[Knee radiosynovectomy with Y90 in patients with rheumatoid arthritis: our experiences]. / La sinoviectomia isotopica del ginocchio con Y90 in pazienti affetti da artrite reumatoide: nostre esperienze.

In this study we resume the results of a twenty year-long experience with knee radiosynoviorthesis in patients with rheumatoid arthritis. We treated 840 patients; the total of treated knees was 1030; from our experience it arises that best and fastest results come from patients in stage I and higher; improvement is between 1st and 3rd year from first treatment in all patients considered. Best improvements occur in less severe patients; in most severe patients they last longer in time. Radioisotopic synoviectomy represents a good therapeutic goal; about 75% of patients shows a significant reduction in presenting numbers of knee swelling events and a benefit on the quality of life.

[Automation and computerization of the articular and Ritchie's indexes calculation]. / Automazione ed informatizzazione del calcolo dell'indice articolare e di Ritchie.

Compilation and calculation of some articular indexes is time consuming. Therefore the authors present a data base for automatic compilation and calculation of articular and Ritchie's indexes. Moreover the program allows to determine the number of the swollen and painful joints.

[Computerized acquisition and elaboration of clinical data in Rheumatology during ten years: state of art and prospectives] / Dieci anni di nostre esperienze nell'acquisizione ed elaborazione informatizzata dei dati clinici in reumatologia: stato dell'arte e prospettive.

The well known complexity to collect the clinical data of patients and in particular in the area of rheumatology push us to develop a computerized clinical chart in order to facilitate the classification, evaluation and monitoring of these patients. The proposed computerized clinical chart is easy to use but at the same time is a very potent tool that allow the clinicians to organize the classic rheumatological pathologies as well as the more complexes or even rare. The proposed clinical chart is based on a relational database (FileMaker Pro 5.0v1) available for both the actual operative systems implemented on personal computers (Windows and Macintosh); this allow the full compatibility among the two systems, the possibility of exchanging data without any loss of information. The computerized clinical chart is structured on modules for specific pathologies and for homogeneous groups of illnesses. Basically the modules are defined correlated files of data for a specific pathology but that can be used also as a common pool for different pathologies. Our experience, based on ten years of use, indicates in the computerized rheumatological clinical chart an indispensable tool for rheumatologists with a real friendly use.

Validation of an Italian version of the arthritis impact measurement scales 2 (ITALIAN-AIMS2) for patients with osteoarthritis of the knee. Gonarthrosis and Quality of Life Assessment (GOQOLA) Study Group.

OBJECTIVE: To validate a translated version of the revised and expanded Arthritis Impact Measurement Scales (AIMS2) to be used by Italian patients with osteoarthritis (OA) of the knee. METHODS: The AIMS2 was translated into Italian and administered to a cohort of 178 outpatients with symptomatic OA of the knee who attended 12 participating rheumatological institutes in northern, central and southern Italy. A random sample of 71 patients were readministered the AIMS2, 7 days after the first visit, to evaluate the instrument's test-retest reliability. After 6 months, the subjects were asked to return to the institutes for a second administration of the questionnaire. RESULTS: The internal consistency reliability of each scale score, as estimated by Cronbach's alpha coefficient, was high and indicated that the components of the scale measured the same construct. The items all correlated with each other, but there was no redundancy; this indicates that each domain addressed a somewhat different aspect of functional disability. The test-retest reliability equalled or exceeded 0.80 for eight of the 12 scales. Factor analysis provided a three-factor health status model explaining 63.5% of the variance. Arthritis pain and psychological scale were loaded on the first factor, together with physical scales for mobility level and walking and bending. The upper limb function scales formed the second factor. The third factor was determined by the social dimension. These results demonstrate that the physical health status scales of the AIMS2 are valid, as shown by the significant, moderate to high correlations between the AIMS2 subscales and the majority of the clinical measures. CONCLUSION: Our data suggest that, like the original questionnaire, the translated version of AIMS2 is a reliable, consistent and valid instrument for measuring health status and physical functioning in patients with OA of the knee.

[Churg-Strauss syndrome. Personal caseload and review of the literature]. / La sindrome di Churg-Strauss. Casistica personale e rassegna della letteratura.

Churg-Strauss syndrome (CSS) is a disease characterised by hypereosinophilia and systemic vasculitis occurring in patients with asthma and allergic rhinitis. In the course of CSS three phases may be distinguished. The prodromal phase, which may persist for many years, consists of allergic disease. The second phase is characterised by peripheral blood eosinophilia and eosinophilic tissue infiltrates that produce a clinical picture diagnosed as Loeffler's syndrome, chronic eosinophilic pneumonia or eosinophilic gastroenteritis. The third phase is dominated by systemic vasculitis in which skin, cardiovascular system, gastrointestinal tract and peripheral nervous system are frequently involved. Renal disease in CSS is less common and generally less severe than that classical polyarteritis nodosa and Wegener's granulomatosis. Genitourinary tract may be involved, too. In the postvaculitic phase, allergic rhinitis and asthma usually persist and clinical picture is characterised by the consequences of the vasculitic illness, most commonly in form of neuropathy and hypertension. The pathogenesis of CSS is unknown but its association with asthma and allergic rhinitis may indicate an abnormal immune reactivity. The recently reported association with antineutrophil cytoplasmic antibodies with antimyeloperoxidase specificity may suggest a their role in the pathogenesis of the disease. An important role may be played by eosinophils, too. The main therapy is that with corticosteroids, possibly in association with immunosuppressive drugs.

The Chronic Arthritis Systemic Index (CASI).

Ninety-four rheumatoid patients were studied through laboratory, clinical, algometric, functional and psychological parameters (29 variables in all). Using factorial analysis, four factors emerged which explained 74% of the common variance. The four factors were: the disability factor (explaining 39% of the variance); the biology factor (explaining 21%); the algology factor (explaining 8%); and the clinical factor represented by the Ritchie Articular Index (RAI) (explaining 6%). The four items were used to construct a Chronic Arthritis Systemic Index (CASI) which correlated significantly with other indices, such as the Mallya-Mace, the Thompson and the limited Lansbury indices. CASI provided to be very useful in monitoring the disease course in a short term study of 22 patients undergoing DMARD treatment. Taking into account the parameters proposed as outcome measures by several workshops, CASI can monitor both the activity and severity of chronic arthritides through simple measures.

[Weekly low-dose methotrexate in rheumatoid arthritis. Review of the literature]. / Il methotrexate a basse dosi settimanali nell'artrite reumatoide. Rassegna della letteratura.

Methotrexate (MTX) is an antifolic drug that in recent years has been largely employed in the treatment of Rheumatoid Arthritis (RA). Both short and long term clinical trials have demonstrated its efficacy and good tolerability. It induces a significant improvement of all clinical variables and a decrease in the erythrocyte sedimentation rate and other acute phase reactants with a steroid sparing effect. The probability of continuing MTX therapy for up to 5 years is 46-55% whereas that of continuing gold, hydroxychloroquine, sulfasalazine or D-penicillamine therapy is less than 20%. MTX is a rapidly acting drug with a clinical response within 4 weeks and a plateau phase after 6 months of therapy. Discontinuation of long-term MTX therapy induces a flare-up of the disease so that patients receiving long-term MTX must continue the drug to maintain clinical benefits. In spite of its clinical efficacy, MTX does not seem to have a significant effect on disease progression as determined radiographically. In this respect, MTX appears to have some superiority when compared to azathioprine, but not when compared to gold salts. MTX has been employed in patients with RA unresponsive to other Disease-Modifying Antirheumatic Drugs (DMARDs), but according to some recent views on the therapeutic strategy of RA, it could be used in early RA as a first choice drug. Toxic effects are the main reason in limiting long-term MTX treatment. Hepatic toxicity is one of the more common side-effects of MTX, but the recognition of its "risk factors" such as alcohol abuse, may reduce it. Acute pneumonitis is one of the more severe complications of MTX therapy and may be life-threatening. In RA patients treated with MTX are also reported complications of immunosuppression, such as Pneumocystis carinii pneumonia whose clinical-radiological picture may be similar to that of acute pneumonitis. The mechanism of action of low-dose weekly MTX in RA is still unclear, but it might be more antiinflammatory than immunosuppressive, as supported by the rapid clinical response. The inhibition of Interleukin-1 activity or other inflammatory cytokines and inflammatory cells may play an important role in the antiinflammatory effect of MTX. MTX effects in RA are not fully understood and further studies are needed to clarify its mechanism of action and its place in the therapeutic strategy of this disease.

[The validity and reliability of the Italian version of the Arthritis Impact Measurement Scales in patients with rheumatoid arthritis]. / Validità ed affidabilità della versione italiana dell'Arthritis Impact Measurement Scales in pazienti con artrite reumatoide.

The validity and the reliability of the Italian version of AIMS (Arthritis Impact Measurement Scales) was tested in Rheumatoid Arthritis (RA). The factorial analysis performed on tests obtained from 274 patients showed a strict similarity with the original version. The five extracted factors (upper-limb function, lower-limb function, psycho-affective dimension, social dimension and pain) explain 80% of the common variance. The internal consistency (Cronbach's alfa coefficient = 0.78) and the test-retest performance (r = 0.86) support the reliability of the Italian AIMS. The analysis of the correlations with clinical parameters (the Ritchie's and Thompson's articular indexes, the systemic Lansbury's index, the joint count, the grip strength and morning stiffness), with pain measures (VAS, MPQ, PPI) and psychometric measures (ZDI, ZAI) assessed in 143 out of 274 patients, demonstrates the concurrent validity. The results show that the Italian version of AIMS is a practical value in the management of RA patients. The construct certainly allows its application even in other common chronic diseases.

Relationship between procollagen III peptide serum levels, synovitis of weight bearing joints and disability in rheumatoid arthritis.

We studied P-III-P levels along with several acute phase reactants, Beta-2-microglobulin and autoantibody synthesis in 52 rheumatoid patients. No relationship arose between P-III-P levels and immunological parameters nor with acute phase reactants. We observed a highly significant difference between P-III-P levels in patients with knee and/or hip involvement with respect to those with only polyarthritis of small joints (86.1 +/- 21.5 vs 61.2 +/- 19.1 ng/ml; p less than 0.001). In 24 consecutive patients we also observed a significant correlation (p less than 0.02) between P-III-P levels and AIMS score. We conclude that P-III-P levels are mainly related to the synovial inflammation of major joints and as such P-III-P might represent the biochemical marker of the synovial mass in rheumatoid arthritis.

DISH and ankylosing spondylitis. Case report and review of the literature.

Ankylosing spondylitis (A.Sp.) and diffuse idiopatic skeletal hyperostosis (DISH), represent the most common inflammatory and degenerative enthesopathies, respectively. Despite their rather frequent occurrence in the rheumatic disease care setting, few case reports of their simultaneous presence in the same patient have appeared in the literature. We describe here a further observation and review the rheumatologic literature.