Ecological transformations in the forest landscape unit at one alpine spruce (Picea abies K.) CONECOFOR plot, 1998-2004

The landscape unit (LU) of the Lavazé Pass (Trentino-AltoAdige) is mainly formed (75.3%) by a forest cover dominated by Picea abies. In the period 1998-2004 the LU changed the composition of its forest cover because of the increasing of the ski rides (+2.9%) and the naturally destroyed patches (+3.1%). These quite small transformations did not change the geo-botanical structure of the LU, while carried altered ecological consequences. The diagnostic index of the LU, based on a set of 10 landscape ecological parameters, diminished in only 6 years from 0.75 to 0.60. Consequently, in absence of re-balancing interventions, the landscape characters of the LU are changing from semi-natural to managed ones, thus affecting the selected plot too

The Role of Ultrasonography in the Assessment of Skeletal Hand Involvement in Systemic Sclerosis

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Rheumatoid Nodules Predating Seroconversion and Rheumatoid Arthritis: An Uncommon Case Report

Rheumatoid nodulosis is a benign condition associated with mild or no arthritis. Differently from classical rheumatoid nodules, which are relatively common in patients with long-standing rheumatoid arthritis, particularly in rheumatoid factor (RF)-positive patients, rheumatoid nodulosis may rarely precede arthritis onset and even seroconversion. We describe the clinical course of a patient with isolated painful rheumatoid nodules, who subsequently experienced RF and anti-citrullinated protein antibodies (ACPA) seroconversion and finally developed overt rheumatoid arthritis. This case should raise clinical awareness to consider rheumatoid nodulosis as a possible diagnosis even in the absence of arthritis and of RF positivity, whenever facing with isolated subcutaneous nodules

Tocilizumab Effects on Coagulation Factor XIII in Patients with Rheumatoid Arthritis

Introduction: Rheumatoid arthritis (RA) is a chronic systemic auto-immune disease associated with a prothrombotic state. Tocilizumab, an interleukin-6 receptor inhibitor, is highly effective in controlling disease activity and thrombotic risk. Factor XIII (FXIII), involved in thrombotic complications, has been reported to be reduced in RA patients during maintenance treatment with tocilizumab, but no data are available before and after the drug administration. Thus, we investigated the effects of tocilizumab on FXIII, thrombin generation and inflammation in patients with RA na\uefve for the drug. Methods: We studied 15 consecutive adult patients with RA at baseline and 4 weeks after the onset of parenteral administration of tocilizumab, measuring disease activity and plasma levels of C-reactive protein (CRP), FXIII, and prothrombin fragments F1+2 by immunoenzymatic methods. Fifteen healthy subjects, sex-and age-matched with patients, served as normal controls for laboratory measurements. Results: At baseline, patients with established RA had a median DAS28 of 4.8 (3.2\u20138.3) and, compared to healthy controls, had higher plasma levels of CRP (p < 0.0001), FXIII (p = 0.017) and F1+2 (p < 0.0001). Four weeks after starting treatment with tocilizumab, based on the EULAR response criteria, eight patients were classifiable as responders and seven as non-responders. In responders, we observed a statistically significant reduction not only of the values of DAS28 and CRP (p = 0.012 for both), ut also of plasma levels of FXIII (p = 0.05) and F1+2 (p = 0.025). In non-responders, all the studied parameters were unchanged. Conclusion: The decrease of FXIII and F1+2 levels after tocilizumab treatment observed only in those patients who responded to the drug indicates that the effect of tocilizumab on the prothrombotic state is linked to the control of inflammation and disease activity and not to a direct effect of the drug, thus contributing to the reduction of the cardiovascular risk

COVID-19 infection and rheumatoid arthritis: Faraway, so close!

The outbreak of the new coronavirus infections COVID-19 in December 2019 in China has quickly become a global health emergency. Given the lack of specific anti-viral therapies, the current management of severe acute respiratory syndrome coronaviruses (SARS-CoV-2) is mainly supportive, even though several compounds are now under investigation for the treatment of this life-threatening disease. COVID-19 pandemic is certainly conditioning the treatment strategy of a complex disorder as rheumatoid arthritis (RA), whose infectious risk is increased compared to the general population because of an overall impairment of immune system typical of autoimmune diseases combined with the iatrogenic effect generated by corticosteroids and immunosuppressive drugs. However, the increasing knowledge about the pathophysiology of SARS-CoV-2 infection is leading to consider some anti-rheumatic drugs as potential treatment options for the management of COVID-19. In this review we will critically analyse the evidences on either positive or negative effect of drugs commonly used to treat RA in this particular scenario, in order to optimize the current approach to RA patients

Effectiveness and safety of oxycodone/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers : Two case reports

Digital ulcers (DUs) are a severe and frequent clinical feature of patients with systemic sclerosis (SSc). The presence of DUs may cause severe pain and often lead to impairment of patient\u2019s functional activities and health-related quality of life. Moreover, poor patient cooperation during the wound care procedure due to pain may be associated with a negative outcome of DU healing. Therefore, pain management has a key role in patients with SSc. These two case reports describe the effectiveness and safety of oxycodone/naloxone in patients with SSc complicated by painful chronic DUs. Such a therapy has provided pain relief and consequently an increased compliance during redressing wounds

A systematic review of systemic sclerosis instruments for the eular outcome measures library : An evolutionary database of validated patient-reported instruments

Background: Over time, a patient-centered evaluation of health status has become more important for systemic sclerosis (SSc), both in research and clinical setting. Patient-reported outcomes (PROs) are being increasingly used to measure various domains of disease status relevant to patients and physicians. The EULAR Outcome Measures Library (OML) is a freely available website with structured access to a growing database of validated PROs [1], but currently there are no PROs available on SSc at the EULAR OML. Objectives: To provide a comprehensive review of validated SSc-specific PROs and to critically appraise their validity. Methods: A sensitive search was developed in Medline and Embase (08/2015) to identify all validation studies, cohort studies, reviews or metaanalyses in which the objective were the development or validation of PROs evaluating organ involvement, disease activity or damage in SSc. A reviewer screened title and abstracts, selected the studies, and collected data concerning validation using ad hoc forms based on the COSMIN checklist. Results: From 13,140 articles captured, 74 met the predefined criteria. After excluding an instrument for the unavailability of an English version, the selected studies provided information on 6 SSc-specific PROs: the Scleroderma Assessment Questionnaire (SAQ), the scleroderma functional score (FS), the Raynaud's condition score (RCS), the Mouth Handicap in SSc (MHISS), the University of California Los Angeles-Scleroderma Clinical Trial Consortium Gastro-Intestinal tract (UCLA-SCTC-GIT 2.0), and the Skin Self-Assessment. The table summarizes the instruments and their measurement properties: Table 1 SSc-specific PROs Domains No. of items and range Measurement properties Reliability IC/TR/ME Validity Responsiveness Interpretability SAQ Functional status (vascular, respiratory, GIT and musculoskeletal apparatus) Items: 23Range: 0\u20133 ICC 0.79\u20130.95 Total score higher in pts with systemic involvement Vascular z=0.92\u20132.97; Respiratory z=1.34\u20132.52; GIT z= 123.14\u20134.03; Musculoskeletal status z=0.68\u20133.16 \u2013 FS Functional ability (upper limbs & muscle weakness) Items: 11Range: 0\u201333 Intra-observkw 0.19\u20130.6inter-observkw0.69\u20130.94 HAQ-DI r=0.90Skin score r=0.11 FS correlates with HAQ-DI 0.59, & Hand HAQ-DI 0.58 \u2013 RCS Severity and impact of Raynaud's phenomenon Item: 1Range 0\u201310 ICC 0.70 Disease activity, Rp measures, digital ulcers, mood/tension 67% variance ES 0.6SRM 0.64 MID 14\u201315 points (0\u2013100 VAS)PASS 34 points MHISS Disability involving the mouth Items: 12Range: 0\u201348 ICC 0.96 HAQ r=0.33, CHFS r=0.37, mouth opening r= 120.34, MACTAR r=0.11, HADd r=0.26, HADa r=0.17 \u2013 \u2013 UCLA SCTC GIT 2.0 GIT symptoms severity Items: 34Range: 0\u20133 Cronbach's \u3b1>0.70, constipation (\u3b1=0.67)ICC 0.71 Total GIT score r=0.60; Upper GIT r=0.52; Lower GIT r=0.60 rho 0.05\u20130.48 MID/improvement: 0.07\u20130.36;MID/worsening: 0.06 120.21;Floor: noneCeiling: 4% Skin self-assessment Skin thickening Items: 17Range: 0\u201351 ICC 0.5\u20130.61 Skin score r=0.435 No changes 1 yr follow-up \u2013 dcSScFloor 15%Ceiling n.a. Conclusions: Six SSc-specific PROs have a minimum validation and will be included in the EULAR OML. In general, the level of validation attained could be improved. Further development in the area of disease-specific PROs in SSc is warranted. References: Castrej\uf3n I, Gossec L, Carmona L. Ann Rheum Dis. 2015;74(2):475\u2013

Olive Oil and Nuts in Rheumatoid Arthritis Disease Activity

Few observational studies investigated the relationship between single food groups and disease activity in rheumatoid arthritis (RA). Within a recent Italian cross-sectional study (365 patients, median age: 58.46 years, 78.63% females), we focused on two food groups, olive oil and nuts, representing vegetable sources of fatty acids. Disease activity was measured with Disease Activity Score on 28 joints based on C-reactive protein (DAS28-CRP) and the Simplified Disease Activity Index (SDAI). Robust linear and logistic regression models included tertile-based consumption categories of each food group and several confounders. Stratified analyses were performed by disease severity or duration. Higher consumption of both food groups exerted a favorable effect on disease activity, significant only for olive oil (Beta: -0.33, p-value: 0.03) in the linear regression on the overall sample. This favorable effect was stronger in the more severe or long-standing forms of RA (p-value for heterogeneity <0.05, especially for disease severity). Significant ORs were as low as ~0.30 for both food groups, strata (i.e., more severe and long-standing RA), and disease activity measures. Mean DAS28-CRP significantly decreased by ~0.70 for olive oil and ~0.55 for nuts in the two strata; mean SDAI significantly decreased by 3.30 or more for olive oil in the two strata. Globally, the beta coefficients doubled, and the ORs halved (in absolute values) for both food groups, reaching significance in 12 of the 16 available models fitted to the more severe or long-standing RA strata. More compromised forms of RA may benefit from increasing consumption of olive oil, olives, and nuts