Effectiveness and safety of filgotinib in rheumatoid arthritis: a real-life multicentre experience.

OBJECTIVES: We investigated the effectiveness and safety of filgotinib in a real-life multicentre cohort of rheumatoid arthritis (RA) patients. METHODS: RA patients were evaluated at baseline and after 12 and 24 weeks and were stratified based on previous treatments as biologic disease-modifying anti-rheumatic drug (bDMARD)-naive and bDMARD-insufficient responders (IR). Concomitant usage of methotrexate (MTX) and oral glucocorticoids (GC) was recorded. At each timepoint we recorded disease activity, laboratory parameters and adverse events. RESULTS: 126 patients were enrolled. 15.8% were bDMARD-naive (G0), while 84% were bDMARD-IR (G1). In G0, 45% of patients were in monotherapy (G2) and 55% were taken MTX (G3). In G1, 50% of patients were in monotherapy (G4) and 50% used MTX (G5).A significant reduction in all parameters at 12 weeks was observed; in the extension to 24 weeks the significant reduction was maintained for patient global assessment (PGA), examiner global assessment (EGA), visual analogue scale (VAS) pain, VAS fatigue, disease activity score (DAS)28- C-reactive protein (CRP) and CRP values. Filgotinib in monotherapy showed better outcomes in bDMARD-naive patients, with significant differences for patient reported outcomes (PROs) and DAS28-CRP. At 12 weeks, low disease activity (LDA) and remission were achieved in a percentage of 37.2 % and 10.7 % by simplified disease activity index (SDAI), 42.6 % and 5.7 % by clinical disease activity index (CDAI), 26.8 % and 25.2 % by DAS28-CRP, respectively. A significant decrease in steroid dose was evidenced in all patients. We observed a major adverse cardiovascular event in one patient and an increase in transaminase in another. No infections from Herpes Zoster were reported. CONCLUSIONS: Our real-world data confirm the effectiveness and safety of filgotinib in the management of RA, especially in bDMARD-naive patients.

Estimating crop coefficients and actual evapotranspiration in citrus orchards with sporadic cover weeds based on ground and remote sensing data.

Accurate estimations of actual crop evapotranspiration are of utmost importance to evaluate crop water requirements and to optimize water use efficiency. At this aim, coupling simple agro-hydrological models, such as the well-known FAO-56 model, with remote observations of the land surface could represent an easy-to-use tool to identify biophysical parameters of vegetation, such as the crop coefficient Kc under the actual field conditions and to estimate actual crop evapotranspiration. This paper intends, therefore, to propose an operational procedure to evaluate the spatio-temporal variability of Kc in a citrus orchard characterized by the sporadic presence of ground weeds, based on micro-meteorological measurements collected on-ground and vegetation indices (VIs) retrieved by the Sentinel-2 sensors. A non-linear Kc(VIs) relationship was identified after assuming that the sum of two VIs, such as the normalized difference vegetation index, NDVI, and the normalized difference water index, NDWI, is suitable to represent the spatio-temporal dynamics of the investigated environment, characterized by sparse vegetation and the sporadic presence of spontaneous but transpiring soil weeds, typical of winter seasons and/or periods following events wetting the soil surface. The Kc values obtained in each cell of the Sentinel-2 grid (10 m) were then used as input of the spatially distributed FAO-56 model to estimate the variability of actual evapotranspiration (ETa) and the other terms of water balance. The performance of the proposed procedure was finally evaluated by comparing the estimated average soil water content and actual crop evapotranspiration with the corresponding ones measured on-ground. The application of the FAO-56 model indicated that the estimated ETa were characterized by root-mean-square-error, RMSE, and mean bias-error, MBE, of 0.48 and -0.13 mm d-1 respectively, while the estimated soil water contents, SWC, were characterized by RMSE equal to 0.01 cm3 cm-3 and the absence of bias, then confirming that the suggested procedure can produce highly accurate results in terms of dynamics of soil water content and actual crop evapotranspiration under the investigated field conditions.

The management of patients with inflammatory bowel disease-associated spondyloarthritis: Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and Italian Society of Rheumatology (SIR) recommendations based on a pseudo-Delphi consensus.

Spondyloarthritis (SpA) is the most frequent extraintestinal manifestation in patients with inflammatory bowel diseases (IBD). When IBD and spondyloarthritis coexist, musculoskeletal and intestinal disease features should be considered when planning a therapeutic strategy. Treatment options for IBD and SpA have expanded enormously over the last few years, but randomized controlled trials with specific endpoints focused on SpA are not available in the IBD setting. To address this important clinical topic, the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and the Italian Society of Rheumatology (SIR) jointly planned to draw updated therapeutic recommendations for IBD-associated SpA using a pseudo-Delphi method. This document presents the official recommendations of IG-IBD and SIR on the management of IBD-associated SpA in the form of 34 statements and 4 therapeutic algorithms. It is intended to be a reference guide for gastroenterologists and rheumatologists dealing with IBD-associated SpA.

Detecting crop water requirement indicators in irrigated agroecosystems from soil water content profiles: An application for a citrus orchard.

Most perennial crops sensitive to water scarcity, such as citrus, can benefit from efficient water management, which allows for reduced water consumption while increasing crop production on a long-term basis. However, when implementing water-saving strategies, it is necessary to monitor soil and/or plant water status in order to determine crop water demand. A plethora of devices providing indirect measurements of volumetric soil water content, such as the "drill and drop" multi-sensors probes (Sentek, Inc., Stepney, Australia), have been developed over the last decade. The objective of the paper was to analyse time-series of soil water content profiles and meteorological data collected in an adult citrus orchard over three years of field observations (2017-2020) in order to estimate actual crop evapotranspiration and derive crop coefficients. Simultaneous measurements of sap fluxes also allowed for the estimation of the basal crop coefficient, Kcb, used as a control variable. The temporal dynamics of soil water content profiles following rainfall or irrigation events provided information on soil evaporation, root water uptake, and actual crop transpiration. After soil wetting events, in particular, it was possible to recognize patterns of actual crop evapotranspiration similar to those detected with sap flow sensors. The knowledge of actual crop evapotranspiration at the daily time-step, in conjunction with the corresponding reference crop evapotranspiration, allowed for appropriate estimations of the crop coefficient associated with the various development stages. The proposed method provided interesting insights into the dynamics of root water uptake and crop evapotranspiration of the studied citrus orchard, and it represents a promising tool for precise irrigation scheduling in other agroecosystems.

Identification of the clinical features distinguishing psoriatic arthritis and fibromyalgia.

OBJECTIVE: To identify the clinical features that can help to distinguish between psoriatic arthritis (PsA) and fibromyalgia (FM). METHODS: Our cross-sectional study was carried out in 10 Italian rheumatology centers between January and September 2009, and enrolled all consecutive patients with PsA and FM who agreed to participate. Standard clinical and laboratory data for PsA and FM were collected from all patients. Records were made of somatic symptoms, response to nonsteroidal antiinflammatory drugs (NSAID), self-evaluated pain, general health, disability, and responses to the Fibromyalgia Impact Questionnaire. Data were statistically analyzed by univariate and multivariate analyses, and receiver-operating characteristic curves. The analysis concentrated on the clinical features shared by the 2 conditions. RESULTS: Two hundred sixty-six patients with PsA (mean age 51.7 yrs; disease duration 10.2 yrs) and 120 patients with FM (mean age 50.2 yrs; disease duration 5.6 yrs) were evaluated. Univariate analysis showed that patients with FM had higher mean tender point and enthesitis scores, more somatic symptoms, and responded less to NSAID. Multivariate analysis showed that the presence of ≥ 6 FM-associated symptoms and ≥ 8 tender points was the best predictor of FM. CONCLUSION: The shared clinical features of PsA and FM that had the greatest discriminating power for FM were the number of FM-associated symptoms and tender point count.

The effectiveness and safety of TNF-alpha blockers in the treatment of early psoriatic arthritis: an Italian multicentre longitudinal observational pilot study.

The objective of this study is to assess the effectiveness and safety of TNF-α blockers in a group of early psoriatic arthritis (PsA) patients with an unsatisfactory response to previous conventional treatment consecutively enrolled in five Italian centres. A 24-week open-label trial was carried out in consecutive early PsA patients classified according to the CASPAR criteria, with unsatisfactory response to previous treatments and with a DAS28 threshold as ≥3.2, seen at the outpatient clinics of each centre. Exclusion criteria were previous usage of TNF-α blockers and a disease duration >12 months. The choice of any of the three TNF-α blockers was decided by the expert's opinion, without any restriction. Effectiveness was considered as an improvement of DAS28 at 12 and 24 weeks of treatment. Secondary endpoints were an improvement of TJC, SWJ, HAQ score and PASI score. Changes from baseline to the 12- and 24-week follow-up assessments were analysed using the Wilcoxon paired sign rank test. Twenty-nine patients (14 males, 15 females, median age 37 years, range 20-65 years) were enrolled. A statistical improvement of the DAS28 was observed at 12 and 24 weeks from baseline (p<0.001). Secondary endpoints also confirmed the effectiveness of the TNF-α blockers in the treatment of early PsA. No severe adverse events were observed during the treatment period, and no patient withdrew from the medications. This study suggests that the TNF-α blockers can be effective in the management of early PsA. Further controlled studies will provide more data on this challenging topic.