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OBJECTIVES: To describe the baseline characteristics of the patients enrolled in the QUality of life in patients with Axial SpondyloARthritis (QUASAR) study in terms of quality of life (QoL), disease activity, therapy adherence, and work ability in a real-world setting. METHODS: QUASAR is an Italian multicentre, prospective 12-month observational study, including consecutive adult patients classified as axial spondyloarthritis (axSpA) according to the Assessment of SpondyloArthritis international Society criteria for axSpA. RESULTS: Of 512 patients enrolled in 23 rheumatology centres, 80.7% had ankylosing spondylitis (AS) and 19.3% had non-radiographic axSpA (nr-axSpA). Mean ages were 34.1±13.3 years at axSpA symptoms onset and 39.5±13.0 years at diagnosis. Of the patients, 51.4% presented with ≥1 extra articular manifestation (EAM); the most common were psoriasis (17.8%) and uveitis (16.4%). Patients with nr-axSpA and AS had similar EAM rates, disease activity, and QoL. Biologic disease-modifying anti-rheumatic drugs (bDMARDs; 83.2%) were the most commonly received medication, followed by conventional synthetic DMARDs (22.9%) and non-steroidal anti-inflammatory drugs (NSAIDs; 16.6%). At baseline, higher treatment satisfaction was reported with bDMARDs which, together with NSAIDs, were associated with the best overall scores for disease activity, function, and QoL in the overall population and AS subgroup. CONCLUSIONS: QUASAR is the first Italian prospective study that comprehensively evaluated a large axSpA patient sample in a real-world setting. This interim analysis at baseline confirmed that i) patients with AS and nr-axSpA have similar QoL and disease burden, ii) nearly all axSpA patients receive treatment, and iii) bDMARDs and NSAIDs, overall, yield better disease activity and QoL.
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Antirreumáticos , Calidad de Vida , Espondiloartritis , Espondilitis Anquilosante , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Espondiloartritis/fisiopatología , Espondiloartritis/psicología , Espondilitis Anquilosante/fisiopatología , Espondilitis Anquilosante/psicología , Adulto JovenRESUMEN
OBJECTIVES: Rheumatoid arthritis (RA) patients with moderate disease activity show progression of joint damage and have impaired quality of life, physical function, work and daily activities. Little is known about management of patients with moderate RA. The aim of the study was to assess the 1-year response to anti-TNF in biologic-naïve RA patients with moderate (3.2
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Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/uso terapéutico , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Artritis Reumatoide/diagnóstico , Certolizumab Pegol/uso terapéutico , Progresión de la Enfermedad , Etanercept/uso terapéutico , Femenino , Humanos , Infliximab/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida , Inducción de Remisión , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Spondyloarthritis are chronic inflammatory diseases affecting spine, peripheral joints and enthesis, as well as extra-articular sites (bowel, eyes, skin). Diagnosis of spondyloarthritis often is slow and requires a multidisciplinary approach. The "Early SpA Clinic" project aimed at improving the patient care and journeys, by solving some organizational issues existing in Rheumatology Clinics. The "Early SpA Clinic" involved 19 Italian Rheumatology Centers using in-depth organizational analyses to identify areas for improvement. From the results of the analyses, some organizational solutions were suggested, and their impact measured at the end of the project through specific KPI. With the implementation of the suggested organizational solutions, Centers achieved relevant results, positively impacting on all the phases of the patient journey: decrease in waiting lists (-23%) and in the time length to transit the Center (-22%), increase in the percentage of new diagnoses (+20%), in the saturation of outpatient clinic capacity (+16%), and in the patient satisfaction (+4%). Centers involved in the "Early SpA Clinic" implemented several organizational actions based on an overall assessment of their activities and on solutions that required no additional resources. Overall, the Centers achieved the "Early SpA Clinic" objectives in terms of better management of resources, personnel, spaces, equipment, in relation to the volumes of patients.
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In this prospective observational study, data were collected from 34 rheumatology clinics in Italy in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) who started golimumab (GLM) as a second anti-TNFα drug. The primary objective was to evaluate the effectiveness of GLM after 6 months. Changes in quality of life using the EQ-5D-5L were also assessed. A total of 194 patients aged 53.2 ± 12 years started GLM as a second anti-TNF drug: 39 (20.1%) with RA, 91 (46.9%) with PsA and 64 (32.9%) with axSpA. After 6 months of GLM treatment, 68% of RA patients achieved low disease activity (LDA; DAS28-CRP ≤ 3.2), 31.9% of PsA patients achieved minimal disease activity and 32.5% of axSpA patients achieved LDA (ASDAS-CRP < 2.1). Good/moderate EULAR response was achieved in 61.9% and 73.8% of patients with RA and PsA, respectively, and 16% of axSpA patients achieved a 50% improvement in BASDAI. Across all indications, improvements in disease activity measures and EQ-5D-5L domains were observed over 6 months. The main reasons for GLM interruption were lack/loss of efficacy (7.2%) or adverse events (2%). This study confirms the effectiveness of GLM as a second-line anti-TNF for the treatment of RA, PsA and axSpA in a real-world setting in Italy.
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Artritis Psoriásica , Artritis Reumatoide , Humanos , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/tratamiento farmacológico , Anticuerpos Monoclonales/efectos adversos , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , ItaliaRESUMEN
BACKGROUND: Nailfold video-capillaroscopy (VCP) is nowadays worldwide considered as one of the best diagnostic noninvasive imaging technique able to study microcirculation in vivo. AIM: To review the applications of VCP in the clinical practice and its results in rheumatic and non-rheumatic diseases. METHODS: Review of literature RESULTS: The possibility of managing the imaging, by means of dedicated software able to characterize quantitative and qualitative data, represents another relevant property of VCP. This technique is very useful at the identification of microvascular involvement in many rheumatic diseases, particularly in systemic sclerosis and related disorders. At the same time, VCP has been showed valuable in many other extra-rheumatic diseases. The authors review the applications of VCP in the clinical practice and its results in rheumatic and non-rheumatic diseases.
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Capilares/patología , Angioscopía Microscópica/métodos , Enfermedades Reumáticas/diagnóstico , Reumatología , Grabación en Video , Enfermedades Autoinmunes/diagnóstico , Enfermedad de Crohn/diagnóstico , Angiopatías Diabéticas/diagnóstico , Diagnóstico Diferencial , Fiebre Mediterránea Familiar/diagnóstico , Humanos , Hipertensión/diagnóstico , Angina Microvascular/diagnóstico , Enfermedad de Raynaud/diagnóstico , Reproducibilidad de los Resultados , Enfermedades Reumáticas/patología , Reumatología/métodosRESUMEN
OBJECTIVES: To systematically review the evidence for a synergistic effect of combining rehabilitation with biological anti-tumour necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS). METHODS: Data were analysed to identify the most effective rehabilitation programmes, the best endpoints for effectiveness, and patient subgroups most likely to benefit from combination therapy. Systematic MEDLINE and Embase searches were performed to identify studies evaluating rehabilitation programmes and biological therapy in patients with AS. Evidence was categorised by study type, and efficacy, adverse effects and other outcomes were summarised. RESULTS: Of the 75 studies identified, 13 investigated the combination of a rehabilitation programme with TNF inhibitor therapy, while the remainder studied rehabilitation with standard therapy (often not specified). Data from these few studies suggest that combined rehabilitation plus anti-TNF therapy is more effective in terms of symptom severity, disease activity, disability and quality-of-life indices versus biologic alone or rehabilitation with standard medical therapy, or, in non-comparative studies, compared with baseline. The most effective rehabilitation appears to be supervised or in-patient programmes with an educational component. Available data do not provide guidance on most appropriate endpoints or identify patients most likely to benefit from combination therapy. Combined, TNF inhibitor and rehabilitation therapy appear to have a synergistic effect, possibly due to increased adherence to exercise. Exercise regimes are more effective if supervised and include an education component. CONCLUSIONS: Further randomized, controlled trials comparing endpoints and investigating longer-term benefits of combining TNF inhibitors with rehabilitation in different AS subgroups are needed.
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Terapia por Ejercicio , Espondilitis Anquilosante/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Antirreumáticos/uso terapéutico , Terapia Combinada , Humanos , Espondilitis Anquilosante/rehabilitación , Resultado del TratamientoRESUMEN
Hospital physicians employed in 37 departments of medicine in the Regions of Campania and Molise were asked to reply to a questionnaire aimed at evaluating, among their inpatients, the real extent of gastrointestinal side effects caused by nonsteroidal anti-inflammatory drugs and steroids, and to point out which gastroprotective drugs they thought were preferable in various clinical situations. In this way, a study group of internists has gathered information about the outlook of internists towards gastroprotection; they have also calculated the pharmacoeconomic burden of these measures.
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Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios/efectos adversos , Prescripciones de Medicamentos/estadística & datos numéricos , Gastropatías/inducido químicamente , Gastropatías/prevención & control , Encuestas de Atención de la Salud , Humanos , Medicina Interna , Italia , Cuerpo Médico de Hospitales , EsteroidesRESUMEN
Septic arthritis of the sternoclavicular joint (SCJ) is an uncommon form of arthritis generally occurring in immuno-compromised patients with contiguous or distant foci of infection and central venous catheters. Septic SCJ arthritis in previously healthy subjects is a very rare occurrence requiring a high index of suspicion for the diagnostic assessment. We report here one patient without predisposing factors presenting Staphylococcus aureus SCJ infection.