Search

Rheumatoid arthritis (RA) is an autoimmune disorder in which gut and oral microbiota play a crucial role. Diet is a modifiable factor that can influence both microbiota composition and arthritis outcome, previous studies have suggested associations between dietary habits and RA, with contrasting results. We investigate the protective effect of the Mediterranean diet (MD) on disease activity and the gut microbiota profile in RA patients. Sixty consecutive RA patients were enrolled upon filling a validated 14-item questionnaire for the assessment of adherence to the Mediterranean diet (Prevention with Mediterranean Diet-PREDIMED). Then, 16S analysis was employed to explore the gut microbiota within the two cohorts of patients. Patients with high adherence to MD (20) had a significantly lower C-reactive protein (p &lt, 0.037) and disease activity (p &lt, 0.034) than the 40 patients with low/moderate adherence to MD. An inverse association between MD and disease activity was confirmed by multivariate analysis after adjustments for all the different demographic, clinical and serologic variables. A healthier gut microbiota composition was observed in the high adherence group, with a significant decrease in Lactobacillaceae and an almost complete absence of Prevotella copri with respect to the low/moderate adherence group. In conclusion, our findings support the protective role of MD on disease activity and microbiota composition in RA patients, and suggest the feasibility of shifting the habitual diet to modulate the gut microbiota and promote the benefits associated with MD.

Summary The recent European Union and Italian regulations in the matter of in vivo test could strongly impact on current diagnostic approach, increasing the usage of in vitro tests in daily clinical practice. We evaluated 506 patients with both skin prick test and a microarray system (ImmunoCAP ISAC 112). The overall evaluation between ImmunoCAP® ISAC vs SPT showed a moderate agreement (k=0.509, 95% C.I. 0.480-0.540, SE: 0.016) considering both aeroallergens and food allergens. When we considered the concordant results (double-positive plus double-negatives), the agreement ranged from 69% to 80% for pollen allergens, between 74% and 76% for dust mites, and between 74% and 93% for animal epithelia. In the case of food allergens, the accordance was pretty lower, accounting values ranging from 67% to 86%. ISAC testing identified from 22% to 26% more cases than SPTs in peach and nuts hyper-sensitivity. In 2.8% of the control group, the ISAC-test failed to detect an allergy sensitization caused by dust mite, shrimp, Anisakis, or seed storage proteins. Multiplex testing is more than a promising tool for more precise and comprehensive profiling of allergic patients and can be considered as a second-line approach, after the anamnesis, in the diagnosis of allergic diseases.

Summary Background. The development of recombinant technology supported the allergy diagnostic work-up in the daily clinical practice, representing a useful tool for epidemiological studies. Methods. An atlas of the IgE sensitization profiles found throughout Italy was prepared from a nationwide, multicenter, cross-sectional study. Results. 6052 unselected consecutive individuals, belonging to North-West [NW], North-East [NE], Centre [C], South [S], and Islands subset [Is] were evaluated by means of the ImmunoCAP ISAC test. The top-ranked sensitizations found were Cup a 1 in [C] (58.1%) and [S] (53.6%), Phl p 1 in the North (from 46.1% to 49%), and Cyn d 1 in [Is] (44.2%). High frequency of house dust mite group 2 molecules sensitization was found in [C] (36.9%) and [S] Italy (40.8%), whilst low level of reactivity was recorded in [NW] (20%). Pellitory hypersensitivity was mainly found in [C], [S], and [Is], whilst ragweed Amb a 1 sensitivity was particularly found in [NW] Italy. IgE recognition of PR-10, Profilin, and nsLTP was mutually exclusive in 69.1% of cases, PR-10 reactivity mostly occurring in [NE], Profilin in [NW], and nsLTP molecules recognition mainly recorded in [C] and [S]. Conclusions. Divergent IgE sensitization patterns were found along Italy, possibly linked to the distinct geographical locations, indicating multiplex system IgE analysis as a reliable approach for epidemiological evaluation even in small geographical areas.

Background: A timely diagnosis and a suitable therapy allow a better control of disease activity and limit joint damage in autoimmune arthritis. Biological therapies played a key role, modifying disease natural history. However, the use of these drugs implies several risks and increases health-care costs [1]. This has raised a question: could be possible, in patients in a state of sustained remission or low disease activity (LDA), choose an optimized regimen of treatment? Recommendations provided by EULAR in 2013 includes this possibility, especially if biologic therapy is in association with DMARDs [2]. While optimized regimen has been attempted in different clinical trials with good results, strong evidences are currently lacking [3]. Objectives: The aim of our study was to analyse the effectiveness of optimization of biologic therapies in a cohort of patients with Rheumatoid and Psoriasic Arthritis (RA and PA). Methods: We retrospectively included patients undergoing optimized therapy in a cohort of 328 outpatients (190 RA, 128 PA) treated with first-line biologic therapy from 2006 to 2017. Optimization was considered as predefined dose downtitration and/or expansion of dose interval in patients with a sustained remission or LDA (DAS 28 -ESR 20% over baseline or by the onset of at least one tender and swollen joint. Our principal end-points were: (I) estimate the proportion of subjects able to optimize therapy (II) define the rate of relapse at 6–12 and 24 months follow-up (FU) in patients undergoing optimization (III) compare the effectiveness of optimized therapy in RA and PA patients and value the rate of optimization in relation to different biologic drugs. Survival analysis (Kaplan-Meier Curves) and Chi Square test were used and a p value Results: During FU, 15/190 (8%) RA patients and 16/138 (12%) PA patients reached a persistent LDA or remission and started the optimized biologic therapy. In survival analysis, rates of relapse at 6 months were 10 % and 0% in RA ad PA respectively, increasing to 21% and 8% at 12 months and finally to 48 % and 34% at 24 months. No significant differences emerged between the two groups. The use of Etanercept was associated with higher possibility to optimize biologic treatment (p=0.007). Conclusions: Biologic therapy optimization is a workable option in RA ad PA patients who reached persistent remission or LDA. In our cohort Etanercept seems to be the most promising drug. Further studies are needed to better define the predictive factors of response in order to identify eligible patients. References [1] Keystone EC. Safety of biologic Therapies – an update. J. of Rheumatol2005;32(Supplement 74):8–12. [2] Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoidarthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis2014;73:492–509. [3] Maneiro JR, Perez-Pampin E, Salgado E, et al. Observational study of optimization of biologic therapies in rheumatoid arthritis: a single-centre experience. Rheumatol Int2014;34(8):1059–63. Disclosure of Interest: None declared

Summary The families of seed storage proteins, together with profilins, oil-bodies-associated oleosins, and pathogenesis-related (PR) proteins like PR-10 (Bet v 1-like), PR-12 (defensins) and PR-14 (non-specific lipid transfer protein), are the main causes of IgE sensitization to tree nuts, legumes and seeds. All these allergens, with the exclusion of profilins and of PR-10, are heat-stable and possibly responsible for fatal or almost fatal adverse reactions to such foods. In this short review, we will discuss the relationship and amino acid identities among some of the seed storage homologue molecules identified to date from tree nuts, seeds and legumes.