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Research paper thumbnail of Potential Short-Term Air Pollution Effects on Rheumatoid Arthritis Activity in Metropolitan Areas in the North of Italy: A Cross-Sectional Study

International Journal of Environmental Research and Public Health, Aug 11, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Short-term exposure to outdoor air pollutants and rheumatoid arthritis activity in metropolitan areas in the North of Italy

Background: Air pollution is believed to cause oxidative stress and systemic inflammation, that c... more Background: Air pollution is believed to cause oxidative stress and systemic inflammation, that could trigger autoimmunity in rheumatoid arthritis (RA). Several epidemiological studies investigated the possible role of air pollution in the outbreak of RA with controversial results. As far as we know, studies on the effects on disease activity of short-term exposure have not been published. Objectives: To evaluate the impact of short-term exposure to air pollutants (daily mean PM10, PM2.5, NO2 and O3) on disease activity in patients with RA. Methods: Consecutive patients with RA (ACR/EULAR Criteria 2010) resident in Lombardy (Italy) were enrolled. In each patient Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI) were assessed. Daily PM10, PM2.5, NO2 and O3 concentrations, estimated by Regional Environmental Protection Agency at municipality resolution, were used to assign short-term exposure from day of visit back to 14 days. Multivariable linear regression models were performed to identify the day of the pollutants independently associated with disease activity indices, adjusting for the variables significant at the univariate analysis. \u3b2 coefficients were reported for 1 \u3bcg/m3 increments of pollutants\u2019 concentrations. Results: 422 RA patients were enrolled in the study between January and June 2018: 81.5% females, mean age 58.2\ub113.3 years, mean disease duration 16.1\ub111.5 years, 27.3% current smokers, 59.5% RF positivity, 54.5% ACPA positivity. Sparse punctual statistically significant negative associations emerged at the multivariate analysis between PM10, PM2.5, NO2 and the outcomes, although with very low estimates, whereas positive associations resulted for O3. Afterwards patients were stratified in 3 subgroups according to their ongoing treatment (no therapy, n=25, conventional synthetic Disease Modifying anti-Rheumatic Drugs -DMARDs-, n=108 and biological or targeted synthetic DMARDs, n=289). A statistical significance was found by analysing the influence of therapy on the interaction between PM2.5 and DAS28 (Figure below): a positive trend between PM2.5 and DAS28 appeared in the first two groups (no therapy, 0.013\ub10.007, p=0.06 and csDMARDs, 0.006\ub10.004, p=0.17), whereas a statistically significant inverse association was seen in the b/tsDMARDs group (-0.005\ub10.002, p=0.01). Therapy interaction was particularly evident in several days before the visit also for O3. Conclusion: The changes of the outcome measures related to the increase of the pollutants\u2019 levels did not reach the minimal clinically important difference, therefore air pollution seems barely relevant on disease activity once the loss of tolerance is established in RA. O3 and PM/NO2 always exhibit an opposite performance having inversely proportional atmospheric concentrations, whereas the biological role of this substance is still matter of debate and will need further understanding. Therapy seems to be able to interact with the relation between air pollutants and the parameters considered

Research paper thumbnail of THU0116 is the Role of Medical Consultation in Rheumatoid Arthritis a Timely Topic?

Annals of the Rheumatic Diseases, Jun 1, 2020

Conversely, median age at RA-ILD diagnosis, positive ratio of anti-CCP antibody, smoking habits, ... more Conversely, median age at RA-ILD diagnosis, positive ratio of anti-CCP antibody, smoking habits, respiratory comorbidities, SDAI score, and therapeutics at both RA-ILD and AE onset had no significant associations with AE. Patients with initial serum KL-6 > 551 U/mL at RA-ILD onset and ΔKL-6 > 10%/year before AE had a significantly worse AE-free survival rate compared to others (p < 0.001). (Figure 1). Moreover, patients with AE had significantly lower overall survival rate (p < 0.001) and respiratory-related deaths-free survival rate (p < 0.001) than those without AE.

Research paper thumbnail of The burden of air pollution and temperature on Raynaud's phenomenon secondary to systemic sclerosis

Epidemiologia e prevenzione, Jul 1, 2020

OBJECTIVES to evaluate the effect of air pollution (ozone - O3 and particulate matter <=10 μm ... more OBJECTIVES to evaluate the effect of air pollution (ozone - O3 and particulate matter <=10 μm and <=2.5 μm - PM10 and PM2.5) on the severity of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc). DESIGN cross-sectional, observational, and single centre study. SETTING AND PARTICIPANTS all consecutive SSc patients residing in Lombardy (Northern Italy) were enrolled. PM10, PM2.5, and O3 concentrations were calculated for each patient at municipality resolution in the week before the evaluation. Similar considerations were made for meteorological variables (temperature and humidity). MAIN OUTCOME MEASURES patients were asked to assess RP severity during the week before the evaluation according to a visual analogue scale (VAS). Ordinal logistic regression models were fitted to evaluate the short-term effect of temperature and air pollution with respect to RP. A univariate linear regression model was created to consider the association between temperature and pollutants. RESULTS in this study, 87 SSc patients were enrolled. Temperature was confirmed to strongly influence RP severity. PM10 and PM.5 were found to significantly worsen RP severity for the first four days before the evaluation, including the day of the visit, and as mean up to six days before the evaluation. O3 seemed to exert a protective effect on RP severity that was significant for the first four days before the evaluation, including the day of the visit, and as mean up to seven days before the evaluation. CONCLUSIONS since the overwhelming effect of temperature on RP, final conclusions about the exact contribution of pollutants on RP severity cannot be drawn because of the strong inter-correlation between air pollution and temperature.

Research paper thumbnail of The role of extracellular vesicles in rheumatoid arthritis: a systematic review

Clinical Rheumatology, Feb 5, 2021

Rheumatoid arthritis (RA) is a chronic inflammatory disease that carries high social and economic... more Rheumatoid arthritis (RA) is a chronic inflammatory disease that carries high social and economic costs and can lead to permanent disability. RA pathogenesis has not been completely elucidated yet. Extracellular vesicles (EVs) are membrane-contained vesicles released by cells playing a role in cell-to-cell communication and they could be involved in different diseases. Evidence on the involvement of EVs in RA is currently inconclusive. Therefore, a systematic review on the role of EVs in RA was performed in order to explore this relationship. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was conducted on PubMed, Scopus, and Embase up to March 5, 2020: 41 studies were analyzed out of 674 screened. The total plasmatic and synovial fluid (SF) EV number seems increased in RA as compared with healthy controls. Both RA plasma and SF contained EVs subpopulations of heterogenous origin, especially derived from platelets and immune system cells. No univocal evidence emerged on miRNA expression and EV content profile within RA patients. EVs showed to enhance pro-inflammatory pathways, such as cytokines and chemokine release and TNF blockade seemed to revert this effect. Our work highlights the requirement to standardize study methodologies in order to make results comparable and draw conclusions that remain, at present, unclear.

Research paper thumbnail of Relevant non‐pharmacologic topics for clinical research in rheumatic musculoskeletal diseases: The patient perspective

International Journal of Rheumatic Diseases, Aug 5, 2020

ObjectiveThe research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and pa... more ObjectiveThe research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and patient involvement is an emerging issue to obtain relevant information to research. Despite growing interest in non‐pharmacologic aspects of clinical research in RMDs, the patients’ perspectives are currently poorly explored.MethodsA cross‐sectional no‐profit online survey was devised to identify and rank the priorities for clinical research in RMDs according to patients’ perspectives. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, work activity, social participation, physical activity, emotional well‐being/stress, alternative medicine, and patient‐physician relationship. The survey was disseminated by ALOMAR (Lombard Association for Rheumatic Diseases) between June and October 2019.ResultsTwo hundred RMD patients completed the survey. The topic most rated 188 (94%) was the doctor‐patient relationship, considered very or extremely important. Other topics rated as follows: psychological well‐being 185 (92.5%), physical activity 155 (77.5%), nutrition, eating habits 150 (75%), alternative therapies 144 (72%), work activity 144 (72%), environmental pollution 134 (67%), social life 121 (60.5%) and cigarette smoke 119 (59.5%). The topics considered relevant were perceived to be able to influence disease symptoms. Environmental pollution and smoking were considered the most important for RMD prevention in 43.3% and 48.7% respectively.ConclusionsThis survey highlights the relevance of several unmet needs and indicates that active patient involvement is essential to design successful translational studies and improve clinical outcomes.

Research paper thumbnail of Rheumatoid Arthritis Activity and Short-Term Exposure to Air Pollutants in Metropolitan Areas in the North of Italy

Authorea (Authorea), Nov 9, 2020

This a preprint and has not been peer reviewed. Data may be preliminary.

Research paper thumbnail of Physician-patient relationship in rheumatoid arthritis management

Acta Reumatologica Portuguesa, 2021

Research paper thumbnail of AB0229 Short-Term Exposure to Outdoor Air Pollutants and Rheumatoid Arthritis Activity in Metropolitan Areas in the North of Italy

Annals of the Rheumatic Diseases, Jun 1, 2020

Background:Air pollution is believed to cause oxidative stress and systemic inflammation, that co... more Background:Air pollution is believed to cause oxidative stress and systemic inflammation, that could trigger autoimmunity in rheumatoid arthritis (RA). Several epidemiological studies investigated the possible role of air pollution in the outbreak of RA with controversial results. As far as we know, studies on the effects on disease activity of short-term exposure have not been published.Objectives:To evaluate the impact of short-term exposure to air pollutants (daily mean PM10, PM2.5, NO2and O3) on disease activity in patients with RA.Methods:Consecutive patients with RA (ACR/EULAR Criteria 2010) resident in Lombardy (Italy) were enrolled. In each patient Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI) were assessed. Daily PM10, PM2.5, NO2and O3concentrations, estimated by Regional Environmental Protection Agency at municipality resolution, were used to assign short-term exposure from day of visit back to 14 days. Multivariable linear regression models were performed to identify the day of the pollutants independently associated with disease activity indices, adjusting for the variables significant at the univariate analysis. β coefficients were reported for 1 μg/m3increments of pollutants’ concentrations.Results:422 RA patients were enrolled in the study between January and June 2018: 81.5% females, mean age 58.2±13.3 years, mean disease duration 16.1±11.5 years, 27.3% current smokers, 59.5% RF positivity, 54.5% ACPA positivity. Sparse punctual statistically significant negative associations emerged at the multivariate analysis between PM10, PM2.5, NO2and the outcomes, although with very low estimates, whereas positive associations resulted for O3.Afterwards patients were stratified in 3 subgroups according to their ongoing treatment (no therapy, n=25, conventional synthetic Disease Modifying anti-Rheumatic Drugs -DMARDs-, n=108 and biological or targeted synthetic DMARDs, n=289). A statistical significance was found by analysing the influence of therapy on the interaction between PM2.5and DAS28 (Figure below): a positive trend between PM2.5and DAS28 appeared in the first two groups (no therapy, 0.013±0.007, p=0.06 and csDMARDs, 0.006±0.004, p=0.17), whereas a statistically significant inverse association was seen in the b/tsDMARDs group (-0.005±0.002, p=0.01). Therapy interaction was particularly evident in several days before the visit also for O3.Conclusion:The changes of the outcome measures related to the increase of the pollutants’ levels did not reach the minimal clinically important difference, therefore air pollution seems barely relevant on disease activity once the loss of tolerance is established in RA. O3and PM/NO2always exhibit an opposite performance having inversely proportional atmospheric concentrations, whereas the biological role of this substance is still matter of debate and will need further understanding. Therapy seems to be able to interact with the relation between air pollutants and the parameters considered.Disclosure of Interests:Francesca Ingegnoli: None declared, Tania Ubiali: None declared, Tommaso Schioppo: None declared, Valentina Longo: None declared, Simona Iodice: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Orazio De Lucia: None declared, Antonella Murgo: None declared, Valentina Bollati: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp &amp;amp; Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

Research paper thumbnail of SAT0090 Effects of Adherence to Mediterranean Diet on Rheumatoid Arthritis Impact of Disease (Raid) Score

Annals of the Rheumatic Diseases, Jun 1, 2020

Background: Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially an... more Background: Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially anti-inflammatory diet that encompasses all food groups. Presently, there are conflicting data about the benefits of MD in rheumatoid arthritis (RA). Not enough evidence support a role of MD in the prevention and treatment of RA, and a modest impact of MD on laboratory parameters has been described. Greater effect on subjective aspects of the disease such as joint pain, morning stiffness, and fatigue was reported. Objectives: To investigate whether the adherence to MD affects RA perception as measured by Rheumatoid Arthritis Impact of Disease (RAID) score. Methods: Consecutive patients Results: 205 RA patients were enrolled: median age at visit 53 (q1-q3: 44-59) years, female 80.5 %. The median MD and RAID score were 35 (q1-q3: 32-39) and 2.42 (q1-q3: 0.63-4.51) respectively. RAID total score had a statistically significant negative relationship with MD score (regression coefficient -0.08; p-value=0.016). Concerning the single RAID items, a statistically significant negative association was found for pain (regression coefficient -0.08; p-value=0.025), functional disability (regression coefficient -0.13; p-value Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other. Conclusion: To our knowledge, this is the first study addressing the relationship between the adherence to MD and the perception of RA impact. A better MD adherence was associated with lower self-reported composite total RAID score as well as lower pain, functional disability, sleep, physical well-being and coping. The effect of MD adherence on overall RAID is relevant but, at the same time, a prominent effect of one single item on the others could not be documented. This study confirmed the importance of non-pharmacological interventions, such as diet, in RA management. References: [1] Gossec L, et al. Ann Rheum Dis 2011;70(6):935-42. [2] Panagiotakos DB, et al. Nutr Metab Cardiovasc Dis 2006;16(8):559-68. Disclosure of Interests: Francesca Ingegnoli: None declared, Isabella Scotti: None declared, Tommaso Schioppo: None declared, Tania Ubiali: None declared, Giuseppe Marano: None declared, Patrizia Boracchi: None declared, Orazio De Lucia: None declared, Antonella Murgo: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

Research paper thumbnail of Adherence to Mediterranean diet and patient perception of rheumatoid arthritis

Complementary Therapies in Medicine, Aug 1, 2020

To evaluate the association between the adherence to Mediterranean diet (MD) and disease impact, ... more To evaluate the association between the adherence to Mediterranean diet (MD) and disease impact, activity, and comorbidities in patients with rheumatoid arthritis (RA). Design: Consecutive patients with RA were enrolled in this cross-sectional study. For each patient, Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI), RA Impact of Disease (RAID), Health Assessment Questionnaire (HAQ), patient global assessment (PGA) and general health (GH) and a self-reported questionnaire called MD score were recorded. Results: 205 RA patients (median age 53 years, female 80.49 %) were enrolled. An association between MD score and HAQ (p-value = 0.033), PGA and GH (p-value 0.023 both) was observed. RAID total score had a statistically significant negative relationship with MD score (p-value = 0.016). A statistically significant negative association was found for pain (p-value = 0.025), functional disability (p-value < 0.001), sleep (p-value = 0.041), physical well-being (p-value = 0.027) and coping (p-value = 0.008). Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other. A negative trend, although not statistically significant was found for DAS28 and SDAI. The only comorbidity associated with MD score was arterial hypertension (OR = 0.94). Conclusions: In this Italian RA cohort, the adherence to MD was significantly associated with a better RAID, PGA and GH, but higher MD score was not significantly associated with lower disease activity. Our study suggests an overall potential beneficial effect of MD in RA patients.

Research paper thumbnail of Is the role of medical consultation in rheumatoid arthritis a timely topic

Background: Despite the treat-to-target recommendations and the efforts in dissecting factors tha... more Background: Despite the treat-to-target recommendations and the efforts in dissecting factors that contribute to achieving disease control, the goal of remission in rheumatoid arthritis (RA) is accomplished in less than half of patients. Disease activity is assessed using composite indexes which are reliant on patient-reported outcomes, mainly the patient global assessment of disease activity (PGA). The debate on variables that can influence PGA is still open, and different internal and external factors had been taken into account: the origin of pain symptoms, psychosocial and lifestyle factors. Objectives: To canvass the opinion of RA Italian patients concerning patient-perceived topics that matter most for future research. Methods: A cross-sectional no-profit on-line anonymous survey was devised to evaluate opinions of the rheumatic diseases patients. In this sub-study we focused only on the data about RA patients. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, type of work, social participation, physical activity, emotional well-being/stress, alternative medicine, patient-physician relationship. Moreover, patients were inquired about why the topic was considered important (disease prevention, stop disease progression, control symptoms, cure the disease). The survey was disseminated between June and October 2019. Descriptive statistics were used to summarize the patient demographic, clinical data and survey results. Results: 94% (82/87) of RA patients (81 female, median age 50 yrs) rated the patient-physician relationship as the main topic for future research (figure below). Likewise, intriguing results came from the reasons of previous patient rating: the patient-physician relationship was considered important for a better control of RA symptoms (48.8%), to cure the disease (30.5%), to stop disease progression (19.5%), and to prevent the disease (1.2%). These results were similar in all age groups. Conclusion: These results highlight that the importance of medical consultation to patients and its impact on disease control should not be under-estimated. Administrative duties, time and economic constraints undermine the patient-physician relationship that is central to clinical care. The limited time spent for medical consultation is directly related to patient dissatisfaction, which in turn, may influence the patient\\u2019s perception about the absence of disease activity and could be one of motives behind the worse evaluation of PGA. Acknowledgments: We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR), Maria Vittoria Ausilio and Patrizia Angiolillo from the IT service of the University of Milan

Research paper thumbnail of Early and Late Response and Glucocorticoid-Sparing Effect of Belimumab in Patients with Systemic Lupus Erythematosus with Joint and Skin Manifestations: Results from the Belimumab in Real Life Setting Study—Joint and Skin (BeRLiSS-JS)

Journal of Personalized Medicine, Apr 20, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of POS0693 EFFICACY and Safety of Belimumab in Patients with Lupus Nephritis in Real-Life Setting: Results from a Large, Nationwide, Multicentric, Prospective Cohort

Annals of the Rheumatic Diseases, 2021

Background:LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarg... more Background:LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarget therapy is needed to control the disease especially in refractory cases.Objectives:To evaluate renal response in SLE patients with glomerulonephritis (GN) treated with Belimumab in real-life setting.Methods:Patients with proteinuria >0.5 g/24 h and/or active sediment at baseline enrolled in a multicentre Italian cohort of SLE patients (BeRLiSS study), treated with monthly iv Belimumab 10 mg/kg plus standard of care were considered in this study. Complete renal response (CRR) was defined as proteinuria <0.5 g/24 h, estimated glomerular filtration rate (eGFR)≥90ml/min/1.73m2 and no rescue therapy. Primary efficacy renal response (PERR) was defined as proteinuria ≤0.7 g/24 h, eGFR ≥60ml/min/1.73m2 and no rescue therapy. Prevalence and predictive factors of CRR and PERR at 12 and 24 months after Belimumab initiation were analyzed by multivariate logistic regression analysis.Results:...

Research paper thumbnail of Primary Antiphospholipid Syndrome Patients Display Increased Levels of Cell-Bound C4d in Comparison to SLE and Healthy Donors

Research paper thumbnail of Does Pizza Consumption Favor an Improved Disease Activity in Rheumatoid Arthritis?

Nutrients

To our knowledge, no studies so far have investigated the role of pizza and its ingredients in mo... more To our knowledge, no studies so far have investigated the role of pizza and its ingredients in modulating disease activity in rheumatoid arthritis (RA). We assessed this question via a recent cross-sectional study including 365 participants from Italy, the birthplace of pizza. Multiple robust linear and logistic regression models were fitted with the tertile consumption categories of each available pizza-related food item/group (i.e., pizza, refined grains, mozzarella cheese, and olive oil) as independent variables, and each available RA activity measure (i.e., the Disease Activity Score on 28 joints with C-reactive protein (DAS28-CRP), and the Simplified Disease Activity Index (SDAI)) as the dependent variable. Stratified analyses were carried out according to the disease severity or duration. Participants eating half a pizza >1 time/week (vs. ≤2 times/month) reported beneficial effects on disease activity, with the significant reductions of ~70% (overall analysis), and 80% (the...

Research paper thumbnail of AB1098 Early prosthesis implantation is possible in patients affected by juvenile idiopathic arthritis, treated with biologics: a monocentric experience of 160 prosthesis from the last twenty years

Paediatric rheumatology, 2018

Conclusions: Kids can have a variety of musculoskeletal disorders. We feel that management of rhe... more Conclusions: Kids can have a variety of musculoskeletal disorders. We feel that management of rheumatological conditions in kids need to be approached in a multidisciplinary way. Genetic disorders mimicking inflammatory conditions need to be considered all time. In those places particularly where paediatric rheumatologists are not available, involvement of paediatricians may be useful. In terms of PPRD, it is commonly mistaken as juvenile rheumatoid arthritis, however there is no inflammatory process going on in PPRD.

Research paper thumbnail of Is the role of medical consultation in rheumatoid arthritis a timely topic

EULAR 2019 : Congress of the European League against Rheumatism, Jun 1, 2020

Background: Despite the treat-to-target recommendations and the efforts in dissecting factors tha... more Background: Despite the treat-to-target recommendations and the efforts in dissecting factors that contribute to achieving disease control, the goal of remission in rheumatoid arthritis (RA) is accomplished in less than half of patients. Disease activity is assessed using composite indexes which are reliant on patient-reported outcomes, mainly the patient global assessment of disease activity (PGA). The debate on variables that can influence PGA is still open, and different internal and external factors had been taken into account: the origin of pain symptoms, psychosocial and lifestyle factors. Objectives: To canvass the opinion of RA Italian patients concerning patient-perceived topics that matter most for future research. Methods: A cross-sectional no-profit on-line anonymous survey was devised to evaluate opinions of the rheumatic diseases patients. In this sub-study we focused only on the data about RA patients. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, type of work, social participation, physical activity, emotional well-being/stress, alternative medicine, patient-physician relationship. Moreover, patients were inquired about why the topic was considered important (disease prevention, stop disease progression, control symptoms, cure the disease). The survey was disseminated between June and October 2019. Descriptive statistics were used to summarize the patient demographic, clinical data and survey results. Results: 94% (82/87) of RA patients (81 female, median age 50 yrs) rated the patient-physician relationship as the main topic for future research (figure below). Likewise, intriguing results came from the reasons of previous patient rating: the patient-physician relationship was considered important for a better control of RA symptoms (48.8%), to cure the disease (30.5%), to stop disease progression (19.5%), and to prevent the disease (1.2%). These results were similar in all age groups. Conclusion: These results highlight that the importance of medical consultation to patients and its impact on disease control should not be under-estimated. Administrative duties, time and economic constraints undermine the patient-physician relationship that is central to clinical care. The limited time spent for medical consultation is directly related to patient dissatisfaction, which in turn, may influence the patient\u2019s perception about the absence of disease activity and could be one of motives behind the worse evaluation of PGA. Acknowledgments: We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR), Maria Vittoria Ausilio and Patrizia Angiolillo from the IT service of the University of Milan

Research paper thumbnail of Hyaluronic Acid Therapy in Hip OA Does Not Perform Equally in Osteoarthritis Secondary to Juvenile Idiopathic Arthritis When Compared to Primary Osteoarthritis: A 2-Year Preliminary Evaluation

Advances in Therapy, 2022

Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain an... more Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain and disability. Total hip arthroplasty (THA) is considered the standard when medical approaches fail to relieve pain. However, THA is problematic for many reasons. As current literature lacks studies valuating medical management of osteoarthritis (OA) secondary to JIA, we assessed the long-term pain relief effect of US-guided intra-articular viscosupplementation in hip osteoarthritis secondary to JIA versus primary OA under different etiological conditions. Patients in both groups received intra-articular Hylan G-F 20 2 ml once a month for 3 consecutive months and every 6 months for 2 years as maintenance. Effectiveness (VAS and WOMAC), NSAID/analgesic consumption, tolerability, withdrawals and reason for discontinuation were collected at each time point. An inverse probability weighting was used to balance the two groups. We retrospectively retrieved data of 14 JIA patients and 26 primary OA. Weighting successfully accounted for differences between the disease groups supporting the results. Viscosupplementation led to an early and significant improvement of pain and function and concomitant decrease in NSAIDs consumption, while the response diverged over 1 year with loss of benefits in JIA. The worst outcome was observed in active JIA. Duration of symptom relief after intra-articular injection of hyaluronic acid depends on the nature of arthritis. Multiple courses of viscosupplementation are required to maintain low-dose NSAIDs consumption in patients responsive to treatment while shortening the time between consecutive injections might provide persistent positive results in patients suffering from JIA.

Research paper thumbnail of EEcacy, Safety, and Predictor of Response to Belimumab in a Large Nationwide Cohort Study of Patients with Active Systemic Lupus Erythematosus

Research paper thumbnail of Potential Short-Term Air Pollution Effects on Rheumatoid Arthritis Activity in Metropolitan Areas in the North of Italy: A Cross-Sectional Study

International Journal of Environmental Research and Public Health, Aug 11, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Short-term exposure to outdoor air pollutants and rheumatoid arthritis activity in metropolitan areas in the North of Italy

Background: Air pollution is believed to cause oxidative stress and systemic inflammation, that c... more Background: Air pollution is believed to cause oxidative stress and systemic inflammation, that could trigger autoimmunity in rheumatoid arthritis (RA). Several epidemiological studies investigated the possible role of air pollution in the outbreak of RA with controversial results. As far as we know, studies on the effects on disease activity of short-term exposure have not been published. Objectives: To evaluate the impact of short-term exposure to air pollutants (daily mean PM10, PM2.5, NO2 and O3) on disease activity in patients with RA. Methods: Consecutive patients with RA (ACR/EULAR Criteria 2010) resident in Lombardy (Italy) were enrolled. In each patient Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI) were assessed. Daily PM10, PM2.5, NO2 and O3 concentrations, estimated by Regional Environmental Protection Agency at municipality resolution, were used to assign short-term exposure from day of visit back to 14 days. Multivariable linear regression models were performed to identify the day of the pollutants independently associated with disease activity indices, adjusting for the variables significant at the univariate analysis. \u3b2 coefficients were reported for 1 \u3bcg/m3 increments of pollutants\u2019 concentrations. Results: 422 RA patients were enrolled in the study between January and June 2018: 81.5% females, mean age 58.2\ub113.3 years, mean disease duration 16.1\ub111.5 years, 27.3% current smokers, 59.5% RF positivity, 54.5% ACPA positivity. Sparse punctual statistically significant negative associations emerged at the multivariate analysis between PM10, PM2.5, NO2 and the outcomes, although with very low estimates, whereas positive associations resulted for O3. Afterwards patients were stratified in 3 subgroups according to their ongoing treatment (no therapy, n=25, conventional synthetic Disease Modifying anti-Rheumatic Drugs -DMARDs-, n=108 and biological or targeted synthetic DMARDs, n=289). A statistical significance was found by analysing the influence of therapy on the interaction between PM2.5 and DAS28 (Figure below): a positive trend between PM2.5 and DAS28 appeared in the first two groups (no therapy, 0.013\ub10.007, p=0.06 and csDMARDs, 0.006\ub10.004, p=0.17), whereas a statistically significant inverse association was seen in the b/tsDMARDs group (-0.005\ub10.002, p=0.01). Therapy interaction was particularly evident in several days before the visit also for O3. Conclusion: The changes of the outcome measures related to the increase of the pollutants\u2019 levels did not reach the minimal clinically important difference, therefore air pollution seems barely relevant on disease activity once the loss of tolerance is established in RA. O3 and PM/NO2 always exhibit an opposite performance having inversely proportional atmospheric concentrations, whereas the biological role of this substance is still matter of debate and will need further understanding. Therapy seems to be able to interact with the relation between air pollutants and the parameters considered

Research paper thumbnail of THU0116 is the Role of Medical Consultation in Rheumatoid Arthritis a Timely Topic?

Annals of the Rheumatic Diseases, Jun 1, 2020

Conversely, median age at RA-ILD diagnosis, positive ratio of anti-CCP antibody, smoking habits, ... more Conversely, median age at RA-ILD diagnosis, positive ratio of anti-CCP antibody, smoking habits, respiratory comorbidities, SDAI score, and therapeutics at both RA-ILD and AE onset had no significant associations with AE. Patients with initial serum KL-6 > 551 U/mL at RA-ILD onset and ΔKL-6 > 10%/year before AE had a significantly worse AE-free survival rate compared to others (p < 0.001). (Figure 1). Moreover, patients with AE had significantly lower overall survival rate (p < 0.001) and respiratory-related deaths-free survival rate (p < 0.001) than those without AE.

Research paper thumbnail of The burden of air pollution and temperature on Raynaud's phenomenon secondary to systemic sclerosis

Epidemiologia e prevenzione, Jul 1, 2020

OBJECTIVES to evaluate the effect of air pollution (ozone - O3 and particulate matter <=10 μm ... more OBJECTIVES to evaluate the effect of air pollution (ozone - O3 and particulate matter <=10 μm and <=2.5 μm - PM10 and PM2.5) on the severity of Raynaud's phenomenon (RP) secondary to systemic sclerosis (SSc). DESIGN cross-sectional, observational, and single centre study. SETTING AND PARTICIPANTS all consecutive SSc patients residing in Lombardy (Northern Italy) were enrolled. PM10, PM2.5, and O3 concentrations were calculated for each patient at municipality resolution in the week before the evaluation. Similar considerations were made for meteorological variables (temperature and humidity). MAIN OUTCOME MEASURES patients were asked to assess RP severity during the week before the evaluation according to a visual analogue scale (VAS). Ordinal logistic regression models were fitted to evaluate the short-term effect of temperature and air pollution with respect to RP. A univariate linear regression model was created to consider the association between temperature and pollutants. RESULTS in this study, 87 SSc patients were enrolled. Temperature was confirmed to strongly influence RP severity. PM10 and PM.5 were found to significantly worsen RP severity for the first four days before the evaluation, including the day of the visit, and as mean up to six days before the evaluation. O3 seemed to exert a protective effect on RP severity that was significant for the first four days before the evaluation, including the day of the visit, and as mean up to seven days before the evaluation. CONCLUSIONS since the overwhelming effect of temperature on RP, final conclusions about the exact contribution of pollutants on RP severity cannot be drawn because of the strong inter-correlation between air pollution and temperature.

Research paper thumbnail of The role of extracellular vesicles in rheumatoid arthritis: a systematic review

Clinical Rheumatology, Feb 5, 2021

Rheumatoid arthritis (RA) is a chronic inflammatory disease that carries high social and economic... more Rheumatoid arthritis (RA) is a chronic inflammatory disease that carries high social and economic costs and can lead to permanent disability. RA pathogenesis has not been completely elucidated yet. Extracellular vesicles (EVs) are membrane-contained vesicles released by cells playing a role in cell-to-cell communication and they could be involved in different diseases. Evidence on the involvement of EVs in RA is currently inconclusive. Therefore, a systematic review on the role of EVs in RA was performed in order to explore this relationship. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was conducted on PubMed, Scopus, and Embase up to March 5, 2020: 41 studies were analyzed out of 674 screened. The total plasmatic and synovial fluid (SF) EV number seems increased in RA as compared with healthy controls. Both RA plasma and SF contained EVs subpopulations of heterogenous origin, especially derived from platelets and immune system cells. No univocal evidence emerged on miRNA expression and EV content profile within RA patients. EVs showed to enhance pro-inflammatory pathways, such as cytokines and chemokine release and TNF blockade seemed to revert this effect. Our work highlights the requirement to standardize study methodologies in order to make results comparable and draw conclusions that remain, at present, unclear.

Research paper thumbnail of Relevant non‐pharmacologic topics for clinical research in rheumatic musculoskeletal diseases: The patient perspective

International Journal of Rheumatic Diseases, Aug 5, 2020

ObjectiveThe research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and pa... more ObjectiveThe research approach on rheumatic musculoskeletal diseases (RMDs) is challenging and patient involvement is an emerging issue to obtain relevant information to research. Despite growing interest in non‐pharmacologic aspects of clinical research in RMDs, the patients’ perspectives are currently poorly explored.MethodsA cross‐sectional no‐profit online survey was devised to identify and rank the priorities for clinical research in RMDs according to patients’ perspectives. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, work activity, social participation, physical activity, emotional well‐being/stress, alternative medicine, and patient‐physician relationship. The survey was disseminated by ALOMAR (Lombard Association for Rheumatic Diseases) between June and October 2019.ResultsTwo hundred RMD patients completed the survey. The topic most rated 188 (94%) was the doctor‐patient relationship, considered very or extremely important. Other topics rated as follows: psychological well‐being 185 (92.5%), physical activity 155 (77.5%), nutrition, eating habits 150 (75%), alternative therapies 144 (72%), work activity 144 (72%), environmental pollution 134 (67%), social life 121 (60.5%) and cigarette smoke 119 (59.5%). The topics considered relevant were perceived to be able to influence disease symptoms. Environmental pollution and smoking were considered the most important for RMD prevention in 43.3% and 48.7% respectively.ConclusionsThis survey highlights the relevance of several unmet needs and indicates that active patient involvement is essential to design successful translational studies and improve clinical outcomes.

Research paper thumbnail of Rheumatoid Arthritis Activity and Short-Term Exposure to Air Pollutants in Metropolitan Areas in the North of Italy

Authorea (Authorea), Nov 9, 2020

This a preprint and has not been peer reviewed. Data may be preliminary.

Research paper thumbnail of Physician-patient relationship in rheumatoid arthritis management

Acta Reumatologica Portuguesa, 2021

Research paper thumbnail of AB0229 Short-Term Exposure to Outdoor Air Pollutants and Rheumatoid Arthritis Activity in Metropolitan Areas in the North of Italy

Annals of the Rheumatic Diseases, Jun 1, 2020

Background:Air pollution is believed to cause oxidative stress and systemic inflammation, that co... more Background:Air pollution is believed to cause oxidative stress and systemic inflammation, that could trigger autoimmunity in rheumatoid arthritis (RA). Several epidemiological studies investigated the possible role of air pollution in the outbreak of RA with controversial results. As far as we know, studies on the effects on disease activity of short-term exposure have not been published.Objectives:To evaluate the impact of short-term exposure to air pollutants (daily mean PM10, PM2.5, NO2and O3) on disease activity in patients with RA.Methods:Consecutive patients with RA (ACR/EULAR Criteria 2010) resident in Lombardy (Italy) were enrolled. In each patient Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI) were assessed. Daily PM10, PM2.5, NO2and O3concentrations, estimated by Regional Environmental Protection Agency at municipality resolution, were used to assign short-term exposure from day of visit back to 14 days. Multivariable linear regression models were performed to identify the day of the pollutants independently associated with disease activity indices, adjusting for the variables significant at the univariate analysis. β coefficients were reported for 1 μg/m3increments of pollutants’ concentrations.Results:422 RA patients were enrolled in the study between January and June 2018: 81.5% females, mean age 58.2±13.3 years, mean disease duration 16.1±11.5 years, 27.3% current smokers, 59.5% RF positivity, 54.5% ACPA positivity. Sparse punctual statistically significant negative associations emerged at the multivariate analysis between PM10, PM2.5, NO2and the outcomes, although with very low estimates, whereas positive associations resulted for O3.Afterwards patients were stratified in 3 subgroups according to their ongoing treatment (no therapy, n=25, conventional synthetic Disease Modifying anti-Rheumatic Drugs -DMARDs-, n=108 and biological or targeted synthetic DMARDs, n=289). A statistical significance was found by analysing the influence of therapy on the interaction between PM2.5and DAS28 (Figure below): a positive trend between PM2.5and DAS28 appeared in the first two groups (no therapy, 0.013±0.007, p=0.06 and csDMARDs, 0.006±0.004, p=0.17), whereas a statistically significant inverse association was seen in the b/tsDMARDs group (-0.005±0.002, p=0.01). Therapy interaction was particularly evident in several days before the visit also for O3.Conclusion:The changes of the outcome measures related to the increase of the pollutants’ levels did not reach the minimal clinically important difference, therefore air pollution seems barely relevant on disease activity once the loss of tolerance is established in RA. O3and PM/NO2always exhibit an opposite performance having inversely proportional atmospheric concentrations, whereas the biological role of this substance is still matter of debate and will need further understanding. Therapy seems to be able to interact with the relation between air pollutants and the parameters considered.Disclosure of Interests:Francesca Ingegnoli: None declared, Tania Ubiali: None declared, Tommaso Schioppo: None declared, Valentina Longo: None declared, Simona Iodice: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Orazio De Lucia: None declared, Antonella Murgo: None declared, Valentina Bollati: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp &amp;amp; Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

Research paper thumbnail of SAT0090 Effects of Adherence to Mediterranean Diet on Rheumatoid Arthritis Impact of Disease (Raid) Score

Annals of the Rheumatic Diseases, Jun 1, 2020

Background: Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially an... more Background: Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially anti-inflammatory diet that encompasses all food groups. Presently, there are conflicting data about the benefits of MD in rheumatoid arthritis (RA). Not enough evidence support a role of MD in the prevention and treatment of RA, and a modest impact of MD on laboratory parameters has been described. Greater effect on subjective aspects of the disease such as joint pain, morning stiffness, and fatigue was reported. Objectives: To investigate whether the adherence to MD affects RA perception as measured by Rheumatoid Arthritis Impact of Disease (RAID) score. Methods: Consecutive patients Results: 205 RA patients were enrolled: median age at visit 53 (q1-q3: 44-59) years, female 80.5 %. The median MD and RAID score were 35 (q1-q3: 32-39) and 2.42 (q1-q3: 0.63-4.51) respectively. RAID total score had a statistically significant negative relationship with MD score (regression coefficient -0.08; p-value=0.016). Concerning the single RAID items, a statistically significant negative association was found for pain (regression coefficient -0.08; p-value=0.025), functional disability (regression coefficient -0.13; p-value Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other. Conclusion: To our knowledge, this is the first study addressing the relationship between the adherence to MD and the perception of RA impact. A better MD adherence was associated with lower self-reported composite total RAID score as well as lower pain, functional disability, sleep, physical well-being and coping. The effect of MD adherence on overall RAID is relevant but, at the same time, a prominent effect of one single item on the others could not be documented. This study confirmed the importance of non-pharmacological interventions, such as diet, in RA management. References: [1] Gossec L, et al. Ann Rheum Dis 2011;70(6):935-42. [2] Panagiotakos DB, et al. Nutr Metab Cardiovasc Dis 2006;16(8):559-68. Disclosure of Interests: Francesca Ingegnoli: None declared, Isabella Scotti: None declared, Tommaso Schioppo: None declared, Tania Ubiali: None declared, Giuseppe Marano: None declared, Patrizia Boracchi: None declared, Orazio De Lucia: None declared, Antonella Murgo: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

Research paper thumbnail of Adherence to Mediterranean diet and patient perception of rheumatoid arthritis

Complementary Therapies in Medicine, Aug 1, 2020

To evaluate the association between the adherence to Mediterranean diet (MD) and disease impact, ... more To evaluate the association between the adherence to Mediterranean diet (MD) and disease impact, activity, and comorbidities in patients with rheumatoid arthritis (RA). Design: Consecutive patients with RA were enrolled in this cross-sectional study. For each patient, Disease Activity Score on 28 joints (DAS28), Simple Disease Activity Index (SDAI), RA Impact of Disease (RAID), Health Assessment Questionnaire (HAQ), patient global assessment (PGA) and general health (GH) and a self-reported questionnaire called MD score were recorded. Results: 205 RA patients (median age 53 years, female 80.49 %) were enrolled. An association between MD score and HAQ (p-value = 0.033), PGA and GH (p-value 0.023 both) was observed. RAID total score had a statistically significant negative relationship with MD score (p-value = 0.016). A statistically significant negative association was found for pain (p-value = 0.025), functional disability (p-value < 0.001), sleep (p-value = 0.041), physical well-being (p-value = 0.027) and coping (p-value = 0.008). Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other. A negative trend, although not statistically significant was found for DAS28 and SDAI. The only comorbidity associated with MD score was arterial hypertension (OR = 0.94). Conclusions: In this Italian RA cohort, the adherence to MD was significantly associated with a better RAID, PGA and GH, but higher MD score was not significantly associated with lower disease activity. Our study suggests an overall potential beneficial effect of MD in RA patients.

Research paper thumbnail of Is the role of medical consultation in rheumatoid arthritis a timely topic

Background: Despite the treat-to-target recommendations and the efforts in dissecting factors tha... more Background: Despite the treat-to-target recommendations and the efforts in dissecting factors that contribute to achieving disease control, the goal of remission in rheumatoid arthritis (RA) is accomplished in less than half of patients. Disease activity is assessed using composite indexes which are reliant on patient-reported outcomes, mainly the patient global assessment of disease activity (PGA). The debate on variables that can influence PGA is still open, and different internal and external factors had been taken into account: the origin of pain symptoms, psychosocial and lifestyle factors. Objectives: To canvass the opinion of RA Italian patients concerning patient-perceived topics that matter most for future research. Methods: A cross-sectional no-profit on-line anonymous survey was devised to evaluate opinions of the rheumatic diseases patients. In this sub-study we focused only on the data about RA patients. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, type of work, social participation, physical activity, emotional well-being/stress, alternative medicine, patient-physician relationship. Moreover, patients were inquired about why the topic was considered important (disease prevention, stop disease progression, control symptoms, cure the disease). The survey was disseminated between June and October 2019. Descriptive statistics were used to summarize the patient demographic, clinical data and survey results. Results: 94% (82/87) of RA patients (81 female, median age 50 yrs) rated the patient-physician relationship as the main topic for future research (figure below). Likewise, intriguing results came from the reasons of previous patient rating: the patient-physician relationship was considered important for a better control of RA symptoms (48.8%), to cure the disease (30.5%), to stop disease progression (19.5%), and to prevent the disease (1.2%). These results were similar in all age groups. Conclusion: These results highlight that the importance of medical consultation to patients and its impact on disease control should not be under-estimated. Administrative duties, time and economic constraints undermine the patient-physician relationship that is central to clinical care. The limited time spent for medical consultation is directly related to patient dissatisfaction, which in turn, may influence the patient\\u2019s perception about the absence of disease activity and could be one of motives behind the worse evaluation of PGA. Acknowledgments: We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR), Maria Vittoria Ausilio and Patrizia Angiolillo from the IT service of the University of Milan

Research paper thumbnail of Early and Late Response and Glucocorticoid-Sparing Effect of Belimumab in Patients with Systemic Lupus Erythematosus with Joint and Skin Manifestations: Results from the Belimumab in Real Life Setting Study—Joint and Skin (BeRLiSS-JS)

Journal of Personalized Medicine, Apr 20, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of POS0693 EFFICACY and Safety of Belimumab in Patients with Lupus Nephritis in Real-Life Setting: Results from a Large, Nationwide, Multicentric, Prospective Cohort

Annals of the Rheumatic Diseases, 2021

Background:LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarg... more Background:LN is still a severe manifestation of Systemic lupus erythematosus (SLE) and multitarget therapy is needed to control the disease especially in refractory cases.Objectives:To evaluate renal response in SLE patients with glomerulonephritis (GN) treated with Belimumab in real-life setting.Methods:Patients with proteinuria >0.5 g/24 h and/or active sediment at baseline enrolled in a multicentre Italian cohort of SLE patients (BeRLiSS study), treated with monthly iv Belimumab 10 mg/kg plus standard of care were considered in this study. Complete renal response (CRR) was defined as proteinuria <0.5 g/24 h, estimated glomerular filtration rate (eGFR)≥90ml/min/1.73m2 and no rescue therapy. Primary efficacy renal response (PERR) was defined as proteinuria ≤0.7 g/24 h, eGFR ≥60ml/min/1.73m2 and no rescue therapy. Prevalence and predictive factors of CRR and PERR at 12 and 24 months after Belimumab initiation were analyzed by multivariate logistic regression analysis.Results:...

Research paper thumbnail of Primary Antiphospholipid Syndrome Patients Display Increased Levels of Cell-Bound C4d in Comparison to SLE and Healthy Donors

Research paper thumbnail of Does Pizza Consumption Favor an Improved Disease Activity in Rheumatoid Arthritis?

Nutrients

To our knowledge, no studies so far have investigated the role of pizza and its ingredients in mo... more To our knowledge, no studies so far have investigated the role of pizza and its ingredients in modulating disease activity in rheumatoid arthritis (RA). We assessed this question via a recent cross-sectional study including 365 participants from Italy, the birthplace of pizza. Multiple robust linear and logistic regression models were fitted with the tertile consumption categories of each available pizza-related food item/group (i.e., pizza, refined grains, mozzarella cheese, and olive oil) as independent variables, and each available RA activity measure (i.e., the Disease Activity Score on 28 joints with C-reactive protein (DAS28-CRP), and the Simplified Disease Activity Index (SDAI)) as the dependent variable. Stratified analyses were carried out according to the disease severity or duration. Participants eating half a pizza >1 time/week (vs. ≤2 times/month) reported beneficial effects on disease activity, with the significant reductions of ~70% (overall analysis), and 80% (the...

Research paper thumbnail of AB1098 Early prosthesis implantation is possible in patients affected by juvenile idiopathic arthritis, treated with biologics: a monocentric experience of 160 prosthesis from the last twenty years

Paediatric rheumatology, 2018

Conclusions: Kids can have a variety of musculoskeletal disorders. We feel that management of rhe... more Conclusions: Kids can have a variety of musculoskeletal disorders. We feel that management of rheumatological conditions in kids need to be approached in a multidisciplinary way. Genetic disorders mimicking inflammatory conditions need to be considered all time. In those places particularly where paediatric rheumatologists are not available, involvement of paediatricians may be useful. In terms of PPRD, it is commonly mistaken as juvenile rheumatoid arthritis, however there is no inflammatory process going on in PPRD.

Research paper thumbnail of Is the role of medical consultation in rheumatoid arthritis a timely topic

EULAR 2019 : Congress of the European League against Rheumatism, Jun 1, 2020

Background: Despite the treat-to-target recommendations and the efforts in dissecting factors tha... more Background: Despite the treat-to-target recommendations and the efforts in dissecting factors that contribute to achieving disease control, the goal of remission in rheumatoid arthritis (RA) is accomplished in less than half of patients. Disease activity is assessed using composite indexes which are reliant on patient-reported outcomes, mainly the patient global assessment of disease activity (PGA). The debate on variables that can influence PGA is still open, and different internal and external factors had been taken into account: the origin of pain symptoms, psychosocial and lifestyle factors. Objectives: To canvass the opinion of RA Italian patients concerning patient-perceived topics that matter most for future research. Methods: A cross-sectional no-profit on-line anonymous survey was devised to evaluate opinions of the rheumatic diseases patients. In this sub-study we focused only on the data about RA patients. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, type of work, social participation, physical activity, emotional well-being/stress, alternative medicine, patient-physician relationship. Moreover, patients were inquired about why the topic was considered important (disease prevention, stop disease progression, control symptoms, cure the disease). The survey was disseminated between June and October 2019. Descriptive statistics were used to summarize the patient demographic, clinical data and survey results. Results: 94% (82/87) of RA patients (81 female, median age 50 yrs) rated the patient-physician relationship as the main topic for future research (figure below). Likewise, intriguing results came from the reasons of previous patient rating: the patient-physician relationship was considered important for a better control of RA symptoms (48.8%), to cure the disease (30.5%), to stop disease progression (19.5%), and to prevent the disease (1.2%). These results were similar in all age groups. Conclusion: These results highlight that the importance of medical consultation to patients and its impact on disease control should not be under-estimated. Administrative duties, time and economic constraints undermine the patient-physician relationship that is central to clinical care. The limited time spent for medical consultation is directly related to patient dissatisfaction, which in turn, may influence the patient\u2019s perception about the absence of disease activity and could be one of motives behind the worse evaluation of PGA. Acknowledgments: We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR), Maria Vittoria Ausilio and Patrizia Angiolillo from the IT service of the University of Milan

Research paper thumbnail of Hyaluronic Acid Therapy in Hip OA Does Not Perform Equally in Osteoarthritis Secondary to Juvenile Idiopathic Arthritis When Compared to Primary Osteoarthritis: A 2-Year Preliminary Evaluation

Advances in Therapy, 2022

Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain an... more Hip involvement in juvenile idiopathic arthritis (JIA) is one of most important causes of pain and disability. Total hip arthroplasty (THA) is considered the standard when medical approaches fail to relieve pain. However, THA is problematic for many reasons. As current literature lacks studies valuating medical management of osteoarthritis (OA) secondary to JIA, we assessed the long-term pain relief effect of US-guided intra-articular viscosupplementation in hip osteoarthritis secondary to JIA versus primary OA under different etiological conditions. Patients in both groups received intra-articular Hylan G-F 20 2 ml once a month for 3 consecutive months and every 6 months for 2 years as maintenance. Effectiveness (VAS and WOMAC), NSAID/analgesic consumption, tolerability, withdrawals and reason for discontinuation were collected at each time point. An inverse probability weighting was used to balance the two groups. We retrospectively retrieved data of 14 JIA patients and 26 primary OA. Weighting successfully accounted for differences between the disease groups supporting the results. Viscosupplementation led to an early and significant improvement of pain and function and concomitant decrease in NSAIDs consumption, while the response diverged over 1 year with loss of benefits in JIA. The worst outcome was observed in active JIA. Duration of symptom relief after intra-articular injection of hyaluronic acid depends on the nature of arthritis. Multiple courses of viscosupplementation are required to maintain low-dose NSAIDs consumption in patients responsive to treatment while shortening the time between consecutive injections might provide persistent positive results in patients suffering from JIA.

Research paper thumbnail of EEcacy, Safety, and Predictor of Response to Belimumab in a Large Nationwide Cohort Study of Patients with Active Systemic Lupus Erythematosus