[Semeiology of "early arthritis"].

The main problems related to "early arthritis" are making an accurate diagnosis and predicting the outcome. Clinical evidence strongly suggest that structural damage occur early and that early DMARD treatment improves the long term outcome of disease. Clinical criteria would facilitate early referral of the patients to establish the risk of persistent disease. From the "early arthritis clinics" (E.A.C.) experience has been developed a set of diagnostic criteria characterized by an excellent ability to discriminate, at the first visit, between self-limiting, persistent non-erosive and persistent erosive arthritis. The proposed set consists of 7 criteria: symptom duration (6 weeks – 6 months), morning stiffness of at least 1 hour, arthritis in ≥ 3 joints, bilateral compression pain in the metatarsophalangeal joints, IgM-rheumatoid factor positivity, anti-cyclic-citrullinated-peptide antibody positivity and erosions on radiographs of the hands or feet. This approach requests an easy organization to simplify the access to sanitary services and represents an hard challenge both for rheumatologist and health administration

A2A and A3 adenosine receptor expression in rheumatoid arthritis: upregulation, inverse correlation with disease activity score and suppression of inflammatory cytokine and metalloproteinase release

Introduction The reduction of the inflammatory status represents one of the most important targets in rheumatoid arthritis (RA). A central role of A2A and A3 adenosine receptors (ARs) in mechanisms of inflammation has been reported in different pathologies. The primary aim of this study was to investigate the A2A and A3ARs and their involvement in RA progression measured by Disease Activity Score in 28 or 44 joints (DAS28 or DAS). Methods ARs were analyzed by saturation binding assays, mRNA and Western blotting analysis in lymphocytes from early and established RA patients. The effect of A2A and A3AR agonists in nuclear factor kB (NF-kB) pathway was evaluated. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) release was carried out by A2A and A3AR activation. AR pharmacological regulation in matrix metalloproteinase-1 (MMP-1) and metalloproteinase-3 (MMP-3) release was also studied. Results In lymphocytes obtained from RA patients, A2A and A3ARs were up-regulated if compared with healthy controls. A2A and A3AR activation inhibited the NF-kB pathway and diminished inflammatory cytokines such as TNF-α, IL-1β and IL-6. A2A and A3AR agonists mediated a reduction of MMP-1 and MMP-3 release. A2A and A3AR density inversely correlated with DAS28 and DAS suggesting a direct role of the endogenous activation of these receptors in the control of RA joint inflammation. Conclusions Taken together these data demonstrate that the inflammatory and clinical responses in RA are regulated by A2A and A3ARs and support the use of A2A and/or A3AR agonists as novel and effective pharmacological treatment in RA patients

Improved pregnancy outcome in patients with Rheumatoid Arthritis who followed an ideal clinical pathway

Among women with rheumatoid arthritis (RA) we aimed to assess the effect of optimal management of pregnancy, on a composite outcome of miscarriage and complicated birth

Il neuroimaging nell’approccio al coinvolgimento neurologico nelle patologie sistemiche autoimmuni di pertinenza reumatologica

none2noneGOVONI M; PADOVAN MGovoni, Marcello; Padovan, Meliss

I farmaci impiegati nella terapia del LES

none3Rassegna a carattere divulgativo sui farmaci utilizzati nella terapia del lupus eritematoso sistemicononeGOVONI M; Rizzo N; Padovan MGovoni, Marcello; Rizzo, Nicoletta; Padovan, Meliss

L'interessamento renale nella sindrome di Sjogren

Il coinvolgimnto renale è abbastanza frequente in corso di Sindrome di Sjogren. Nella maggioranza dei casi decorre in modo subclinico e asintomatioco. La lesione istopatologica più frequente è la nefrite tubulointerstiziale. Rara è la glomerulonefrite, segnalata per lo più in presenza di crioglobuline

La qualità di vita nelle malattie reumatiche. Le misure in Reumatologia.

Manuale dedicato alla descrizione dei principali metodi di valutazione della qualità di vita nelle malattie reumatiche. Vengono riportati e brevemente commentati alcuni dei questionari validati per il nostro paese tra cui l'SF-36 (versione italiana), l'HAQ (versione italiana) e l'l'AIMS2

L’image radiologique dans la dèfinition de la “Early-arthritis”

Elementi fondamentali di diagnostica radiologica in tema di artrite in fase early: indicazione all'impiego delle specifiche tecniche radiologich

HLA-G 14BP POLYMORPHISM REGULATES THE METHOTREXATE RESPONSE IN RHEUMATOID ARTHRITIS AND MAY BE PREDICTIVE OF RESPONSIVENESS

Background: Methotrexate (MTX) represents the most used anti-rheumatic drug in rheumatoid arthritis (RA). HLA-G antigens are inducible non classical MHC class Ib molecules important in maintaining anti-inflammatory conditions. HLA-G gene is characterized by a deletion/insertion polymorphism of 14 bp, that controls the specific mRNA stability and the protein levels. It has been reported that MTX therapy mediates an increase of Interleukin-10 (IL-10) producing cells. This cytokine up-regulates HLA-G expression. Objectives: To test the hypothesis of a MTX mediated HLA-G production and the possible relationship between the HLA-G 14 bp polymorphism and therapeutic responsiveness to MTX. Methods: Peripheral blood mononuclear cells (PBMCs) from 25 healthy subjects and 5 no-MTX-treated RA patients were activated with different MTX concentrations. sHLA-G and IL-10 production was investigated by specific immunoenzimatic assay (ELISA). HLA-G 14 bp polymorphism genotyping was also performed in 162 healthy subjects and in 156 RA patients, defined as "responders" (n=88) and "non responders" (n=68) to the MTX therapy after a 6 months therapeutic trial, on the basis of EULAR response criteria. Results: MTX activation induces the production of sHLA-G molecules. A significant association was observed between the highest sHLA-G concentrations and the -14/-14 bp genotype. The analysis of the HLA-G 14bp polymorphism in MTX treated RA patients confirmed an increase of the -14/-14 bp genotype in the responder group (p = 0.036; Fisher exact p test) (OR = 2.77 [95%CI 1.19 - 6.45] logistic regression model). Conclusion: Our results suggest that MTX induces the production of anti-inflammatory sHLA-G molecules that concur to the overall therapeutic response. Furthermore, the association between -14/-14 bp genotype and MTX responsiveness, indicates that HLA-G 14 bp polymorphism may be useful in the therapeutic decision during the early phases of the disease. A prospective study aimed to confirm these data is ongoing. References: Carosella ED, Moreau P, Aractingi S, Rouas-Freiss N. HLA-G: a shield against inflammatory aggression. Trends Immunol 2001; 10: 553-555. Hviid TV, Rizzo R, Christiansen OB, Melchiorri L, Lindhard A, Baricordi OR. HLA-G and IL-10 in serum in relation to HLA-G genotype and polymorphisms