Usefulness of the classification criteria for RA as guidance for treatment selection in an early arthritis cohort: 2010 criteria lead to higher rates of clinical remission

Background Early diagnosis and early treatment with DMARDs lead to better outcomes in rheumatoid arthritis (RA) (1,2). The 2010 ACR/EULAR criteria for RA were developed for early classification (3) and have good sensitivity, lower specificity and overall moderate accuracy. Their usefulness to lead treatment selection has not been investigated yet. Objectives To compare clinical remission (CR) rates in patients with early polyarthritis in which the decision to start methotrexate (MTX) was based on the 1987 ACR vs 2010 ACR/EULAR criteria, over the first 12 months follow up. Methods This is an observational non concurrent cohort study. Patients classified as RA or undifferentiated arthritis (UA) attending for the first time our early arthritis clinic (2005-2013) were eligible for inclusion. At baseline, before October 2010, patients classified as RA according to the 1987 criteria were treated with MTX (from 10 mg/wk up to 20 mg/wk), while patients with UA received hydroxychloroquine (HCQ) (1987 cohort). After October 2010, patients fulfilling the 2010 criteria received MTX (from 15 mg/wk up to 25mg/wk), while UA received HCQ (2010 cohort). Low-dose prednisone could be given according to clinician's decision. Patients were seen every 2 months in the first six months and every 3 afterwards; treatment was increased in order to achieve low disease activity (DAS28<3.2). CR (DAS28<2.6) was evaluated at every visit. Analyses were performed with a Cox proportional hazard regression analysis, and results presented as hazard ratios (HR) and 95% confidence intervals (CI). Results Out of 676 patients, 467 were included in the 1987 cohort and 209 in the 2010 cohort. There were no significant differences between the two cohorts in terms of age, gender, VAS pain, RF and ACPA positivity. Patients in the 2010 cohort had significantly fewer median (IQR) tender (4 (2-8) vs 5 (2-10), p=0.018) and swollen joints (4 (2-7) vs 6 (3-10), p<0.0001) over 28 joints, ESR (19 (10-34) vs 22 (13-39), p=0.007) and CRP (0.4 (0.3-1.2) vs 0.7 (0.31-2.09), p=0.001), mean (SD) DAS28 (4.44 (1.14) vs 4.74 (1.25), p=0.005) and median (IQR) HAQ (0.75 (0.375-1.25) vs 1 (0.5-1.625), p=0.0001). Comparing the two cohorts, the 2010 cohort was more likely to achieve CR even when the analysis was limited to patients who strictly followed the protocol or actually received MTX, both in crude and adjusted analyses (Tab1). Conclusions Patients with early arthritis in which the decision to start MTX is driven by the 2010 criteria achieve more often CR compared to those treated according to the 1987 criteria. Beside the limited diagnostic accuracy of the 2010 criteria, these results support their usefulness as treatment selection guidance in practice. (Table Presented)

Italian consensus recommendations for the management of hepatitis C infection in patients with rheumatoid arthritis

Objectives: The recent introduction of direct-acting antiviral agents (DAAs) which can eliminate Hepatitis C virus (HCV) had revolutionized the treatment of HCV infections also in a complex clinical setting such as the patients with rheumatoid arthritis (RA). HCV elimination is also opportune due to the availability of more efficient immunosuppressive drugs, whose effect on the course of HCV infection is largely unknown.Methods: Consensus process was endorsed by the Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) to review the available evidence and produce practical, hospital-wide recommendations. The consensus panel consisted of 18 infectious diseases consultants, 20 rheumatologists and one clinical epidemiologist, who used the criteria of the Oxford Centre for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations.Results: A core-set of statements about management of patients with RA and infection by HCV have been developed to help clinicians in their clinical practice.Conclusions: A screening for HCV should be performed in all RA patients and it is mandatory before starting an immunosuppressive therapy. Finally, a DAA treatment should be considered in all HCV-infected patients

Measuring multimorbidity inequality across Italy through the multisource comorbidity score: A nationwide study

none14noBackground: Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy. Methods: Beneficiaries of the Italian National Health Service aged 50-85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared. Results: Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones. Conclusion: MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.noneCorrao G.; Rea F.; Carle F.; Di Martino M.; De Palma R.; Francesconi P.; Lepore V.; Merlino L.; Scondotto S.; Garau D.; Spazzafumo L.; Montagano G.; Clagnan E.; Martini N.Corrao, G.; Rea, F.; Carle, F.; Di Martino, M.; De Palma, R.; Francesconi, P.; Lepore, V.; Merlino, L.; Scondotto, S.; Garau, D.; Spazzafumo, L.; Montagano, G.; Clagnan, E.; Martini, N

W-doped vanadium dioxide films by pulsed laser deposition for IR Photonics

The semiconductor-to-metal phase transition exhibited by vanadium dioxide at the critical temperature of 68 °C, enables reversible changes in its optical and electrical properties. Moreover, the possibility to modify the transition temperature by introducing dopants within the VO2 crystal, allows a temperature tunability of all these properties, making this phase change material very appealing for active, dynamic, tunable Photonic applications. In this work we report on fabrication and structural, morphological, and optical characterization of tungsten (W)-doped VO2 thin films synthesized by pulsed laser deposition, a technique which allows a unique versatility to obtain W-doped VO2 films using custom made VO2 targets with different amounts of W. Results show that appropriate W-doping leads to VO2 thin films with tunable and controllable perfect IR absorption, paving the way to the development of promising thermooptical devices including infrared filters, radiative cooling devices, and thermal emitters. Furthermore, by varying the amount of W, tailored infrared phonon and plasmon polaritonic responses at room temperature can be obtained, allowing then the realization of VO2 films with a given degree of semiconducting/metallic behaviour, exploitable for the realization of tunable midinfrared metamaterial devices operating at room temperature

Disease activity assessment of rheumatic diseases during pregnancy: a comprehensive review of indices used in clinical studies.

Pregnancy requires a special management in women with inflammatory rheumatic diseases (RDs), with the aim of controlling maternal disease activity and avoiding fetal complications. Despite the heterogeneous course of RDs during pregnancy, their impact on pregnancy largely relates to the extent of active inflammation at the time of conception. Therefore, accurate evaluation of disease activity is crucial for the best management of pregnant patients. Nevertheless, there are limitations in using conventional measures of disease activity in pregnancy, as some items included in these instruments can be biased by symptoms or by physiological changes related to pregnancy and the pregnancy itself may influence laboratory parameters used to assess disease activity. This article aims to summarize the current literature about the available instruments to measure disease activity during pregnancy in RDs. Systemic lupus erythematosus is the only disease with instruments that have been modified to account for several adaptations which might interfere with the attribution of signs or symptoms to disease activity during pregnancy. No modified-pregnancy indices exist for women affected by other RDs, but standard indices have been applied to pregnant patients. The current body of knowledge shows that the physiologic changes that occur during pregnancy need to be either adapted from existing instruments or developed to improve the management of pregnant women with RDs. Standardized instruments to assess disease activity during pregnancy would be helpful not only for clinical practice but also for research purposes

The provisional OMERACT ultrasonography score for giant cell arteritis

Objectives: To develop an Outcome Measures in Rheumatology (OMERACT) ultrasonography score for monitoring disease activity in giant cell arteritis (GCA) and evaluate its metric properties.Methods: The OMERACT Instrument Selection Algorithm was followed. Forty-nine members of the OMERACT ultrasonography large vessel vasculitis working group were invited to seven Delphi rounds. An online reliability exercise was conducted using images of bilateral common temporal arteries, parietal and frontal branches as well as axillary arteries from 16 patients with GCA and 7 controls. Sensitivity to change and convergent construct validity were tested using data from a prospective cohort of patients with new GCA in which ultrasound-based intima-media thickness (IMT) measurements were conducted at weeks 1, 3, 6, 12 and 24.Results: Agreement was obtained (92.7%) for the OMERACT GCA Ultrasonography Score (OGUS), calculated as follows: sum of IMT measured in every segment divided by the rounded cut-off values of IMTs in each segment. The resulting value is then divided by the number of segments available. Thirty-five members conducted the reliability exercise, the interrater intraclass correlation coefficient (ICC) for the OGUS was 0.72-0.84 and the median intrareader ICC was 0.91. The prospective cohort consisted of 52 patients. Sensitivity to change between baseline and each follow-up visit up to week 24 yielded standardised mean differences from -1.19 to -2.16, corresponding to large and very large magnitudes of change, respectively. OGUS correlated moderately with erythrocyte sedimentation rate, C reactive protein and Birmingham Vasculitis Activity Score (corr(coeff) 0.37-0.48).Conclusion: We developed a provisional OGUS for potential use in clinical trials

Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospective Italian P-RHEUM.it study

objectives: to investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. methods: pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 rheumatology centres for 5 years (2018-2023). maternal and infant information were collected in a web-based database. results: we analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. exclusive maternal breast feeding was received by 404 (46.7%) neonates. the edinburgh postnatal depression scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. conclusions: multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. disease-specific issues need to be further addressed to plan preventative measures