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  • 1
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    Low muscle mass and body composition analysis in a group of postmenopausal women affected by primary Sjögren’s syndrome
    Termedia Sp. z.o.o. ; 2021
    In:  Rheumatology Vol. 59, No. 3 ( 2021-7-16), p. 153-160
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 59, No. 3 ( 2021-7-16), p. 153-160
    Abstract: Sarcopenia is the pathological reduction of skeletal muscle mass and strength. This condition is often underestimated in clinical practice, particularly in connective tissue diseases. The purpose of this study is to evaluate the prevalence of low muscle mass in primary Sjögren’s syndrome (pSS) and to explore the relationships linking muscles and bone tissue. Material and methods Twenty-eight postmenopausal pSS patients were matched with 30 healthy controls and their body composition analysis was performed by dual-energy X-ray absorptiometry to investigate for sarcopenia considering appendicular lean mass (ALM) and the skeletal muscle mass index (SMI) as references. Bone mineral density analysis of lumbar spine (L1–L4), whole femur, femoral neck and whole body was also performed. Linear regression was used to assess the relationship between body composition and bone mineralization. Results Low muscle mass was significantly higher in the pSS group compared to controls whether expressed as ALM, SMI [odds ratio (OR) = 18.40, confidence interval (CI): 4.84–72.08, p 〈 0.0001] or considering total body lean masses. Lean masses appeared to be the best estimators of bone mineralization: total lean body mass (TLBM) lumbar spine R2 = 0.72, p 〈 0.0001; TLBM femoral neck R2 = 0.36, p 〈 0.004; lean mass of upper limbs lumbar spine R2 = 0.70, p 〈 0.0001; femoral neck R2 = 0.66; lean mass of lower limbs lumbar spine R2 = 0.66, p 〈 0.0001; femoral neck R2 = 0.44, p = 0.008). Primary Sjögren’s syndrome patients had a significantly higher android/gynoid fat ratio compared to controls. Conclusions Female pSS patients have lower muscle mass compared to healthy controls and are exposed to a higher risk of developing sarcopenia than healthy subjects. Our research demonstrates that the amount of lean tissue is the main predictor of bone mineralization in pSS.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2021.106909
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2021
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  • 2
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    Bone-sparing effects of tocilizumab in rheumatoid arthritis: a monocentric observational study
    Termedia Sp. z.o.o. ; 2022
    In:  Rheumatology Vol. 60, No. 5 ( 2022-11-4), p. 326-331
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 60, No. 5 ( 2022-11-4), p. 326-331
    Abstract: Bone loss is a common feature in several autoimmune and chronic inflammatory diseases, such as rheumatoid arthritis (RA). Indeed, the high levels of pro-inflammatory cytokines seem to enhance bone resorption and to diminish bone formation, thus producing an uncoupling between osteoclast and osteoblast function and favoring the onset of juxtarticular as well as systemic osteoporosis. Many papers underline the high prevalence of osteoporosis in RA, as well as the negative correlation between interleukin 6 (IL-6) serum levels and bone mineral density (BMD). The aim of this study was to assess the effectiveness of one-year treatment with tocilizumab (TCZ), the first approved IL-6 receptor inhibitor, in reducing bone loss in RA. Material and methods We enrolled 18 patients fulfilling 2010 ACR and EULAR criteria for RA from our arthritis outpatient clinic, assessing clinical and biochemical parameters during a 12-month period. The patients received TCZ 8 mg/kg i.v. every 4 weeks and underwent dual energy X-ray absorptiometry (DXA) for the measurement of bone mineral density (BMD) at baseline and at the end of study. Serum levels of C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), IL-6, serum CrossLaps, osteoprotegerin (OPG), receptor activator of nuclear factor κβ ligand (RANK-L) and dickkopf-1 (DKK-1) were measured at baseline, at 6 months and 1 year. Results No significant difference in IL-6, RANK-L, DKK-1, OPG and serum CrossLaps levels between baseline, 6 months and 1 year were found. A significant increase of lumbar spine BMD was evidenced after 1 year of TCZ treatment. No difference in total body and femoral neck BMD was documented the end of the study. Conclusions This study suggest the bone-sparing effect of TCZ in RA affected individuals.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2022.120756
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2022
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  • 3
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    Diagnostic role of minor salivary glands biopsy in Sjögren’s syndrome: correlations between histology and autoimmunity in a large, monocentric cohort
    Termedia Sp. z.o.o. ; 2023
    In:  Rheumatology Vol. 61, No. 2 ( 2023-5-10), p. 109-115
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 61, No. 2 ( 2023-5-10), p. 109-115
    Abstract: Based on ACR/EULAR classification criteria, minor salivary glands biopsy (MSGB) is a useful diagnostic tool for the diagnosis of primary Sjögren’s syndrome (SS). The main objective of our study was to evaluate the diagnostic role of MSGB, as well as to highlight correlations between histological findings and autoimmune profiles. Material and methods We retrospectively evaluated histological and autoimmunity data from patients who underwent MSGB in our department in cases of suspected SS, from March 2011 to December 2018. Salivary gland samples were evaluated using Chisholm and Mason (CM) grading and the focus score (FS). Results A total of 1,264 patients (108 males, 1,156 females) were included. The median age was 55.22 ±13.51 years (range: 15–87). In univariate binary logistic regression, CM ≥ 3 and FS ≥ 1 were significantly predicted by antinuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-Ro/SSA titer as well as anti-La/SSB, anti-Ro/SSA, rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) positivity. In multivariate analysis, CM ≥ 3 and MSGB positivity were significantly associated with ANA titer; FS ≥ 1 was not associated with laboratory findings. A positive biopsy was associated with laboratory findings, as ANA and ENA titers, anti-Ro/SSA, anti-La/SSB, RF and ACPA positivity may discriminate patients with SS-related histological findings. Conclusions Minor salivary glands biopsy is a useful tool to diagnose SS in cases of highly suggestive clinical symptoms but in the absence of a specific autoimmunity.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum/163213
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2023
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  • 4
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    Polymyalgia rheumatica following infective triggersor vaccinations: a different subset of disease?
    Termedia Sp. z.o.o. ; 2020
    In:  Rheumatology Vol. 58, No. 2 ( 2020-4-30), p. 76-80
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 58, No. 2 ( 2020-4-30), p. 76-80
    Abstract: Polymyalgia rheumatica (PMR) is the commonest inflammatory disorder of the elderly; an association with environmental triggers and a deregulated immune response have been described. The aim of this study was to investigate the association of environmental triggers before the onset of PMR. Material and methods The database of 58 consecutive PMR patients recruited from a single rheumatology secondary care setting was retrospectively analyzed to investigate the frequency of environmental triggers and correlations with clinical characteristics, ultrasound and laboratory data. Results Fifteen PMR patients (26%) described a connection with environmental agents: six PMR patients reported a vaccination, 4 reported a respiratory tract infection, 5 reported seasonal influenza before the onset of the disease. The model of multivariate linear regression which better predicted a shorter time to normalize inflammatory reactants (R2 = 27.46%, p = 0.0042) comprised the presence of an environmental trigger and a higher PCR. A linear regression analysis confirmed an inverse correlation between PCR at onset and time to normalize inflammatory reactant (r = –0.3031, p = 0.0208). A significant correlation was demonstrated between presence of environmental trigger and shorter time to normalize inflammation (r = –0.5215, p 〈 0.0001), and lesser frequency of gleno-humeral synovitis on US (r = –0.3774, p = 0.0038). Conclusions Our work describes a correlation between environmental triggers in PMR and higher CRP at diagnosis, faster response to therapy, and milder shoulder synovitis. We may suppose that these patients belong to a more specific subtype of PMR, in whom external stimuli, such as vaccination or infection, may lead to a deregulated response within the context of an impaired senescent immuno-endocrine system.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2020.95360
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2020
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  • 5
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    Difference in pain and accuracy of two hyaluronic acid injection techniques for symptomatic knee osteoarthritis in overweight patients
    Termedia Sp. z.o.o. ; 2021
    In:  Rheumatology Vol. 59, No. 1 ( 2021-3-5), p. 23-26
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 59, No. 1 ( 2021-3-5), p. 23-26
    Abstract: To evaluate differences of injection related pain, and the accuracy of the techniques in two groups of overweight patients, performing the anterolateral approach for one group (G1) and the superolateral approach for the second group (G2). Material and methods In the study, 126 knee joints from 86 osteoarthritis (OA) patients were evaluated. Inclusion criteria were body mass index (BMI) ≥ 25, absence of effusion and coagulopathy. Pain evaluation during injection was evaluated with Visual Analogue Scale (VAS), while accuracy of the procedure was evaluated with ultrasound (US). Results The patients’ mean age was 69.9 ±9.01, VAS for G1 group was 1.71 ±1.89, for G2 group was 1.74 ±1.31. Mean BMI was 29.69 ±2.86, for G1 group was 28.29 ±3.29, for G2 group was 30.32 ±2.41. No adverse events (AE) occurred in both studied groups. The accuracy rate of the procedure was 69.1% for G1 (38/55 knees), 95.7% for G2 (68/71 knees). No significant difference was found in VAS pain score between G1 and G2 group (p = 0.45). We found the significant correlation between BMI and VAS pain score in anterolateral accesses (G1) (r = 0.51; p 〈 0.005). No correlation was found between age and VAS pain score in anterolateral access (G1). For the superolateral access (G2), no correlation was found for age or BMI and VAS pain score. Conclusions Hyaluronic acid injection is safe therapeutic option for knee OA with no significant differences between anterolateral and superolateral approaches in terms of pain in overweight patients. However, higher BMI seems to be a predictor of pain in anterolateral access, and the superolateral approach should be preferred in this group of patients.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2021.103646
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2021
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  • 6
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    Giant cell arteritis presenting as a stroke in the internal carotid artery territory: a case-based review
    Termedia Sp. z.o.o. ; 2021
    In:  Rheumatology Vol. 59, No. 2 ( 2021-4-28), p. 121-125
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 59, No. 2 ( 2021-4-28), p. 121-125
    Abstract: Giant cell arteritis (GCA) is a large-vessel vasculitis, typically affecting the aorta and its branches. The involvement of vertebral and internal carotid arteries occurs in a limited number of cases, and stroke as a presenting symptom of GCA is extremely unusual: this subset of the disease has a poor prognosis and rarely responds to immunosuppression. 〈 br / 〉 We report the case of a 70-year-old woman, who presented to the Emergency Department for ische­mic stroke, which appeared to be the first and only symptom of GCA. The prompt administration of steroids and tocilizumab (TCZ) led to clinical and radiological resolution, with no residual disability at 6-month follow-up. 〈 br / 〉 Our case-based review, highlighting the rarity of a large vessel vasculitis presenting only with a cerebrovascular accident, provides new evidence for the efficacy of TCZ even in more unusual varieties of GCA: in these cases, TCZ should be immediately prescribed, in order to prevent mortality and severe long-term morbidity.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2021.105414
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2021
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  • 7
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    Effects of antiresorptive agents on body composition: a case-control retrospective study.
    Termedia Sp. z.o.o. ; 2023
    In:  Rheumatology
    Details
    In: Rheumatology, Termedia Sp. z.o.o.
    Abstract: Osteoporosis is the most represented metabolic bone disease and is characterized by the reduction of bone mineral density (BMD), exposing patients to high fracture risk and disability. Bisphosphonates (BPs) are the main compounds exploited in treatment of osteoporosis and significantly reduce fracture risk. Sarcopenia is the pathological reduction of muscle masses and strength, and many studies highlighted its co-existence in patients with impaired bone mass. Indeed, the pathological reduction of lean tissue has been linked to a higher risk of falls and, consequently, fractures and disability. Moreover, the pathological reduction of lean tissue seems to share many pathological mechanisms with impaired bone strength and structure; thus, in this context, we decided to conduct a retrospective case-control study aimed at evaluating the effects of BPs on lean mass and body composition. Material and methods We enrolled postmenopausal women from our metabolic bone diseases outpatient clinic who underwent at least two consecutive dual-energy X-ray absorptiometry (DXA) examinations concomitantly to the beginning of an antiresorptive agent. The body composition of patients and controls was compared by fat masses, lean masses and android-to-gynoid ratio (A/G ratio). Results A total of 64 female subjects were considered for the study: 41 starting a BP and 23 without treatment were used as control. The fat masses and lean masses appeared to be unaffected by BPs. Conversely, A/G ratio was lower in BPs group after 18 months of therapy compared to baseline (p 〈 0,05). From the stratification based on the single BP we failed to highlight any significant difference between the tested variables. Conclusions Bisphosphonates treatment did not modify lean tissues, however a significant reduction of A/G ratio in BP group was documented. Thus the BPs seems to act on patients body composition and extra-skeletal tissues but larger prospective studies are needed to evaluate whether these modifications have clinical relevance.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2023.124335
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2023
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  • 8
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    Bone-sparing effects of rituximab and body composition analysis in a cohort of postmenopausal women affected by rheumatoid arthritis – retrospective study
    Termedia Sp. z.o.o. ; 2021
    In:  Rheumatology Vol. 59, No. 4 ( 2021-9-2), p. 206-210
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    In: Rheumatology, Termedia Sp. z.o.o., Vol. 59, No. 4 ( 2021-9-2), p. 206-210
    Abstract: Osteoporosis is the most common bone tissue disease and it is characterized by a re�duced bone mineral density (BMD). The main physiopathological mechanisms converge on the un�coupling between bone formation and resorption, thus leading to an enhanced risk of fractures. Several papers have documented the inverse relationships linking high inflammatory cytokines, anti�citrullinated protein antibodies, rheumatoid factor, and BMD in rheumatoid arthritis (RA). Rituximab (RTX) is a chimeric monoclonal antibody directed against the CD20 receptor of B cells. Since the Food and Drug Administration approved it for RA in 2006, there have been many clinical experiences regarding its use. Nevertheless, few studies evaluate the effect of rituximab on BMD. RA is a disease characterized by immune dysfunction with high levels of inflammatory cytokines, autoantibodies, and it is reasonable that a B cell depleting therapy could restore a physiological cytokine balance, thus exerting an osteoprotective effect on the bone tissue. The purpose of this paper is to highlight any difference in BMD and to assess differences in body composition over a retrospective 18-month follow-up period after RTX treatment with a B cell depleting therapy. Material and methods We analyzed by dual energy X-ray absorptiometry BMD expressed as g/cm2 and body composition modifications over 18 months with RTX treatment of 20 postmenopausal RA patients. Results After eighteen months of therapy with RTX, a statistically significant increase in vertebral (L1–L4) BMD and the stability of femoral BMD were documented. Conclusions Rituximab is associated with an improvement of vertebral and preservation of femo�ral BMD, suggesting a bone-sparing effect due to B cell depletion. Furthermore, patients displayed a redistribution of fat masses toward the hip region.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2021.108430
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2021
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  • 9
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    Routine IgG4 staining in minor salivary gland biopsy in a cohort of Italian Caucasian patients suffering from xerostomia
    Termedia Sp. z.o.o. ; 2022
    In:  Rheumatology Vol. 60, No. 1 ( 2022-2-10), p. 12-15
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 60, No. 1 ( 2022-2-10), p. 12-15
    Abstract: IgG4-related disease is a potentially systemic disease mimicking and overlapping with different autoimmune diseases, such as primary Sjögren’s syndrome (pSS). The involvement of salivary glands, previously called Mikulicz’s disease, has been reclassified as IgG4-related sialadenitis (SA). The aim of this study was to assess the prevalence of IgG4-SA in a cohort of Italian Caucasian patients presenting with xerostomia and to evaluate the eventual overlap between IgG4-SA and pSS. Material and methods We included 154 patients – 15 males and 139 females, mean age 54.18 ±14.24 years, who underwent minor salivary gland biopsy between March and December 2019 for xerostomia. Histopathology was evaluated using Chisholm-Mason (CM) and focus score (FS) for pSS and immunohistochemical study with IgG4 staining for IgG4-SA were performed. Serum autoantibodies (anti-SSa/RoAb, anti-SSB/LaAb, antinuclear antibodies, rheumatoid factor) were also assessed. Results In 69 patients (44.8%) FS 0 was found, while FS ≥ 1 was presented in 85 (55.2%). Chisholm-Mason score 〈 3 and CM ≥ 3 was found in 73 (47.4%) and 81 (52.6%) cases, respectively. IgG4/high-power field level was 20 in 3 pSS patients (1.9%), but none of them had an IgG4/IgG ratio ≥ 40, as well as tissue fibrosis with storiform pattern, obliterative vasculitis, and tissue eosinophilia. The diagnosis of pSS, was confirmed in 92 patients (59.74%). No patient was definitively diagnosed with an IgG4-related disease. Conclusions In the case of xerostomia, the evaluation of the histopathological specimen for IgG4 should not be routinely performed, at least in an Italian-based Caucasian population. Moreover, immunohistochemistry should not be requested in the case of a negative result of biopsy for pSS.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2022.114207
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2022
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  • 10
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    Paraneoplastic arthritides: an up-to-date case-based systematic review
    Termedia Sp. z.o.o. ; 2022
    In:  Rheumatology Vol. 60, No. 6 ( 2022-12-30), p. 422-436
    Details
    In: Rheumatology, Termedia Sp. z.o.o., Vol. 60, No. 6 ( 2022-12-30), p. 422-436
    Abstract: Among the rheumatic diseases whose symptoms are more often associated with the possibility of cancer and other malignancies are systemic sclerosis, dermatomyositis and rheumatic polymyalgia. However, a differential diagnosis should be performed in each case of non-typical rheumatic disease and/or other neoplastic disease risk factors. The article’s aim was based on a literature review of this subject and presentation own a case description and discussion about arthritis as a paraneoplastic syndrome. The conclusions of our analysis were as follows: more often paraneoplastic arthritis occurs in men, in ages higher than 50 years old, in patients who poorly respond to treatment of arthritis with polyarticular symmetrical involvement of the limbs, seronegative type of inflammatory joint disease. In this group of patients, complete remission after treatment of the primary tumor and recurrence of the symptoms in the presence of metastasis was observed.
    Type of Medium: Online Resource
    ISSN: 0034-6233 , 2084-9834
    URL: Article
    DOI: 10.5114/reum.2022.123672
    Language: Unknown
    Publisher: Termedia Sp. z.o.o.
    Publication Date: 2022
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