Incidental papillary thyroid cancer diagnosis in patient with adult-onset Still’s disease-like manifestations

Adult onset Still’s disease (AOSD) is a systemic inflammatory disease characterized primarily by a triad consisting of daily fever, arthritis and maculopapular exanthema. The pathogenesis and etiology of AOSD are unknown and the diagnosis, which can be very challenging, is often made by exclusion. Here, we report a case of a 61-year-old woman with a history of mild psoriatic arthritis, fever, arthritis and maculopapular exanthema. Her initial laboratory tests showed neutrophilic leukocytosis, hypertransaminasemia, and markedly elevated levels of the erythrocyte sedimentation rate and C-reactive protein. With a presumptive diagnosis of AOSD, based on Yamaguchi criteria, the patient started an extensive diagnostic work-up to exclude other potential differential diagnoses. With fluorodeoxyglucose (FDG) positron-emission tomography, a thyroid nodule with moderate FDG uptakes was detected. The fine needle aspiration biopsy led to diagnosis of papillary thyroid cancer. The history of psoriatic arthritis, the patient’s age, and atypical features of the skin rash described as not concomitant with fever flares, suggested a diagnosis of paraneoplastic AOSD-like manifestations

Effectiveness of Golimumab as Second Anti-TNFα Drug in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis in Italy: GO-BEYOND, a Prospective Real-World Observational Study

In this prospective observational study, data were collected from 34 rheumatology clinics in Italy in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) who started golimumab (GLM) as a second anti-TNFα drug. The primary objective was to evaluate the effectiveness of GLM after 6 months. Changes in quality of life using the EQ-5D-5L were also assessed. A total of 194 patients aged 53.2 ± 12 years started GLM as a second anti-TNF drug: 39 (20.1%) with RA, 91 (46.9%) with PsA and 64 (32.9%) with axSpA. After 6 months of GLM treatment, 68% of RA patients achieved low disease activity (LDA; DAS28-CRP ≤ 3.2), 31.9% of PsA patients achieved minimal disease activity and 32.5% of axSpA patients achieved LDA (ASDAS-CRP < 2.1). Good/moderate EULAR response was achieved in 61.9% and 73.8% of patients with RA and PsA, respectively, and 16% of axSpA patients achieved a 50% improvement in BASDAI. Across all indications, improvements in disease activity measures and EQ-5D-5L domains were observed over 6 months. The main reasons for GLM interruption were lack/loss of efficacy (7.2%) or adverse events (2%). This study confirms the effectiveness of GLM as a second-line anti-TNF for the treatment of RA, PsA and axSpA in a real-world setting in Italy

Early systemic sclerosis: short –term disease evolution and factors predidting the development of new manifestations of organ involvement

INTRODUCTION: We investigated early systemic sclerosis (SSc) (that is, Raynaud's phenomenon with SSc marker autoantibodies and/or typical capillaroscopic findings and no manifestations other than puffy fingers or arthritis) versus undifferentiated connective tissue disease (UCTD) to identify predictors of short-term disease evolution. METHODS: Thirty-nine early SSc and 37 UCTD patients were investigated. At baseline, all patients underwent clinical evaluation, B-mode echocardiography, lung function tests and esophageal manometry to detect preclinical alterations of internal organs, and were re-assessed every year. Twenty-one early SSc and 24 UCTD patients, and 25 controls were also investigated for serum endothelial, T-cell and fibroblast activation markers. RESULTS: At baseline, 48.7% of early SSc and 37.8% of UCTD patients had at least one preclinical functional alteration (P > 0.05). Ninety-two percent of early SSc patients developed manifestations consistent with definite SSc (that is, skin sclerosis, digital ulcers/scars, two or more teleangectasias, clinically visible nailfold capillaries, cutaneous calcinosis, X-ray bibasilar lung fibrosis, X-ray esophageal dysmotility, ECG signs of myocardial fibrosis and laboratory signs of renal crisis) within five years versus 17.1% of UCTD patients (X(2 )= 12.26; P = 0.0005). Avascular areas (HR = 4.39 95% CI 1.18 to 16.3; P = 0.02), increased levels of soluble IL-2 receptor alpha (HR = 4.39; 95% CI 1.03 to 18.6; P = 0.03), and of procollagen III aminopropeptide predicted disease evolution (HR = 4.55; 95% CI 1.18 to 17; P = 0.04). CONCLUSION: Most early SSc but only a few UCTD patients progress to definite SSc within a short-term follow-up. Measurement of circulating markers of T-cell and fibroblast activation might serve to identify early SSc patients who are more likely to develop features of definite SSc

The data project: a shared approach between stakeholders of the healthcare system in definition of a therapeutic algorithm for inflammatory arthritis

: Rheumatic musculoskeletal diseases or RMD [rheumatoid arthritis (RA) and spondyloarthritis (SpA)] are systemic inflammatory diseases for which there are no biomarkers capable of predicting treatments with a higher likelihood of response in naive patients. In addition, the expiration of the anti-TNF blocking drugs' patents has resulted in the availability of anti-TNF biosimilar drugs with the same efficacy and safety than originators but at significantly reduced prices. To guarantee a personalized therapeutic approach to RMD treatment, a board of rheumatologists and stakeholders from the Campania region, Italy, developed a clinically applicable arthritis therapeutic algorithm to guide rheumatologists (DATA project). The general methodology relied on a Delphi technique forecast to produce a set of statements that summarized the experts' consensus. Selected clinical scenarios were discussed in light of the available evidence, and there were two rounds of voting on the therapeutic approaches. Separate discussions were held regarding rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. The decision-making factors for each disease were clinical presentation, demographics, and comorbidities. In this paper, we describe a virtuous process between rheumatologists and healthcare system stakeholders that resulted in the development of a shared therapeutic algorithm for RMD patients naive to bDMARDs

Efficacy of diclofenac eyedrops in preventing postoperative inflammation and long-term cystoid macular edema

Purpose: To compare the efficacy and tolerance of diclofenac 0.1% eyedrops with a regimen that included a brief course of steroids in the treatment of postoperative inflammation after extracapsular cataract surgery and posterior chamber intraocular lens implantation. A second objective was to compare the efficacy of diclofenac 0.1% eyedrops in the same patients and control group in preventing cystoid macular edema (CME). Setting: Eight university/hospital centers and one company in Italy. Methods: The multicenter, controlled, randomized, prospective, double-blind study included 281 patients. All were evaluated at baseline, at surgery, and after 1, 5, 36, 67, and 140 days. Postoperative inflammation was measured by the clinical assessment of inflammation: conjunctival hyperemia, ciliary flush, Tyndall effect, and cells in the anterior chamber. Fluorescein angiography was performed to evaluate the presence/absence of CME before surgery and after 36 and 140 days. Results: During follow-up, no differences in intraoperative pressure were observed within or between groups or between operated and fellow eyes. No statistically significant between-group differences in postoperative inflammation were found. After 36 days, angiographic CME was found in 9 patients (6.43%) in the diclofenac group and 20 (15.15%) in the control group (P = .033) with a relative risk for developing CME of 0.40 (Cl-95 0.19 to 0.84). At the end of follow-up, it was found in 4 patients in the diclofenac group (3.31%) and 10 (9.26%) in the control group (P = .05) with a relative risk of 0.36 (Cl-95 0.12 to 0.90). Conclusion: Diclofenac sodium was as effective as the control regimen in controlling postoperative inflammation after cataract surgery. It also had a protective effect on the development of angiographic CME after 36 and 140 days. RI Bonini, Stefano/A-2250-201

Efficacy of diclofenac eyedrops in preventing postoperative inflammation and long-term cystoid macular edema.

PURPOSE: To compare the efficacy and tolerance of diclofenac 0.1% eyedrops with a regimen that included a brief course of steroids in the treatment of postoperative inflammation after extracapsular cataract surgery and posterior chamber intraocular lens implantation. A second objective was to compare the efficacy of diclofenac 0.1% eyedrops in the same patients and control group in preventing cystoid macular edema (CME). SETTING: Eight university/hospital centers and one company in Italy. METHODS: The multicenter, controlled, randomized, prospective, double-blind study included 281 patients. All were evaluated at baseline, at surgery, and after 1, 5, 36, 67, and 140 days. Postoperative inflammation was measured by the clinical assessment of inflammation: conjunctival hyperemia, ciliary flush, Tyndall effect, and cells in the anterior chamber. Fluorescein angiography was performed to evaluate the presence/absence of CME before surgery and after 36 and 140 days. RESULTS: During follow-up, no differences in intraoperative pressure were observed within or between groups or between operated and fellow eyes. No statistically significant between-group differences in postoperative inflammation were found. After 36 days, angiographic CME was found in 9 patients (6.43%) in the diclofenac group and 20 (15.15%) in the control group (P = .033) with a relative risk for developing CME of 0.40 (CI95 0.19 to 0.84). At the end of follow-up, it was found in 4 patients in the diclofenac group (3.31%) and 10 (9.26%) in the control group (P = .05) with a relative risk of 0.36 (CI95 0.12 to 0.90). CONCLUSION: Diclofenac sodium was as effective as the control regimen in controlling postoperative inflammation after cataract surgery. It also had a protective effect on the development of angiographic CME after 36 and 140 days