15 research outputs found
Calciphylaxis in a patient affected by rheumatoid arthritis, chronic renal failure, and hyperparathyroidism: a case report
No full textAlfredomaria Lurati,1 Antonella Laria,1 Donatella Paolotti,2 Magda Scarpellini1 1Rheumatology Unit, 2Department of Pathology, Fornaroli Hospital Magenta, Magenta, Italy Abstract: Calciphylaxis, or calcific uremic arteriolopathy, is the tissue and vascular calcification that occurs mainly in chronic kidney disease. However, it can be secondary to parathyroid dysfunction and it has been described in rheumatic patients. We present a case of calciphylaxis in a woman with inactive rheumatoid arthritis, acute renal failure, and hyperparathyroidism. Keywords: calciphylaxis, rheumatoid arthritis, renal failure, hyperparathyroidis
Safety of etanercept in elderly subjects with rheumatoid arthritis
No full textAlfredomaria Lurati, Mariagrazia Marrazza, Katia Angela, Magda ScarpelliniFornaroli Hospital, Rheumatology Unit, Magenta, ItalyObjective: To report side effects seen in a clinical cohort of patients aged >65 years with rheumatoid arthritis (RA) treated with the tumor necrosis factor-α TNF-α blocker etanercept and to compare the side effects rate with patients aged ≤65 years.Methods: All patients with RA that started etanercept and who were referred to our rheumatology unit from November 2005 to March 2009 were included in this study and prospectively followed to collect side effects related to therapy.Results: One hundred three patients were enrolled: 41 (37 females, 4 males) aged >65 years and 62 (40 females, 22 males) aged <65 years. In the patients aged >65 years, the safety profile (defined as rate of side effects) of etanercept was similar to that in patients aged ≤65 years (P > 0.05) and the survival curves between the groups were similar (P > 0.05).Conclusions: In our three-year experience, the anti-TNFα agent etanercept has been well tolerated and safe in elderly patients. The risk of side effects in these patients was no greater than in subjects aged ≤65 years. However, such inhibitors are associated with various and numerous side effects and elderly patients with RA should be carefully monitored to limit the risk of side effects during anti-TNFα therapy as much as possible.Keywords: anti-TNF therapy, rheumatoid arthritis, elderl
The macrophages in rheumatic diseases
No full textAntonella Laria, Alfredomaria Lurati , Mariagrazia Marrazza , Daniela Mazzocchi, Katia Angela Re, Magda Scarpellini Rheumatology Unit, Fornaroli Hospital, Magenta, Italy Abstract: Macrophages belong to the innate immune system giving us protection against pathogens. However it is known that they are also involved in rheumatic diseases. Activated macrophages have two different phenotypes related to different stimuli: M1 (classically activated) and M2 (alternatively activated). M1 macrophages release high levels of pro-inflammatory cytokines, reactive nitrogen and oxygen intermediates killing microorganisms and tumor cells; while M2 macrophages are involved in resolution of inflammation through phagocytosis of apoptotic neutrophils, reduced production of pro-inflammatory cytokines, and increased synthesis of mediators important in tissue remodeling, angiogenesis, and wound repair. The role of macrophages in the different rheumatic diseases is different according to their M1/M2 macrophages phenotype. Keywords: macrophage, rheumatic disease
Routine Assessment of Patient Index Data 3 (RAPID3) is a Valid Index for Routine Care in Patients with Osteoarthritis
No full textObjective: To compare Routine Assessment of Patient Index Data 3 (RAPID3) on a Multidimensional Health Assessment Questionnaire (MDHAQ) with the Western Ontario and Mc-Master Universities Osteoarthritis Index (WOMAC) in patients with knee or hip osteoarthritis and to evaluate its reliability. Methods: 678 patients with hip or knee osteoarthritis were assessed in daily practice clinical care during 2009-2013. Patients completed an MDHAQ and so a RAPID3 was calculated (physical function, pain, patient global estimate). Pain, stiffness, and physical functions using the standard WOMAC indices for hip and knee osteoarthritis were assessed too; correlation between WOMAC total scores and RAPID3 scores were estimated with Spearman’s rho. Furthermore a linear regression model was developed with a coefficient of determination R2. Finally we evaluated validity and reliability of this index to evaluate that RAPID3 is not inferior to WOMAC. Results: RAPID3 and WOMAC were correlated significantly, with a global correlation Spearman’ rho index of 0.84 (P<0.01). Computing analysis for diagnosis the correlation index was 0.83 for hip osteoarthritis (p<0.01) and 0.87 for knee osteoarthritis. Conclusion: RAPID3 scores provide similar quantitative information to WOMAC in patients with hip or knee osteoarthritis
Different T cells' distribution and activation degree of Th17 CD4+ cells in peripheral blood in patients with osteoarthritis, rheumatoid arthritis, and healthy donors: preliminary results of the MAGENTA CLICAO study
No full textAlfredomaria Lurati,1 Antonella Laria,1 Arianna Gatti,2 Bruno Brando,2 Magda Scarpellini1 1Rheumatology Unit, Fornaroli Hospital, Magenta, Italy; 2Transfusional Centre, Legnano Hospital, Legnano, Italy Objective: To determine distribution of T cells and activation degree of Th CD4+ cells in peripheral blood of patients with osteoarthritis (OA), rheumatoid arthritis (RA), and healthy donors. Methods: Patients with established diagnosis of RA according to American College of Rheumatology/European League Against Rheumatism 2010 criteria, knee or hip OA according to American College of Rheumatology criteria, and healthy blood donor volunteers were eligible. Multi-channel flow cytometry and monoclonal antibodies against CD3, CD4, CD8, CCR6, CD38, CXCR3, and HLA DR were used to distinguish and evaluate T cells' subpopulation. Results: We analyzed blood samples of 15 patients with well-defined RA, 56 with hip or knee OA, and 20 healthy age matched controls. Blood samples from RA patients showed significantly higher counts of CD4+ CD38+ DR+ (activated CD4 T cells) and Th17 (CCR6+ CXCR3-) cells as compared to OA patients and control group (P<0.01). Furthermore the samples from the OA patients showed a higher percentage of activated CD4 T cells and Th17 cells as compared to control group (P<0.05). Interestingly there was no difference between Th1 (CD4+ CXCR3+ CCR6-) and Th2 (CD4+ CXCR3- CCR6-) between the three groups (P>0.1). Conclusion: According to the latest view of OA disease pathogenesis, our preliminary results support the hypothesis that OA may also be a disease with an immunological/inflammatory involvement like RA. It seems that there is a quantitative but non-qualitative difference in Th17 cells' profile, including the expression of activation markers, between RA and OA. Keywords: Th17, flow cytometry, osteoarthriti
Efficacy of repeated intravenous infusions of an anti-tumor necrosis factor alpha monoclonal antibody, infliximab, in persistently active, refractory juvenile idiopathic arthritis : results of an open-label prospective study
No full textOBJECTIVE: To evaluate the efficacy and safety of a chimeric monoclonal anti-tumor necrosis factor alpha antibody (infliximab) with methotrexate (MTX) in juvenile idiopathic arthritis (JIA) with an active polyarticular course that is not responsive to MTX. METHODS: Twenty-four young adults with long-lasting, refractory JIA were enrolled in an open, prospective, 2-year pilot study. Patients received intravenous infliximab at 3 mg/kg of body weight at weeks 0, 2, and 6 and every 8 weeks thereafter, with weekly subcutaneous MTX. RESULTS: The median duration of therapy was 9.1 months. Significant improvements were observed in the number of joints (28-joint count) with active disease (median 6 at baseline, 2 at 2 weeks, 0 at 6 months, 0 at 1 year; P < 0.05). Pain as well as patient's and physician's global assessments of disease status were assessed on 0-100-mm (0 = best; 100 = worst) visual analog scales (VAS). There were significant improvements in VAS pain scores (45 at baseline, 25 at 2 weeks, 8.5 at 6 months, 10 at 1 year; P < 0.05), patient's global assessment of disease status (50 at baseline, 22 at 2 weeks, 11.5 at 6 months, 18 at 1 year; P < 0.05), and physician's global assessment of disease status (50.5 at baseline, 22.5 at 2 weeks, 6.5 at 6 months, 10 at 1 year; P < 0.01). In addition, there were significant improvements in the erythrocyte sedimentation rate (64 mm/hour at baseline, 36 mm/hour at 2 weeks, 23.5 mm/hour at 6 months, 35 mm/hour at 1 year; P < 0.01) and C-reactive protein level (4.9 mg/dl at baseline, 2.8 mg/dl at 2 weeks, 3.1 mg/dl at 6 months, 3.2 mg/dl at 1 year; P < 0.005). The percentage of patients meeting the American College of Rheumatology 20% improvement criteria at each assessment ranged from 54.2% to 86.7%. Of the responses on the Disease Activity Score in 28 joints, 37.5-63.6% were classified as "good," 14.3-33.3% were classified as "moderate," and 18-37.5% were classified as "no response." Twelve patients (50%) had adverse events, and 5 patients (20.8%) withdrew. CONCLUSION: Infliximab plus MTX showed high effectiveness and safety in short- and medium-term treatment of long-lasting refractory JIA. A controlled multicenter clinical trial is needed
NK cell count as predictor of clinical response in patients with rheumatoid arthritis treated with rituximab
No full textAlfredomaria Lurati, Luca Bertani, Mariagrazia Marrazza, Katia Angela Re, Daniela Bompane, Magda ScarpelliniRheumatology Unit, Fornaroli Hospital, Magenta, ItalyPurpose: The relationship between antiCD20 therapy with rituximab and the lymphocytes phenotype in patients with rheumatoid arthritis was investigated, with an attempt to establish a relationship between commonly used clinical activity indices and variations in leukocyte count, in particular natural killer (NK) lymphocytes.Methods: Patients with seropositive (cyclic citrullinated peptides and rheumatoid factor positive) rheumatoid arthritis (according to the American College of Rheumatology 1987 criteria) refractory to conventional and antitumor necrosis factor-alpha agents who were subsequently treated with rituximab, a chimeric monoclonal antibody directed against CD20, were enrolled between January 2009 and September 2009. All subjects were treated with rituximab standard rheumatologic dose of 1.0 g on days 1 and 15 every 6 months for at least 2 years. A clinical evaluation was performed at baseline and subsequently every 3 months thereafter. At each assessment activated NK (CD56+/CD16+/CD54bright) cell count was collected and disease activity was assessed using Disease Activity Score in 28 Joints and the Simplified Disease Activity Index (SDAI).Results: Thirty-four patients were enrolled (mean age &plusmn; standard deviation: 54.8 &plusmn; 12.8 years). Basal SDAI was 21.75 &plusmn; 5.4 and NK cell count mean value was 157.6 &plusmn; 90. After 24 months, SDAI was 14 &plusmn; 1.2 and NK cell count mean value was 301.7 &plusmn; 21 (P &lt; 0.05). An inverted correlation between SDAI and NK count was observed at 3 months (r = -0.36, P &lt; 0.05), 6 months (r = -0.48, P &lt; 0.45), 9 months (r = -0.47, P &lt; 0.05), 12 months (r = -0.41, P &lt; 0.01), 15 months (r = -0.58, P &lt; 0.05), 18 months (r = -0.53, P &lt; 0.05), 21 months (r = -0.68, P &lt; 0.05), and 24 months (r = -0.61, P &lt; 0.05). A linear regression model between all variables collected and SDAI/Disease Activity Score in 28 Joints at 6 months and 12 months confirmed a significant relationship between SDAI/Disease Activity Score in 28 Joints and NK cell count.Conclusion: The data confirm the clinical efficacy of rituximab and suggests the use of NK cells as a predictor of clinical response in patients with rheumatoid arthritis.Keywords: NK cells, rituximab, predictor, response, rheumatoid arthriti
Successful Treatment of a Patient with Giant Cell Vasculitis (Horton Arteritis) with Tocilizumab a Humanized Anti-Interleukin-6 Receptor Antibody
No full textGiant cell arteritis (GCA) is the most common form of systemic vasculitis in adults, affecting preferentially medium-large size arteries. Here we report a case of a female with a diagnosis of GCA based on temporal artery biopsy, successfully treated with tocilizumab, a humanized anti-interleukin-6 receptor antibody
Paget bone disease demonstrated on 18F-fluorocholine PET/CT: a case report
Get PDFPaget disease (PD) is a chronic disorder resulting in enlarged and misshapen bones, caused by disorganized bone remodeling. This case involves a 64-year-old man with prostatic adenocarcinoma and PD of some skeletal areas with increased uptake shown on 18 F-fluoro-methyl-choline (FMC) positron emission tomography/ computed tomography (PET/CT) performed for cancer restaging. Besides this feature, Paget disease may mimic metastases on PET/CT using various radiotracers, including 18 F-FMC PET/CT. In particular, this case highlights the potential of multiparametric disease characterization on PET. Therefore, in suspected cases, in which differential diagnosis is difficult, histology can be a helpful tool for diagnostic purposes
