Antibodies Against Domain 1 and Domain 4/5 of β2 Glycoprotein I : Clinical Relevance in Obstetric Anti-Phospholipid Syndrome

Background/Purpose: The domain reactivity of antibodies against b2 glycoprotein I (anti-b2GPI) has been investigated in patients with thrombotic anti-phospholipid syndrome (APS), leading to the identification of antibodies targeting domain 1 of the molecule (anti-D1) as the most relevant autoantibody subpopulation. Scarce attention has been paid to the domain profiling of patients with pregnancy morbidity (PM). The aim of this study was to characterize the relevance of the fine epitope reactivity of anti-b2GPI antibodies in anti-phospholipid antibody (aPL)-associated PM. Methods: Women with persistent positivity for anti-b2GPI IgG antibodies at medium-high titers, with at least one pregnancy and without systemic autoimmune disease were included. Anti-D1 and anti-D4/5 antibodies were tested using a chemiluminescent immunoassay and a research ELISA assay, respectively (QUANTA Flash b2GPI IgG and QUANTA Lite, Inova Diagnostics). Statistical analysis was performed using R package. Results: 138 women fulfilling the inclusion criteria were retrospectively recruited at 3 referral centres. 49 patients (35%) had obstetric APS, 18 (13%) thrombotic APS, 37 (27%) thrombotic and obstetric APS while 34 women (25%) were asymptomatic aPL carriers. 81 women (60%) displayed triple aPL positivity, 32 (23%) had two positive aPL test and 23 (17%) carried a single aPL positivity. 110 patients had at least one untreated pregnancy, culminating in a live birth in 31 cases (28%). 89 women underwent a pregnancy course while receiving treatment, with 71 women (80%) having a live birth. A significant difference in the distribution of positive anti-D1 antibodies emerged between women with or without PM and with or without thrombosis (p=0.05, c2=2.710 and p<0.001, c2=12.174, respectively); no significant difference was observed for anti-D4/5 antibodies (Table 1). In a multivariate logistic regression model also encompassing treatment, positive anti-D1 antibodies, but not anti-D4/5, were significantly associated with obstetric complications, conferring an odds ratio (OR) of 2.32 (p=0.040 and p=0.724, respectively). Triple aPL positivity corrected by treatment significantly predicted PM (p=0.015, OR=2.78). Conclusion: Our data suggest that anti-D1 antibodies are significantly associated not only with thrombosis but also with obstetric morbidity while positive anti-D4/5 antibodies are not predictive of PM

Impaired health-related quality of life in idiopathic inflammatory myopathies: a cross-sectional analysis from the COVAD-2 e-survey

Objectives To investigate health-related quality of life in patients with idiopathic inflammatory myopathies (IIMs) compared with those with non-IIM autoimmune rheumatic diseases (AIRDs), non-rheumatic autoimmune diseases (nrAIDs) and without autoimmune diseases (controls) using Patient-Reported Outcome Measurement Information System (PROMIS) instrument data obtained from the second COVID-19 vaccination in autoimmune disease (COVAD-2) e-survey database. Methods Demographics, diagnosis, comorbidities, disease activity, treatments and PROMIS instrument data were analysed. Primary outcomes were PROMIS Global Physical Health (GPH) and Global Mental Health (GMH) scores. Factors affecting GPH and GMH scores in IIMs were identified using multivariable regression analysis. Results We analysed responses from 1582 IIM, 4700 non-IIM AIRD and 545 nrAID patients and 3675 controls gathered through 23 May 2022. The median GPH scores were the lowest in IIM and non-IIM AIRD patients {13 [interquartile range (IQR) 10–15] IIMs vs 13 [11–15] non-IIM AIRDs vs 15 [13–17] nrAIDs vs 17 [15–18] controls, P < 0.001}. The median GMH scores in IIM patients were also significantly lower compared with those without autoimmune diseases [13 (IQR 10–15) IIMs vs 15 (13–17) controls, P < 0.001]. Inclusion body myositis, comorbidities, active disease and glucocorticoid use were the determinants of lower GPH scores, whereas overlap myositis, interstitial lung disease, depression, active disease, lower PROMIS Physical Function 10a and higher PROMIS Fatigue 4a scores were associated with lower GMH scores in IIM patients. Conclusion Both physical and mental health are significantly impaired in IIM patients, particularly in those with comorbidities and increased fatigue, emphasizing the importance of patient-reported experiences and optimized multidisciplinary care to enhance well-being in people with IIMs

Management of thrombotic and obstetric antiphospholipid syndrome: A systematic literature review informing the EULAR recommendations for the management of antiphospholipid syndrome in adults

Objective To perform a systematic literature review (SLR) informing the European Lmmendations for the management of antiphospholipid syndrome (APS) in adults. Methods A SLR through January 2018 was performed. Research questions were constructed using the Patient, Intervention, Comparator, Outcome (PICO) format. We included data from articles that reported on each relevant intervention. Summary effect estimates were calculated for direct comparison studies that matched the PICO question exactly, and for studies with the relevant intervention and comparator. When meta-analyses were available, we used these estimates. Results From 7534 retrieved articles (+15 from hand searches), 188 articles were included in the review. In individuals with high-risk antiphospholipid antibody (aPL) profile without prior thrombotic or obstetric APS, two meta-analyses showed a protective effect of low-dose aspirin (LDA) against thrombosis. Two randomised controlled trials (RCTs) and three cohort studies showed no additional benefit of treatment with vitamin K antagonists at target international normalised ratio (INR) 3-4 versus INR 2-3 in patients with venous thrombosis. In patients with arterial thrombosis, two RCTs and two cohort studies showed no difference in risk of recurrent thrombosis between the two target INR groups. One open-label trial showed higher rates of thrombosis recurrences in triple aPL-positive patients treated with rivaroxaban than those treated with warfarin. RCTs and cohort studies showed that combination treatment with LDA and heparin was more effective than LDA alone in several types of obstetric APS. SLR results were limited by the indirect evidence and the heterogeneity of patient groups for some treatments, and only a few high-quality RCTs. Conclusion Well-designed studies of homogeneous APS patient populations are needed. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ

Programma nazionale Italiano per la raccolta di dati alieutici modulo: CAMP-BIOL 2003 Rapporto finale sulle specie demersali nello Stretto di Sicilia (Sub Area Geografica 16; Mar Mediterraneo)

Il modulo (CAMP-BIOL) del programma nazionale Italiano per la raccolta dei dati alieutici, in applicazione della normativa prevista dai regolamenti comunitari n°1534/2000 e 1639/2001, si propone di campionare pesci, molluschi e crostacei sfruttati dalla pesca commerciale con l’obiettivo di acquisire informazioni riguardanti le caratteristiche biologiche del pescato

Does seronegative obstetric APS exist? “pro” and “cons”

Antiphospholipid Syndrome (APS) is the commonest treatable cause of recurrent miscarriage and pharmacological treatment of pregnant patients with antiphospholipid antibodies (aPL) should aim at preventing obstetric complications and maternal thrombotic events. Conventional treatment for patients with an established diagnosis of obstetric APS (OAPS), generally resulting in over 70–80% successful pregnancies. Since seropositive (SP)-APS and seronegative (SN)-APS patients had shown similar clinical profiles, patients with SN- OAPS, as well as SP-OAPS, should receive combined treatment in order to improve the pregnancy prognosis; indeed, current standard of care increased good pregnancy outcome in SN-APS, with similar effect to confirmed APS. The above data suggest that there are patients with the clinical manifestations of OAPS but persistently negative to conventional aPL that need to be identified to ensure adequate therapy and therefore a better prognosis. The clinical utility of non-criteria aPL in the diagnosis of SN-APS is still a matter of debate. In the last decade more and more studies have reported the presence of patients suffering from SN-APS in which non-conventional (“non-criteria”) aPL might be present or antibodies may be detected using methodological approaches different from the traditional assays. To improve test standardization large prospective, multicenter, and multinational studies are needed. Therefore, when assessing a patient with clinical manifestations consistent with OAPS but aPL negative using the conventional available assays, the clinician should consider the possibility that the patient is affected with SN-APS. © 2019 Elsevier B.V

LITIASI COLECISTO-COLEDOCICA: APPROCCIO VIDEOLAPAROSCOPICO

La VideoLaparoScapia è diventata in amni esperte l'intervento di prima scelta per il trattamento della calcolosi sintomatica della colecisti. Rimane dibattuto il trattamento della calcolosi del coledoco. Molteplici sono i protocolli diagnostico-terapeutici proposti per la litiasi colecisto-coledocica.... Gli AA dopo un analisi della bibliografia e della propria esperienza concludono che la coledocolitiasi non rappresenta più un limite alla chirurgia laparoscopica

Litiasi colecisto-coledocica: approccio videolaparoscopico

La VideoLaparoScapia è diventata in amni esperte l'intervento di prima scelta per il trattamento della calcolosi sintomatica della colecisti. Rimane dibattuto il trattamento della calcolosi del coledoco. Molteplici sono i protocolli diagnostico-terapeutici proposti per la litiasi colecisto-coledocica.... Gli AA dopo un analisi della bibliografia e della propria esperienza concludono che la coledocolitiasi non rappresenta più un limite alla chirurgia laparoscopica