481 research outputs found
Assessment of psoriatic nail disease activity by rheumatologists: comment on the article by Lubrano et al Reply
No full textAxial psoriatic arthritis: an intriguing clinical entity or a subset of an intriguing disease?
No full textThis article summarizes the state of the art of axial involvement in psoriatic arthritis (axial PsA). The definition and measurement of axial disease in PsA still remain problematic, and this, in turn, could affect the best approach of recognition and treatment of this intriguing subset of the psoriatic disease. Axial PsA has been studied over the last few years looking at the difference in function and radiological finding compared to ankylosing spondylitis (AS), trying to differentiate it from a coincidental AS with psoriasis. Finally, this review has described the diagnosis and treatment of axial PsA reporting the data obtained from the literature
L'imperialismo, come la lebbra, si cura con la morte": intesecting narratives in Ennio Flaiano's Tempo di uccidere
No full textIncludes abstract.Includes bibliographical references.In 1947 Ennio Flaiano published what was to become his only full-length novel, Tempo di uccidere. Set in Abyssinia during the 1935-1936 Italo-Ethiopian War, it is a work that, notwithstanding its ostensibly "realist" subject matter, displays a palpable dissonance with the coeval cultural and literary landscape of post-war Italy, then dominated by the age of neorealism. With Tempo di uccidere, Flaiano chooses to counter the largely nationally inward, materialist gaze of his contemporary authors by shifting the focus to a socio-political and cultural environment ghat would have proved largely foreign to the majority of his readers...The primary aim of this MA dissertation is to explore-and to critically engage with - the two indentifiable narratives that frame the interpretation of the novel..
Psoriatic Arthritis and Psoriasis Projects in Italy: A Report from the GRAPPA 2011 Annual Meeting
No full textRecent evidence that psoriatic arthritis (PsA) is more frequent and more severe than previously thought has led to several studies on genetic susceptibility, pathogenesis, clinical spectrum, diagnostic tools, and treatment of PsA. Concomitant with these studies has been the development of appropriate classification/diagnostic criteria and disease-specific outcome measures for PsA. Many Italian rheumatologists have taken part in these efforts by conducting collaborative multicenter research projects, which were described at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA; Naples, Italy, July 2011). Highlights of these Italian contributions included performance of CASPAR (ClASsification for Psoriatic ARthritis) criteria in early PsA; radiological assessments of axial PsA; development and validation of the PASRI (PsA Spondylitis Radiology Index in patients with established PsA); and the effect of etanercept on axial manifestations of established PsA. (J Rheumatol 2012;39:2201-3; doi:10.3899/jrheum.120824
Psoriatic disease: Update on traditional disease-modifying antirheumatic drugs
No full textWe present an update on the effects of methotrexate (MTX), sulfasalazine (SSZ), leflunomide (LEF), and cyclosporine (CSA) in psoriatic arthritis (PsA) by reviewing data published from January 2010 to June 2014. The most relevant study on MTX, the Methotrexate In Psoriatic Arthritis (MIPA) trial, did not show a significant difference between this drug and placebo in improving peripheral synovitis. The trial, however, had several limitations. A cohort study on a small number of patients found that MTX does not inhibit radiographic progression. In a large observational study, 86% of LEF-treated patients met PsA Response Criteria (PsARC) at Week 24. No studies of sufficient relevance on SSZ were published in the examined time frame. In an open-label trial, CSA alone was compared to adalimumab (ADA) alone and to the combination ADA/CSA. The ADA arms showed a significantly higher response rate, but as many as 65% of CSA-treated patients were PsARC responders at Month 12. No relevant data on the effects of these 4 drugs on psoriatic enthesitis, dactylitis, or spondylitis have recently been published, and no new safety signals have been reported. Observational data from 2 registers suggest that concomitant MTX increases the retention rate of tumor necrosis factor-α inhibitors. The studies published in the examined time frame confirm that MTX, SSZ, LEF, and CSA have moderate symptom-modifying effect on psoriatic synovitis, and probably little effect on the other manifestations of PsA
Current approach to the management of psoriatic arthritis according to a sample of Italian rheumatologists
No full textOBJECTIVES:
The purpose of this study was to have an overview of the current approach to psoriatic arthritis (PsA) by a group of Italian rheumatologists.
METHODS:
Rheumatologists from all around Italy were asked to participate in a survey to give their opinion on a number of statements made by a panel of rheumatologists who are experts in PsA. The survey was conducted through two rounds using a Delphi-like method. The two rounds yielded a consensus on the management of PsA.
RESULTS:
Fifty rheumatologist from 50 rheumatology centres participated in the survey. Of the 117 proposed statements, only 10 did not reach the 66% concordance threshold. The main results of the survey were that diagnosis of PsA should be made using both the CASPAR criteria and clinical judgment, that all of the features of the psoriatic disease are relevant in the assessment and therapy of PsA, that treatment recommendations are taken into account, that all of the available biological agents may be used in bio-naïve patients, that anti-drug antibody testing is still not used in daily practice, that both switching or swapping are useful options in the case of bio-failure because of lack or loss of efficacy, and that swapping is considered the best choice in the case of bio-failure due to adverse events.
CONCLUSIONS:
The results of this survey showed that a comprehensive evaluation of the patient and a therapy choice based on both patient clinical features and evidence of drug efficacy and safety are considered the current best of care for PsA patients
New approaches in tumor necrosis factor antagonism for the treatment of psoriatic arthritis: certolizumab pegol
No full textThe pathogenesis of psoriatic arthritis (PsA) is still under discussion but great advances have been made in the last 2 decades that confirm the central role of tumor necrosis factor-α (TNF-α) in its inflammatory milieu. New therapeutic approaches have been proposed, and new molecules with anti-TNF-α activity have been chemically altered to improve their pharmacological properties. Certolizumab pegol (CZP) is a PEGylated Fc-free anti-TNF that has been shown clinically to be effective in the treatment of rheumatoid arthritis (RA), skin psoriasis, and PsA. This article summarizes available data on its clinical efficacy and safety profile in the treatment of patients with PsA
Clinical Characteristics of Potential “Difficult-to-treat” Patients with Psoriatic Arthritis: A Retrospective Analysis of a Longitudinal Cohort
No full textINTRODUCTION: The EULAR group recently published the definition of difficult-to-treat (D2T) patients for rheumatoid arthritis. However, a similar definition is lacking for patients with psoriatic arthritis (PsA), in which its multi-domain expression may impact the treatment response. The aim of the study was to characterize the potential D2T PsA patients, to assess the risk factors, and to determine the burden of disease. METHODS: Retrospective analysis of a longitudinal cohort of PsA patients attending a tertiary care center. At each visit, the patients underwent a complete physical examination and the clinical/laboratory data were collected. Data on comorbidities with the assessment of different comorbidity indices were also collected. Disease activity was assessed by using the DAPSA score and the MDA. The PsAID and HAQ-DI were also collected. We use the previous identified definition of D2T patients, applied to our PsA group and modified for this study. RESULTS: A total of 106 patients fulfilled the inclusion criteria and were evaluated. Of these, 36 (33.9%) patients fulfilled the criteria for the potential D2T patients. D2T patients showed a significantly higher BMI and higher prevalence of fibromyalgia. Furthermore, D2T patients showed a significantly higher median Functional Comorbidity Index and a significantly higher BSA, LEI, pain level, PsAID score, and HAQ-DI than non-D2T patients. Potential D2T patients also showed a significant delay in the time from diagnosis to first b/ts DMARDs treatment. CONCLUSIONS: Our study firstly evaluated the presence of clinical characteristics of potential D2T patients and may contribute to future research on this intriguing aspect
Therapeutic Targets for Ankylosing Spondylitis - Recent Insights and Future Prospects
No full textAnkylosing spondylitis (AS) is a chronic inflammatory rheumatic disease belonging to the axial spondyloarthritis (axSpA), a group of diseases that affects the axial skeleton and causes severe pain and disability. An early diagnosis and appropriate treatment can reduce the severity of the disease and the risk of progression. TNF-alpha inhibitors demonstrated efficacy and effectiveness in axSpA patients by reducing disease activity, minimizing inflammation and improving the quality of life. More recently, new insights in pathogenesis of axSpA, including the discovery of the role of IL-23/IL-17 axis and intracellular pathways, led to the development of new biologics and small molecules that improve our therapeutic armamentarium. New alternatives are also being soon available. The aim of this paper is to narratively review the recent insights and future prospects in the treatment of AS and, more in general, axSpA
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