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1.
Clin Exp Rheumatol ; 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31287415

RESUMO

Antiphospholipid syndrome (APS) is a systemic autoimmune disease which manifests as thrombotic and/or obstetric adverse events, mediated by persistent circulating antiphospholipid antibodies (aPL) detected by means of three tests: lupus anticoagulant, anticardiolipin and anti ß2-glycoprotein I antibodies. It can be isolated or associated with other autoimmune rheumatic diseases. During pregnancy, patients with APS have a higher risk of obstetric complications and a higher thrombotic risk due to the pregnancy itself. Therefore, a preconception counselling is crucial to assist the patient and her family in planning the pregnancy and to optimise the management by implementing preventive measures that can allow the best outcomes for both the mother and the baby. In clinical practice, we can distinguish between different subsets of patients that require alternative approaches: patients with obstetric APS, patients with thrombotic APS, patients with APS associated with other autoimmune diseases, and asymptomatic individuals (aPL carriers). Pregnancy and foetal outcomes have greatly improved in the past 2 decades as a result of a therapeutic implementation based on individual risk stratification and a combination of low dose aspirin and heparin. Additional strategies have been suggested for women with pregnancy failure despite this management.

2.
Clin Exp Rheumatol ; 37 Suppl 116(1): 63-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30747099

RESUMO

OBJECTIVES: Fibromyalgia (FM) is a syndrome of unknown aetiology that is characterised by widespread musculoskeletal pain, fatigue and disordered sleep, and often associated with neuropsychiatric and cognitive symptoms. Current treatment options are only partially effective, but hyperbaric oxygen therapy (HBOT) seems to be capable of relieving some of the symptoms. The aim of this study was to evaluate the efficacy and safety of HBOT after fewer sessions than generally used, chosen on the basis of pre-clinical and clinical data showing its rapid and sustained antinociceptive effect. METHODS: Patients with FM underwent HBOT (100% oxygen at 2.5 ata with air breaks) administered on three days per week for a total of twenty 90-minute sessions. Pain, fatigue, the quality of sleep, symptoms of anxiety and depression, and the patients' health-related quality of life were prospectively assessed before and after ten and twenty sessions. RESULTS: Twenty-eight of the 32 study patients completed the 20 HBOT sessions. Pain scores and the symptoms of anxiety (but not those of depression) significantly improved after both 10 and 20 sessions, whereas fatigue and FM symptom severity scores significantly improved only after 20 sessions. There was no significant change in the quality of sleep. The adverse effects were limited. CONCLUSIONS: These findings support the view that HBOT is an effective, rapid and safe means of treating various symptoms of FM.


Assuntos
Fibromialgia/terapia , Oxigenação Hiperbárica , Qualidade de Vida , Humanos , Oxigenação Hiperbárica/efeitos adversos , Oxigênio , Estudos Prospectivos , Resultado do Tratamento
3.
Autoimmun Rev ; 18(2): 164-176, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30572134

RESUMO

Pregnancy requires a special management in women with inflammatory rheumatic diseases (RDs), with the aim of controlling maternal disease activity and avoiding fetal complications. Despite the heterogeneous course of RDs during pregnancy, their impact on pregnancy largely relates to the extent of active inflammation at the time of conception. Therefore, accurate evaluation of disease activity is crucial for the best management of pregnant patients. Nevertheless, there are limitations in using conventional measures of disease activity in pregnancy, as some items included in these instruments can be biased by symptoms or by physiological changes related to pregnancy and the pregnancy itself may influence laboratory parameters used to assess disease activity. This article aims to summarize the current literature about the available instruments to measure disease activity during pregnancy in RDs. Systemic lupus erythematosus is the only disease with instruments that have been modified to account for several adaptations which might interfere with the attribution of signs or symptoms to disease activity during pregnancy. No modified-pregnancy indices exist for women affected by other RDs, but standard indices have been applied to pregnant patients. The current body of knowledge shows that the physiologic changes that occur during pregnancy need to be either adapted from existing instruments or developed to improve the management of pregnant women with RDs. Standardized instruments to assess disease activity during pregnancy would be helpful not only for clinical practice but also for research purposes.


Assuntos
Complicações na Gravidez/fisiopatologia , Doenças Reumáticas/fisiopatologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/patologia , Doenças Reumáticas/patologia
4.
Curr Rheumatol Rep ; 20(10): 59, 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30105597

RESUMO

PURPOSE OF REVIEW: This review focuses on new pathogenesis and clinical-therapeutic aspects of obstetric anti-phospholipid syndrome (ob-APS) in the last 5 years. RECENT FINDINGS: The pathogenesis of ob-APS is multifactorial, including placental infarctions, infiltration of inflammatory cells that cause acute and chronic inflammation, leading to uncontrolled inflammation and poor pregnancy outcomes. A preconception counseling and a patient-tailored treatment are fundamental to improve maternal and fetal outcomes. Thanks to conventional treatment, based on low-dose aspirin and heparin, 70% of women with ob-APS can have successful pregnancies. Women with positive anti-phospholipid antibodies (aPL) without clinical manifestations ("aPL carriers") or with obstetric manifestation not fulfilling ob-APS criteria need to be further investigated in order to assess their best management. Great interest has been given to drugs that could interact in the pathophysiological mechanisms, such as hydroxychloroquine, statins, and eculizumab. These drugs could be considered for patients refractory to conventional therapy.

5.
J Med Case Rep ; 12(1): 154, 2018 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-29859543

RESUMO

BACKGROUND: Tocilizumab is a monoclonal antibody directed against the interleukin-6 receptor, which is approved for the treatment of moderate-to-severe rheumatoid arthritis. Authors have found that it prevents lung and subcutaneous nodulosis in patients with rheumatoid arthritis but, to the best of our knowledge, there are no data concerning the acceleration of subcutaneous nodulosis during tocilizumab therapy. CASE PRESENTATION: We report for the first time a small case series of five patients with rheumatoid arthritis: a 46-year-old white woman, a 70-year-old white woman, a 63-year-old white woman, a 69-year-old white man, and a 72-year-old white woman (mean age 64 ± 10.6 years); they experienced worsening subcutaneous nodulosis during treatment with intravenously administered tocilizumab. Four of the five patients were positive for rheumatoid factor and five for anti-citrullinated peptide antibodies. All of the patients had previously been treated with various conventional and biological drugs; at the time of our observation, three were taking methotrexate, two hydroxychloroquine, and four were taking prednisone. Tocilizumab 8 mg/kg was administered intravenously every 4 weeks for a mean of 43.4 ± 32.4 months, and led to good disease control in three cases. All of the patients had a history of subcutaneous nodulosis, which considerably worsened during tocilizumab treatment, with the development of new nodules on their fingers, elbows, or in the inframammary fold, tending to ulcerate. The management of this medical event included discontinuation of methotrexate, the administration of steroids, the addition of hydroxychloroquine or colchicine, the use of antibiotics, and surgery. However, neither pharmacological nor surgical treatment was completely effective, as the nodules tended to recur and increased in number and size. CONCLUSIONS: To the best of our knowledge, this is the first report describing accelerated subcutaneous nodulosis in a small case series of patients with rheumatoid arthritis treated with tocilizumab.

6.
Clin Rheumatol ; 37(9): 2573-2577, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29732494

RESUMO

In a previous report of two married cohabiting couples affected by polymyalgia rheumatica (PMR), we noticed that the wife of one couple and both members of the other couple suffered from symptomatic diverticular disease (DD), whose diagnosis was made before the onset of PMR. We investigated whether DD might be a risk factor for the development of PMR. We conducted a case-control study informed on a database containing the prospectively collected medical records of consecutive PMR patients. Among comorbidities, attention was focused on symptomatic DD, provided that the diagnosis had been made by colonoscopy and/or computed tomography scan. As controls, we identified one control per case at random among those matched by age and sex attending the ophthalmic and orthopedic outpatient clinics, as long as a PMR diagnosis had been excluded. A logistic regression model was used, following a multiplicative model, and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). The most frequent comorbidities in the two groups of patients (121 cases and 121 controls) were chronic coronary artery disease, atrial fibrillation, diabetes mellitus, hypertension, DD, hypercholesterolemia, osteoporosis, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and cholelithiasis. The association between PMR and DD (OR = 4.06; 95% CI: 1.76-9.35) was by far stronger than that found comparing PMR with the other comorbidities. The chronic bowel inflammation induced by dysbiosis in patients with symptomatic DD could be a critical immunopathological mechanism supporting the development or exacerbation of PMR in susceptible individuals.

7.
Expert Rev Clin Immunol ; 14(1): 69-82, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29202589

RESUMO

BACKGROUND: Interstitial lung diseases (ILDs) are among the most serious complications associated with systemic rheumatic diseases, and lead to significant morbidity and mortality; they may also be the first manifestation of connective tissue diseases (CTDs). The aim of this narrative review is to summarise the data concerning the pathogenesis of CTD/ILD and its distinguishing features in different rheumatic diseseas. Areas covered: The pathogenesis, clinical aspects and treatment of ILD associated with rheumatic systemic diseases and CTDs were reviewed by searching the PubMed, Medline, and Cochrane Library databases for papers published between 1995 and February 2017 using combinations of words or terms. Articles not written in English were excluded. Expert commentary: The management of CTD-ILD is challenging because of the lack of robust data regarding the treatments used, the heterogeneity of the diseases themselves, and the scarcity of well-defined outcome measures. Treatment decisions are often made clinically on the basis of functional, radiographic progression, and exacerbating factors such as age and the burden of comorbidities. Given the complexities of diagnosis and the paucity of treatment trials, the management of CTD patients with ILD requires multidisciplinary collaboration between rheumatologists and pulmonologists in CTD-ILD clinics.


Assuntos
Doenças Autoimunes/diagnóstico , Doenças do Tecido Conjuntivo/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Reumáticas/diagnóstico , Doenças Autoimunes/complicações , Doenças Autoimunes/epidemiologia , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/epidemiologia , Diagnóstico Diferencial , Humanos , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/epidemiologia , Doenças Reumáticas/complicações , Doenças Reumáticas/epidemiologia
8.
Best Pract Res Clin Rheumatol ; 32(4): 500-510, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-31174819

RESUMO

Central nervous system (CNS) involvement is quite unusual in patients with rheumatoid arthritis (RA), although cerebral vasculitis, rheumatoid nodules and meningitis have all been reported, and patients with RA may also have CNS comorbidities such as stroke and neuro-degenerative and demyelinating syndromes. It has been found that biological drugs, especially anti-tumour necrosis factor-alpha (anti-TNF-α) drugs, slightly increase the risk of developing demyelinating diseases, and they are consequently discouraged in patients with multiple sclerosis and related disorders. Furthermore, the risk of opportunistic CNS infections is increased in immunosuppressed patients. To review the current literature concerning CNS involvement in patients with RA (including RA-related forms and comorbidities) and the incidence of new-onset CNS diseases in patients with RA undergoing biological treatment (anti-TNF or non-anti-TNF drugs), the Medline database was searched using the key words 'rheumatoid arthritis', 'central nervous system', 'anti-TNF', 'abatacept', 'tocilizumab', 'rituximab' and 'anakinra'. Abstracts not in English were excluded. We selected 76 articles published between 1989 and 2017, which were divided into four groups on the basis of whether CNS involvement was RA-related or not and according to the type of biological agent used (TNF inhibitors or other agents). The RA-related diseases included aseptic meningitis, vasculitis and cerebral rheumatoid nodules, which benefit from immunosuppressive treatments. CNS comorbidities included stroke, seizures, dementia and neuropsychiatric disorders, which have been frequently described in biological agent-naïve patients with RA, and other rarely reported neurological diseases, such as extra-pyramidal syndromes and demyelinating disorders. CNS comorbidities are relatively frequent among patients with RA and may be related to systemic inflammation or concomitant medications. The use of anti-TNF drugs is associated with the risk of developing demyelinating diseases, and CNS infections have been described in patients treated with anti-TNF and non-anti-TNF agents. Non-anti-TNF drugs may be preferred in the case of demyelinating diseases, cerebral vasculitis or neurolupus. Patients with RA may suffer from CNS involvement as a manifestation of RA or as a comorbidity. The treatment of such medical conditions should be guided on the basis of their etiopathogenesis: steroids and immunosuppressants are useful in the case of RA-related CNS diseases but are often detrimental in other situations. Similarly, the choice of biological agents in patients with RA with CNS complications should be guided by a correct diagnosis in order to prevent further complications.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/etiologia , Fatores Biológicos/uso terapêutico , Sistema Nervoso Central/patologia , Antirreumáticos/farmacologia , Artrite Reumatoide/patologia , Fatores Biológicos/farmacologia , Humanos
9.
Expert Opin Emerg Drugs ; 22(4): 357-367, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29250975

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a chronic disorder whose symptoms of pain, fatigue, sleep disturbances and depression have a devastating effect on patients' lives as it limits their ability to engage in everyday working and social activities, and make it difficult to maintain normal relationships with family, friends and employers. None of the currently available drugs are fully effective against the whole spectrum of symptoms. The aim of this narrative review is to summarise the data relating to the new therapeutic options that have become available over the last few years. Areas covered: Increasing efforts by the pharmaceutical industry have led to the introduction of new investigational drugs and new formulations of older drugs, and studies have been carried out in order to investigate the possibility of using drugs that are currently used for other diseases. Expert opinion: Slight improvements in the health of FM patients treated with drugs targeting a range of molecular mechanisms have been observed, but there is still no single drug that is capable of offering substantial efficacy against all of the characteristic symptoms of FM. The identification of new and improved therapies for FM requires consideration of the heterogeneity of the condition, which suggests the existence of different patient subgroups, a relationship between central and peripheral aspects of the pathophysiology, and the need for combined treatment with drugs targeting multiple molecular mechanisms.


Assuntos
Desenho de Drogas , Drogas em Investigação/uso terapêutico , Fibromialgia/tratamento farmacológico , Indústria Farmacêutica/tendências , Fibromialgia/fisiopatologia , Humanos , Resultado do Tratamento
10.
Dis Markers ; 2017: 9545930, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28912623

RESUMO

BACKGROUND: The aim of our study was to evaluate the serum concentration of klotho in a cohort of systemic sclerosis (SSc) patients compared to that of healthy controls and to correlate its levels with the degree and the kind of organ involvement. METHODS: Blood samples obtained from both patients and controls were collected and analysed by an ELISA test for the determination of human soluble klotho. Scleroderma patients were evaluated for disease activity through clinical, laboratory, and instrumental assessment. RESULTS: Our cohort consisted of 81 SSc patients (74 females, mean age 63.9 ± 13.1 years) and 136 healthy controls (78 females, mean age 50.5 ± 10.7 years). When matched for age, serum klotho concentration significantly differed between controls and patients (p < 0.001). However, in SSc patients, we did not find any significant association between serum klotho and clinical, laboratory, and instrumental findings. Lower serum levels of klotho were detected in 4 patients who were anticitrullinated peptide antibody (ACPA) positive (p = 0.005). CONCLUSIONS: Our data show a lower concentration of klotho in the serum of SSc patients compared to that of healthy controls, without any significant association with clinical manifestations and laboratory and instrumental findings. The association between serum klotho and ACPA positivity requires further investigation.


Assuntos
Glucuronidase/sangue , Escleroderma Sistêmico/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Rheumatol Int ; 37(12): 2035-2042, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28875224

RESUMO

To investigate the influence of fibromyalgia (FM) on achieving remission defined on the basis of the Simplified Disease Activity Index (SDAI) remission criteria in patients with long-standing rheumatoid arthritis (RA). This observational longitudinal cohort consisted of long-standing RA patients being treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs). After 6 months of follow-up, the patients fulfilling or not fulfilling the remission criteria were identified and compared with each other in terms of the presence of FM, neuropathic pain, and other comorbidities. At the end of the 6-month observation period, 24 of the 117 patients (20.4%) met the SDAI remission criteria. Logistic regression analysis showed that the modified Rheumatic Disease Comorbidity Index (mRDCI) (p = 0.0001), the FM presence (p = 0.0001), and the 36-item short-form health survey Mental Component Summary (SF-36 MCS) Score (p = 0.0088) were the strongest predictors of not being in SDAI remission. None of the patients with concomitant FM (17.1%) achieved SDAI remission. In comparison with the non-FM patients, the patients with RA and FM patients had worse scores on the SF-36 MCS (p = 0.011), on the sleep Visual Analogue Scale (VAS) (p = 0.018), on the self-counts of tender joints (p = 0.039), and on the PainDetect Questionnaire (PDQ) (p = 0.001). To avoid over treatment, an assessment of FM should be considered in RA patients who do not fulfil the remission criteria.


Assuntos
Artrite Reumatoide/complicações , Fibromialgia/complicações , Fibromialgia/diagnóstico , Medição da Dor/métodos , Índice de Gravidade de Doença , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Feminino , Fibromialgia/tratamento farmacológico , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Qualidade de Vida , Indução de Remissão , Inquéritos e Questionários
12.
J Immunol Res ; 2017: 6836498, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28835902

RESUMO

OBJECTIVE: To provide a narrative review of the most recent data concerning the involvement of the microbiome in the pathogenesis of connective tissue diseases (CTDs) and vasculitides. METHODS: The PubMed database was searched for articles using combinations of words or terms that included systemic lupus erythematosus, systemic sclerosis, autoimmune myositis, Sjögren's syndrome, undifferentiated and mixed CTD, vasculitis, microbiota, microbiome, and dysbiosis. Papers from the reference lists of the articles and book chapters were reviewed, and relevant publications were identified. Abstracts and articles written in languages other than English were excluded. RESULTS: We found some evidence that dysbiosis participates in the pathogenesis of systemic lupus erythematosus, systemic sclerosis, Sjögren's syndrome, and Behçet's disease, but there are still few data concerning the role of dysbiosis in other CTDs or vasculitides. CONCLUSIONS: Numerous studies suggest that alterations in human microbiota may be involved in the pathogenesis of inflammatory arthritides as a result of the aberrant activation of the innate and adaptive immune responses. Only a few studies have explored the involvement of dysbiosis in other CTDs or vasculitides, and further research is needed.


Assuntos
Doenças do Tecido Conjuntivo/microbiologia , Disbiose , Microbiota , Vasculite/microbiologia , Doenças Autoimunes/microbiologia , Doenças Autoimunes/fisiopatologia , Síndrome de Behçet/microbiologia , Síndrome de Behçet/fisiopatologia , Doenças do Tecido Conjuntivo/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/microbiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Escleroderma Sistêmico/microbiologia , Escleroderma Sistêmico/fisiopatologia , Síndrome de Sjogren/microbiologia , Síndrome de Sjogren/fisiopatologia
13.
Clin Exp Rheumatol ; 35 Suppl 105(3): 6-12, 2017 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28681712

RESUMO

Fibromyalgia (FM) is a complex syndrome characterised by chronic pain, fatigue and functional symptoms. Widespread pain is often its most typical feature, whereas other manifestations may be associated to various extents. Its aetiopathogenesis is still a matter of debate, but various pharmacological and non-pharmacological therapies are currently available for its treatment. We review the literature concerning the most recent findings relating to the aetiopathogenesis, assessment and treatment of FM published between January 2016 and January 2017.


Assuntos
Antidepressivos Tricíclicos/uso terapêutico , Terapia Cognitivo-Comportamental , Fibromialgia/terapia , Educação de Pacientes como Assunto , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Terapia por Exercício , Fibromialgia/diagnóstico , Fibromialgia/etiologia , Fibromialgia/fisiopatologia , Humanos , Hipnose , Imagens (Psicoterapia) , Fármacos Neuromusculares/uso terapêutico
14.
Clin Exp Rheumatol ; 35 Suppl 105(3): 81-85, 2017 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28598785

RESUMO

OBJECTIVES: Neuropeptide Y (NPY) is a neurotransmitter released by sympathetic neurons, which is probably involved in pain modulation. Acupuncture is increasingly used as an alternative or complementary means of controlling pain in rheumatic diseases such as fibromyalgia (FM), a chronic widespread pain syndrome accompanied by allodynia and hyperalgesia. The aim of the present study was to assess the effects of an acupuncture cycle on serum NPY levels in patients with FM, and identify possible correlations between its serum levels and clinical and clinimetric parameters. METHODS: The study involved 30 FM patients who underwent clinical and clinimetric evaluations and blood sampling at baseline and at the end of the treatment, and 20 healthy subjects who underwent blood sampling. RESULTS: The baseline serum NPY levels of the patients were higher than those of the controls. They had significantly increased by the end of the treatment, when there was also a statistically significant reduction in pain, the number of tender points number, and the clinimetric scores. CONCLUSIONS: These findings confirm the analgesic properties of acupuncture as a complementary treatment in FM, and indicate that NPY could play a role in pain modulation.


Assuntos
Terapia por Acupuntura , Fibromialgia/terapia , Neuropeptídeo Y/sangue , Adulto , Idoso , Feminino , Fibromialgia/sangue , Humanos , Pessoa de Meia-Idade , Medição da Dor
15.
Expert Opin Drug Saf ; : 1-8, 2016 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-27728981

RESUMO

INTRODUCTION: Pregabalin is indicated for the treatment of fibromyalgia and pregabalin-treated subjects have shown improved pain, sleep and functional measures in placebo-controlled and open-label studies. This article reviews pregabalin's safety profile. Areas covered: The safety findings in pregabalin clinical trials were accessed by a PubMed search using the key words 'pregabalin' or 'anti-epilectics drug' or 'gabapentinoids' or 'anticonvulsants' and 'fibromyalgia'. Although frequent, the side effects of pregabalin therapy are usually mild to moderate, well tolerated in the long term, and can be monitored in a primary care setting. Expert opinion: Pregabalin therapy may be associated with somnolence, dizziness, weight gain and periphereal edema. Potential drug interactions are not common, and pregabalin seems to be well tolerated in combination with antidepressants. The demonstrated efficacy of pregabalin suggests that the risk/benefit ratio favours its use.

16.
Clin Exp Rheumatol ; 34(2 Suppl 96): S129-33, 2016 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27157397

RESUMO

OBJECTIVES: Emerging evidence associates chronic pain syndrome, such as fibromyalgia, with endogenous pain modulatory system dysfunction, leading to an impaired descending pain inhibition. In this study, using resting-state functional magnetic resonance imaging (fMRI), we aimed at seeking possible functional connectivity changes of the periaqueductal gray (PAG), a brainstem area that belongs to the endogenous pain modulatory system, in patients with fibromyalgia. METHODS: In 20 patients with fibromyalgia and 15 healthy subjects, we investigated PAG functional connectivity using resting-state fMRI. We also analysed the correlation between clinical variables, such as pain severity, disease duration, and depressive personality traits with PAG functional connectivity. RESULTS: Compared with control subjects, we identified that patients with fibromyalgia had an increased PAG connectivity with insula, anterior cingulate cortex, and anterior prefrontal cortex. The functional connectivity between PAG and the rostral ventral medulla, however, was not concordantly increased. PAG functional connectivity correlated with pain severity, disease duration, and the depressive personality trait rating. CONCLUSIONS: Our fMRI study showing abnormal resting state functional connectivity of the PAG suggests that patients with fibromyalgia have an endogenous pain modulatory system dysfunction, possibly causing an impaired descending pain inhibition. This abnormal PAG functioning might underlay the chronic pain these patients suffer from.


Assuntos
Dor Crônica , Fibromialgia , Substância Cinzenta Periaquedutal/fisiopatologia , Adulto , Mapeamento Encefálico/métodos , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Feminino , Fibromialgia/complicações , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
17.
Expert Rev Clin Pharmacol ; : 1-7, 2016 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-26794309

RESUMO

Fibromyalgia is a chronic disorder whose symptoms have a devastating effect on patients' lives as they limit their ability to engage in everyday working and social activities, and make it difficult to maintain normal relationships with family, friends and employers. None of the currently available drugs are fully effective against the whole spectrum of symptoms of pain, fatigue, sleep disturbances and depression, but increasing efforts by the pharmaceutical industry have led to the introduction of new investigational drugs and new formulations of older drugs, as well as studies of the possibility of applying drugs currently used for other diseases. The aim of this review is to summarise the data relating to the new therapeutic options that have become available over the last few years.

18.
Clin Rheumatol ; 35(4): 1111-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24728878

RESUMO

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder in elderly people. It is frequently associated with giant-cell arteritis (GCA), although it is still debated if they are the same disease or two distinct pathologies. The etiology of PMR remains challenging, although current knowledge supports the role of both genetic and environmental factors. Among these, there is evidence that infectious agents could trigger the disease's onset in some cases. We describe the peculiar case where PMR occurred in two Italian married and cohabiting couples and provide a review of the literature for similar cases. This is the first reported occurrence of PMR in two conjugal pairs in Italy. Moreover, in the second case, the wife presented PMR associated with GCA. To date, seven cases of PMR and two of GCA in married couples are described in the literature. The occurrence of PMR in both a husband and a wife supports the pathogenetic role of an environmental factor.


Assuntos
Características da Família , Polimialgia Reumática/diagnóstico , Polimialgia Reumática/epidemiologia , Reumatologia/métodos , Idoso , Feminino , Arterite de Células Gigantes/complicações , Humanos , Itália , Masculino , Polimialgia Reumática/complicações , Fatores de Risco
19.
BMC Musculoskelet Disord ; 16: 53, 2015 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-25887374

RESUMO

BACKGROUND: Vitamin D displays immunomodulatory activities and has been proposed as a potential player in the pathogenesis of rheumatoid arthritis (RA). A negative association between serum 25(OH) vitamin D levels and RA activity was demonstrated but longitudinal studies investigating the role of vitamin D levels in predicting RA activity and response to treatment are lacking. Therefore, this study was designed to test the hypothesis of an association between serum 25(OH) vitamin D levels at RA diagnosis and disease activity evaluated by clinimetric, laboratory and ultrasound (US) parameters and to detect the prevalence of remission and response to treatment after 12 months follow-up. METHODS: This is a longitudinal, retrospective study on data obtained from thirty-seven patients with early RA treatment-naïve. Serum inflammatory markers, auto-antibodies and 25(OH) vitamin D levels were obtained at baseline. Hypovitaminosis D was diagnosed for 25(OH) vitamin D levels < 20 ng/ml. Tender joint count (TJCs), swollen joint count (SJCs), Visual Analog Scales (VAS), Disease Activity Score (DAS) 28 score were assessed at baseline and 12 months after diagnosis. Joints synovitis and power-Doppler were evaluated at baseline and 12 months later. RESULTS: At baseline mean 25(OH) vitamin D levels were 24.4 ± 11.9 ng/ml; 35% of study subjects had hypovitaminosis D which strongly associated with higher RA activity and lower prevalence of remission and response to treatment (all p-values < 0.001). The percentage of patients not presenting a reduction of the US synovitis score after 12 months from diagnosis was significantly higher among patients with hypovitaminosis D than in those with normal serum 25(OH) vitamin D at baseline. CONCLUSIONS: In patients with early RA and basal hypovitaminosis D after 12 months follow-up reduction of disease activity and percentage of remission and response to treatment were significantly lower than those observed in patients with normal vitamin D levels. These results provide further support to the immunomodulatory action of vitamin D in RA and suggest a role of basal vitamin D status in the prediction of disease evolution. Vitamin D measurement and possibly vitamin D supplementation should be considered an additional option in the management of early RA patients.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Autoanticorpos/sangue , Índice de Gravidade de Doença , Deficiência de Vitamina D/diagnóstico , Vitamina D/sangue , Adulto , Artrite Reumatoide/sangue , Biomarcadores/sangue , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Articulações/diagnóstico por imagem , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia Doppler , Deficiência de Vitamina D/sangue
20.
Clin Exp Rheumatol ; 33(1 Suppl 88): S68-72, 2015 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25786046

RESUMO

OBJECTIVES: Emerging evidence associates fibromyalgia (FM) with pain system dysfunction. In this study, using laser evoked potentials (LEPs) and paired laser stimuli, we tested excitability in the pain matrices and sought possible changes in patients with FM. METHODS: In 20 patients with FM and 15 healthy subjects, after recording control nociceptive system-mediated Aδ- and C-fibre-related LEPs, we measured excitability in the pain matrices by testing the Aδ-LEP conditioned by a preceding C-LEP. RESULTS: No difference was found in control LEP amplitudes for Aδ- or C-fibres between patients and healthy subjects. Conversely, the Aδ-LEP amplitude, conditioned by a preceding C-LEP, was significantly higher in patients than in healthy subjects (p<0.001). CONCLUSIONS: Objective evidence from increased conditioned Aδ-LEP amplitudes reflecting hyperexcitability in the pain matrices in FM, provides diagnostically useful information and might help in developing new therapeutic approaches.


Assuntos
Fibromialgia/complicações , Hiperalgesia/etiologia , Percepção da Dor , Limiar da Dor , Dor/etiologia , Adulto , Estudos de Casos e Controles , Eletroencefalografia , Feminino , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Humanos , Hiperalgesia/diagnóstico , Hiperalgesia/fisiopatologia , Hiperalgesia/psicologia , Potenciais Evocados por Laser , Lasers de Estado Sólido , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas , Fibras Nervosas Amielínicas , Dor/diagnóstico , Dor/fisiopatologia , Dor/psicologia , Medição da Dor , Valor Preditivo dos Testes , Estudos Prospectivos , Tempo de Reação , Fatores de Tempo
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