoglobulins (Ig) levels and lymphocyte subsets were recorded at RTX administration and 3-6 months later. We assessed frequency of hypogammaglobulinaemia (serum IgG<6 g/L) and its related events. Univariate and multivariable analysis were performed using SPSS 20.0 package. RESULTS Sixty-eight patients (30 AAV, 25 systemic lupus erythematosus, 9 systemic sclerosis and 4 idiopathic inflammatory myopathies) were treated with RTX (95 infusions, median 2 [2-6]). Following RTX, IgG<6 g/L were observed in 15/68 patients (15.8%), IgM<0.4 g/L in 28/68 (41%) and IgA<0.7 g/L in 7/68 (10.2%). Hypogammaglobulinaemia was more common in patients with AAV (p=0.008), short disease duration (p=0.001), low IgG levels at baseline (p=0.008), high cyclophosphamide exposure (p=0.018), high daily and cumulative prednisone dosage (p=0.001 and p=0.006). At multivariate analysis, cumulative cyclophosphamide dosage (OR 1.1 [1.0-1.3] p=0.045), daily prednisone intake >15mg (OR 9.5 [2.2-41.7] p=0.03) and IgG levels before RTX (OR 0.74 [0.59-0.93] p=0.009) were independent predictors of hypogammaglobulinaemia. Five patients experienced severe infections within 12 months, more frequently in those with IgG<6 g/L (26.7% vs 1.9%, p=0.007). CONCLUSIONS Hypogammaglobulinaemia following RTX is uncommon in AAV and CTD and is more likely in patients with high glucocorticoids and cyclophosphamide exposure and low IgG levels at baseline.
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Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy.
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
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Quartuccio L, Bond M, Isola M, Monti S, Felicetti M, Furini F, Murgia S, Berti A, Silvestri E, Pazzola G, Bozzolo E, Leccese P, Raffeiner B, Parisi S, Leccese I, Cianci F, Bettio S, Sainaghi P, Ianniello A, Ravagnani V, Bellando Randone S, Faggioli P, Lomater C, Stobbione P, Ferro F, Colaci M, Alfieri G, Carubbi F, Erre GL, Giollo A, Franzolini N, Ditto MC, Balduzzi S, Padoan R, Bortolotti R, Bortoluzzi A, Cariddi A, Padula A, Di Scala G, Gremese E, Conti F, D'Angelo S, Matucci Cerinic M, Dagna L, Emmi G, Salvarani C, Paolazzi G, Roccatello D, Govoni M, Schiavon F, Caporali R, De Vita S. Alveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors. J Autoimmun 2020; 108:102397. [PMID: 31926833 DOI: 10.1016/j.jaut.2019.102397] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Alveolar haemorrhage (AH) is considered an important cause of morbidity and early mortality in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV). OBJECTIVES The aim of this study was to identify predictors of outcome in patients with AH-AAV and to evaluate outcome and causes of death in this subset. MATERIALS AND METHODS A multicenter retrospective study was conducted in 29 Italian Centers. Clinicians were asked to recruit all patients diagnosed with AAV-associated AH during the last 10 years, from 2007 to 2016. Univariate and multivariable analysis were performed. RESULTS One-hundred and six patients were included (median age at onset of 55 years [IQR 42-67]). The majority were ANCA-positive (PR3 57.1%, MPO 33.7%) and 72.6% had also renal involvement. At presentation, anaemia was shown in 97 (92.4%) patients, hemoptysis in 54 (51.9%), respiratory failure in 68 (66.7%), of whom 48 (70.6%), requiring respiratory support. At the end of the 37 months [IQR 13-77] follow-up, 19/106 (17.9%) patients were dead. The main causes of death were active disease and infections. By stepwise regression analysis, age >65 years (HR 3.66 [95% CI 1.4-9.51], p = 0.008) and the need for respiratory support (HR 4.58 [95% CI 1.51-13.87], p = 0.007) at AH onset were confirmed to be predictive of mortality. CONCLUSIONS Predictors of outcome in AAV-AH were determined. Factors related to the patient's performance status and the severity of the lung involvement strongly influenced the outcome. Balancing harms and benefits for the individual patient in induction and maintenance treatment strategies is crucial.
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Affiliation(s)
- Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy.
| | - Milena Bond
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Miriam Isola
- Institute of Statistics, Department of Medical Area, University of Udine, Udine, Italy
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy; University of Pavia, PhD in Experimental Medicine, Pavia, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Federica Furini
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Stefano Murgia
- CMID-Center of Research of Nephrology, Rheumatology, and Rare Diseases Interregional Coordinating Center of the Network of Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-net Member) G. Bosco Hospital, and University of Turin, Italy
| | - Alvise Berti
- Department of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Italy
| | - Enrica Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Bernd Raffeiner
- Rheumatology Unit, Department of Medicine, Centrale Hospital of Bolzano, Italy
| | - Simone Parisi
- S.C. Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ilaria Leccese
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | - Francesco Cianci
- Rheumatology Institute, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvano Bettio
- Rheumatology Unit, Internal Medicine Department, University Hospital of Cattinara, Trieste, Italy
| | - Pierpaolo Sainaghi
- Rheumatology Unit, CAAD and DiMet, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Aurora Ianniello
- Day Hospital Multidisciplinare, Ospedale di Borgomanero, ASL-NO Novara, Novara, Italy
| | | | - Silvia Bellando Randone
- Department of Experimental and Clinical Medicine University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Paola Faggioli
- ASST Ovest Milanese, UOC Internal Medicine, Legnano, Italy
| | | | | | | | - Michele Colaci
- Dept Clinical and Experimental Medicine University of Catania, Catania, Italy
| | | | | | | | - Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | | | - Maria Chiara Ditto
- S.C. Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy; University of Padua, PhD Program in Clinical and Experimental Sciences, Padua, Italy
| | - Silvia Balduzzi
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | | | - Alessandra Bortoluzzi
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angela Padula
- Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisa Gremese
- Rheumatology Institute, Università Cattolica del Sacro Cuore, Rome, Italy; Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
| | | | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Italy
| | | | - Dario Roccatello
- CMID-Center of Research of Nephrology, Rheumatology, and Rare Diseases Interregional Coordinating Center of the Network of Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-net Member) G. Bosco Hospital, and University of Turin, Italy
| | - Marcello Govoni
- Department of Medical Sciences, UOL Rheumatology, University of Ferrara, Ferrara, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Roberto Caporali
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, Pavia, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, Academic Hospital "Santa Maria della Misericordia", Udine, Italy
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Papo M, Sinico R, Teixeira V, Urban M, Mahrhold J, Monti S, Cassone G, Schiavon F, Seeliger B, Neumann T, Kroegel C, Groh M, Samson M, Jayne D, Hellmich B, Salvarani C, Guillevin L, Emmi G, Vaglio A, Terrier B. La granulomatose éosinophilique avec polyangéite (Churg-Strauss) avec positivité des ANCA-PR3 existe-t-elle réellement ? Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Padoan R, Crimì F, Felicetti M, Padovano F, Lacognata C, Stramare R, Quaia E, Cecchin D, Bui F, Zucchetta P, Schiavon F. Fully integrated 18F-FDG PET/MR in large vessel vasculitis. Q J Nucl Med Mol Imaging 2019; 66:272-279. [PMID: 31602964 DOI: 10.23736/s1824-4785.19.03184-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To evaluate the usefulness of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) in large vessels vasculitis (LVV) patients. METHODS We performed an observational retrospective study based on our records. Images were acquired on a PET/MR scanner using 18F-FDG-PET whole body imaging. For each PET scan, a qualitative analysis and a semi-quantitative measure using the maximum of the standardized uptake value (SUVMax) were performed. SUVMax measurements normalized to the liver uptake were categorized using a grading scale. Vessel's wall thickness (WT) was measured at five fixed points (inferior margin of T5, T9, T12, L3, thickest area-max WT). RESULTS 23 LVV patients were included, 56.5% giant cells arteritis, 34.8% Takayasu's arteritis and 8.7% isolated aortitis, all Caucasian, mostly females (82%). We considered 32 PET scans for the LVV group (from min. 1 to max. 3 scans/patient) mainly during follow-up (29/32 scans), and 23 PET scans from a control group of non-metastatic malignancies patients. We found higher SUVMax compared to controls, in all sites, irrespective of clinical disease activity. Mean WT resulted higher in patients than in controls but was not correlated to SUVMax. Mean WT positively correlated with age in both cohorts, inversely correlated to disease duration, while no correlation with SUVMax was observed. The concordance between clinically active disease and PET hypermetabolism was poor (K Cohen 0.33). CONCLUSIONS PET/MR is a safe imaging technique capable of detecting inflammation in aortic wall. Low radiological exposure of PET/MR should be considered especially in young women receiving follow-up studies.
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Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy -
| | - Filippo Crimì
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Federica Padovano
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Carmelo Lacognata
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Roberto Stramare
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Emilio Quaia
- Radiology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy.,Padova Neuroscience Center, University of Padua, Padua, Italy
| | - Franco Bui
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, Padua, Italy
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Padoan R, Cazzador D, Pendolino AL, Felicetti M, De Pascalis S, Zanoletti E, Bovo R, Martini A, Schiavon F. Cogan’s syndrome: new therapeutic approaches in the biological era. Expert Opin Biol Ther 2019; 19:781-788. [DOI: 10.1080/14712598.2019.1611779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Alfonso Luca Pendolino
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Susanna De Pascalis
- Emergency Unit, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Elisabetta Zanoletti
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Roberto Bovo
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Alessandro Martini
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Padoan R, Crimì F, Felicetti M, Punzi L, Lacognata C, Stramare R, Cecchin D, Bui F, Zucchetta P, Schiavon F. 107. FULLY INTEGRATED 18F-FDG PET/MR IN LARGE VESSEL VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Diego Cecchin
- Nuclear Medicine, University of Padova Padova, Italy
| | - Franco Bui
- Nuclear Medicine, University of Padova Padova, Italy
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Brescia G, Schiavon F, Nicolè L, Zanoletti E, Zanotti C, Padoan R, Felicetti M, Parrino D, Cinetto F, Cangiano D, Giacomelli L, Cappellesso R, Martini A, Fassina A, Marioni G. No Differences in Nasal Tissue Inflammatory Cells and Adhesion Molecules (iCAM-1 and vCAM-1) Based on the Comparison of EGPA With Eosinophilic Chronic Sinusitis With Polyposis. Am J Rhinol Allergy 2019; 33:395-402. [DOI: 10.1177/1945892419836819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background An example of aggressive eosinophilic polyposis can be found in eosinophilic granulomatosis with polyangiitis (EGPA). Intercellular adhesion molecule-1 (iCAM-1) and vascular cell adhesion molecule-1 (vCAM-1) play a part in mediating the recruitment and adhesion of leukocytes to the vessel wall, and their blood-to-tissue migration under inflammatory conditions. Objective This prospective study compared 3 groups—patients with a definite diagnosis EGPA, non-EGPA patients with phenotypic features suggestive of EGPA, and patients with non-eosinophilic nasal polyposis (controls)—in terms of nasal tissue histology, iCAM-1 and vCAM-1 expression, and blood inflammatory cells. Methods A total of 58 adults underwent sinus surgery (13 patients with EGPA, 23 suspected of having EGPA, and 22 controls). Results Mean tissue eosinophil counts were significantly higher in EGPA patients and suspected cases of EGPA than in controls. Although iCAM-1 and vCAM-1 were diffusely expressed in sinonasal tissues, they did not differently stain EGPA, eosinophilic-type and non-eosinophilic polyposis. Blood basophil and eosinophil levels were high in both the EGPA and the suspected EGPA groups. Intergroup differences were found for eosinophils but not for basophils. Conclusions We do not have yet blood or tissue markers able to differentiate the early phase of EGPA from chronic rhinosinusitis with nasal polyps. Further investigations are mandatory considering EGPA patients at their initial diagnosis and before any treatment, in terms of nasal histology and blood inflammatory cells, to identify markers characterizing sinonasal mucosa inflammation and useful for an early diagnosis of EGPA.
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Affiliation(s)
- Giuseppe Brescia
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Franco Schiavon
- Rheumatology Division, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Lorenzo Nicolè
- Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Elisabetta Zanoletti
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Claudia Zanotti
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Roberto Padoan
- Rheumatology Division, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Mara Felicetti
- Rheumatology Division, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Daniela Parrino
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Francesco Cinetto
- Clinical Immunology and Hematology Unit, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Daniela Cangiano
- Clinical Trials and Biostatistics Unit, IRCSS Istituto Oncologico Veneto, Padova, Italy
| | | | | | - Alessandro Martini
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | | | - Gino Marioni
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
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Bond M, Quartuccio L, Monti S, Felicetti M, Furini F, Berti A, Emmi G, Pazzola G, Cariddi A, Leccese P, Raffeiner B, Padula A, Paolazzi G, Salvarani C, Dagna L, Rocatello D, Conti F, Gremese E, Schiavon F, Govoni M, Caporali R, Vita SD. 233. ALVEOLAR HEMORRHAGE IN ANCA-ASSOCIATED VASCULITIS: LONG TERM OUTCOME AND MORTALITY PREDICTORS. A RETROSPECTIVE LONG-TERM STUDY ON 106 ITALIAN PATIENTS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.007] [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: 11/14/2022] Open
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Felicetti M, Padoan R, Monti S, Berti A, Bond M, Delvino P, Bortolotti R, Paolazzi G, Quartuccio L, Caporali R, Vita SD, Schiavon F. 242. 1996 FIVE FACTOR SCORE VS 2009 REVISED FIVE FACTOR SCORE PROGNOSTIC VALUE IN A MULTICENTRIC COHORT OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS PATIENTS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez062.016] [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: 11/13/2022] Open
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Padoan R, Felicetti M, Ghirardello A, Beggio M, Doria A, Schiavon F. 039. ANTI-PENTRAXIN-3 AUTOANTIBODIES IN ANCA-ASSOCIATED VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez057.038] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Andrea Doria
- Rheumatology Unit, University of Padova Padova, Italy
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Berti A, Felicetti M, Monti S, Ortolan A, Padoan R, Brunori G, Bortolotti R, Caporali R, Montecucco C, Schiavon F, Paolazzi G. 128. DISEASE AND TREATMENT-RELATED MORBIDITY AND COMPLICATIONS IN YOUNG AND ELDERLY PATIENTS WITH ANCA-ASSOCIATED VASCULITIS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez059.005] [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: 11/12/2022] Open
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Papo M, Sinico A, Teixeira V, Urban ML, Mahrhold J, Cassone G, Schiavon F, Groh M, Marvisi C, Samson M, Barba T, Jayne D, Hellmich B, Salvarani C, Kahn JE, Bonnotte B, Durel CA, Cohen P, Puéchal X, Mouthon L, Guillevin L, Emmi G, Vaglio A, Terrier B. 354. EFFICACY OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS TREATMENTS ACCORDING TO THE TYPE OF MANIFESTATIONS BASED ON ANALYSIS OF 636 PATIENTS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez063.078] [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: 11/13/2022] Open
Affiliation(s)
- Matthias Papo
- Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | | | | | | | | | | | | | | | | | | | - David Jayne
- University of Cambridge Addenbrookes Hospital Cambridge, United Kingdom
| | | | | | | | | | | | - Pascal Cohen
- Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | - Luc Mouthon
- Cochin Hospital National Referral Center Paris, France
| | - Loïc Guillevin
- Hôpital Cochin, Université Paris Descartes, Paris, France
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Emmi G, Bettiol A, Urban ML, Sinico R, Schiavon F, Caporali R, Prisco D, Vaglio A. 135. ATHERO-THROMBOTIC AND VENOUS EVENTS (AVTE) IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA): A MULTICENTRE STUDY OF 573 ITALIAN PATIENTS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez059.012] [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: 11/14/2022] Open
Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | | | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | | | | | | | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
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Papo M, Sinico R, Teixeira V, Urban ML, Mahrhold J, Cassone G, Schiavon F, Groh M, Marvisi C, Samson M, Barba T, Jayne D, Hellmich B, Salvarani C, Kahn JE, Bonnotte B, Durel CA, Cohen P, Puéchal X, Mouthon L, Guillevin L, Emmi G, Vaglio A, Terrier B. 117. PREDICTION OF LONG-TERM EVOLUTIONARY PROFILES IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (CHURG– STRAUSS) BASED ON BASELINE AND FOLLOW-UP CHARACTERISTICS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez058.057] [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: 11/13/2022] Open
Affiliation(s)
- Matthias Papo
- Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | | | | | | | | | | | | | | | | | - Thomas Barba
- Internal Medicine, E. Herriot Hospital Lyon, France
| | - David Jayne
- University of Cambridge Addenbrookes Hospital Cambridge, United Kingdom
| | | | | | | | | | | | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | - Luc Mouthon
- Cochin Hospital National Referral Center Paris, France
| | | | | | | | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, Paris, France
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Zanatta E, Famoso G, Boscain F, Montisci R, Pigatto E, Polito P, Schiavon F, Iliceto S, Cozzi F, Doria A, Tona F. Nailfold avascular score and coronary microvascular dysfunction in systemic sclerosis: A newsworthy association. Autoimmun Rev 2018; 18:177-183. [PMID: 30572139 DOI: 10.1016/j.autrev.2018.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS We aimed to assess the relationship between nailfold videocapillaroscopy (NVC) abnormalities and coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD) in patients with systemic sclerosis (SSc). METHODS We studied 39 SSc patients (33 females, mean ± SD age 54 ± 12 years, median disease duration 11 years, range 6-22) and 22 controls (matched for age and sex) without any evidence of cardiovascular disease. Clinical assessment was performed by modified Rodnan skin score (mRss) and EUSTAR score. Coronary flow velocities in the left anterior descending coronary artery were measured by transthoracic echocardiography. Average peak flow velocities, CFR and microvascular resistance at baseline (BMR) and in hyperaemic (HMR) condition were assessed. CFR ≤2.5 was considered marker of CMD. Six NVC-abnormalities were evaluated by a semi quantitative scoring system: enlarged and giant capillaries (diameter > 20 μm and >50 μm, respectively), hemorrhages, disarray, capillary ramifications and loss of capillaries (avascular score). Statistic was performed using SPSS. RESULTS CFR was lower in SSc patients than in controls (2.6 ± 0.5 vs 3.3 ± 0.5). CMD was detected in 24 patients (61.5%) vs 0 controls (p < .0001). CFR was inversely correlated with NVC-avascular score (rho =-0.750, p < .0001). Avascular and capillary ramifications scores (p = .001 and p = .03, respectively), mRss (p = .003) and EUSTAR score (p = .01) were higher in patients with CMD than in those without. At multivariable analysis, avascular score was independently associated with CMD (p = .01). HMR was directly correlated with avascular score (rho = 0.416, p = .008). CONCLUSIONS In our SSc patients NVC-avascular score was associated with CMD which seems to be the result of a structural microvascular remodeling.
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Affiliation(s)
- Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Giulia Famoso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesca Boscain
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health, San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
| | - Erika Pigatto
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Papo M, Emmi G, Schiavon F, Groh M, Samson M, Kahn J, Sinico R, Puéchal X, Mouthon L, Guillevin L, Vaglio A, Terrier B. Caractéristiques au diagnostic et profils évolutifs des patients atteints de granulomatose éosinophilique avec polyangéite (Churg-Strauss) : données d’une étude rétrospective collaborative européenne. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
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Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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Gracia IE, Rondón C, Campo P, Prieto A, Mayorga L, Galindo L, Molina A, Blanca M, Torres MJ, Morikawa T, Fukuoka A, Matsushita K, Fujieda S, Yoshimoto T, Iwasaki N, Smulders T, Van Egmond D, Van Drunen K, Van Der Schee M, Beule AG, Berings M, Jult A, Vermeulen H, De Ruyck N, Derycke L, Ucar H, Ghekiere P, Temmerman R, Ellis J, Bachert C, Lambrecht B, Dullaers M, Gevaert P, Arasi S, Perna S, Resch Y, Lupinek C, Chen KW, Vrtala S, Valenta R, Matricardi PM, Gonçalves I, Jacinto T, Amaral R, Pereira AM, Araújo LM, Couto M, Fonseca JA, Stjarne P, Kaulsay R, Pohl W, Plaza MC, Prieto AM, Mayorga C, Herknerova M, Wang T, Wu C, Kilimajer J, Pujols L, Roca-Ferrer J, Callejas B, Fuentes-Prado M, Perez-Gonzalez M, Alobid I, Valero A, Picado C, Murray R, Mullol J, Steelant B, Martens K, Boeckxstaens G, Seys SF, Hellings PW, Biggs TC, Hayes SM, Harries PG, Pender S, Salib RJ, Kim J, Lee HS, Kalogjera L, Vrkic N, Topic A, Tomljenovic D, Greguric T, Radovanovic PB, Jund R, Haimerl P, Chaker AM, Schober Y, Schindela S, Nockher A, Schmidt-Weber CB, Bieren JEV, Ickrath P, Kleinsasser N, Beyersdorf N, Ding X, Hagen R, Hackenberg S, Cangiano D, Cinetto F, Brescia G, Marioni G, Zanotti C, Schiavon F, Padoan R, Caputo I, Neri R, Agostini C, Kim JH, Jang YJ, Lim JY, Kim SH, Savlevich E, Gaganov L, Kochnova M, Egorov V, Fok JS, Hanif T, Renkonen J, Joenväärä S, Kankainen M, Mäkelä M, Kauppi P, Pelkonen A, Mattila P, Renkonen R, Toppila-Salmi S, Holtappels G, Lambrecht BN, Blanca-López N, Gonzalez-Visiedo M, Jurado R, Canto G. Abstracts from the 11th Symposium on Experimental Rhinology and Immunology of the Nose (SERIN 2017). Clin Transl Allergy 2017. [PMCID: PMC5576386 DOI: 10.1186/s13601-017-0163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Oliviero F, Galozzi P, Ramonda R, de Oliveira FL, Schiavon F, Scanu A, Punzi L. Unusual Findings in Synovial Fluid Analysis: A Review. Ann Clin Lab Sci 2017; 47:253-259. [PMID: 28667024] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Synovial fluid analysis is one of the most useful laboratory test in the diagnosis of joint diseases. It allows to determine the degree of synovial inflammation, the presence of pathogenic crystals and microorganisms, and to evaluate the effect of pharmacological treatments as well as the progression of the disease. Synovial fluid therefore represents a precious substrate able to give valuable information from both the clinical and the research points of view.In this educational review we present and discuss some unusual findings, at times associated with rare rheumatic conditions, observed while routine synovial fluid examination is performed. These findings can be highlighted under ordinary or polarized light using simple wet preparations and supravital staining.
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Affiliation(s)
- Francesca Oliviero
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | | | - Franco Schiavon
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Anna Scanu
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine - DIMED, University of Padova, Padova, Italy
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Biscetti F, Carbonella A, Parisi F, Bosello SL, Schiavon F, Padoan R, Gremese E, Ferraccioli G. The prognostic significance of the Birmingham Vasculitis Activity Score (BVAS) with systemic vasculitis patients transferred to the intensive care unit (ICU). Medicine (Baltimore) 2016; 95:e5506. [PMID: 27902615 PMCID: PMC5134801 DOI: 10.1097/md.0000000000005506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Systemic vasculitides represent a heterogeneous group of diseases that share clinical features including respiratory distress, renal dysfunction, and neurologic disorders. These diseases may often cause life-threatening complications requiring admission to an intensive care unit (ICU). The aim of the study was to evaluate the validity and responsiveness of Birmingham Vasculitis Activity Score (BVAS) score to predict survival in patients with systemic vasculitides admitted to ICU.A retrospective study was carried out from 2004 to 2014 in 18 patients with systemic vasculitis admitted to 2 different Rheumatology divisions and transferred to ICU due to clinical worsening, with a length of stay beyond 24 hours. We found that ICU mortality was significantly associated with higher BVAS scores performed in the ward (P = 0.01) and at the admission in ICU (P = 0.01), regardless of the value of Acute Physiology And Chronic Health Evaluation (APACHE II) scores (P = 0.50). We used receiver-operator characteristic (ROC) curve analysis to evaluate the possible cutoff value for the BVAS in the ward and in ICU and we found that a BVAS > 8 in the ward and that a BVAS > 10 in ICU might be a useful tool to predict in-ICU mortality.BVAS appears to be an excellent tool for assessing ICU mortality risk of systemic vasculitides patients admitted to specialty departments. Our experience has shown that performing the assessment at admission to the ward is more important than determining the evaluation before the clinical aggravation causing the transfer to ICU.
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Affiliation(s)
- Federico Biscetti
- Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome
| | - Angela Carbonella
- Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome
| | - Federico Parisi
- Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome
| | - Silvia Laura Bosello
- Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome
| | - Franco Schiavon
- Operative Unit of Rheumatology, Department of Internal Medicine, University of Padua, Padua, Italy
| | - Roberto Padoan
- Operative Unit of Rheumatology, Department of Internal Medicine, University of Padua, Padua, Italy
| | - Elisa Gremese
- Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Institute of Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University School of Medicine, Rome
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Padoan R, Felicetti M, Marconato M, Cinetto F, Agostini C, Punzi L, Schiavon F. FRI0387 Peripheral Neuropathy in Eosinophilic Granulomatosis with Polyangiitis (EGPA). Incat Disability Score To Evaluate Damage and To Predict Long Term Outcome in 50 Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Felicetti M, Cazzador D, Faccioli C, Padoan R, Emanuelli E, Zanoletti E, Martini A, Schiavon F. AB0551 Clinical Application of Two Different Disease Activity Scores for ENT Involvement in Granulomatosis with Polyangiitis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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