Interessamento entesitico in bambini e adolescenti con malattia infiammatoria cronica intestinale: uno studio ecografico

Background: joint involvement is the most common extraintestinal manifestation in paediatric IBD patients. Several studies in adult population have shown that enthesis ultrasound (US) has a high sensitivity in the diagnosis of enthesitis. Objectives: The objective is to evaluate, using a high frequency ultrasound probe, the prevalence of subclinical entheseal involvement in paediatric IBD patients. Methods: 27 paediatric IBD patients [12 Crohn's disease, 13 ulcerative colitis and 2 IBD type unclassified; 15 females and 12 males, mean age of 13,7 years (ranging 7,2-21,0 years)] without clinical signs or symptoms of musculo-skeletal involvement were consecutively investigated with US (ESAOTE MyLAB 70 6-18 MHz linear array transducer) and compared with 24 healthy controls matched for age and sex. Twelve enthesis were scored according to the Madrid Sonographic Enthesis Index (MASEI) in both groups. Results: no patients reached the MASEI score value suggestive for an early spondyloarthritis involvement but the average MASEI score was significantly higher in IBD patients compared to controls (3.15\ub12.84 vs 0.96\ub11.12, p=0.0006).There was also a significantly higher percentage of patients with at least one enthesis with power Doppler (PD) score 652 (37% vs 16%; p= 0.037) and at least one enthesis with dishomogeneous echostructure (59% vs 0%; p= 0.000). No differences were found in terms of erosions, calcifications and structural thickness. In IBD patients, no correlation was found between MASEI total score and sex, age, disease duration and clinical activity scores. Conclusions: US detectable enthesopathy is frequent even in paediatric IBD patients

Serum klotho concentrations inversely correlate with the severity of nailfold capillaroscopic patterns in patients with systemic sclerosis

Klotho is a transmembrane and soluble glycoprotein that governs vascular integrity. Previous studies have demonstrated reduced serum klotho concentrations in patients with systemic sclerosis (SSc), and it is known that klotho deficiency can impair the healing of digital ulcers related to microvessel damage. The aim of this study was to evaluate the association between serum klotho levels and nailfold capillaroscopic abnormalities in SSc patients. We retrospectively enrolled 54 consecutive patients with SSc diagnosed on the basis of the 2013 EULAR/ACR criteria [11 with diffuse SSc; 47 females; median age 68.0 years (IQ 18); median disease duration 11.0 years (IQ 7)]. Serum klotho concentrations were determined by means of an enzyme-linked immunosorbent assay. On the basis of the 2000 classification of Cutolo et al., 14 patients had normal nailfold capillaroscopic findings, 8 had an early scleroderma pattern, 21 an active scleroderma pattern, and 11 a late scleroderma pattern. The median serum klotho concentration was 0.29 ng/mL (IQ 1). Regression analysis of variation showed an inverse correlation between serum klotho concentrations and the severity of the capillaroscopic pattern (p=0.02; t -2.2284), which was not influenced by concomitant treatment. Logistic regression did not reveal any significant association between the risk of developing digital ulcers and nailfold capillaroscopic patterns, serum klotho levels, or concomitant medications. The presence of avascular areas significantly correlated with calcinosis (p=0.006). In line with previous studies, our findings confirm that klotho plays a role in preventing microvascular damage detected with nailfold capillaroscopy

Efficacy and safety of anti-TNF agents in the Lombardy rheumatoid arthritis network (LORHEN) = Efficacia e sicurezza degli agenti anti-TNF nel registro Lombardo (LORHEN)

L\u2019artrite reumatoide (AR) \ue8 una patologia ad andamento cronico, caratterizzata da sinovite persistente, progressiva distruzione delle strutture articolari e disabilit\ue0. Gli agenti biologici anti-Tumor Necrosis Factor-\u3b1 (TNF-\u3b1) (etanercept, infliximab e adalimumab) sono dotati di attivit\ue0 anti-infiammatoria, mediata dalla neutralizzazione del TNF-\u3b1, e presentano alcuni importanti vantaggi rispetto ai \u201cDisease-Modifying Anti-rheumatic Drugs\u201d DMARDs. Gli agenti-anti-TNF-\u3b1 sia in monoterapia sia in associazione al methotrexate (MTX), agiscono pi\uf9 rapidamente rispetto ai DMARDs e sono in grado di ridurre l\u2019attivit\ue0 di malattia non solo nei pazienti che hanno una risposta parziale ai farmaci di fondo, ma anche in quelli non responsivi. Nello stesso momento in cui in Europa veniva approvato il terzo farmaco anti-TNF per trattare i pazienti affetti da artrite reumatoide (AR), la Societ\ue0 Italiana di Reumatologia (SIR) avviava un database per registrare e monitorare i pazienti affetti da AR trattati con i farmaci anti-TNF. Fin dal 1999, tutti i pazienti affetti da AR secondo i criteri dell\u2019American College of Rheumatology (ACR) trattati con almeno una dose di farmaco anti-TNF presso quattro Centri di Reumatologia siti in Lombardia (nord est Italia) sono stati inclusi nel registro Lombardy Rheumatology Network (LORHEN) per valutare l\u2019efficacia e la sicurezza dei tre agenti anti-TNF attualmente in commercio durante i primi tre anni di trattamento.Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic synovitis and bone damages, which consist of joint destruction. Clinical trials have shown that anti-tumour necrosis factor (TNF) drugs are effective in patients with rheumatoid arthritis (RA) refractory to disease-modifying antirheumatic drugs (DMARDs). At about the same time as the European approval of the third anti-TNF agent for treating rheumatoid arthritis (RA) patients, the Italian Society of Rheumatology (Societ\ue0 Italiana di Reumatologia [SIR]) started a database for the registration and active follow-up of patients with RA treated with biological response modifiers. Since 1999, all patients with RA (ACR criteria) and treated with at least one dose of an anti-TNF agent at four Rheumatology Centres in Lombardy (northwest Italy) have been included in the Lombardy Rheumatology Network (LORHEN) registry in order to track the efficacy and safety of the three available TNF inhibitors during the first three years of treatment

Efficacy and safety of anti-TNF agents in the Lombardy rheumatoid arthritis network (LORHEN)

Clinical trials have shown that anti-tumour necrosis factor (TNF)-α drugs are effective in patients with rheumatoid arthritis (RA) refractory to disease- modifying antirheumatic drugs (DMARDs) (1-4). At about the same time as the European approval of the third anti-TNFα agent (adalimumab) for treating RA patients, the Italian Society of Rheumatology (Societa Italiana di Reumatologia [SIR]) started a database for the registration and active follow-up of RA patients treated with biological response modifiers, which contains all of the demographic and clinical parameters, as well as the therapeutic data, usually needed to follow RA patients..