Autoantibodies in inflammatory arthritis

Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease characterized by extensive synovitis resulting in erosions of articular cartilage and marginal bone with joint destruction. The lack of immunological tolerance in RA represents the first step toward the development of autoimmunity. Susceptible individuals, under the influence of environmental factors, such as tobacco smoke, and silica exposure, develop autoimmune phenomena that result in the presence of autoantibodies. HLA and non-HLA haplotypes play a major role in determining the development of specific autoantibodies differentiating anti-citrullinated antibodies (ACPA)-positive and negative RA patients. Rheumatoid factor (RF) and ACPA are the serological markers for RA, and during the preclinical immunological phase, autoantibody titers increase with a progressive spread of ACPA antigens repertoire. The presence of ACPA represents an independent risk factor for developing RA in patients with undifferentiated arthritis or arthralgia. Moreover, anti-CarP antibodies have been identified in patients with RA as well as in individuals before the onset of clinical symptoms of RA. Several autoantibodies mainly targeting post-translational modified proteins have been investigated as possible biomarkers to improve the early diagnosis, prognosis and response to therapy in RA patients. Psoriatic arthritis (PsA) is distinguished from RA by infrequent positivity for RF and ACPA, together with other distinctive clinical features. Actually, specific autoantibodies have not been described. Recently, anti-CarP antibodies have been reported in sera from PsA patients with active disease. Further investigations on autoantibodies showing high specificity and sensibility as well as relevant correlation with disease severity, progression, and response to therapy are awaited in inflammatory arthritides

Heart failure and anti tumor necrosis factor-alpha in systemic chronic inflammatory diseases.

Tumor necrosis factor alpha (TNF-alpha) antagonists have emerged as an effective therapy for patients with diseases as Crohn's disease, rheumatoid arthritis, and other chronic systemic inflammatory diseases. In the last years, there has been a growing interest in the role that inflammatory cytokines, which sustain the pathogenesis of these diseases, plays in regulating cardiac structure and function, particularly in the progression of chronic heart failure. In fact there is an increase of anti-TNF alpha levels in advanced heart failure but the treatment with anti-TNF alpha has been shown to worsen the prognosis of heart failure in randomized controlled trials. Patients with rheumatoid arthritis have an increased risk for cardiovascular disease and anti-TNF alpha therapy seems to be beneficial on the risk of cardiovascular disease. In Crohn's disease the increased risk of cardiovascular disease is controversial and therefore it is impossible to demonstrate an effect in reduction of the risk; however, heart failure in patients treated with anti-TNF alpha, despite in a small proportion, has been observed. On the basis of this observation, anti-TNF alpha therapy is contraindicated in patients with Crohn's disease and III-IV New York Heart Association heart failure class

A study of maternal competence in preterm birth condition, during the transition from hospital to home: An early intervention program’s proposal

The study was conducted with 104 mothers (average age 32.5 years, SD 6.1) of preterm infants (very and moderately preterm but still healthy) to monitor the perceived maternal role competence from the time of hospitalisation to post-discharge, in order to define an intervention program to support mothers during this transition. A targeted Q-Sort tool (Maternal Competence Q-Sort in preterm birth) was applied at two different times as a self-observation tool for parenting competence in neonatology. A tendency towards dysregulation of the maternal role competence was detected, mainly in terms of low self-assessment and was found to worsen during post-discharge, particularly with regard to caregiving ability. This study suggests the importance of accompanying parenting competence in preterm birth conditions, not only during hospitalisation in the Neonatal Intensive Care Unit (NICU) but also following discharge in order to promote the development of premature infants. This paper reports in the last part a specific integrated psychoeducational intervention program (psychologist and nurses), which we defined precisely in light of the suggestions offered by the study data on perceived maternal competence created with the Q-sort

Functioning of family system in pediatric oncology during treatment phase

The study focuses on parents\u2019 psychological implications caused by the treatment of their children su\ufb00ering from tumor. It investigates some speci\ufb01c mothers\u2019 resource factors such as their strategies of coping and the perception of their own family functioning in terms of cohesion and adaptability. The study was performed with 34 mothers of children su\ufb00ering from acute lymphoblastic leukemia(ALL),duringthetreatmentphase.TheusedtoolsweretheCopingOrientationtoProblem Experienced\u2014New Italian Version, to investigate coping strategies, and the Family Adaptability and Cohesion Evaluation Scale-III, to analyze both real and ideal perception of family functioning. The data related to coping, show how the involved mothers tend to mainly use the strategies of positive aptitude, orientation toward problem and social support ( F = 99.88, d f= 4, P< .01). The family functioning, in terms of adaptabilit y, is described as chaotic relating to both the real (\u3c72 = 13.29,d f =3, P=.004)andideal(\u3c72=11.52,d f=2, P=.003)family,whereasintermsof cohesion, itisperceivedaschie\ufb02ydisengagedintherealfamily(\u3c72 =12.3,d f=3, P=.006)andasenmeshed in the ideal one (\u3c72 = 12.58, d f= 3, P= .006). Statistically positive correlations were only detected between adaptability and avoidance ( r = 0.49, P< .01); adaptability and orientation toward problem (r = 0.36, P< .05); and adaptability and transcendent orientation ( r = 120.04, P< .05). Despitethecriticalsituation,themothershaveshownoptimisticview,careforproblemmanagementandcapabilitytoaskforhelp.Thesecopingstrategiesallowthetherapeuticalliancebetween families and health care workers, so useful for the quality of childcarThe study focuses on parents\u2019 psychological implications caused by the treatment of their children su\ufb00ering from tumor. It investigates some speci\ufb01c mothers\u2019 resource factors such as their strategies of coping and the perception of their own family functioning in terms of cohesion and adaptability. The study was performed with 34 mothers of children su\ufb00ering from acute lymphoblastic leukemia(ALL),duringthetreatmentphase.TheusedtoolsweretheCopingOrientationtoProblem Experienced\u2014New Italian Version, to investigate coping strategies, and the Family Adaptability and Cohesion Evaluation Scale-III, to analyze both real and ideal perception of family functioning. The data related to coping, show how the involved mothers tend to mainly use the strategies of positive aptitude, orientation toward problem and social support ( F = 99.88, d f= 4, P< .01). The family functioning, in terms of adaptabilit y, is described as chaotic relating to both the real (\u3c72 = 13.29,d f =3, P=.004)andideal(\u3c72=11.52,d f=2, P=.003)family,whereasintermsof cohesion, itisperceivedaschie\ufb02ydisengagedintherealfamily(\u3c72 =12.3,d f=3, P=.006)andasenmeshed in the ideal one (\u3c72 = 12.58, d f= 3, P= .006). Statistically positive correlations were only detected between adaptability and avoidance ( r = 0.49, P< .01); adaptability and orientation toward problem (r = 0.36, P< .05); and adaptability and transcendent orientation ( r = 120.04, P< .05). Despitethecriticalsituation,themothershaveshownoptimisticview,careforproblemmanagementandcapabilitytoaskforhelp.Thesecopingstrategiesallowthetherapeuticalliancebetween families and health care workers, so useful for the quality of childcar

Restoration of peripheral blood natural killer and B cell levels in patients affected by rheumatoid and psoriatic arthritis during etanercept treatment

Etanercept (ETN) is an anti-tumour necrosis factor (TNF)-α agent used in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Few studies focused on the effects of anti-TNF-α on peripheral blood cells. We aimed to evaluate peripheral blood cells in RA and PsA patients during ETN treatment and to explore their relationships with disease activity. RA (n = 82) and PsA (n = 32) patients who started ETN were included into the study and evaluated prospectively before the beginning of ETN therapy and after 14, 22, 54 and 102 weeks. Patients were studied in terms of disease activity score on 28 joints (DAS28), clinical response and laboratory findings. Natural killer (NK) cells, B cells and T cells were characterized by immunophenotyping. Both the RA and the PsA patients showed reduced NK and B cell count before ETN treatment compared with controls. A negative correlation was demonstrated between DAS28 and B cell count in RA patients at baseline. Sustained significant increase of NK and B cells up to normal levels was observed in RA and PsA patients along ETN treatment. Increase of NK cell count was associated with a good-moderate clinical response to ETN in both RA and PsA patients. During ETN treatment peripheral blood NK and B cells levels were restored in RA and PsA patients. Correlations between NK and B cells with disease activity were observed, suggesting that those effects could be mediated by ETN treatment.Etanercept (ETN) is an anti-tumour necrosis factor (TNF)-α agent used in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Few studies focused on the effects of anti-TNF-α on peripheral blood cells. We aimed to evaluate peripheral blood cells in RA and PsA patients during ETN treatment and to explore their relationships with disease activity. RA (n = 82) and PsA (n = 32) patients who started ETN were included into the study and evaluated prospectively before the beginning of ETN therapy and after 14, 22, 54 and 102 weeks. Patients were studied in terms of disease activity score on 28 joints (DAS28), clinical response and laboratory findings. Natural killer (NK) cells, B cells and T cells were characterized by immunophenotyping. Both the RA and the PsA patients showed reduced NK and B cell count before ETN treatment compared with controls. A negative correlation was demonstrated between DAS28 and B cell count in RA patients at baseline. Sustained significant increase of NK and B cells up to normal levels was observed in RA and PsA patients along ETN treatment. Increase of NK cell count was associated with a good-moderate clinical response to ETN in both RA and PsA patients. During ETN treatment peripheral blood NK and B cells levels were restored in RA and PsA patients. Correlations between NK and B cells with disease activity were observed, suggesting that those effects could be mediated by ETN treatment

A critical analysis of the tools to evaluate neuropsychiatric lupus.

Neuropsychiatric symptoms occur commonly in patients with systemic lupus erythematosus, but they are not always due to active disease. It is crucial to identify cases that are due to active systemic lupus erythematosus so that appropriate treatment can be instituted. There is no single serological or imaging test that distinguishes active neuropsychiatric systemic lupus erythematosus from neuropsychiatric manifestations caused by other factors such as infection. Most patients with neuropsychiatric systemic lupus erythematosus have generalised features of disease activity. Raised anti-dsDNA and low C3 complement levels are often seen, but are not an invariable guide. The presence of antiphospholipid antibodies is more suggestive of thrombotic than inflammatory causation. A number of other autoantibody tests have been proposed as biomarkers for neuropsychiatric systemic lupus erythematosus, but results in clinical studies have been inconsistent and none has so far entered routine clinical practice. Cerebrospinal fluid features and magnetic resonance imaging appearances are non-specific in neuropsychiatric systemic lupus erythematosus, but are useful in excluding other causes of neuropsychiatric symptoms. Newer magnetic resonance imaging sequences show promise for distinguishing new neuropsychiatric systemic lupus erythematosus activity from previous damage and recent research suggests these may correlate with changes in cognitive function in patients with systemic lupus erythematosus. However, formal cognitive testing is seldom carried out in the acute setting

Green tea and pomegranate extract administered during critical moments of the production cycle improves blood antiradical activity and alters cecal microbial ecology of broiler chickens

Phytobiotics are usually tested in feed and throughout the production cycle. However, it could be beneficial to evaluate their effects when administered only during critical moments, such as changes in feeding phases. The aim of the trial was to investigate the effect of a commercial plant extract (PE; IQV-10-P01, InQpharm Animal Health, Kuala Lumpur, Malaysia) on growth performance, blood antiradical activity and cecal microbiome when administered in drinking water to broiler chickens during the post-hatching phase and at each change of diet. In the experiment, 480 1-day-old male broiler chicks were assigned to two groups in a 50-day trial. Broilers received drinking water (C) or drinking water plus PE (T) at a rate of 2 mL/L on days 0 to 4, 10\u201311 and 20\u2013 21. PE did not affect performance and water intake, while total antiradical activity was improved (p &lt; 0.05). A greater abundance of lactic acid bacteria (false discovery rate (FDR) &lt; 0.05) was found in the T group and the result was confirmed at a lower taxonomic level with higher Lactobacillaceae abundance (FDR &lt; 0.05). Our findings suggest that PE administration during critical moments of the production cycle of broiler chickens may exert beneficial effects at a systemic level and on gut microbial ecology

ps1 15 expression of adhesion molecules cd44v3 and cd44v6 on t cells in sle patients correlation with clinical phenotype and disease activity

Background Adhesion molecule CD44 enables T lymphocytes' adhesion to endothelium and during inflammation contributes to T cell migration into target organs. CD44 isoforms seem to be involved in the infiltration of peripheral tissues in SLE. A higher expression of CD44v3 and v6 has been observed on T cells from SLE patients compared to healthy subjects (HS) and the expression levels seem to correlate with disease activity. The aim of this study was to investigate the expression of the CD44v3/v6 isoforms on T cells of SLE patients to evaluate their correlation with disease activity and disease phenotypes. Patients and methods 33 female patients (mean age ±SD 45.7±12.3 years, mean disease duration ±SD 14±7.8 years) affected by SLE according to the 1997 ACR criteria, were enrolled. Disease activity was evaluated by SLEDAI-2K. 15 patients were in remission (SLEDAI-2k=0), and 18 patients had an active disease (SLEDAI-2K=4 or higher). 16 HS (mean age ±SD 33.3±12.0 years) were also recruited. Expression of CD44v3/v6 was determined by flow cytometry analysis. Results Expression of CD44v3 on CD4 +T cells and on CD8 +T cells was higher in active patients compared to HS (p=0.0097 and p=0.0096). CD44v3 on CD8 +T cells was also higher in active patients compared to patients in remission (p=0.038). CD44v6 was higher on CD4 +and CD8+T cells from active patients compared to HS (p=0.003 and p=0.0036) and compared to patients in remission (p=0.01 and p=0.02) Fig.1. In active patients the ratio CD44v3/v6 was unbalanced towards isoform v6 on both T cell populations. When using a ROC curve analysis, comparing HS and SLE patients, CD44v6 on CD4 +T cells was the most sensible and specific one (specificity of 81.8%, sensitivity of 75%). Expression of CD44v6 on CD4 +and CD8+T cells correlated with the SLEDAI-2k (p=0.03, r=0.38 and p=0.02, r=0.39). The expression of CD44v6 and of CD44v3 on CD8 +T cells is associated with renal involvement and arthritis respectively (p Conclusions CD44v3 and v6 expression is significantly associated with different degree of disease activity and with different disease manifestations. Isoform v6 on CD4 +T cells could be useful as a disease biomarker

One year in review 2020:comorbidities, diagnosis and treatment of primary Sjogren's syndrome

Primary Sjogren's syndrome (pSS) is a complex and heterogeneous disorder characterised by a wide spectrum of glandular and extra-glandular features. The discovery of novel biomarkers allowed to characterise the disease not only phenotypically on the basis of clinical presentation, but also on the basis of the endotype. Moreover, a better stratification of patients has important value in the evaluation of mechanisms underlying the risk of lymphoproliferative disorders in these patients. Finally, novel targeted therapies may open new possibilities for the application of personalised medicine in pSS