Unita Operativa di Reumatologia

Santa Maria Nuova, Italy

Unita Operativa di Reumatologia

Santa Maria Nuova, Italy

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Salaffi F.,Marche Polytechnic University | Franchignoni F.,Salvatore Maugeri Foundation | Giordano A.,Salvatore Maugeri Foundation | Ciapetti A.,Marche Polytechnic University | And 2 more authors.
Clinical and Experimental Rheumatology | Year: 2013

Objectives. The aim of this study was to perform a psychometric analysis of the Italian Fibromyalgia Impact Questionnaire Revised version (FIQR), using both classical test theory (CTT) and Rasch analysis (RA) in order to better analyse its construct validity and provide a rational basis for a possible improvement of its metric quality. Methods. The study involved 503 patients with fibromyalgia (FM) (423 women and 80 men) with mean age of 51.3±10.1 years (range 19-74) and mean duration of symptoms of 11.1±8.7 years (range 1-30). All patients completed the Italian FIQR during their clinical visit. The translation and cultural adaptation process of the Italian FIQR followed the published guidelines and no local adjustments were made except for a slight adaptation of item 13 related to "energy". Results. Factor Analysis revealed two salient dimensions: function (items 1-9) and symptoms (items 12-21). RA was thus performed on these two subscales. Rating scale diagnostics suggested collapsing the eleven rating categories of the scale into five. After combining these rating categories, RA showed that most items of each of the two subscales fitted the respective constructs to measure (MnSq 0.7-1.3). The reliability levels of the two subscales were higher than 0.80. Conclusion. This study provides psychometric evidence of the reliability, internal validity and two-dimensional structure of the FIQR in a FM population. Our results support the use of two separate subscales for "function" and "symptoms", and provide a useful starting point for further refinement of the scale. © Clinical and Experimental Rheumatology 2013.


Bajocchi G.,Unita Operativa di Reumatologia | Piro R.,Unita Operativa di Pneumologia | Lombardini C.,Servizio di Anestesia e Rianimazione | Cavazza A.,Servizio di Anatomia Patologica | Facciolongo N.,Unita Operativa di Pneumologia
Clinical and Experimental Rheumatology | Year: 2012

We present the case of a 48-year-old male with an acute respiratory distress syndrome which later proved to be an unexpected and initial manifestation of antisynthetase syndrome. Recognising this as a rare combination of an acute respiratory failure and a connective tissue disease in a previously asymptomatic subject is possible only by means of diagnostic exclusion. Based on similar case reports, the only way to reverse the disease and minimise the sequelae is to begin long-term immunosuppressive therapy as soon as possible once the diagnosis has been made. A review of similar cases with antibody anti-Jo-1 is presented with the aim of providing clinicians with useful indications for promptly recognising this poorly-defined and life-threatening emergency. © Clinical and experimental rheumatology 2012.


Covelli M.,University of Bari | Sarzi-Puttini P.,Unita Operativa di Reumatologia | Atzeni F.,Unita Operativa di Reumatologia | Macchioni P.,Unita Operativa di Reumatologia
Reumatismo | Year: 2010

Rheumatoid arthritis (RA) is a chronic disease that requires a long-term administration of immunomodulatory drugs with a greater risk of side effects like malignancies, serious infections and cardiovascular diseases. Furthermore, patients with RA are more prone than general population to these manifestations. Safety of rituximab has been evaluated in the short-term (6 months) and in the medium-term (up to 10 years) in patients who had been previously treated with antagonists of tumor necrosis factor (a-TNF) and/or with methotrexate (MTX) and in patients who were not. Data obtained from clinical trials demonstrated that rituximab is well tolerated either after a single course or after multiple courses. The overall rate of adverse events (AEs) was stable after the first three courses. The most frequent adverse event was infusion-related reactions (IRR). Serious infections did not increase after multiple courses. Data from "real life" confirm that treatment with rituximab is well tolerated.


Ciccia F.,University of Palermo | Alessandro R.,University of Palermo | Rizzo A.,Cervello | Raimondo S.,University of Palermo | And 8 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objective: To study the expression of interleukin (IL)-33 and to evaluate its relationship with macrophage polarisation in artery biopsy specimens from patients with giant cell arteritis (GCA). Methods: IL-33, ST2, p-STAT-6 and perivascular IL-1 receptor-associated kinase 1 (p-IRAK1) tissue distribution was evaluated by immunohistochemistry. Inducible nitric oxide synthase and CD163 were also used by immunohistochemistry to evaluate the M1 and M2 polarisation, respectively. Quantitative gene expression analysis of IL-33, T-helper (Th)2-related transcription factor STAT6, Th2 cytokines (IL-4, IL-5, IL-25) and interferon (IFN)-γ was performed in artery biopsy samples obtained from 20 patients with GCA and 15 controls. Five additional patients who had received prednisone when the temporal artery biopsy was performed were also enrolled. Results: IFN-γ and IL-33 were significantly overexpressed in the in flamed arteries of GCA patients. IL-33 overexpression was not accompanied by a concomitant increase of Th2 cytokines. Neovessels scattered through the inflammatory infiltrates were the main sites of IL-33 expression. The expression of IL-33 receptor ST2 and of p-IRAK1 was also increased in GCA patients. Arteries from glucocorticoid-treated patients had a lower expression of IL-33. IL-33 was accompanied by the expression of p-STAT6 and a clear M2 macrophages polarisation. Conclusions: A role for IL-33 in the inflammation of GCA patients is supported by these findings.


Salvarani C.,Unita Operativa di Reumatologia | Pipitone N.,Unita Operativa di Reumatologia | Hunder G.G.,Mayo Medical School
Current Opinion in Rheumatology | Year: 2016

Purpose of review This article summarizes the current evidence on the management of primary and secondary central nervous system (CNS) vasculitis. Recent findings Two recent retrospective cohort studies have described the treatment and outcomes of patients with adult primary central nervous system vasculitis (PCNSV). Although the majority of the patients (>60%) responded to therapy with glucocorticoids alone or in conjunction with cyclophosphamide (CYC) and tended to improve during the follow-up period, an overall increased mortality was observed. The treatment response and the outcomes appeared primarily related to the size of the vessels involved in the inflammatory process. The involvement of small cortical/leptomeningeal vessels was associated with a more benign course, whereas the involvement of larger/proximal cerebral vessels was related to a less favorable prognosis and identified cases that should be treated more aggressively. Glucocorticoids combined with CYC are the mainstay of therapy for secondary CNS vasculitis. Observational studies have documented the efficacy of rituximab as induction therapy in patients with antineutrophil cytoplasm antibody-associated vasculitis (AAV) and CNS disease, while the role of antitumor necrosis factor (TNF) agents is more controversial. Case series have demonstrated the efficacy of anti-TNF agents in patients with neuro-Behçet's disease. Tocilizumab may also be effective in this condition. Summary Recognition of findings at diagnosis that predict the course or outcomes of PCNSV may serve as guide for therapy. Biological agents may provide benefit to difficult-to-treat patients with CNS involvement secondary to AAV and Behçet's disease. © Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.


Catanoso M.,Unita Operativa di Reumatologia
Internal and emergency medicine | Year: 2011

Biological agents have originally been developed to treat refractory arthritis, but evidence has been accruing, supporting their use in vasculitis as well. In the large-vessel vasculitides giant cell arteritis and Takayasu arteritis, TNF-α inhibitors have shown some efficacy in patients with relapsing disease. In contrast, in patients with recent onset of giant cell arteritis, TNF-α inhibitors failed to provide a significant benefit over and above that conferred by glucocorticoids alone. More recent, preliminary data suggest a role for the interleukin-6 receptor antagonist tocilizumab in both resistant and treatment-naïve giant cell arteritis and Takayasu arteritis. Biological agents have also been proposed to treat difficult anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. Uncontrolled observations suggest that the TNF-α inhibitor infliximab might be beneficial in resistant cases. On the contrary, a randomized controlled trial did not show superiority of the recombinant human soluble TNF-α p75 receptor fusion protein etanercept over placebo in maintaining remission in granulomatosis with polyangiitis. Two randomized controlled trials have demonstrated that the anti-CD20 monoclonal antibody rituximab was as effective as the standard-of-care agent cyclophosphamide in inducing remission. In addition, rituximab appeared to be superior to cyclophosphamide in inducing remission in the subset of patients with relapsing disease. These findings prove that biological therapy has a role in vasculitis. Research is investigating novel therapies as well as focusing on how to best use the available drugs.


Macchioni P.,Unita Operativa di Reumatologia | Boiardi L.,Unita Operativa di Reumatologia | Catanoso M.,Unita Operativa di Reumatologia | Pazzola G.,Unita Operativa di Reumatologia | Salvarani C.,Unita Operativa di Reumatologia
Annals of the Rheumatic Diseases | Year: 2014

Objective To compare the performance of published classification/diagnostic criteria for polymyalgia rheumatica (PMR), including the new 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria, in a single-centre study. Methods: We studied all consecutive patients with new-onset PMR seen in our centre over 6 years, whose diagnosis was confirmed during a prospective 12-month follow-up period. Subjects were classified by each of the seven different criteria. Sensitivity and specificity were compared. Control population consisted of all consecutive patients aged ≥50 years seen in a 4-year period in our early arthritis clinic who had a 12-month confirmation of a diagnosis of rheumatoid arthritis (RA) or other inflammatory articular diseases. Results: Data were collected from 136 cases and 149 controls, including 94 patients with RA. The most sensitive criteria were the new 2012 EULAR/ACR classification criteria (92.6%). Adding ultrasound (US) specificity increased from 81.5% to 91.3% in total cases and from 79.7% to 89.9% in RA. Bird criteria had a sensitivity of 89.2% but the lowest specificity (40.2% in total cases and 72.5% in RA). Jones and Nobunaga criteria were the most specific criteria (96.7% and 97.8% in total cases and 98.6% and 99.5% in RA) but the less sensitive (63.1% and 58.2%) ones. Overall, discriminatory ability, as reflected by the area under the receiver operating characteristic curve, was better for the 2012 US EULAR/ACR criteria (0.920 in total cases and 0.910 in RA). Conclusions: The new EULAR/ACR criteria in newonset PMR patients perform best in discriminating PMR from RA and other inflammatory articular diseases. Ultrasound further increases the specificity of the criteria.


Salvarani C.,Unita Operativa di Reumatologia | Brown R.D.,Mayo Medical School | Christianson T.J.H.,Mayo Medical School | Huston J.,Mayo Medical School | And 4 more authors.
Seminars in Arthritis and Rheumatism | Year: 2015

Objective: To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in adult primary central nervous system vasculitis (PCNSV). Methods: We studied a cohort of 163 patients with PCNSV who were seen at the Mayo Clinic from 1983 to 2011. We compared patients treated with MMF and those receiving other therapies. Results: We identified 16 patients treated with MMF. MMF in combination with GCs achieved a favorable response in most patients. A significant proportion of patients treated with MMF had a less severe disability at last follow-up compared to those receiving other therapies (p = 0.023) and cyclophosphamide and prednisone (p = 0.017). No statistically significant differences were observed regarding relapses and ability to discontinue therapy at last follow-up. A trend to a more favorable treatment response was observed in patients treated with MMF compared to those treated with other therapies (p = 0.075). Only 1 patient suspended MMF for severe leukopenia. Conclusion: MMF seems to be an effective and safe therapy for adult PCNSV. © 2015 Elsevier Inc.


Bozzola E.,Unita Operativa di Malattie Infettive | Krzysztofiak A.,Unita Operativa di Malattie Infettive | Cortis E.,Unita Operativa di Reumatologia
Infezioni in Medicina | Year: 2010

Human parvovirus B19 (HPV-B19) is usually a self-limiting infection in immunocompetent children. In this case report, instead, we describe an immunocompotent child with evidence of persistent HPV-B19 infection, arthritis and neurological impairment. He was first admitted to hospital for HPV-B19 infection and sent home in good clinical condition after anti-inflammatory therapy. Eight months later he was re-admitted to hospital for episodes of arthritis and weakness, myalgia, tremors in his legs and hands, and was unable to walk unaided. In both plasma and serum, HPV-B19 DNA, detected by polymerase chain reaction, was still present. For neurological symptoms, he underwent magnetic resonance, which showed increased signal intensity at the spinal roots in the lumbar region, compatible with polyradiculoneuritis. After immunoglobulin therapy he had an excellent response in clinical and radiological terms, suggesting an association between neurological impairment and HPV-B19 infection. Eleven months after the second admission, the patient was still in good clinical condition.


Giannini C.,Mayo Medical School | Salvarani C.,Unita Operativa di Reumatologia | Hunder G.,Mayo Medical School | Brown R.D.,Mayo Medical School
Acta Neuropathologica | Year: 2012

Primary vasculitis of the central nervous system (PCNSV) is a rare and diagnostically challenging form of vasculitis limited to the brain and/or spinal cord. It is a complex and often severe disease with multifaceted clinical and pathological appearances, suggesting multiple disease subtypes and the potential existence of multiple etiologic pathways. We describe in detail the clinical, imaging, and neuropathological findings of PCNSV summarizing literature data and our observations from a cohort of 131 patients diagnosed at Mayo Clinic over a 25-year period (1983-2007). Unlike systemic vasculitis, little is known regarding PCNSV pathogenesis and the involved immunological mechanisms. Increased recognition of the disease spectrum and in-depth characterization of its histopathologic and immunological phenotype will be critical to eventually understanding the underlying derangements and mechanisms driving PCNSV. Improved understanding of the pathogenetic mechanisms of the disease may also help determine whether the different histologic patterns and clinical subsets represent more than one disease and ultimately may permit development of novel diagnostic and therapeutic strategies for it. © Springer-Verlag 2012.

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