Search

Introduction: The Patient Acceptable Symptoms State (PASS) is a validated instrument that is used to assess whether a patient with psoriatic arthritis (PsA) accepts her/his disease status by asking them a simple question: “Think about all the ways your PsA has affected you during the last 48 h. If you were to remain in the next few months as you were during the last 48 h, would this be acceptable to you?” Methods: This was a cross-sectional study that included two PsA cohorts. To identify the DAPSA, PsAID and HAQ-DI thresholds that differentiated patients who reported “yes” in response to the PASS question from those who reported “no,” we used the receiver operating characteristic curves both for the female and male sexes. Moreover, Cohen’s kappa test was used to determine the agreement of a PASS “yes” with DAPSA ≤ 14, PsAID ≤ 4 and HAQ-DI ≤ 0.5. Results: Three-hundred ten patients were considered for the study. The DAPSA, PsAID-12 and HAQ-DI thresholds that differentiated PASS “yes” patients from PASS “no” patients were 11.7, 1.85 and 0.625 in male patients and 13.3, 3.85 and 0.750 in female patients, respectively. Conclusion: Female patients accept their disease at higher DAPSA, PsAID and HAQ-DI values than male patients do. The clinical meaning of this could be that a female patient generally has a greater global disease acceptance inclination. Therefore, this study further supports the concept that sex differences are present in patients with PsA.

Introduction: An overarching principle for the management of psoriatic arthritis (PsA) is a shared decision-making process between physicians and patients. The aim of this study is to assess the patient–physician relationship in a group of patients with PsA, by using the Perceived Efficacy in Patient–Physician Interactions (PEPPI) and CollaboRATE instruments. Methods: This is a cross-sectional multicenter study where consecutive patients with PsA were enrolled. For each patient, the main demographic, comorbid conditions, and clinical data were collected, including the assessment of disease activity, function, quality of life, and impact of disease. PEPPI and CollaboRATE questionnaires were used, respectively, to evaluate the patient’s perception of the patient–physician relationship and the shared decision-making process. Results: A total of 81 patients with PsA were enrolled at four centers in Italy. Overall, our patients showed a high level of confidence in obtaining needed health care, with relatively high median (IQR) values of PEPPI (20; 16–23), and a good shared decision-making process, with high median (IQR) values of CollaboRATE questionnaire (7; 6–9). PEPPI and CollaboRATE scores showed a statistically significant inverse correlation with different clinical variables such as disease duration, Leeds Enthesitis Index, PsA impact of Disease, Health Assessment Questionnaire, pain, patient’s global assessment of disease activity and clinical disease activity for PsA. The presence of comorbidities did not appear to be associated with lower values of PEPPI and CollaboRATE. Conclusions: In this study, few patients with PsA were at risk of suboptimal communication with their physician. This phenomenon appeared to be primarily related to higher disease activity and burden.

Introduction: The concept of severity in a multidomain disease such as psoriatic arthritis (PsA) is still not well defined. The aim of this study was to identify the clinical characteristics of patients with severe peripheral PsA. Methods: Retrospective analysis of a longitudinal cohort. Demographic and clinical characteristics of patients with PsA were collected at baseline and at last follow-up. We defined the severe population using the modified Composite Psoriatic Disease Activity Index (mCPDAI); which excludes ankylosing spondylitis quality of life scale). Hence, patients with a score of 3 in at least one domain were defined as having severe PsA. Clinical characteristics of patients fulfilling the definition of severe PsA were compared to those non-severe. Results: We evaluated 177 patients with peripheral PsA (M/F: 98/76). Of these, 64 (36.1%) were identified as severe according to the mCPDAI criteria, at baseline. Eighteen patients (10.1%) at last follow-up still met the definition of severe PsA. At last follow-up visit, severe patients with PsA were only males (18/18, P< 0.01) and have worse outcomes in terms of disease activity, pain, function, and impact of disease. Male sex and the severity of skin involvement at baseline were factors associated with the presence of severe PsA. The agreement between the presence of severe PsA and the absence of minimal disease activity was slight [Cohen’s k: 0.174 (0.084–0.264)]. Conclusions: Our study showed that severe patients with PsA had more disease activity, pain, and impact of disease than non-severe patients. Furthermore, we demonstrated that severity and disease activity are not interchangeable concepts.

ObjectiveThe main aim of the study was to evaluate the performance of 2 proposed criteria for difficult-to-treat (D2T) psoriatic arthritis (PsA) in a group of patients and to evaluate the agreement between the 2 sets of criteria.MethodsWe performed a cross-sectional analysis of 2 longitudinal cohorts of patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis (CASPAR), with at least 1 year of follow-up. A detailed medical history was collected and a physical examination was performed for all recruited patients. The proposed criteria for patients with D2T PsA were applied in our group. To test the performance of the 2 sets of criteria, we used an external validator (absence of patient acceptable symptom state + physician global assessment ≥ 6 cm). Finally, the agreement between the 2 sets of criteria was assessed.ResultsWe evaluated 378 patients with PsA (219 male/159 female), with a mean age (range) of 58 (19-75) years. Seventy-five (19.8%) patients fulfilled the D2T criteria proposed by Perrotta et al and 58 (15.3%) the D2T criteria proposed by Kumthekar et al. Both criteria showed comparable performance, with low sensitivity (Perrotta: 37.8%, Kumthekar: 29.7%) but good specificity (Perrotta: 82.1%, Kumthekar: 86.2%). Finally, the agreement between the 2 sets of criteria is substantial (Fleiss [Formula] 0.72), suggesting that both criteria identify nearly the same group of patients.ConclusionOur study compared 2 published sets of criteria showing comparable performance and substantial agreement. This study may pave the way for further research in this field.

ObjectiveThe aim was to evaluate the sex differences in sensitivity, specificity, positive and negative predictive values, and likelihood ratio of the outcome indices minimal disease activity (MDA), Disease Activity Score for Psoriatic Arthritis (DAPSA), and Psoriatic Arthritis Impact of Disease (PsAID) with respect to clinical remission, evaluated from both the physician and patient perspective, in a multicenter cohort of patients with PsA.MethodsIn this cross-sectional analysis of 2 longitudinal cohorts, all patients with PsA consecutively attending our rheumatology units were considered potentially eligible for the study. In all patients, a complete clinical examination was carried out. The DAPSA was calculated for each patient (DAPSA values ≤ 4 were considered as remission) and MDA was also evaluated. Patient and physician global assessment values ≤ 1 were considered as a surrogate of remission from the patient and physician perspective, respectively.ResultsTwo hundred seventy-two patients with PsA were enrolled (mean age 55.7 [SD 12.4]; 141 male, 131 female). In both sexes, MDA had good sensitivity and specificity toward remission as assessed by the rheumatologist. Remission according to DAPSA had excellent values of specificity but lacks sensitivity in both sexes. PsAID ≤ 4 had excellent values of sensitivity but lacked specificity in both sexes. Remission defined by DAPSA values was found to be more sensitive and specific in female patients (45.4% and 100%, respectively) than in male patients (33.3% and 84.2%, respectively) with respect to physician-judged remission.ConclusionThe results of this study demonstrate for the first time, to our knowledge, that some differences between the 2 sexes on the different outcome indices are possible. This could be important in the clinical management of patients with PsA.

Purpose: Psoriasis is a chronic autoimmune inflammatory disease that affects skin and nails but may also involve further sites of clinical or subclinical inflammation, including the joints. The aim of this review is to explore the role of PET imaging in psoriasis and psoriatic arthritis, especially in the assessment of joint and systemic inflammation and vascular inflammation, such as aortitis. Methods: We conducted an unstructured search of the literature for any studies employing the f [18F]-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in the assessment of inflammation in patients with psoriasis or psoriatic arthritis. Results: The role of [18F]-FDG PET/CT has been explored, with special focus on potential novel biomarkers, assessment of disease severity, and the imaging monitoring and validation of novel therapeutic strategies, including also future perspectives concerning further PET tracers, such as [18F]fluoride PET imaging. Conclusions: The possibility of the evaluation of inflammation in different sites can be used to evaluate both systemic, articular and periarticular inflammation, giving the possibility of a comprehensive assessment of the patients. The emerging clinical needs for novel biomarkers in the psoriasis field can be potentially supported by novel biomarkers on FDG PET imaging in several research settings but further multicentric trials are needed for the implementation in the clinical practice.

Psoriatic arthritis (PsA) is a chronic inflammatory disease that can lead to a reduction of function and quality of life. Early diagnosis could be important to prevent damage and improve patient-reported outcomes (PROs), such as pain and disease consequences.

Psoriatic arthritis (PsA) is a chronic inflammatory disease that can lead to a reduction of function and quality of life. Early diagnosis could be important to prevent damage and improve patient-reported outcomes (PROs), such as pain and disease consequences.

Psoriatic arthritis (PsA) is a complex and chronic inflammatory condition in which the achievement of the best possible disease control has been proposed as the treatment target, which includes the possibility of reaching remission in all disease domains. However, due to the complexity of this multidomain disease, some patients may still have high disease activity in one or more domain and a high burden of disease, potentially leading to various treatment changes and to difficulty with the overall management. In this paper, we overview the concept of patients with difficult-to-treat PsA and the concept of patients with refractory-to-treatment PsA by providing a distinction between these two concepts and the possible implication for the management of patients with PsA.

Introduction: The aim of this work is to characterize which Minimal Disease Activity (MDA) domains are mainly achieved, based on different treatments, in psoriatic arthritis (PsA) patients. Moreover, the association between MDA achievement and the different treatment groups was assessed. Methods: We conducted a cross-sectional analysis of two longitudinal PsA groups. Inclusion criteria were: age ≥ 18 years, PsA diagnosis, stable treatment for at least 6 months. Patients were grouped depending on the therapy: group 1: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)/cyclooxygenase 2 inhibitors (COX2i)/steroids, group 2: conventional synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs), group 3: Tumor Necrosis Factor α  inhibitors (TNFi), group 4: interleukin inhibitors (IL)12-23i or IL-23i, group 5: IL-17i, group 6: phosphodiesterase 4 inhibitors (PD4i). For each group, the achieved domains based on therapy were assessed. Multivariate logistic regression analysis was performed to assess the association between the treatment groups and the MDA achievement. Results: A total of 220 patients were enrolled, and MDA was achieved in 45.8% of them. In all treatment groups, the first MDA domains achieved were: body surface area ≤ 3, swollen joint count ≤ 1 and Leeds Enthesitis Index ≤ 1, while MDA domains less frequently achieved were Patient Global Assessment (PtgA) ≤ 2 cm and pain on visual analogue scale ≤ 1.5 cm. The logistic regression analysis showed higher odds ratios for the achievement of the MDA in those patients in groups 3 and 4. Conclusions: In each treatment group, MDA domains less frequently achieved were PtGA and pain, suggesting that “patient-driven domains” are still an unmet need.

Objective: To assess any differences and similarities in psoriatic arthritis (PsA) between sexes. Any possible differences of psoriasis and its potential impact on disease burden between sexes with PsA were also evaluated. Methods: Cross-sectional analysis of two longitudinal PsA cohorts. The impact of psoriasis on the PtGA was evaluated. Patients were stratified in four groups based on BSA. The median PtGA was then compared between the four groups. Moreover, a multivariate linear regression analysis was performed in order to evaluate associations between PtGA and skin involvement, split by sexes. Results: We enrolled 141 males and 131 females: PtGA, PtPnV, tender, swollen joint count, DAPSA, HAQ-DI, PsAID-12 were statistically significant higher in females (p≤ 0.05). PASS “yes” was deemed more in males than in females and BSA was higher in males. MDA was present more in males than females. When the patients were stratified on BSA, median PtGA was not different between males and females with BSA = 0. Instead, in females with BSA > 0, a higher PtGA was observed compared to males with BSA > 0. There was not a statistically significant association between skin involvement and PtGA at linear regression analysis, even if a trend seems to be present in female. Conclusions: Psoriasis is more present in males, but it seems to be related to a worse impact in females. In particular, a possible role of psoriasis as an influencing factor the PtGA was found. Moreover, female PsA patients tended to have more disease activity, worse function, and higher disease burden.

Objectives: To stratify psoriatic arthritis (PsA) patients based on psoriasis (PsO) onset age: early onset psoriasis (EOP) vs. late onset psoriasis (LOP), and to assess if there are differences in disease characteristics, activity/function/impact of the disease, and comorbidity indices. Methods: Cross-sectional analysis of a longitudinal PsA cohort. Patients were stratified based on PsO onset age. Results: One hundred and sixty PsA patients were enrolled (84 in EOP and 76 in LOP group) in the study. EOP PsA patients seem to have an increased probability to have dactylitis rather than LOP ones, OR 9.64 (3.77–24.6). Comorbidity indices (Rheumatic Disease Comorbidity Index and Charlson Comorbidity Index) were higher in LOP PsA patients, but these data were not confirmed when adjusted by age and sex. There are also differences in the treatment regimen: EOP PsA patients were more frequently treated with anti-interleukin (IL) 17; instead, LOP patients were more frequently treated with non-steroid anti-inflammatory drugs and conventional synthetic disease-modifying anti-rheumatics drugs. There were no differences in the disease activity, function, or impact of the disease. Conclusions: There are some clinical and therapeutic differences in PsA patients linked to the PsO onset age, namely dactylitis in EOP. Other characteristics found were: a “comorbidities trend” in LOP patients and a more frequent use of anti-IL17 in EOP.

Introduction: The EULAR group recently published the definition of difficult-to-treat (D2T) patients for rheumatoid arthritis. However, a similar definition is lacking for patients with psoriatic arthritis (PsA), in which its multi-domain expression may impact the treatment response. The aim of the study was to characterize the potential D2T PsA patients, to assess the risk factors, and to determine the burden of disease. Methods: Retrospective analysis of a longitudinal cohort of PsA patients attending a tertiary care center. At each visit, the patients underwent a complete physical examination and the clinical/laboratory data were collected. Data on comorbidities with the assessment of different comorbidity indices were also collected. Disease activity was assessed by using the DAPSA score and the MDA. The PsAID and HAQ-DI were also collected. We use the previous identified definition of D2T patients, applied to our PsA group and modified for this study. Results: A total of 106 patients fulfilled the inclusion criteria and were evaluated. Of these, 36 (33.9%) patients fulfilled the criteria for the potential D2T patients. D2T patients showed a significantly higher BMI and higher prevalence of fibromyalgia. Furthermore, D2T patients showed a significantly higher median Functional Comorbidity Index and a significantly higher BSA, LEI, pain level, PsAID score, and HAQ-DI than non-D2T patients. Potential D2T patients also showed a significant delay in the time from diagnosis to first b/ts DMARDs treatment. Conclusions: Our study firstly evaluated the presence of clinical characteristics of potential D2T patients and may contribute to future research on this intriguing aspect.

Introduction: MRI allows a better evaluation of inflammatory and structural lesions of the sacroiliac joints and spine in patients with axial spondyloarthritis (axial SpA), so MRI plays an important role in the classification and diagnosis of axial SpA. The aim of our study was to assess extra-axial MRI findings at pelvic sites and their possible associations with clinical indices in patients with axial SpA. Methods: Axial-SpA patients who were classified according to the ASAS criteria and consecutively attended our clinic were assessed with pelvic MRI. The main clinical and demographic characteristics of all patients, including age, sex, BMI, presence of HLA-B27 and type of axial SpA (radiographic or nonradiographic), were evaluated. The main indices of disease activity and joint function were assessed, including BASDAI, ASDAS-PCR, BASMI and BASFI. Finally, the presence/absence of inflammatory/structural lesions at extra-axial structures (the hip joints, pubic symphysis, greater and lesser trochanters, ischial tuberosity, iliac spines and iliac crest) was evaluated. Results: 35 patients (21 males and 14 females) with a mean age (SD) of 47 (12.7) years and a mean duration of symptoms of 5 (2.1) years were enrolled. Hip abnormalities were found in 14 (40%) patients. Trochanteric enthesopathy/bursitis and pubic osteitis were found in 2 patients (5.7%) and 1 patient (2.8%), respectively. No other abnormalities were found at other sites. We found significant associations between the presence of extra-axial alterations, disease activity and joint function. Conclusions: Our study demonstrated the presence of extra-axial abnormalities in more than one-third of patients with axial SpA, suggesting that MRI evaluation should be extended to the entire pelvis.

Psoriatic arthritis (PsA) is a complex, multiform and chronic inflammatory disease characterized by the association of psoriasis and arthritis with other musculoskeletal and extra-articular manifestations. The treatment of PsA is rapidly evolving due to the introduction of new biologic and small-molecule drugs, and the aim of treatment is to induce a condition of remission or low disease activity in all disease domains. However, unmet treatment needs still persist for those patients with impaired function, reduced quality of life or comorbidities. In this context, physical therapy and rehabilitation could provide additional benefits by reducing disease activity and improving function. Although a large number of studies have assessed the role of physical therapy and exercise in other forms of chronic inflammatory arthritis, such as axial spondyloarthritis and rheumatoid arthritis, evidence on their effect on persons with PsA is still lacking. However, some studies have reported the potential positive role of physical therapy on the different disease domains of PsA, in helping to improve disease activity, prevent or improve articular impairment, improve pain management and improve quality of life. Here, we review current evidence on physical therapy, exercise and rehabilitation in patients with PsA. In particular, we review the literature focusing on each domain, to provide evidence of efficacy and effectiveness of exercise and rehabilitation on skin, peripheral arthritis, axial involvement, dactylitis, enthesitis and comorbidities.

Introduction: Minimal disease activity (MDA) is a validated outcome measure in psoriatic arthritis (PsA) defining a low disease activity state with a cutoff of 5/7. The main aim of the study was to look at the MDA divided into in the seven cutoffs, analyzing the more frequently achieved domains. The relationship between MDA, PASS, PsAID, DAPSA, and the PhGA in all cutoffs was also evaluated. Methods: Cross-sectional analysis on PsA patients satisfying CASPAR criteria. An assessment of disease activity, treatment target, function, and impact of disease was performed. Patients achieving MDA were compared to patients not achieving MDA in order to evaluate the most frequent domain found. Results: Ninety-three PsA patients were enrolled. MDA was satisfied in 44/93, while in 47 MDA ranged from 1/7 to 4/7. Among the seven domains, Leeds Enthesitis Index (LEI) was the most frequent domain found in all patients. In those not in MDA, BSA ≤ 3 (70%) and swollen joints count ≤ 1 (68%) were also well represented. The domains with a lower percentage of patients not in MDA were HAQ-DI ≤ 0.5 (38.8%), tender joint count ≤ 1 (23%), PtGA ≤ 20 (4.2%) and VAS pain ≤ 15 mm (2%). There was a growing trend, from MDA 1/7 to MDA 7/7 in the percentage of patients in PASS yes, in PsAID ≤ 4, and in DAPSA ≤ 14. Conclusions: The present study detailed the domains more achieved also in those patients not in MDA showing that “physician-driven” domains are more frequently achieved in our patients.

ObjectiveA remarkable lack of detailed knowledge on pain areas in psoriatic arthritis (PsA) is present, and their clinical relevance is quite unknown. The main aim of the study was to explore pain areas in PsA, comparing them with those involved in patients with fibromyalgia (FM). In addition, a secondary aim was to investigate any possible association between pain areas and outcome measures in PsA.MethodsThis was a case-control study on patients with PsA satisfying Classification Criteria for Psoriatic Arthritis criteria and patients with FM. In all patients with PsA and FM, a body chart filled in by the patient reporting pain areas in 80 body locations was performed. The Widespread Pain Index (WPI) was performed in all patients with PsA and FM. In all patients with PsA, an assessment of disease activity, treatment target, function, and impact of disease was carried out.ResultsFifty patients with PsA and 50 FM controls were evaluated. A significantly higher number of pain areas in the body chart and higher WPI scores were found in patients with FM when compared to patients with PsA. In PsA, the number of areas reported in the body chart significantly correlated with the Disease Activity Index for PsA, Health Assessment Questionnaire–Disability Index, and PsA Impact of Disease. Patients who showed a significantly high number of extraarticular pain areas involved were those who were not in remission/minimal disease activity, or who did not have a greater impact of disease or reduced function.ConclusionThe main results showed that widespread and extraarticular pain was present in patients with PsA, showing that this nonarticular pain had an impact on important disease domains. The present study could contribute to an important aspect of this challenging and multifaceted disease—namely, the assessment of widespread pain.

Objective: The primary aim of the study was to assess the potential differences in clinical features, disease activity, function and impact of disease between Psoriatic Arthritis (PsA) patients with oligoarticular and polyarticular involvement.Methods: Consecutive PsA patients attending our unit were divided into 2 groups: 1) Oligoarticular (<5 involved joints with or without enthesitic/axial manifestations) and 2) Polyarticular (≥5 joints with or without enthesitic/axial manifestations). A full clinical examination with the assessment of disease characteristics, disease activity (DAPSA, MDA), function (HAQ-DI) and impact of disease (PsAID-12) was performed. Furthermore, a 6-month follow-up evaluation was carried out in order to assess disease differences at baseline and at follow-up.Results: Of the 102 enrolled patients, oligoarticular subset was present in 63 (61.7%), while 39 (38.3%) patients had polyarticular involvement. Patients with oligoarticular subset showed, at baseline evaluation, lower values of global disease activity assessed by physician, HAQ-DI and DAPSA compared to patients with polyarticular pattern. No differences in the impact of disease (PsAID), patient global assessment of disease activity or pain were found. At 6-month follow-up, no significant changes in each group occurred.Conclusion: Our study showed some differences in patients with oligoarticular and polyarticular involvement in terms of disease activity and HAQ-DI, while the overall impact of the disease and the presence of enthesitis, dactylitis and axial disease seem to be similar, with no substantial changes after 6-month follow-up. These results could mean that clinical phenotype might not be responsible for the impact of the disease perceived by the patient.

Introduction: The aim of this study was to evaluate the impact of comorbidities on disease activity, patient’s impact of the disease, patient global assessment, and function in psoriatic arthritis (PsA). Methods: Consecutive PsA patients were enrolled in this cross-sectional study. During the visit, the patients underwent a complete physical examination and clinical/laboratory data were collected, including type and number of comorbidities, recorded as simple comorbidity count (SCC). Results: A total of 144 patients were enrolled. At least one comorbidity was registered in 104 (72.2%) patients. The SCC was associated with DAPSA (ß?=?1.48, p?=?0.013), PsAID (ß?=?0.41, p?&lt;?0.01), HAQ-DI (ß?=?0.11, p?&lt;?0.01) and PtGA (ß?=?0.50, p?&lt;?0.01). The comorbidities that showed an impact on outcome measures were anxiety and fibromyalgia (FM). Anxiety showed an impact on DAPSA (ß?=?14.46, p?&lt;?0.001), PsAID (ß?=?1.98, p?=?0.039) and HAQ-DI (ß?=?0.54, p?=?0.036). FM showed an impact on DAPSA (ß?=?6.46, p?=?0.025), PsAID (ß?=?2.88, p?&lt;?0.001), HAQ-DI (ß?=?0.70, p?&lt;?0.001), PtGA (ß?=?2.00, p?=?0.014), and MDA (ß?=?- 2.79, p?=?0.01). The median PtGA value was different among patients with different numbers of comorbidities. Conclusions: This study showed that comorbidities, either as a simple comorbidity count number or as single comorbidity, might have an impact on the main domains affecting PsA patients in real clinical practice.

Introduction: The performance of seven cardiovascular (CV) risk algorithms is evaluated in a multicentric cohort of ankylosing spondylitis (AS) patients. Performance and calibration of traditional CV predictors have been compared with the novel paradigm of machine learning (ML). Methods: A retrospective analysis of prospectively collected data from an AS cohort has been performed. The primary outcome was the first CV event. The discriminatory ability of the algorithms was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), which is like the concordance-statistic (c-statistic). Three ML techniques were considered to calculate the CV risk: support vector machine (SVM), random forest (RF), and k-nearest neighbor (KNN). Results: Of 133 AS patients enrolled, 18 had a CV event. c-statistic scores of 0.71, 0.61, 0.66, 0.68, 0.66, 0.72, and 0.67 were found, respectively, for SCORE, CUORE, FRS, QRISK2, QRISK3, RRS, and ASSIGN. AUC values for the ML algorithms were: 0.70 for SVM, 0.73 for RF, and 0.64 for KNN. Feature analysis showed that C-reactive protein (CRP) has the highest importance, while SBP and hypertension treatment have lower importance. Conclusions: All of the evaluated CV risk algorithms exhibit a poor discriminative ability, except for RRS and SCORE, which showed a fair performance. For the first time, we demonstrated that AS patients do not show the traditional ones used by CV scores and that the most important variable is CRP.The present study contributes to a deeper understanding of CV risk in AS, allowing the development of innovative CV risk patient-specific models.

Programmed death-ligand 1 (PD-L1) expression on cancer cells is a clinically important biomarker to select patients with non-small cell lung cancer (NSCLC) for treatment with programmed death-1/PD-L1 inhibitors. Clinical trials of immunotherapy in patients with NSCLC have required histologic evidence for PD-L1 testing; in clinical practice, cytologic samples commonly are acquired in patients with advanced disease.

The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viral-induced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.

Objective: To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer.Methods: This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point).Results: All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis (n= 6), pneumonia (n= 1), respiratory failure (n= 1), and pulmonary embolism (n= 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p= 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor (p= 0.001).Conclusions: Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

Introduction: The aim of this work is to investigate the improvement of physical function and its determinants in axial spondyloarthritis (SpA) patients treated with tumor necrosis factor (TNF) inhibitors in a real clinical practice setting. Methods: An observational study was conducted in patients with axial SpA treated with anti-TNF from 2010 to 2018 with a minimum 6 months of follow-up. All patients fulfilled ASAS or the modified New York criteria. The Bath Ankylosing Spondylitis Metrology Index (BASMI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) were used as objective and self-reported functional indices. The improvement of function and factors associated were evaluated for the present study, as well as disease activity and patient-reported outcome measures. Results: A total of 183 patients with axial SpA were examined. Among them, 27 were non-radiographic axial SpA, while the remaining 156 were ankylosing spondylitis patients. BASFI and BASMI significantly improved during follow-up. Improvement of metrology index BASMI inverse correlated with disease duration (rho − 0.2, p= 0.009) and directly correlated with the improvement of BASDAI (rho 0.26, p= 0.003) and CRP (rho 0.26, p= 0.0003). Improvement of BASFI significantly inversely correlated with disease duration and directly correlated with the improvement of BASDAI, CRP, and baseline ESR. Male sex, lower disease duration, high ESR, and the improvement of BASDAI were found to be associated with the improvement of BASFI. Conclusions: Our results showed that in real-life settings, patients improve in BASMI and BASFI. Furthermore, factors associated with this improvement were identified.

ObjectiveRemission or low disease activity should be the treatment target of psoriatic arthritis (PsA). However, residual disease activity (RDA) in some domains could persist. The aim of this study was to assess RDA and its associated factors in a group of patients with PsA.MethodsPatients with PsA were enrolled if they satisfied ClASsification for Psoriatic ARthritis (CASPAR) criteria with > 6 months’ followup and achieved a status of low disease activity (LDA), minimal disease activity (MDA), or remission [Disease Activity Index for PsA (DAPSA) remission or very low disease activity (VLDA)]. RDA was assessed by the percentage of patients who had, although in LDA or remission, tender and/or swollen joints > 1, Leeds Enthesitis Index > 1, Health Assessment Questionnaire > 0.5, Psoriasis Area Severity Index (PASI) > 1, patient’s global assessment > 20, physician visual analog scale (VAS) > 20, and VAS pain > 15. Associated factors of RDA were also assessed.ResultsOf 113 enrolled patients, 78 (69%) were in MDA. Moreover, DAPSA remission was observed in 46 (40.7%) while VLDA only in 32 (28.3%) of patients with PsA. VLDA seems to be the most stringent criterion, with a minimal RDA only in the VAS physician in 1 patient (3.1%) and none in the different domains, while patients in MDA had RDA in tender joints (14.1%), VAS pain (29.4%) and PASI > 1 or body surface area (BSA) > 3% (17.9%). Of note, although patients in DAPSA remission show a very low rate of RDA in almost all domains, 12 (26%) of them show a PASI > 1 or BSA > 3%. Finally, LDA shows RDA in higher percentages, mainly in patient-reported outcomes, tender joints, and skin domain.ConclusionRDA can be recognized in patients with PsA. VLDA seems to be the most stringent composite index to identify patients in the absence of RDA.

Introduction: Sustained remission should be considered the main therapeutic target in psoriatic arthritis (PsA). Very low disease activity (VLDA) and a DAPSA score ≤ 4 are the most commonly used criteria. The aim of the present study was to evaluate the rate of sustained remission in a group of PsA patients followed in a real-life setting. Methods: All PsA patients satisfying CASPAR criteria were followed prospectively every 3–6 months, in a context of clinical practice by January 2013. Sustained remission was defined when patients achieved a DAPSA score ≤ 4 and/or VLDA for at least 12 months. The exclusion criterion was the presence of a condition of VLDA or DAPSA ≤ 4 at the baseline assessment. Kaplan–Meier survival curve was used to evaluate the survival of patients. Results: A total of 147 PsA patients were evaluated for the study. Of these, 80 performed at least 12 consecutive months of follow-up. The average duration of follow-up was 24 months (range, 12–60 months). At the last follow-up, 22 patients were on csDMARDs treatment while 58 patients were on bDMARDs. Of the 80 patients, 14 (17.5%) achieved a sustained VLDA while 24 (30%) achieved sustained remission according to the DAPSA criteria. The mean duration of remission in patients achieving VLDA and DAPSA ≤ 4 was 17 months for both criteria. High baseline levels of CRP, shorter disease duration, and less pain at baseline were found to be predictors of sustained VLDA and DAPSA remission. Conclusions: In our study, based on clinical practice, a sustained VLDA was achieved in 17.5% and a sustained remission according to the DAPSA criteria in 30% of patients with PsA.

Axial spondyloarthritis (axSpA) is a chronic and inflammatory rheumatic disease characterized by pain, structural and functional impairments, and reduced mobility and potential deformity of the axial skeleton. Treatment of axSpA includes pharmacological and non-pharmacological therapy. However, in the biologic era, unmet needs still remain for patients intolerant to or non-responders to biologic drugs and despite the development of new treatments, physical therapy and rehabilitation are of crucial importance in the management of axSpA patients. The aim of this manuscript is to review the current evidence on the assessment, physical therapy, and rehabilitation in axSpA patients.

Introduction: The present study aimed (a) to evaluate the clinical and radiographic characteristics of hand erosive osteoarthritis (EOA) in a group of consecutive patients, (b) to correlate the severity of radiographic involvement with clinical and laboratory findings and (c) to associate the levels of pain and functional impairment with some radiographic findings. Methods: Patients with EOA were consecutively enrolled. Inclusion criteria required the American College of Rheumatology (ACR) criteria for hand osteoarthritis and the presence of at least one joint in “E” or “R” phase according to Verbruggen–Veys. For each patient, demographic and clinical data were collected including evaluation of pain and function with the Australian Canadian Osteoarthritis Hand Index (AUSCAN) scale and Health Assessment Questionnaire (HAQ). Laboratory parameters and plain radiography of both hands were also collected. Each radiograph was evaluated in accordance with the Verbruggen–Veys classification and scored with the Kallman score. Results: During the study period 60 patients (M/F 13:47) with EAO were enrolled. More severe radiographic disease (“E” or “R”) was often found at II and III distal interphalangeal (IP) joints. In addition, Kallman score, presence of osteophytes, erosions and joint space narrowing correlated significantly with duration of symptoms, AUSCAN, pain and active joints. More severe radiographic involvement was associated with AUSCAN and with the presence of ankylosis only at proximal IP joints. Conclusion: The present study showed that EOA is characterised by a significant correlation between radiographic involvement and some clinical characteristics of the disease. However, an impairment of joint function was mainly associated to radiological proximal IP joint involvement, but not with other symptoms such as pain.

Objective.The purpose of the ULISSE study was to evaluate the prevalence of clinical and ultrasonographic (US) entheseal involvement in patients with psoriatic arthritis (PsA), psoriasis, and fibromyalgia syndrome (FMS).Methods.In this cross-sectional multicenter study, patients with PsA and psoriasis (not taking systemic therapy) and FMS underwent a clinical evaluation of the entheses, and a B-mode and power Doppler examination of 6 pairs of entheses.Results.The study analyzed 140 patients with PsA, 51 with psoriasis, and 51 with FMS. Clinical and US examinations were performed in 1960 and 1680 entheses in the PsA group, and 714 and 612 entheses both in the psoriasis group and in the FMS group. In both per-patient and per-enthesis evaluation, the frequency of entheseal tenderness was higher in patients with FMS (92% of the patients and 46% of the entheses, compared with 66%/23% in the PsA group and 59%/18% in the psoriasis group). With US examination, signs of entheseal involvement were more frequent in both the per-patient and per-enthesis evaluation in PsA and psoriasis (about 90% of patients in both the PsA and psoriasis groups and 75% of patients in the FMS group had at least 1 site affected, and 54%, 41%, and 27% of the pairs of entheses in, respectively, PsA, psoriasis, and FMS patients showed at least 1 enthesis involved).Conclusion.The ULISSE study indicated that enthesitis is a common feature in patients with PsA, those with psoriasis, and in those with FMS if only clinical examination is used. US entheseal assessment showed findings more consistent with the 3 disorders.

Objective.Recommendations regarding “treat to target” in psoriatic arthritis (PsA) have stated that the target should be remission or inactive disease. Potential definitions include very low disease activity (VLDA), PsA Disease Activity Score (PASDAS) near remission, Disease Activity Index for PsA (DAPSA) or clinical DAPSA (cDAPSA) remission. Our aim was to investigate the proportion of patients who fulfill these definitions and how much residual active disease remained.Methods.This analysis used 2 datasets: first, trial data from the Tight Control of PsA (TICOPA) study, which included 206 patients with recent-onset (< 2 yrs) PsA receiving standard and biological disease-modifying antirheumatic drugs (DMARD); and second, an observational clinical dataset from Italy of patients receiving biological DMARD. Proportions achieving each of the 4 potential targets were calculated in each dataset and comparisons between treatment groups were performed in the TICOPA dataset. Levels of residual disease were established for key clinical domains of PsA.Results.All measures could differentiate the TICOPA trial treatment groups (p < 0.03). Lower proportions of patients fulfilled the VLDA criteria compared to DAPSA or cDAPSA remission. PASDAS results were different between the cohorts. Residual active disease was low across all definitions although higher levels were seen in DAPSA and cDAPSA compared to VLDA, particularly for psoriasis. In all measures, the proportion with elevated C-reactive protein was similar and low.Conclusion.VLDA appears the most stringent measure. It ensures that significant active arthritis, enthesitis, and psoriasis are not present, in contrast with DAPSA and PASDAS, in which composite scores can “hide” active disease in some domains.

Pulmonary vascular disorders (PVDs) include primary or secondary diseases who ultimately influence the right heart function. Several researches showed that stem and progenitor cells may represent a novel approach in treating pulmonary hypertension. In particular, circulating endothelial progenitor cells (EPCs) are mobilized either from the bone marrow and/or arteries to replace dysfunctional endothelial cells and restore blood perfusion to ischemic tissues. They may deliver paracrine signals to stimulate local angiogenesis or may be physically incorporated within neovessels. Understanding the molecular mechanisms utilized by vascular endothelial growth factor (VEGF) to stimulate EPC might shed light on novel targets for regenerative medicine. Ca2+ machinery regulates proliferation, migration, tube formation, and, therefore, differentiation of EPCs may give valuable insights into the biology of these cells; the Ca2+ machinery in these cells is extremely plastic and may vary depending on their origin. In this paper, we review EPCs subtypes, their sources, biological properties, functional mechanisms and of course involvement in pulmonary vascular diseases.

Pulmonary vascular disorders (PVDs) include primary or secondary diseases who ultimately influence the right heart function. Several researches showed that stem and progenitor cells may represent a novel approach in treating pulmonary hypertension. In particular, circulating endothelial progenitor cells (EPCs) are mobilized either from the bone marrow and/or arteries to replace dysfunctional endothelial cells and restore blood perfusion to ischemic tissues. They may deliver paracrine signals to stimulate local angiogenesis or may be physically incorporated within neovessels. Understanding the molecular mechanisms utilized by vascular endothelial growth factor (VEGF) to stimulate EPC might shed light on novel targets for regenerative medicine. Ca2+ machinery regulates proliferation, migration, tube formation, and, therefore, differentiation of EPCs may give valuable insights into the biology of these cells; the Ca2+ machinery in these cells is extremely plastic and may vary depending on their origin. In this paper, we review EPCs subtypes, their sources, biological properties, functional mechanisms and of course involvement in pulmonary vascular diseases.

Objective.The aim of this study was to evaluate the influence of sex on response to treatment and disease remission in patients with axial spondyloarthritis (axSpA).Methods.In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria for axSpA, and treated with adalimumab, etanercept, golimumab, or infliximab, were studied. We compared clinical characteristics, patient-reported outcomes, disease activity, function, and response to treatment in male and female patients with this disease.Results.Three hundred forty patients with axSpA (270 with ankylosing spondylitis, 19 with psoriatic arthritis with axial involvement, and 51 with nonradiographic axSpA) were studied. Male subjects had a significantly higher prevalence of grade IV sacroiliitis, higher levels of serum C-reactive protein, lower Maastricht Ankylosing Spondylitis Enthesitis Score, and fatigue when compared with females. Further, Kaplan-Meier survival curves showed that the rate of partial remission, ASAS40 response, and Ankylosing Spondylitis Disease Activity Score (ASDAS) major improvement, but not ASDAS inactive disease, were significantly lower in female patients.Conclusion.Our data suggest that female sex was associated with a lower rate of response to treatment and of disease remission in patients with axSpA treated with antitumor necrosis factor-α drugs.

ABSTRACTObjective: The aim of the CAMPO-RHE study was to determine the incidence of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and polymyalgia rheumatica (PMR) in patients attending a rheumatologic outpatient’s clinic of a new institution in Campobasso, Italy.Methods: Campobasso is a small town of approximately 50,000 inhabitants located in the inland territory of central Italy (Molise), and Public Health is managed from a single health authority. In Italy, all citizens are registered with a National Health System of General Practitioner (GP) Physicians. Between the 1stof June 2014 and the 31stof May 2016, all consecutive adult patients, sent by a GP, of Campobasso with any diagnosis of musculoskeletal symptoms/signs/complaints were evaluated in a single rheumatology outpatient clinic of our Academic Unit. The clinic represents the first and unique reference for GPs about rheumatic diseases in the territory. Subjects were classified using the 2010 EULAR criteria for RA, the CASPAR criteria for PsA and the 2012 ACR classification criteria for PMR.Results: 1003 adult patients, sent by GPs, with articular or musculoskeletal complaints visited our clinic. Of these, 409 inhabitants of the municipality of Campobasso were evaluated for the study. During the 2-year study period we diagnosed 18, 19 and 12 new cases of RA, PsA and PMR respectively, with a new incident cases rate of 21.4, 22.59 and 27.43/100,000/year on the population at risk.Conclusion: The results of our study could contribute to better define the incidence of these rheumatic diseases classified with the new classification criteria.