Targeting Inflammation to Prevent Cardiovascular Disease in Chronic Rheumatic Diseases: Myth or Reality?

Evidence for increased risk of cardiovascular morbidity and mortality in chronic inflammatory rheumatic diseases has accumulated during the last years. Traditional cardiovascular risk factors contribute in part to the excess of cardiovascular risk in these patients and several mechanisms, including precocious acceleration of subclinical atherosclerotic damage, inflammation, and immune system deregulation factors, have been demonstrated to strictly interplay in the induction and progression of atherosclerosis. In this setting, chronic inflammation is a cornerstone of rheumatic disease pathogenesis and exerts also a pivotal role in all stages of atherosclerotic damage. The strict link between inflammation and atherosclerosis suggests that cardiovascular risk may be reduced by rheumatic disease activity control. There are data to suggest that biologic therapies, in particular TNFα antagonists, may improve surrogate markers of cardiovascular disease and reduce CV adverse outcome. Thus, abrogation of inflammation is considered an important outcome for achieving not only control of rheumatic disease, but also reduction of cardiovascular risk. However, the actual effect of anti-rheumatic therapies on atherosclerosis progression and CV outcome in these patients is rather uncertain due to great literature inconsistency. In this paper, we will summarize some of the main mechanisms linking the inflammatory pathogenic background underlying rheumatic diseases and the vascular damage observed in these patients, with a particular emphasis on the pathways targeted by currently available therapies. Moreover, we will analyze current evidence on the potential atheroprotective effects of these treatments on cardiovascular outcome pointing out still unresolved questions

VALUTAZIONE ECOGRAFICA DEL COINVOLGIMENTO DELLE GHIANDOLE SALIVARI IN CORSO DI SINDROME DI SJÖGREN E ALTRE CONNETTIVITI: CORRELAZIONI SIEROLOGICHE E CLINICHE

Il nostro studio ha valutato l’associazione tra le caratteristiche ecografiche (quantitative e qualitative) e parametri clinici e laboratoristici al fine di identificare il ruolo dell’assetto sierologico nel determinare alterazioni morfo-strutturali in patologie autoimmunitarie del sistema connettivo (Sindrome di Sjögren, Lupus eritematoso sistemico, Sclerosi sistemica, Connettivite indifferenziata e Connettivite mista). In particolare abbiamo studiato la relazione tra le positività auto-anticorpali singole o associate di anti-Ro60 e anti-Ro52 e il grado di coinvolgimento (espresso in termini di score ecografico) delle ghiandole salivari maggiori. E' stata anche eseguita un'analisi volta a identificare la relazione tra la sede delle ghiandole salivari prese in esame (parotidi vs sottomandibolari) e lo status sierologico dei pazienti

One year in review 2015: idiopathic inflammatory myopathies

Idiopathic inflammatory myopathies (IIM) are a group of rare acquired muscle diseases that mainly affect skeletal muscles. Recently, novel insights into the pathogenesis, diagnosis and treatment of these complex diseases have been provided. Herewith we provided an overview of the most significant literature contributions published over the year

One year in review 2017: systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominately affects women. It is characterised by a broad spectrum of clinical manifestations, however, its course and organ involvement are unpredictable. Although over the last few decades an improvement in survival for SLE patients has been observed, pathogenic mechanisms underlying this disease are still unclear. Comorbidities, due to both disease and treatment, as well as multiple aspects of SLE, are under intensive investigation. Following the previous annual reviews of this series, we hereby provide a critical digest of the recent papers on SLE focusing on pathogenesis, clinical and laboratory features, as well as current and new therapeutic strategies published over the last year

ANTI-CITRULLINATED ALPHA ENOLASE ANTIBODIES, INTERSTITIAL LUNG DISEASE AND BONE EROSION IN RHEUMATOID ARTHRITIS

RA is an articular chronic inflammatory disease that in a subgroup of patients can also present with extra-articular manifestations (EAMs). Despite intense investigation on this topic, reliable biomarkers for EAMs are lacking. In recent years several ACPAs, including those targeting anti-citrullinated alpha enolase peptide-1 (anti-CEP-1), have been identified in patients with RA. Data about the ability of anti-CEP-1 to predict the development of erosive disease are confliciting and no evidence concerning their possible association with EAMs in RA is currently available. The aim of this study was to investigate the prevalence and significance of anti-CEP-1 with regard to the association with erosive disease and EAMs in a large cohort of patients with RA. METHODS: Anti-CCP and anti-CEP-1 antibodies have been assessed on serum samples of RA patients, healthy donors and patients with SpA using commercially available ELISA kits. RESULTS: Anti-CEP-1 antibodies are detectable in over 40% of RA patients and are associated with erosive RA and with RA-associated interstitial lung disease (ILD). CONCLUSION: Anti-CEP-1 antibodies may represent a useful biomarker for RA-associated ILD and erosive disease to be employed in clinical practice

James Baldwin and American Identity

James Baldwin’s nonfiction work—primarily The Fire Next Time— seeks to define the concept of the American identity by exploring the influence of racial relations within the United States on both black and white Americans’ perceptions of the American identity. My research involves the use of academic journals and literary criticism regarding Baldwin’s nonfiction work, as well as a thorough study of The Fire Next Time. In my project on The Fire Next Time, I articulate Baldwin’s argument that the creation and development of the American identity is determined by one’s race and perpetuated by American society