Reumatismo最新文献

Objective: Psoriatic arthritis (PsA) can be treated with biological drugs targeting IL-17A, such as secukinumab, with good responses and long-term positive outcomes in clinical studies.

Methods: An observational study was conducted on adult subjects with PsA and comorbidities, treated with secukinumab after prior therapy with conventional disease-modifying anti-rheumatic drugs or biological agents that were discontinued due to lack of efficacy or adverse drug reactions. Patients were followed up with clinical visits at 3, 6, 9, and 12 months and evaluated for disease activity, pain, and quality of life, with respect to values recorded at baseline. Moreover, a narrative review of the literature was performed on secukinumab's use for PsA in real life.

Results: Fifteen patients completed 6 months of follow-up, eleven patients completed 9 months, and six patients were followed for 12 months. The major comorbidities recorded were fibromyalgia (33% of patients), recurrent bilateral anterior uveitis, and autoimmune thyroiditis with hypothyroidism (both 13% of the patients). A significant improvement in Disease Activity Score-28 was recorded at 6 and 9 months, while a significant difference vs. baseline was seen at 3, 6, and 9 months for the Psoriasis Area Severity Index. The Bath Ankylosing Spondylitis Disease Activity Index showed significant differences vs. baseline at 9 and 12 months. There was an improving trend at 9 and 12 months for pain scores and a significant improvement at 6 and 9 months for the physical component and at 12 months for the social component (Short Form 36 Health Survey quality of life scores). For the review of the literature, 35 articles were identified but only 17 papers were eventually considered.

Conclusions: Secukinumab has demonstrated effectiveness for PsA treatment in several real-world studies. Both patient-oriented and clinician-oriented outcomes showed a significant improvement with this treatment. The present real-world evaluation adds further evidence of the use of secukinumab for PsA treatment, showing the rapid, safe, clinically significant, and sustained responses of PsA patients affected by co-morbidities.

Objective: To assess the adherence to the vaccination campaign against SARS-CoV-2 in patients with immunoglobulin-G4-related disease (IgG4-RD) and to evaluate the development of local and systemic adverse events (AEs) following vaccination. Additionally, to investigate the rate and outcome of SARS-CoV-2 infection in IgG4-RD patients.

Methods: Patients with IgG4-RD in follow-up before the onset of the SARS-CoV-2 pandemic were contacted by telephone and asked to answer an ad hoc questionnaire regarding their vaccination status against SARS-CoV-2 and related AEs following vaccination. The occurrence and the outcome of SARS-CoV-2 infection were also recorded. The same questionnaire was proposed to healthy controls (HC).

Results: 20 patients and 40 HC were enrolled. In the patient's cohort, 90% were vaccinated with at least one dose; among them, 9 reported AEs: 44.4% systemic and 22.2% local. Within the HC group, 100% were vaccinated with at least one dose. 13 out of 40 HC had systemic AEs (50%), and 27 (67.5%) reported local AEs. Neither in IgG4-RD nor in HC, serious adverse reactions were observed. Among the patient's cohort, 60% contracted SARS-CoV-2 infection, and 41.67% were on immunosuppressants at the time of the infection. One patient presented with severe COVID-19. No disease flares following vaccination or infection were reported.

Conclusions: Results from our study indicate a good adherence to the vaccination campaign against SARS-CoV-2 in patients with IgG4-RD and support a relatively good safety profile of this vaccine. Compared to controls, patients with IgG4-RD reported slightly more systemic AEs and fewer local AEs. A similar rate of COVID-19 development was observed between IgG4-RD patients and HC.

Objective: Idiopathic inflammatory myopathies (IIM) are rare autoimmune diseases that primarily affect striated muscles; skin, joints, and lungs may be involved with different degrees of severity. Traditional treatment relies on high-dose glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs.

Methods: A growing amount of evidence is demonstrating the potential role of novel treatments in the management of IIM. We report our experience with Janus kinase inhibitors (JAKi) in these conditions and review the current evidence for the use of small molecules in real-life clinical practice.

Results: A total of 41 papers were retrieved from PubMed, 37 papers concerning IIM and JAKi, and 4 papers concerning IIM and apremilast.

Conclusions: An overall good efficacy was evidenced in IIM-associated skin lesions, including rash, ulcers, and calcinosis. If present, muscle and joint involvement demonstrated a good response to therapy, while it was not possible to draw any conclusion about dysphagia. No life-threatening adverse events were reported.

Rheumatoid arthritis (RA) is rarely reported among patients with sickle cell disease (SCD). RA treatment in these patients is believed to be more challenging due to fear of increasing the risk of infection and complications of SCD. We are reporting 7 patients with concurrent SCD and RA. The average age at the time of the diagnosis of RA was 33.3±12.6 years (ranging from 16 to 53 years), and most were women (5/7). Most of the patients were positive for rheumatoid factor (6/7) or anticyclic citrullinated peptide (6/7). Four patients were treated with hydroxyurea. The most used antirheumatic drugs were methotrexate (7/7), biologic agents (5/7), and prednisone (4/7). Two patients were in remission, four had low and one had high disease activity. Four patients (4/7) had avascular necrosis, two in the shoulders and two in the hip joints. Four patients had emergency visits or hospitalizations within one year of the diagnosis of RA, but none had blood transfusions, infections, or death. The start of antirheumatic medication was not associated with an increased risk of infection, blood transfusions, emergency visits, or hospitalizations, nor with a worsening of laboratory measures. The findings suggest that the treatment of RA in patients with SCD should follow the same strategy as in patients without SCD. However, treatment should be individualized according to the individual patient's risk of infection and SCD complications.

Objective: Intra-articular injections of hyaluronic acid (HA) have been reported to alleviate pain, reduce disability, and improve joint function in glenohumeral osteoarthritis (GH-OA). This retrospective study aimed to evaluate the effectiveness of a HA-based formulation (Hyalubrix®) in reducing the pain of patients with GH-OA and improving both patient's shoulder functions and quality of life (QoL).

Methods: Data collected during the standard clinical practice of the center was retrospectively analyzed. The Simple Shoulder Test (SST) questionnaire reported data on the patient's ability to perform daily activities; the Euro-Quality of Life Health Assessment (EQ-5D) collected evidence on QoL; and changes in pain were evaluated through the Visual Analog Scale (VAS). SST and EQ-5D scores were analyzed comparing baseline values with those at the last follow-up, while VAS was investigated for all the available visits. Continuous values were summarized as mean ± standard deviation, median, and 25-75th percentiles. Shapiro-Wilk test assessed normality, with significance set at p<0.05, and no adjustments for multiple comparisons were made.

Results: All scores showed a significant improvement: VAS decreased from 55.4±13.8 to 16.2±16.3 (p<0.001), the SST increased from 38.0 to 65.5 (p<0.001), as well as the EQ-5D (from 41.7 to 76.7; p<0.001).

Conclusions: GH-OA treatment with Hyalubrix® proved to be highly beneficial, leading to complete pain reduction in more than 50% of patients and a significant reduction in 27.5% of cases. This resulted in improved joint function and QoL.

Objective: To provide a comprehensive overview of peripheral spondyloarthritis (pSpA), focusing specifically on its occurrence and management in patients with inflammatory bowel disease (IBD).

Methods: An exhaustive literature search was conducted in PubMed, Embase, Cochrane Database of Systematic Reviews, and Google Scholar to identify relevant studies on pSpA in IBD patients. Titles, abstracts, and full-text articles were screened for relevance. Data on study design, patient characteristics, diagnostic criteria, main findings, and conclusions were extracted from selected articles. Study quality was assessed using appropriate checklists. Information was synthesized narratively to summarize current understanding.

Results: pSpA is the most common extraintestinal manifestation in IBD, with a median prevalence of 16%. It worsens quality of life and requires collaboration between gastroenterologists and rheumatologists for optimal diagnosis and treatment. Several "red flags" guide appropriate specialist referral of IBD patients with suspected pSpA. Once the diagnosis is confirmed, the choice of therapy depends on IBD phenotype and patterns of articular/axial involvement. Anti-tumor necrosis factor (TNF) drugs are first-line biologics, with interleukin (IL)-12/23 and IL-23 inhibitors as alternatives for anti-TNF failure. Small molecules like apremilast and Janus kinase inhibitors also have utility. Recommended treatment algorithms exist, but more randomized controlled trials are needed.

Conclusions: Early identification of pSpA is crucial in IBD patients to enable timely intervention, prevent structural damage, and minimize disability. A multidisciplinary, holistic approach addressing musculoskeletal and extra-musculoskeletal manifestations is key to optimal patient outcomes.

Objective: Juvenile dermatomyositis (JDM) is a rare chronic systemic inflammatory disorder with a highly variable clinical course. It is important to identify the patients at risk of developing more severe disease. However, based on the existing literature, there is a lack of data regarding predictors of poor outcomes. Obtaining knowledge about clinical and laboratory risk factors for disease progression and severity at an earlier stage of the disease could potentially lead to a better long-term prognosis for patients with JDM.

Methods: A narrative review with the aim of identifying risk factors for poor outcomes in patients with JDM, such as death, severe disease, refractory disease, and functional impairment, was conducted. A total of 27 articles was included.

Results: Certain clinical manifestations and immunology features appear to worsen the prognosis in children with JDM. The recognition of these risk factors is essential for all pediatric rheumatologists as it allows the earlier identification of patients with potentially worse outcomes. These patients should receive closer follow-up and aggressive and individualized therapy in order to reduce their morbimortality.

Conclusions: Additional research is needed not only to identify more predictors of worse outcomes but also to identify more effective treatment approaches targeted toward these patients.

Objective: Patients Acceptable Symptom State (PASS) is a single dichotomized question assessing health satisfaction. We aimed to investigate PASS achievement within 4 weeks of treatment with Janus kinase (JAK) inhibitors (Jakinibs) and its association with treatment response after 4 and 12 weeks in rheumatoid arthritis (RA) patients.

Methods: We recruited consecutive RA patients starting baricitinib or tofacitinib. At baseline, 4 and 12 weeks, we calculated disease activity [Disease Activity Score on 28 joints (DAS28), Clinical Disease Activity Index, Simplified Disease Activity Index], disease status [remission and low-disease activity (LDA)], percentage of patients achieving PASS, and the time to attain PASS. We assessed the impact of clinically relevant variables on PASS achievement by logistic regression analysis.

Results: We enrolled 113 patients [98 (86.7%) females; median age 59.6 (interquartile range 16.9), median disease duration 144 (132) months]. 90 (79.6%) patients achieved PASS after 10 (8) days. A similar percentage of PASS achievers and non-achievers was in remission/LDA at weeks 4 and 12, but the reduction of disease activity was significantly greater in PASS achievers. All patients achieving Boolean remission at weeks 4 and 12 had achieved PASS within 4 weeks. The impact of Patients Global Assessment (PGA) on DAS28 was significantly greater in PASS non-achievers compared to PASS achievers; inversely, the impact of C-reactive protein was more relevant in PASS achievers. At multivariate analysis, pain and PGA were significantly associated with PASS.

Conclusions: In our cohort, Jakinibs allowed an early achievement of PASS in a great percentage of RA patients. PASS is strictly dependent on PGA and pain and could suggest, early in the management of RA patients, therapeutic success.

Takayasu arteritis and spondyloarthritis are two rheumatological diseases whose co-existence is well-documented in the literature. Data on the presence of inflammatory back pain in Takayasu arteritis without a diagnosis of spondyloarthritis, however, is scarce. Here, we present a 33-year-old man who was admitted to the emergency department with acute-onset chest pain associated with left carotidynia, carotid bruit, and left arm claudication, normal electrocardiogram and computed tomography angiographic features suggesting Takayasu arteritis, including stenosis and occlusion of the aorta and its branches. Two years prior, he had undergone a clinical work-up for an inflammatory back pain accompanied by alternating buttocks pain, morning stiffness lasting more than half an hour, and heel pain. HLA-B27 status and magnetic resonance imaging of the sacroiliac joints were both negative. He was prescribed non-steroidal anti-inflammatory drugs and was placed on adalimumab 40 mg SC every two weeks but had to switch to etanercept two months before his emergency admission due to supply issues. Oral prednisolone was initiated at a dose of 60 mg/day with symptomatic improvement in both his inflammatory back pain and his chest pain, but he had to be switched to methotrexate and infliximab due to steroid side effects. Inflammatory aortitis should be considered as a possibility during the assessment of inflammatory back pain to mitigate the risks of delayed diagnosis.

The objective of this case series is to describe the efficacy and safety of baricitinib (BARI) in a group of patients with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA). These patients were treated with BARI due to either a refractory disease course or the unavailability of tocilizumab because of the pandemic. A total of six patients (five females and one male, median age 64 years, range 50-83) were treated with BARI. Two of them had isolated PMR, two had PMR with associated large vessel (LV)-GCA, one had LV-GCA presenting as fever of unknown origin, and one had cranial-GCA. All patients reported improvement with BARI. At the time of starting BARI, patients were taking a median prednisone dose of 8.75 mg/day (range 0-25), and the four patients with PMR had a median PMR-AS of 23.3 (indicating high disease activity), which decreased to 1.58 after 6 months of treatment with BARI. Two of them could stop glucocorticoids (GC) and continued BARI monotherapy. One patient suffered from pneumonia, and BARI was therefore stopped. No other adverse events attributable to BARI were detected. Our case series supports previous reports suggesting efficacy of Janus kinase inhibitors as a GC-sparing strategy in PMR and GCA.