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  • 1
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. Suppl 1 ( 2022-06), p. 970.2-971
    Abstract: Patients with autoimmune systemic diseases (ASDs) can be counted among frail populations as regards the predisposition to COVID-19 due to the frequent visceral organ involvement and comorbidities, as well as the ongoing immunomodulating treatments. Objectives Our long-term multicenter telephone survey prospectively investigated the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients during the first 3 pandemic waves. Methods A large series of 3,918 ASD patients (815 M, 3103 F; mean age 59±12SD years) was consecutively recruited at the 36 referral centers of COVID-19 & ASD Italian Study Group. In particular, ASD series encompassed the following conditions: rheumatoid arthritis (n: 981), psoriatic arthritis (n: 471), ankylosing spondylitis (n: 159), systemic sclerosis (n: 1,738), systemic lupus (172), systemic vasculitis (n: 219), and a miscellany of other ASDs (n: 178). The development of COVID-19 was recorded by means of telephone survey using standardized symptom-assessment questionnaire (1). Results A significantly increased prevalence of COVID-19 (8.37% vs 6.49%; p 〈 0.0001) was observed in our ASD patients, while the cumulative death rate revealed statistically comparable to the Italian general population (3.65% vs 2.95%; p: ns). In particular, among the 328 ASD patients complicated by COVID-19, 57 (17%) needed hospitalization, while mild-moderate manifestations were observed in the large majority of individuals (83%). In addition, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular manifestations. Interestingly, a significantly higher COVID-19-related death rate was observed in systemic sclerosis patients compared to the Italian general population (6.29% vs 2.95%; p=0.018). Other adverse prognostic factors to develop COVID-19 were the patients’ older age, male gender, pre-existing ASD-related interstitial lung involvement, and chronic steroid treatment. Conversely, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%; p=0.000), as well as the chronic administration of low dose aspirin in a subgroup of SSc patients (with 5.57% vs without 27.84%; p=0.000). Conclusion The cumulative impact of COVID-19 on ASD patients after the first 3 pandemic waves revealed less severe than that observed during the first phase of pandemic (1), especially with regards to the death rate that was comparable to the Italian general population in spite of the increased prevalence of complicating COVID-19 in the same ASD series. Ongoing long-term treatments, mainly csDMARDs, might usefully contribute to generally positive outcomes of in this frail patients’ population. Of note, a significantly increased COVID-19-related mortality was recorded in only SSc patients’ subgroup, possibly favored by pre-existing lung fibrosis. Among different ASD, SSc deserves special attention, since it shares the main pathological alterations with COVID-19, namely the interstitial lung involvement and the endothelial injury responsible for diffuse microangiopathy. Besides SSc, the patients’ subgroups characterized by older age, chronic steroid treatment, pre-existing interstitial lung disease, and/or impaired COVID-19 vaccine response (1-3), may deserve well-designed prevention and management strategies. References [1]Ferri C, et al. Ann Rheum Dis. 2020 Oct 14 doi: 10.1136/annrheumdis-2020-219113. [2]Ferri C et al. J Autoimmun. 2021 Dec;125:102744. doi: 10.1016/j.jaut.2021.102744. [3]Visentini M et al. Ann Rheum Dis. 2021 Nov 24. doi: 10.1136/annrheumdis-2021-221248 Disclosure of Interests None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 2
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1924.1-1924
    Abstract: The Italian Society for Rheumatology (SIR) comprises committees for Rheumatologists under the age of 40 (SIRyoung) and for Women in Rheumatology (Reumatologhe Donne – ReDO). As female representation is increasing in rheumatology worldwide [1] , there has been interest in assessing gender-related issues. Objectives: To describe the gender distribution among young members of SIR and academic positions in Rheumatology in Italy. To assess the expectations and needs of young rheumatologists with regard to their career. Methods: SIRyoung members developed a web-based survey which was distributed among SIR members under the age of 40 during the spring of 2019. Responses were collected and analysed anonymously. ReDO retrieved and analysed the data regarding academic positions in Italy in September 2019 from official data by “Ministry of Education, University and Research” ( www.miur.it ). Results: Out of 478 SIR members under 40 (66.5% F), 113 (23.7%) completed the SIRyoung survey (62.1% F). Regarding career plans, male and female members responded: hospital physician (36.9% vs 37.8%), outpatient clinic physician (18.5% vs 28.3%), academic career (23.9% vs 22.8%), private practice (16.3% vs 9.4%), and industry (4.3 vs 1.6%), respectively. When asked about their interest in doing a fellowship in another national center or abroad, 60.8% of male and 72.8% of female respondents were interested but thought they could not afford it. Reasons reported by males and females were: working reasons, namely barriers to temporarily leave the workplace (61.3% vs 50.7%), family reasons (16.1% vs 25.4%), financial reasons (22.6% vs 16.5%), respectively. As for academic rheumatology in Italy, 113 positions were retrieved. Men held 64 positions (57%) and women 49 (43%). Full professors were mostly men (92%), while assistant professors were women in 65% of the cases (58% of those with a permanent position; 72% of those with a temporary position) (Figure) [2]. Conclusion: Our study explored for the first time gender distribution and related issues in Rheumatology in Italy. Female representation accounts for two thirds of SIR members under 40. This could reflect the general trend of medical school being chosen more often by women than men. No differences were observed in the career expectations of male and female rheumatologists. Interestingly, nearly one fourth of female respondents were interested in academic career, confirming the trend toward female predominance observed for assistant professors. Therefore, it is likely that the next generation of full professors will have a balanced gender distribution, as it is already for associate professors. The choice of a fellowship is still hampered by several problems, but it seems that reasons for not pursuing such opportunities are similarly distributed in males and females. Although family reasons tend to be more frequent in female rheumatologists, this is not significant as compared to men. This could indicate that family affects career choices of both male and female rheumatologists. It is important that national societies promote surveys for the assessment of gender specific issues among their members, in order to identify unmet needs and design interventions for career support regardless of gender. References: [1]Andreoli L, et al. Joint, Bone, Spine: Revue du Rhumatisme. 2019;86(6):669-672. [2]Bosello SL, et al. Reumatismo 2020; in press. Acknowledgments: SIRyoung and ReDO wish to thank the Steering Committee of SIR Disclosure of Interests: Laura Andreoli: None declared, Stefano Alivernini: None declared, Alessia Alunno: None declared, Silvia Laura Bosello: None declared, Cecilia Chighizola: None declared, Paola Conigliaro: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Cristina Iannuccelli: None declared, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Francesca Romana Spinelli Grant/research support from: Pfizer, Consultant of: Novartis, Gilead, Lilly, Sanofi, Celgene, Speakers bureau: Lilly, Marta Vadacca: None declared, Maria Sole Chimenti: None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 3
    In: Revue du Rhumatisme, Elsevier BV, Vol. 73, No. 10-11 ( 2006-11), p. 1202-1203
    Type of Medium: Online Resource
    ISSN: 1169-8330
    Language: French
    Publisher: Elsevier BV
    Publication Date: 2006
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  • 4
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. Suppl 1 ( 2022-06), p. 960.2-961
    Abstract: The impact of the severe acute respiratory syndrome Coronavirus 2 disease (COVID-19) pandemic on people with systemic autoimmune rheumatic diseases (SARDs) remains to be fully established. It is unclear whether SARDs are an independent risk factor for COVID-19 infection and poor outcome. Objectives The aim of our study is to assess the incidence and prognosis of test-proven SARS-CoV-2 infection during the first COVID-19 wave in a large population of SARD patients of the Lazio Italian region. Methods We retrospectively evaluated in a cohort of 4.716.119 subjects aged over 18 years and affiliated to the health system of the Lazio Italian Region, the incidence and 30-day outcomes of COVID-19 infection in 40.490 SARD pts and compared to the affiliated population as incidence rate ratio adjusted for demographics and comorbidities (adjIRR). SARD diagnosis and comorbidities were derived from medical administrative records using the Chronic Related Group classification system. Data on COVID-19 infection were derived from a dedicated regional digital network. Results The risk of COVID-19 infection was increased in patients with Psoriatic Arthritis (adjIRR=1.21, 95% CI 1.10-1.33) and Undifferentiated Connective Tissue Disease (adjIRR=1.26, 95% CI 1.03-1.54). The risk of hospitalisation was higher in patients with Axial Spondylarthritis (adjIRR=2.16, 95% CI 1.45-3.22), and Systemic Vasculitis (adjIRR=1.81, 95% CI 1.07-3.06) while the risk of Intensive care unit admission was higher in Systemic Erythematous Lupus (adjIRR=3.67, 95% CI 1.52-8.83) and primary Sjögren Syndrome (adjIRR=4.13, 95% CI 1.71-9.96) patients. An increased COVID-19 mortality was reported in patients with Rheumatoid Arthritis (adjIRR=1.50, 95% CI 1.04-2.17), Systemic Erythematous Lupus (adjIRR=2.67, 95% CI 1.10-6.44), primary Sjögren Syndrome (adjIRR=2.51, 95% CI 1.12-5.62), and Scleroderma (adjIRR=4.60, 95% CI 2.06-10.29). Conclusion The incidence of severe COVID-19 is not increased in the same percentage in SARDs. Each SARD presents a peculiar pattern in terms of increased risk of COVID-19 incidence, hospitalisation, intensive care unit admission and death, that is not linked to the immunosuppressive behaviour of the disease. Disclosure of Interests None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 5
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1908.2-1908
    Abstract: Predicting clinical outcomes in ANCA-related glomerulonephritis remains a major challenge. To date, there is no reliable biomarker able to predict renal prognosis in patients with ANCA-associated vasculitis (AAV). Micro-RNA (miRNA) are non-coding RNAs involved in the fine tuning of immune cells biology and this epigenetic modulation associates with different phenotypes and prognosis in several diseases. Objectives: To investigate the expression of miR-155 and miR-34a in kidney biopsies of AAV patients according with renal outcome. Methods: Fifteen patients with AAV and renal involvement (mean age 63.0 ±13.3 years, disease duration 4.9±2.2 months), who underwent renal biopsy. Demographic, clinical and autoimmune parameters were recorded for each patient. Each kidney biopsy was classified according to the Berden Classification, Risk group (according to the ANCA Renal Risk Score) and the chronicity Classification of the Mayo Clinic’s proposed score. MiR-155 and miR-34a expression was investigated on kidney biopsy tissue using the miRNeasy FFPE kit (Qiagen). The quantitative expression of miR-155, miR-34a and housekeeping gene U1, used as control, was assessed by Real Time-PCR. MiR-155 and miR-34a expression was correlated with histopathological and clinical-laboratory parameters. Each patient was followed for 12 months and renal outcome was considered according to KDIGO CKD Classification. Markers of inflammation (ESR, CRP) and urine analysis data were recorded at baseline and after 12 months. Results: Six (40%) patients were p-ANCA positive and 9 (60%) c-ANCA positive. Eight patients (53%) also had pulmonary involvement. The mean baseline GFR was 30.7±28.8 ml/min/1.73 m 2 and 10 patients (66%) showed an active urinary sediment. At disease onset, the mean expression of miR-155 was 9.5±21.1, while the expression of mir-34a was 13.1±46.2. Considering the autoimmune profile, kidney tissue of p-ANCA positive patients was enriched of mir-155 (19.6±30.6 fold) compared to c-ANCA positive patients (1.9±2.9 fold; p=0.001). Particularly, considering the renal function, kidney tissue of patients with greater impairment of renal function ( KDIGO stage 5 ) was enriched of miR-155 (21.5±38.3 fold) compared to patients with less renal impairment ( KDIGO stage 1-4 ) (4.72±8.16 fold, p=0.004). Tissue expression of miR-155 and miR-34a did not correlated with the abovementioned histopathological classifications. After 12 months from kidney biopsy, 3(20%) patients had a worsening of renal function, 5 (33%) still presented elevated markers of inflammation and 3 (20%) still had proteinuria at urine analysis. At baseline, kidney tissue of patients with higher CRP plasma levels and proteinuria at follow-up presented higher expression of miR-155 (p=0.002 and p=0.001), whereas no significant differences were found about miR-34a kidney tissue expression. Conclusion: MiRNAs may play a potential role in the pathogenesis of ANCA-related glomerulonephritis. MiR-155 kidney enrichment seems to mirror the disease inflammatory burden and activity at the onset and after 12 months representing a possible biomarker in ANCA vasculitis with renal involvement. This finding may represent the basis for further studies on miRNA expression in blood samples, aiming to identify a non-invasive biomarker of kidney damage, predicting disease’s relapses and patients’ prognosis. References: [1]Renauer et al, Clin Rev Allergy Immunol. 2016 Disclosure of Interests: Dario Bruno: None declared, Pier Giacomo Cerasuolo: None declared, Clara Di Mario: None declared, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Laura Gigante: None declared, Alessia Musto: None declared, Gisella Vischini: None declared, Stefano Costanzi: None declared, Stefano Alivernini: None declared, Barbara Tolusso: None declared, Giuseppe Grandaliano: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 6
    Online Resource
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    BMJ ; 2022
    In:  Annals of the Rheumatic Diseases Vol. 81, No. Suppl 1 ( 2022-06), p. 740.1-740
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 81, No. Suppl 1 ( 2022-06), p. 740.1-740
    Abstract: The optical coherence tomography angiography (OCTA) is a new non-invasive imaging technique that can detect flow and provide information about the vessel density (VD) at different layers in the eye. The ocular microvascular network has been only occasionally addressed as disease target in scleroderma (SSc) considering the relatively low prevalence of ocular symptoms in these patients. Objectives The study aims to evaluate retinal and choriocapillaris microvasculature in a group of SSc patients compared to matched controls (HC)and according to disease characteristics, capillaroscopy findings and pulmonary function tests. Methods VD was assessed through OCTA at the retinal superficial (SCP) and deep (DCP) capillary plexus, at the foveal avascular zone perimeter (FAZP) and at the choriocapillaris (CC) of 30 SSc patients compared to 30 sex- and age-matched subjects without any retinal disease. Results The SSc patients (age 57.3±10.0, female 86.7%) had diffuse cutaneous skin disease in 30.0% of the cases, an average disease duration of 10.4±7.2 yy, and anti-centromere and anti-Scl70 antibody positivity in 40.0%and in 30.0% of the cases, respectively. Compared to the HC, SSc showed an impaired VD at SCP (47.7±3.6 vs59.1±3.5%, p=0.009), DCP (50.0±6.7 vs 54.3±6.4%, p=0.015), FAZP (48.7±4.55 vs 51.0±3.55%, p=0.034) and CC(67.1±2.2 vs 68.6±1.7, p=.005). Moreover, in the SSc group, the presence of digital ulcers (46.7%),telangiectasias (43.3%) and interstitial lung disease (46.7%) was related to reduced VD at FAZP (46.8±4.1 vs50.3±4.3%, p=0.033), CC (66.1±1.4 vs 67.9±2.4%, p=0.004), and DCP (47.2±8.8 vs 51.9±4.3, p=0.004),respectively. Lastly, the average capillary density on capillaroscopy showed a positive correlation with VD at FAZP (r=0.474, p=0.008), DCP (r=0.414, p=0.023), and foveal CC (r=0.482, p=0.007) and there was also a correlation between CC and both DLco (r=0.467, p=0.009) and FVC/DLco (r=-0.436, p=0.004). Conclusion The SSc patients in our cohort showed lower ocular vessel density at different levels compared to HC. Furthermore, impaired VD at different levels of the eye correlates with the organ involvement and the degree of digital and pulmonary microvascular impairment. According to those data, the OCTA could be proposed as a biomarker tool to investigate the microvascular abnormalities in SSc. Disclosure of Interests None declared
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 7
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 73, No. Suppl 2 ( 2014-06), p. 352.1-352
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2014
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  • 8
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 66, No. 9 ( 2007-03-15), p. 1210-1215
    Type of Medium: Online Resource
    ISSN: 0003-4967
    RVK:
    Language: English
    Publisher: BMJ
    Publication Date: 2007
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  • 9
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 79, No. Suppl 1 ( 2020-06), p. 1016.2-1017
    Abstract: Gender medicine aims at describing how diseases differ between men and women in terms of epidemiology, clinical feature, therapeutic approach, treatment response and prognosis, psychological and social impact. Rheumatoid Arthritis (RA) affects women 2-3 times more than men. Female gender seems to be independently associated to a more refractory disease and a worst response to conventional synthetic Disease Modifying Anti-Rheumatic Drugs (csDMARDs) and biological DMARDs. Male patients achieve remission more often than females probably due to the higher number of tender joints reported by the latter. Objectives: In the light of the effect of Janus kinases inhibitors (JAKi) on pain, the objective of the study was to investigate whether gender might affect the achievement of remission or low disease activity in RA patients treated with baricitinib and tofacitinib. Methods: We performed a multicentric, prospective study on consecutive patients starting one of the two available JAKi: baricitinib and tofacitinib. Demographic and clinical data were recorded in a dedicate database and included: gender, age, disease duration, serological status (Rheumatoid Factor – RF; anti-citrullinated peptide antibodies, ACPA) number of previous csDMARDs and bDMARDs, number of tender joints (TJ) and swollen joints (SJ), C reactive protein (CRP); patient global assessment (PGA) and pain were recorded on a 0-100 mm visual-analogue scale (VAS). Disease activity score (DAS) 28 was calculated at baseline and at two follow-up visits (after 3-4 months and after 6-8 months). Data were expressed as mean±standard deviation or median (interquartile range) according to variables’ distribution. Continuous variables were compared by Mann Whitney test while dichotomous ones by Chi-squared test; p value 〈 0.05 were considered statistically significant. Results: We enrolled 182 RA patients (149 F:33 M) with similar age (F 58 ± 12 vs M 60 ± 10) and disease duration (F 143 ± 101 vs M 147 ± 105 months). Females and males were previously treated with the same number of csDMARDs [2(2)] but female have previously received numerically more bDMARDs [2(3) vs 1(2)] . At the 3 timepoints females and males showed similar number of TJ, SJ, similar values of CRP, PGA and pain. We did not observe any difference in percentage of males and females achieving remission or low disease activity according to gender (figure 1A) nor in terms of reduction of TJ, SJ and PGA; only pain decreased significantly more in male than in female patients at both timepoints (figure 1B). Conclusion: In RA patients treated with JAK inhibitors, even if the effect of JAKi on pain seems to be more relevant in male than in female, gender seems not to influence the overall clinical response, allowing men and women the same probability of reaching the therapeutic target References: Disclosure of Interests: Francesca Romana Spinelli Grant/research support from: Pfizer, Speakers bureau: Lilly, BMS, Celgene, Maria Sole Chimenti: None declared, Marta Vadacca: None declared, Cristina Iannuccelli: None declared, Paola Conigliaro: None declared, Silvia Laura Bosello: None declared, Fulvia Ceccarelli: None declared, Cristina Garufi: None declared, Giulia Raffone: None declared, Paola Di Noi: None declared, Dario Bruno: None declared, Antonella Afeltra: None declared, Roberto Perricone: None declared, fabrizio conti Speakers bureau: BMS, Lilly, Abbvie, Pfizer, Sanofi, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 10
    In: Annals of the Rheumatic Diseases, BMJ, Vol. 72, No. Suppl 3 ( 2013-06), p. A584.3-A585
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
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    Language: English
    Publisher: BMJ
    Publication Date: 2013
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