Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: A systematic review and meta-analysis

BACKGROUND: In this study, we evaluated the impact of obesity and/or overweight on the achievement of minimal disease activity (MDA) in patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA) receiving an anti-rheumatic treatment. Obesity can be considered a low-grade, chronic systemic inflammatory disease and some studies suggested that obese patients with rheumatic diseases exhibit a lower rate of low disease activity achievement during treatment with anti-rheumatic drugs. METHODS: A systematic search was performed in major electronic databases (PubMed, Web of Science, Scopus, Embase) to identify studies reporting MDA achievement in obese and/or overweight patients with RA or PsA and in normal-weight RA or PsA control subjects. Results were expressed as Odds Ratios (ORs) with pertinent 95% Confidence Intervals (95%CIs). RESULTS: We included 17 studies (10 on RA and 7 on PsA) comprising a total of 6693 patients (1562 with PsA and 5131 with RA) in the analysis. The MDA achievement rate was significantly lower in obese patients than in normal-weight subjects (OR 0.447, 95% CI 0.346–0.577, p < 0.001, I (2) = 62.6%, p < 0.001). Similarly, overweight patients showed a significantly lower prevalence of MDA achievement than normal-weight subjects (OR 0.867, 95% CI 0.757–0.994, p = 0.041, I (2) = 64%, p = 0.007). Interestingly, the effect of obesity on MDA was confirmed when we separately analyzed data on patients with RA and patients with PsA. In contrast, when we evaluated the effect of overweight, our results were confirmed for PsA but not for RA. A meta-regression analysis showed that follow-up duration, age, male sex, and treatment duration are covariates significantly affecting the effect of obesity/overweight on MDA achievement. CONCLUSIONS: The results of our meta-analysis suggest that obesity and overweight reduce the chances to achieve MDA in patients with rheumatic diseases receiving treatment with traditional or biologic disease-modifying antirheumatic drugs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13075-016-1194-8) contains supplementary material, which is available to authorized users

Cardiovascular effects of Etanercept in patients with psoriatic arthritis: Evidence from the cardiovascular risk in rheumatic diseases database

Introduction: Many literature data support the possibility of an increased cardiovascular (CV) risk in psoriatic arthritis (PsA) patients compared with the general population. This cannot be entirely explained by the presence of traditional vascular risk factors. It has been suggested that inflammation may act synergistically with traditional vascular risk factors, thus contributing to the atherosclerotic process and to the increased CV risk. Areas covered: In order to evaluate the CV effects of the control of systemic inflammation by Etanercept, in the present study we analyze data recorded in the Cardiovascular Risk in Rheumatic Diseases study group database to perform a further analysis on the effects of Etanercept on primary hemostasis, secondary hemostasis and carotid subclinical atherosclerosis. Platelet reactivity is increased in patients with poorly controlled PsA. Among patients receiving Etanercept, those achieving minimal disease activity show a platelet reactivity comparable to healthy controls. Similarly, the anti-inflammatory effect of Etanercept is associated with a significant improvement of hemostatic and fibrinolytic parameters in PsA subjects, maximal changes being documented in patients achieving minimal disease activity. In addition, the treatment with Etanercept seems to be associated with a carotid intima-media thickness significantly lower as compared with matched patients receiving traditional disease-modifying anti-rheumatic drugs. Expert opinion: Our data can be suggestive of the reduction of the CV risk in patients with PsA treated with Etanercept

Additional file 1: of Impact of body weight on the achievement of minimal disease activity in patients with rheumatic diseases: a systematic review and meta-analysis

Online-only supplemental data (PRISMA flow diagram, publication bias and meta-regression analyses). (DOC 317 kb

Leiomyosarcoma of the inferior vena cava

Inferior vena cava leiomyosarcoma is a rare malignant mesenchymal tumor that originates from the smooth muscle cells of the venous media and is more frequent in females in the V-VI decade of life. Due to scarce and specific symptoms, diagnosis is not simple, and often metastases to the liver, lungs, and/or lymph nodes are already present. A 44-year-old male patient arrives at our institution presenting diffuse abdominal pain and a sense of weight associated with lumbar pain. He showed nothing relevant except for a moderate consumption of alcohol. Ultrasound examination of the abdomen revealed liver enlargement with hyperechoic nodularity and clear margins. Furthermore, the presence of a voluminous solid nodular formation was found, with an inhomogeneous echostructure and moderate vascularization on Doppler. Inferior vena cava leiomyosarcoma is a rare malignancy. The diagnosis is usually established after surgery, however, recurrences are common and the role of chemoradiation therapy remains to be defined. The only potential treatment is surgical resection with possible vessel reconstruction and en bloc removal of adjacent structures with 5 and 10-year survival rates of 49% and 29%, respectively