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Capitolo 11.3 "Malattia da deposizione di cristalli di calcio pirofosfato"
No full textIn questo capitolo la malattia da deposizione di cristalli di calcio pirofosfato viene affrontata descrivendo l'epidemiologia, il quadro clinico, le indagini di laboratorio e strumentali, l'etiologia e la patogenesi, la diagnosi e la terapia
Recommendations for the use of biologic (TNF-alpha blocking) agents in the treatment of rheumatoid arthritis in Italy.
No full text“Vasectomy: study of circulating immune-complexes and its correlation with antisperm immunity in man with a 12 months follow-up study”
No full textCirculating immune-complexes (CIC) have been detected in sera of vasectomized subjects using the Clq Binding Assay. Results seem to indicate that CIC are a feature of the early post-operative period and a consequence of acute immunization against sperm antigens. The progressive disappearance of CIC from the third month after vasectomy with the simultaneous increase in antisperm antibody percentage and titre suggests that CIC could be a temporary feature in vasectomized men and do not lead to a chronic disease, related to a Type III immune reaction
Ultrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy
No full textUltrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy Author(s): Salaffi, F (Salaffi, F.)1; Carotti, M (Carotti, M.)2; Iagnocco, A (Iagnocco, A.)3; Luccioli, F (Luccioli, F.)4; Ramonda, R (Ramonda, R.)5; Sabatini, E (Sabatini, E.)3; De Nicola, M (De Nicola, M.)6; Maggi, M (Maggi, M.)6; Priori, R (Priori, R.)3; Valesini, G (Valesini, G.)3; Gerli, R (Gerli, R.)4; Punzi, L (Punzi, L.)5; Giuseppetti, GM (Giuseppetti, G. M.)2; Salvolini, U (Salvolini, U.)6; Grassi, W (Grassi, W.)1 Source:
RHEUMATOLOGY Volume: 47 Issue: 8 Pages: 1244-1249
DOI: 0.1093/rheumatology/ken222 Published: AUG 2008 Times Cited: 10 (from Web of Science) Cited References: 40 [ view related records ] Citation Map Abstract: Objective. To compare ultrasonography (US) of salivary glands with contrast sialography and scintigraphy, in order to evaluate the diagnostic value of this method in primary SS (pSS).
Methods. The diagnostic value of parotid gland US was studied in 77 patients with pSS (male/female ratio 3/74; mean age 54 yrs) and in 79 with sicca symptoms but without SS. The two groups were matched for sex and age. Imaging findings of US were graded using an ultrasonographic score ranging from 0 to 16, which was obtained by the sum of the scores for each parotid and submandibular gland. The sialographic and scintigraphic patterns were classified in four different stages. The area under receiver operating characteristic curve (AUC-ROC) was employed to evaluate the screening methods performance.
Results. Of the 77 patients with pSS, 66 had abnormal US findings. Mean US score in pSS patients was 9.0 (range from 3 to 16). Subjects without confirmed pSS had the mean US score 3.9 (range from 0 to 9) (P < 0.0001). Results of sialography showed that 59 pSS patients had abnormal findings at Stage 1 (n = 4), Stage 2 (n = 8), Stage 3 (n = 33) or Stage 4 (n = 14), and 58 patients had abnormal scintigraphic findings at Stage 1 (n = 11), Stage 2 (n = 18), Stage 3 (n = 25) or Stage 4 (n = 4). Through ROC curves US arose as the best performer (AUC = 0.863 +/- 0.030), followed by sialography (AUC = 0.804 +/- 0.035) and by salivary gland scintigraphy (AUC = 0.783 +/- 0.037). The difference between AUC-ROC curve of salivary gland US and scintigraphy was significant (P = 0.034). Setting the cut-off score 6 US resulted in the best ratio of sensitivity (75.3%) to specificity (83.5%), with a likelihood ratio of 4.58. If a threshold 8.0 was applied the test gained specificity, at the cost of a serious loss of sensitivity (sensitivity 54.5%, specificity 97.5%, likelihood ratio 21.5).
Conclusions. Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease. Accession Number: WOS:000257787200026 Document Type: Article Language: English Author Keywords: Sjogren's syndrome; salivary glands; ultrasonography; sialography; salivary gland scintigraphy; diagnosis KeyWords Plus: COLOR DOPPLER SONOGRAPHY; PAROTID SIALOGRAPHY; CLASSIFICATION CRITERIA; DIAGNOSTIC-CRITERIA; SICCA SYNDROME; BIOPSY; ECHOGRAPHY Reprint Address: Salaffi, F (reprint author), Univ Politecn Marche, Cattedra Reumatol, Via Colli 52, Ancona, Italy Addresses:
1. Polytechn Univ Marche Reg, Dept Rheumatol, Ancona, Italy
2. Polytechn Univ Marche Reg, Dept Radiol, Ancona, Italy
3. Univ Rome, Rheumatol Unit Sapienza, Rome, Italy
4. Univ Perugia, Dept Clin & Expt Med, Rheumatol Unit, I-06100 Perugia, Italy
5. Univ Padua, Dept Clin & Expt Med, Rheumatol Unit, Padua, Italy
6. Polytechn Univ Marche Reg, Dept Neuroradiol, Ancona, Italy E-mail Address: [email protected] Publisher: OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND Web of Science Category: Rheumatology Subject Area: Rheumatology IDS Number: 328GU ISSN: 1462-032
Increased circulating levels and salivary gland expression of interleukin-18 in patients with Sjögren's syndrome: relationship with autoantibody production and lymphoid organization of the periductal inflammatory infiltrate
Full text linkIL-18, an immunoregulatory and proinflammatory cytokine, has been shown to play an important pathogenic role in Th1-driven autoimmune disorders. In this study, we evaluated the circulating levels and salivary-gland expression of IL-18 in patients with Sjögren's syndrome (SS), a mainly Th1-mediated disease. IL-18 serum levels were measured by ELISA in 37 patients with primary SS, 42 with rheumatoid arthritis, and 21 normal controls. We demonstrated high IL-18 serum levels in SS, similar to those in rheumatoid arthritis patients and significantly higher than in controls (P < 0.01). In addition, IL-18 serum concentrations were significantly higher in anti-SSA/Ro+ and anti-SSB/La+ than in anti-SSA/Ro- and anti-SSB/La- SS patients (respectively, P = 0.01, P < 0.01). Serum IL-18 correlated strongly with anti-SSA/Ro (P = 0.004) and anti-SSB/La (P = 0.01) titers. Salivary gland IL-18 expression was investigated by single/double immunohistochemistry in 13 patients with primary SS and in 10 with chronic sialoadenitis, used as controls. The expression of IL-18 was also examined in periductal inflammatory foci in relation to the acquisition of features of secondary lymphoid organs such as T–B compartmentalization, formation of follicular dendritic cell networks, and presence of germinal-center-like structures. IL-18 expression in SS salivary glands was detected in 28 of 32 periductal foci of mononuclear cells (87.5%), while no IL-18 production by infiltrating cells was detected in patients with chronic sialoadenitis. Within the inflammatory foci, IL-18 immunoreactivity co-localized almost exclusively with CD68+ macrophages. In addition, IL-18 was found in 15 of 19 foci (78.9%) with no evidence of T–B cell compartmentalization (nonsegregated) but in 100% of the segregated aggregates, both in T- and B-cell-rich areas. Strikingly, IL-18 was strongly expressed by CD68+ tingible body macrophages in germinal-centre-like structures both in SS salivary glands and in normal lymph nodes. IL-18 expression was observed in the ducts of all SS biopsies but in only 4 of 10 patients with nonspecific chronic sialoadenitis (P < 0.01). This study provides the first evidence of increased circulating levels and salivary gland expression of IL-18 in SS, suggesting an important contribution of this cytokine to the modulation of immune inflammatory pathways in this condition
Does seronegative antiphospholipid syndrome really exist?
No full textThe diagnosis of seronegative (SN-) antiphospholipid syndrome (APS) has been
suggested for patients with clinical manifestations indicative of APS but with
persistently negative results in the commonly used assays to detect
anti-cardiolipin (aCL) antibodies, anti-β2 Glycoprotein I antibodies (aβ2GPI),
and lupus anticoagulant (LA). To date the best management of these patients is
still unclear. New emerging anti-phospholipid (aPL) assays could improve our
ability in diagnosing APS. However, the availability of aPL assays in routine
laboratory practice is limited. In fact, even aβ2GPI is routinely tested in only
a small number of laboratories, and other aPL, such as anti-prothrombin or
anti-annexin antibodies, in only a few research laboratories. On the other hand
transient or false negative aPL assay and other genetic or acquired
pro-thrombotic conditions can further complicate this issue. This paper is
focused on the arguments for and against the diagnosis of SN-APS and is aimed to
help the clinician when approaching a patient with clinical manifestations
consistent with APS diagnosis but with negative aPL using the commonly available
tests
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