1,721,027 research outputs found
IL TREAT-TO-TARGET NELLA REAL-LIFE IN PAZIENTI AFFETTI DA ARTRITE PSORIASICA
Full text linkObjective: our study aimed at describing, in a real-life cohort of psoriatic arthritis (PsA) patients, the rates of minimal disease activity (MDA) achievement, and to longitudinally explore predictors of MDA. In patients with axial involvement (axPsA), we also examined the rates and predictors of low axial disease activity achievement.
Methods: consecutive PsA patients in stable biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) were enrolled. Disease activity indices, including MDA and Ankylosing spondylitis Disease Activity Score-Low Disease Activity (ASDAS-LDA) for axPsA, were evaluated at baseline and every 6 months, up to 36 months or bDMARDs permanent discontinuation. Patient history, BMI, comorbidities (including osteoarthritis (OA) and fibromyalgia) were collected. Characteristics of patients were compared between patients reaching sustained MDA and those who did not. Multivariable Generalized Estimating Equation (GEE) models were built to identify predictors of MDA and ASDAS-LDA over time. Data were expressed as coefficient (95%CI).
Results: 104 patients were enrolled, 54% males, mean age 55.7 5.0 years; 52% had axPsA. Across all evaluations, 52%-61% reached MDA, and 17%-24% reached ASDAS-LDA. AxPsA, fibromyalgia, OA and BMI35 were less frequently observed in patients with sustained MDA. The GEE model confirmed these factors were negatively and independently associated to MDA (axPsA =–1.07, 95%CI –1.82/–0.33; fibromyalgia: =–3.35, 95%CI–5.09/ –1.61; OA: =–1.87, –3.07/0.66; BMI35: =–2.53; 95% –4.27/–0.79). Older age (=–0.05; 95% CI –0.09/–0.02) and longer bDMARDs duration (=0.31, 95%CI 0.00- 0.02) had a negative and positive association, respectively, with MDA. Older age (=–0.01, 95%CI: –0.04- 0.01), fibromyalgia (=–2.03, 95%CI –3.50/–0.56) and OA (=–1.30; 95% –2.29/–0.31) were independently associated also to ASDAS-LDA.
Conclusion MDA is an attainable target in real-life patients. AxPsA represents a difficult-to-treat subset. Sustained MDA depends both on disease features (axSpA) and patients’ characteristics (age, bDMARDs duration, comorbidities: OA, fibromyalgia).Objective: our study aimed at describing, in a real-life cohort of psoriatic arthritis (PsA) patients, the rates of minimal disease activity (MDA) achievement, and to longitudinally explore predictors of MDA. In patients with axial involvement (axPsA), we also examined the rates and predictors of low axial disease activity achievement.
Methods: consecutive PsA patients in stable biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) were enrolled. Disease activity indices, including MDA and Ankylosing spondylitis Disease Activity Score-Low Disease Activity (ASDAS-LDA) for axPsA, were evaluated at baseline and every 6 months, up to 36 months or bDMARDs permanent discontinuation. Patient history, BMI, comorbidities (including osteoarthritis (OA) and fibromyalgia) were collected. Characteristics of patients were compared between patients reaching sustained MDA and those who did not. Multivariable Generalized Estimating Equation (GEE) models were built to identify predictors of MDA and ASDAS-LDA over time. Data were expressed as coefficient (95%CI).
Results: 104 patients were enrolled, 54% males, mean age 55.7 5.0 years; 52% had axPsA. Across all evaluations, 52%-61% reached MDA, and 17%-24% reached ASDAS-LDA. AxPsA, fibromyalgia, OA and BMI35 were less frequently observed in patients with sustained MDA. The GEE model confirmed these factors were negatively and independently associated to MDA (axPsA =–1.07, 95%CI –1.82/–0.33; fibromyalgia: =–3.35, 95%CI–5.09/ –1.61; OA: =–1.87, –3.07/0.66; BMI35: =–2.53; 95% –4.27/–0.79). Older age (=–0.05; 95% CI –0.09/–0.02) and longer bDMARDs duration (=0.31, 95%CI 0.00- 0.02) had a negative and positive association, respectively, with MDA. Older age (=–0.01, 95%CI: –0.04- 0.01), fibromyalgia (=–2.03, 95%CI –3.50/–0.56) and OA (=–1.30; 95% –2.29/–0.31) were independently associated also to ASDAS-LDA.
Conclusion MDA is an attainable target in real-life patients. AxPsA represents a difficult-to-treat subset. Sustained MDA depends both on disease features (axSpA) and patients’ characteristics (age, bDMARDs duration, comorbidities: OA, fibromyalgia)
Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis
Full text linkBackground: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) was characterized at the end of 2019, and soon spread around the world, generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women. Objective: The aim of this systematic literature review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity, and disease outcomes. A SRL was performed in PubMed and Embase, searching terms corresponding to the ‘PEO’ format: population = adult patients affected with COVID-19; exposure = gender; outcome = any available clinical outcomes by gender, including mortality and disease severity. The search covered the period from January 1 to April 30, 2020. Exclusion criteria were: case reports/series, reviews, commentaries, languages other than English. Full-text, original articles were included. Data on study type, country, and patients’ characteristics were extracted. Study quality was evaluated using the Newcastle–Ottawa scale (NOS). From a total of 950 hits generated by the database search, 85 articles fulfilling the inclusion criteria were selected. Results: A random-effects meta-analysis was performed to compare mortality, recovery rates, and disease severity in men compared with women. The male to female ratio for cases was 1:0.9. A significant association was found between male sex and mortality (OR = 1.81; 95% CI 1.25–2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI 0.55–0.95). Male patients were more likely to present with a severe form of COVID-19 (OR = 1.46; 95% CI 1.10–1.94). Conclusions: Males are slightly more susceptible to SARS-CoV2 infection, present with a more severe disease, and have a worse prognosis. Further studies are warranted to unravel the biological mechanisms underlying these observations
Do Obesity and Overweight Influence Disease Activity Measures in Axial Spondyloarthritis? A Systematic Review and Meta-Analysis
No full textObjective: The aim of our systematic review and meta-analysis was to investigate whether overweight/obesity are associated with higher disease activity measures in patients with axial spondyloarthritis (SpA). Methods: MEDLINE, PubMed, and Web of Science were searched using key terms corresponding to population (axial SpA patients), exposure (overweight/obesity), and outcome (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score [ASDAS]). Predefined inclusion criteria were adult patients with axial SpA, exposure classified according to body mass index (BMI), BASDAI/ASDAS reported for each BMI group, and observational studies. The Newcastle-Ottawa Scale for cohort, cross-sectional, and case–control studies was used for quality check. Random-effects meta-analysis was used to pool results, which were expressed as the mean difference (MD) in BASDAI and ASDAS between BMI groups, with 95% confidence intervals (95% CIs). Results: A total of 10 articles were included in the meta-analysis. The MD in BASDAI between normal BMI and overweight/obese patients was –0.38 (95% CI –0.56, –0.21; P < 0.0001); the MD in ASDAS between the same groups was –0.19 (95% CI –0.29, –0.09; P < 0.0001). The MD in BASDAI between normal BMI and overweight patients was –0.09 (95% CI –0.33, 0.15; P = 0.45), and the MD between normal BMI and obese patients was –0.78 (95% CI –1.07, –0.48; P < 0.0001). For ASDAS, the MD between normal BMI and overweight patients was –0.02 (95% CI –0.19, 0.15; P = 0.79), and the MD between normal BMI and obese patients was –0.42 (95% CI –0.60, –0.23; P < 0.0001). Conclusion: Overweight and obese patients with axial SpA tend to present higher disease activity scores compared to patients with a normal BMI. This difference seems to be clinically meaningful only for the comparison between obese patients and patients with normal BMI, and more for BASDAI than ASDAS
An update on serum biomarkers to assess axial spondyloarthritis and to guide treatment decision
Full text linkAxial spondyloarthritis (axSpA) is a group of debilitating, chronic, rheumatic conditions characterized by inflammation and new bone formation, mainly involving the spine and the sacroiliac joints. The lack of biomarkers in axSpA is well known. Despite significant treatment advances in recent years thanks to the introduction of drugs with a new mode of action, such as new biologic and targeted synthetic disease-modifying antirheumatic drugs, no relevant improvement in the identification of disease biomarkers has been achieved. Common parameters, such as erythrocyte sedimentation rate and C-reactive protein, which are routinely used to measure systemic inflammation, are the sole markers available to date and are not adequate to assess disease activity in all patients. The aim of this study is to review the most promising serum biomarkers that may help treatment decision in axSpA via a proper assessment of disease activity and identification of negative prognostic factors
Erosive hand osteoarthritis: latest findings and outlook
No full textOsteoarthritis (OA) most commonly affects knee joints, and the next most commonly affected sites are the hands and hips. Three distinct hand OA phenotypes have been described: erosive hand OA (EHOA), nodal hand OA — also known as non-erosive hand OA (non-EHOA) — and first carpometacarpal joint OA. EHOA predominantly affects women and is the most aggressive form of hand OA, characterized by a severe clinical onset and progression, leading to joint damage, disability and reduction of quality of life. Clinical signs of inflammation associated with EHOA include the acute onset of pain, swelling and redness. Moreover, EHOA is characterized by radiographic features such as central erosion, saw-tooth and gull-wing lesions and, rarely, ankylosis. The aim of this Review is to report the latest findings on epidemiology, clinical features, pathology and aetiopathogenesis, biomarkers, imaging modalities and treatments for EHOA. The ongoing development of new hand OA classification criteria should facilitate standardization between studies
Efficacy and safety of non-pharmacological and non-biological interventions: a systematic literature review informing the 2022 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis
No full textObjective To update the evidence of non-biological treatments for axial spondyloarthritis (axSpA), as a basis for the 2022 Assessment of SpondyloArthritis international Society-European Alliance of Associations for Rheumatology (ASAS-EULAR) recommendations for the management of axSpA. Methods A systematic literature review (2016-2021) on efficacy and safety of non-pharmacological and non-biological pharmacological treatments was performed, up to 1 January 2022. The research question was formulated according to the PICO format: Population: adult patients with r-axSpA and nr-axSpA; Intervention: non-pharmacological and non-biological pharmacological treatments; Comparator: active comparator or placebo; Outcomes: all relevant efficacy and safety outcomes. Type of studies included were: randomised controlled trials (RCTs), observational studies (for efficacy of non-pharmacological treatments, and safety), qualitative studies. Cohen's effect size (ES) was calculated for non-pharmacological and risk ratio (RR) for pharmacological treatments. Results Of 107 publications included, 63 addressed non-pharmacological interventions, including education (n=8) and exercise (n=20). The ES for education on disease activity, function, mobility was small to moderate (eg. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), ES: 0.06-0.59). Exercise had moderate to high ES on these outcomes (eg. BASDAI, ES: 0.14-1.43). Six RCTs on targeted synthetic disease-modifying antirheumatic drugs (DMARDs) showed efficacy of tofacitinib, upadacitinib and filgotinib (phase 2 only) in r-axSpA (range RR vs placebo for ASAS20: 1.91-3.10), while apremilast and nilotinib were not efficacious. Studies on conventional synthetic DMARDs (n=3), non-steroidal anti-inflammatory drugs (NSAIDs, n=8) and other drugs (n=12) did not provide new evidence on efficacy/safety (efficacy of NSAIDs confirmed; limited efficacy of short-term glucocorticoids in one RCT). Conclusions Education, exercise and NSAIDs confirmed to be efficacious in axSpA. JAKi were proved efficacious in r-axSpA
Disease and treatment-related morbidity in young and elderly patients with granulomatosis with polyangiitis and microscopic polyangiitis
No full textObjective: Aging may be a risk factor for morbidity in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We compared the rate and better characterized the type of disease- and treatment-related complications affecting young and elderly patients with AAV. Methods: All new cases of granulomatosis with polyangiitis or microscopic polyangiitis diagnosed in three referral centers between 2000–2016 were included. Patients were stratified by age into young or elderly (< or ≥65 years old, respectively). Data were collected from diagnosis until end of follow-up, with scheduled annual visits or additional visits in case of relapse or complication requiring hospitalization. Results: Of 141 patients included, 42 were elderly and 99 were young at the time of AAV diagnosis. Median follow-up was 58.0 [25–75% IQR, 31.0–60.0] months in young and 48.0 [23.25–60.0] months in elderly patients (p>0.05). Overall, the elderly group was associated to higher damage accrual assessed by Vasculitis Damage Index during follow-up (β=0.28, p<0.05). Sixty-three (44.7%) patients had acute kidney injury due to AAV-glomerulonephritis at diagnosis. In contrast to elderly, young patients showed significant improvement in renal function over time, particularly in the first 6 months while on induction treatment (ΔeGFR, median [25–75%IQR], 5.3 [0.4–14] versus 22.8 [5.9–52.1] ml/min/1.73m2, p=0.008), without significant changes after ANCA type stratification. Despite similar immunosuppressive therapy approaches and relapse rates, elderly patients had a higher rate of severe infections compared to younger patients (HR 2.1, 95% CIs: 1.1–4.4, p=0.043). Conclusions: Elderly patients with AAV had higher susceptibility to disease- and treatment-related morbidity than younger patients, particularly to renal and infective morbidity
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