Long-term methotrexate use in rheumatoid arthritis patients: real-world data from the MARTE study.

BACKGROUND: The MARTE study investigated the demographic, clinical, and therapeutic characteristics of rheumatoid arthritis (RA) patients ongoing methotrexate (MTX) treatment for longer than 8 years. METHODS: This cross-sectional, observational study considered 587 RA patients from 67 Rheumatology Units across Italy. Data collected included demographic, clinical, and therapeutic characteristics, focusing on MTX prescription patterns (route of administration, dosing regimens, treatment duration, and discontinuation). RESULTS: As initial therapy, 90.6% of patients received one conventional synthetic Disease Modifying Anti Rheumatic Drug (csDMARD), with treatment started within the first 3 months from diagnosis in half of the patients. MTX was the first csDMARD in 46.2% of patients. The prevalent route of administration at diagnosis was the intramuscular (60.5%), while at study entry (baseline) 57.6% were receiving subcutaneous MTX. Patients who required a higher MTX dose at study entry were those who received a significantly lower starting MTX dose (P<0.001). Significantly higher MTX doses were currently required in men (P<0.001), current smokers (P=0.013), and overweight patients (P=0.028), whereas patients on oral therapy received significantly lower doses of MTX (P<0.001). CONCLUSIONS: The MARTE study confirms once again the potential of the proper use of MTX in the treatment of RA. Data from our study suggest that a higher dose of MTX should be used since the first stages in overweight patients, men, and smokers.

[Change in condylar and mandibular morphology in juvenile idiopathic arthritis: cone beam volumetric imaging]. / A fejecs és a mandibula morfológiájának változása juvenilis idiopátiás arthritisben: vizsgálatok cone beam CT-vel.

The aim of this study is to show the importance of Cone Beam Computerized Tomography to volumetrically quantify TMJ damage in patients with JIA, measuring condylar and mandibular real volumes. 34 children with temporomandibular involvement by Juvenile Idiopathic Arthritis were observed by Cone Beam Computerized Tomography. 4 were excluded because of several imaging noises. The mandible was isolated from others craniofacial structures; the whole mandibular volume and its components' volumes (condyle, ramus, hemibody, hemisymphysis on right side and on left side) has been calculated by a 3D volume rendering technique. The results show a highly significant statistical difference between affected side volumetric values versus normal side volumetric values above all on condyle region (P < 0.01), while they don't show any statistical differences between right side versus left side. The Cone Beam Computerized Tomography represents a huge improvement in understanding of the condyle and mandibular morphological changes, even in the early stages of the Juvenile Idiopathic Arthritis. The JIA can lead in children to temporomandibular joint damage with facial development and growth alterations.

Psoriatic arthritis: temporomandibular joint involvement as the first articular phenomenon.

Psoriatic arthritis (PA) is a chronic systemic disease that is difficult to detect. The diagnosis is made on mainly clinical grounds based on the findings of psoriasis and inflammatory arthritis of the joints. Many reports have described the damaging effects of PA on the temporomandibular joints (TMJs), but no study has clearly reported the TMJ as the first articulation to be involved in PA. This article reports a case of PA that was diagnosed several years after TMD onset because no signs besides psoriasis were present. The missed early diagnosis resulted in severe TMJ damage. The TMJ can be the first joint involved in PA. For a correct, early diagnosis of PA, collaboration between dental clinicians and rheumatologists is very important.

Craniofacial growth in children affected by juvenile idiopathic arthritis involving the temporomandibular joint: functional therapy management.

UNLABELLED: The aim of this study was twofold: 1) to asses the effects of a functional appliance on condyles damaged by juvenile idiopathic arthritis (JIA). and 2) to evaluate its ability to reduce alterations in craniofacial development. STUDY DESIGN: Seventy-two JIA patients with temporomandibular involvement, ages ranging between 4 and 16 years, were treated. All of them presented temporomandibular joint involvement. They were treated with an activator and followed for 4 years. RESULTS: At the second examination, it was possible to observe a reduction in mandibular retrusion and in the sagittal discrepancy between mandible and maxilla, a reduction in the angle of divergence, a counterclockwise rotation of the mandible, a reduction of the gonial angle, a longer mandibular ramus, a reduction in the discrepancy between anterior and posterior height caused by an increase in posterior height and a forward positioning of the chin. CONCLUSION: The functional appliance reduces the severity of facial alterations improving mandibular and condylar growth.

[Multiorgan autoimmune syndrome: case report]. / Osservazioni su un caso di sindrome autoimmune multipla.

The present case report refers to a multiorgan autoimmune disease manifesting following thymectomy performed for a benign thymoma. This disease is characterized by hypothyroidism, severe myasthenia, polymyositis and alopecia which are organ-specific diseases probably with a different time of onset but which are all an expression of the same immunopathologic process occurring in individuals who have a genetic predisposition. Characteristic of the present case is not only the association of the different immunopathologic clinical pictures but also the rather difficult differential diagnosis between a hypothyroidism-related myopathy and polymyositis. It was possible to formulate the diagnosis by integrating the results of clinical and laboratory evaluation with the therapeutic outcome. The onset of the syndrome was attributed to the withdrawal, following surgery, of the inhibitory effects of the thymoma on some clones of autoreactive lymphocytes.