39 results on '"Perrotta, Fabio"'
Search Results
2. Sensitivity and Specificity of Composite Indices of Remission in Male and Female Patients With Psoriatic Arthritis: A Multicenter Cross-Sectional Study of Longitudinal Cohorts.
- Author
-
Perrotta FM, Scriffignano S, Triggianese P, Ferraioli M, Chimenti MS, and Lubrano E
- Subjects
- Humans, Male, Female, Middle Aged, Cross-Sectional Studies, Remission Induction, Severity of Illness Index, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic drug therapy, Physicians
- Abstract
Objective: The 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., Methods: In 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., Results: Two 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., Conclusion: The 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., (Copyright © 2024 by the Journal of Rheumatology.)
- Published
- 2024
- Full Text
- View/download PDF
3. The assessment of the drug retention rate of secukinumab in patients with psoriatic arthritis in a real-life multicentre cohort.
- Author
-
Ruscitti P, Pantano I, Perrotta FM, Celletti E, Volpe P, Ciliento MS, Marino V, Raimondi M, Gaggiano E, Mauro D, Cataldi G, Italiano N, Di Muzio C, Navarini L, Zicolella R, Gabini M, Cipollone F, Lubrano E, Giacomelli R, Ciccia F, and Cipriani P
- Subjects
- Humans, Male, Aged, Antibodies, Monoclonal therapeutic use, Prospective Studies, Retrospective Studies, Obesity, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic drug therapy, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Antibodies, Monoclonal, Humanized
- Abstract
Objectives: We aimed to evaluate the drug retention rate (DRR) of secukinumab, an anti-IL-17A monoclonal antibody, in patients with psoriatic arthritis (PsA) in a real-life cohort, and to assess the impact of comorbidities and patient clinical characteristics on the DRR of secukinumab., Methods: A retrospective study of prospective followed-up patients was performed to evaluate the DRR of secukinumab on patients with PsA attending the recruiting centres between January 2016 and June 2022., Results: In 207 patients with PsA, a 60-month DRR of secukinumab of 57.0% was estimated (mean time of administration of 21.5±17.1 months). Male gender, age ≥65 years, disease duration ≥5 years and ≥10 years did not influence the DRR of secukinumab. The presence of comorbidities, considering any concomitant disorder, did not affect the DRR of secukinumab. In patients with cardiometabolic multimorbidity, a trend toward a better DRR of secukinumab was recorded. In fact, patients with high blood pressure, dyslipidaemia, and type 2 diabetes showed a trend toward an improved DRR of secukinumab. Furthermore, the presence of obesity did not influence the DRR of secukinumab. Different dosages, previous bDMARDs, and concomitant therapy with csDMARDs did not influence the DRR of secukinumab., Conclusions: A cumulative 60-month DRR of secukinumab of 57.0% in patients with PsA was retrieved. The presence of cardiometabolic multimorbidity could be associated with an improved DRR of secukinumab, whereas obesity did not affect this feature in our cohort. Previous bDMARDs, concomitant csDMARDs, and different drug dosages could not influence the DRR of secukinumab over time.
- Published
- 2024
- Full Text
- View/download PDF
4. Sex-related differences in psoriatic arthritis.
- Author
-
Lubrano E and Massimo Perrotta F
- Subjects
- Humans, Arthritis, Psoriatic diagnosis, Sex Factors
- Abstract
Competing Interests: We declare no competing interests.
- Published
- 2023
- Full Text
- View/download PDF
5. Cardiovascular comorbidities in psoriatic arthritis: epidemiology and risk factors in two different European populations.
- Author
-
Scriffignano S, Lories R, Nzeusseu Toukap A, Lubrano E, Ciccia F, Steinfeld S, Perrotta FM, Pantano I, Van den Bosch F, and de Vlam K
- Subjects
- Humans, Risk Factors, Prevalence, Belgium epidemiology, Italy epidemiology, Cross-Sectional Studies, Obesity epidemiology, Hyperlipidemias epidemiology, Male, Female, Adult, Middle Aged, Aged, Cardiovascular Diseases epidemiology, Arthritis, Psoriatic complications, Arthritis, Psoriatic epidemiology, Diabetes Mellitus, Type 2 epidemiology, Hypertension epidemiology
- Abstract
Objectives: Psoriatic arthritis (PsA) is a chronic inflammatory disease, frequently associated with cardiovascular (CV) comorbidities. Our aim was to compare the prevalence of CV comorbidities between two groups of PsA patients from different European countries: Belgium and Italy., Methods: This is a cross-sectional analysis of two longitudinal cohorts in which 803 PsA patients were enrolled (463 from Belgium and 340 from Italy). All enrolled patients were ≥18 years old and fulfilled the ClASsification criteria for Psoriatic Arthritis (CASPAR criteria). For each patient, demographics, clinical assessments, smoking habits, the presence of arterial hypertension (AH), obesity (BMI ≥30), type 2 diabetes (T2D), CV diseases (acute myocardial infarction, stroke or transient ischaemic attack), dyslipidaemia (Italy only) and hypercholesterolaemia (Belgium only) were collected., Results: The most prevalent comorbidities among Italian patients with PsA were: AH (45.1%), dyslipidaemia (38.6%) and obesity (30.8%), and among Belgian patients were: hypercholesterolaemia (30.9%), obesity (27%) and AH (26.4%). Moreover, the prevalence of T2D and CV diseases was respectively 14.2% and 7.1% among Italian patients and 7.6% and 3.5% among Belgian patients. When comparing the two groups, AH, T2D and CV diseases were significantly more prevalent in Italian PsA patients. After controlling for different confounders, Italian patients, regardless of age, sex, smoking habits, PsA duration, other CV comorbidities, therapy, disease activity and function, had a higher risk to be hypertensive (OR 2.00, p=0.007). Instead of the country in which patients lived was not a predictor for the risk of T2D and CV diseases. Obesity prevalence was not different between the two groups. The lipid profile was unfavourable in both populations (even if not comparable between the two groups, due to the different way of collection), as is often the case in PsA., Conclusions: The prevalence of AH, T2D and CV diseases were higher in Italian patients rather than Belgians. Moreover, among patients with PsA, the risk of AH was higher in the Italian cohort compared to the Belgian cohort. These results suggest that further research is needed to evaluate potential extrinsic factors (geography and sociocultural aspects) that may contribute to CV risk.
- Published
- 2023
- Full Text
- View/download PDF
6. The Conundrum of Psoriatic Arthritis: a Pathogenetic and Clinical Pattern at the Midpoint of Autoinflammation and Autoimmunity.
- Author
-
Scrivo R, D'Angelo S, Carriero A, Castellani C, Perrotta FM, Conti F, Vecellio M, Selmi C, and Lubrano E
- Subjects
- Humans, Autoimmunity, Skin pathology, Arthritis, Psoriatic genetics, Psoriasis, Arthritis, Rheumatoid
- Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by psoriasis, synovitis, enthesitis, spondylitis, and the possible association with other extra-articular manifestations and comorbidities. It is a multifaceted and systemic disorder sustained by complex pathogenesis, combining aspects of autoinflammation and autoimmunity. Features of PsA autoinflammation include the role of biomechanical stress in the onset and/or exacerbation of the disease; the evidence of involvement of the innate immune response mediators in the skin, peripheral blood and synovial tissue; an equal gender distribution; the clinical course which may encounter periods of prolonged remission and overlapping features with autoinflammatory syndromes. Conversely, the role of autoimmunity is evoked by the association with class I major histocompatibility complex alleles, the polyarticular pattern of the disease which sometimes resembles rheumatoid arthritis and the presence of serum autoantibodies. Genetics also provide important insights into the pathogenesis of PsA, particularly related to class I HLA being associated with psoriasis and PsA. In this review, we provide a comprehensive review of the pathogenesis, genetics and clinical features of PsA that endorse the mixed nature of a disorder at the crossroads of autoinflammation and autoimmunity., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
7. Triple jump for the optimal management of psoriatic arthritis: diet, sleep and exercise - a review.
- Author
-
Lubrano E, Scriffignano S, de Vlam K, Ronga M, Perrotta FM, and Lories R
- Subjects
- Humans, Disease Management, Male, Female, Arthritis, Psoriatic therapy, Diet, Sleep, Exercise
- Abstract
Psoriatic arthritis (PsA) is a complex, multiform and chronic inflammatory disease characterised by the association of arthritis and psoriasis combined with other related conditions and comorbidities. Treatment of PsA has rapidly evolved by the introduction of new biological drugs and small molecules which allow to achieve disease remission or low disease activity in most of the patients. However, unmet treatment needs still persist for those patients with persistent disease activity or symptoms, impaired function, reduced quality of life or comorbidities. In this context, non-pharmacological approaches, including diet modifications, an adequate sleep quality and physical activity could provide additional benefits. In recent years, diet modifications, improvement of sleep quality and physical activity became an area of interest for researchers and some studies showed how a holistic non-pharmacological approach may ameliorate the quality of life of patients with PsA.The aim of this manuscript was to review the current evidence on the intriguing link and potential effects of diet, sleep and exercise in PsA patients. In particular, we reviewed the literature focusing on the possible benefits of a holistic approach to PsA patients considering lifestyle modifications., Competing Interests: Competing interests: Leuven Research and Development, the technology transfer office of KU Leuven, has received consultancy and speaker fees and research grants on behalf of R.J.L. from Abbvie, Boehringer-Ingelheim, Amgen (formerly Celgene), Eli-Lilly, Galapagos, Janssen, Fresenius Kabi, MSD, Novartis, Pfizer, Biosplice Therapeutics (formerly Samumed), UCB and Viatris., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
8. SARS-CoV-2 IgM False-Positivity in a Psoriatic Arthritis Patient Seropositive for Rheumatoid Factor and ACPA: An Interference of Immune Response?
- Author
-
Lubrano E, Scriffignano S, Perrotta FM, and Brunese L
- Subjects
- Autoantibodies, Humans, Immunity, Immunoglobulin M, Rheumatoid Factor, SARS-CoV-2, Arthritis, Psoriatic diagnosis, COVID-19
- Abstract
Competing Interests: The authors declare no conflict of interest.
- Published
- 2021
- Full Text
- View/download PDF
9. Assessment of Widespread and Extraarticular Pain in Psoriatic Arthritis: A Case-control Study.
- Author
-
Lubrano E, Scriffignano S, Morelli R, and Perrotta FM
- Subjects
- Case-Control Studies, Humans, Pain, Pain Measurement, Arthritis, Psoriatic complications, Fibromyalgia complications
- Abstract
Objective: A 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., Methods: This 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., Results: Fifty 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., Conclusion: The 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., (© 2021 by the Journal of Rheumatology.)
- Published
- 2021
- Full Text
- View/download PDF
10. Multimorbidity and comorbidity in psoriatic arthritis - a perspective.
- Author
-
Lubrano E, Scriffignano S, and Perrotta FM
- Subjects
- Age Factors, Animals, Comorbidity, Disease Management, Humans, Multimorbidity, Risk Factors, Arthritis, Psoriatic epidemiology
- Abstract
Introduction: Psoriatic Arthritis (PsA) is a multifaceted disease in which various musculoskeletal and skin manifestations are involved. Beyond these features, PsA is associated with comorbidities that might increase the burden of the disease., Areas Covered: In the last years a growing interest has come out for the concept of multimorbidity in rheumatology. Multimorbidity was defined as the 'co-existence of two or more chronic diseases in the same individual.' In the multimorbidity concept, the patient is of central concern and all coexisting diseases are of equal importance. Comorbidity was defined as the 'occurrence of any distinct additional entity during the clinical course of patient who has the index disease under study.' In PsA, comorbidity and multimorbidity have often been confusingly used interchangeably, showing that there is an unmet need on this topic., Expert Opinion: This perspective article dealt with these different visions of the co-existence of other diseases in PsA, providing a distinction between them, not only for the impact on the treatment decision but also in how this concept might be incorporated into clinical trials design, choosing the right outcome measures for the patient-centric concept of multimorbidity. For this perspective, the authors searched PubMed and the Cochrane library for articles published.
- Published
- 2020
- Full Text
- View/download PDF
11. Residual Disease Activity and Associated Factors in Psoriatic Arthritis.
- Author
-
Lubrano E, Scriffignano S, and Perrotta FM
- Subjects
- Humans, Remission Induction, Severity of Illness Index, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic drug therapy
- Abstract
Objective: Remission 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., Methods: Patients 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., Results: Of 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., Conclusion: RDA can be recognized in patients with PsA. VLDA seems to be the most stringent composite index to identify patients in the absence of RDA.
- Published
- 2020
- Full Text
- View/download PDF
12. Dr. Lubrano, et al reply.
- Author
-
Lubrano E, Scriffignano S, and Perrotta FM
- Subjects
- Humans, Syndrome, Arthritis, Psoriatic
- Published
- 2020
- Full Text
- View/download PDF
13. Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices.
- Author
-
Lubrano E, Scriffignano S, Azuaga AB, Ramirez J, Cañete JD, and Perrotta FM
- Subjects
- Adult, Aged, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic drug therapy, Arthritis, Psoriatic physiopathology, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pain diagnosis, Pain drug therapy, Pain physiopathology, Patient Reported Outcome Measures, Remission Induction, Severity of Illness Index, Arthritis, Psoriatic psychology, Pain psychology, Quality of Life
- Abstract
Objective: The aim of this study was to evaluate the discriminant capability of the Patient Acceptable Symptom State (PASS) according to disease activity, remission/low disease activity indices and quality of life indices in patients with psoriatic arthritis (PsA)., Methods: Consecutive patients with PsA were enrolled in this cross-sectional study. At each visit, the patients underwent a complete physical examination and their clinical/laboratory data were collected. Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis (DAPSA) and remission/low disease activity using the DAPSA minimal disease activity (MDA) and very low disease activity (VLDA) criteria. The Psoriatic Arthritis Impact of Disease (PsAID) and the Health Assessment Questionnaire-Disability Index scores were also collected. Finally, PASS was assessed by asking all patients to answer yes or no to a single question., Results: Patients who answered yes to PASS showed a significantly better overall mean DAPSA score than those who were not in PASS. Furthermore, patients in PASS showed a significantly lower level of systemic inflammation, lower Leeds Enthesitis Index score, a significantly lower impact of disease (PsAID), lower pain and better function than patients who answered no to PASS. A moderate to good agreement was found between PASS, MDA, DAPSA low disease activity and PsAID score ≤4. Good sensitivity and specificity were found with PASS with respect to DAPSA low disease activity, and although PASS is sensitive in the identification of patients with MDA, DAPSA remission and VLDA it lacks of specificity., Discussion: This study showed that PASS might be used as an alternative to determine disease activity in patients with PsA in real clinical practice, mainly in patients with low disease activity according to DAPSA criteria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
- Full Text
- View/download PDF
14. TNF-alpha inhibitors for the six treatment targets of psoriatic arthritis.
- Author
-
Lubrano E, Scriffignano S, and Perrotta FM
- Subjects
- Arthritis, Psoriatic immunology, Arthritis, Psoriatic pathology, Humans, Tumor Necrosis Factor-alpha immunology, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Introduction : Psoriatic Arthritis (PsA) is a chronic inflammatory disease characterized by psoriasis, synovitis, enthesitis, spondylitis, and association with extra-articular manifestations and comorbidities. Treatment of PsA dramatically changed since the introduction of anti-TNF drugs which have shown to reduce the symptoms and signs of the disease and slow the radiographic progression. Despite the introduction of new molecules with different mechanisms of action, the role of anti-TNF in the treatment of all disease manifestations of this intriguing disease is still central. Areas covered : The aim of this paper is to review the role of anti-TNF drugs in the treatment of different disease domains in PsA (peripheral and axial joints, skin, enthesis, patient's reported outcomes, extra-articular manifestations), reporting data from randomized clinical trials and observational studies. An extensive literature search was performed on PubMed, with no limits or filters. The following search terms were used: 'anti-TNF', 'Psoriatic Arthritis'. Expert opinion : Despite the emergence of different new treatments, anti-TNF therapy remains central in the management of all disease domains in PsA patients.
- Published
- 2019
- Full Text
- View/download PDF
15. Psoriatic Arthritis, Psoriatic Disease, or Psoriatic Syndrome?
- Author
-
Lubrano E, Scriffignano S, and Perrotta FM
- Subjects
- Antimicrobial Cationic Peptides metabolism, Arthritis, Psoriatic metabolism, Biomarkers metabolism, Cytokines metabolism, Humans, Lupus Erythematosus, Systemic metabolism, Lupus Erythematosus, Systemic pathology, Syndrome, Cathelicidins, Arthritis, Psoriatic pathology, Terminology as Topic
- Published
- 2019
- Full Text
- View/download PDF
16. Ultrasonographic and Clinical Assessment of Peripheral Enthesitis in Patients with Psoriatic Arthritis, Psoriasis, and Fibromyalgia Syndrome: The ULISSE Study.
- Author
-
Macchioni P, Salvarani C, Possemato N, Gutierrez M, Grassi W, Gasparini S, Perricone C, Perrotta FM, Grembiale RD, Bruno C, Tripolino C, Govoni M, Ciancio G, Farina I, Ramonda R, Frallonardo P, Desiati F, Scarpa R, Costa L, Zabotti A, De Vita S, D'Attino RM, Gualberti G, Merolla R, di Luzio Paparatti U, Aldigeri R, and Marchesoni A
- Subjects
- Adult, Arthritis, Psoriatic diagnostic imaging, Cross-Sectional Studies, Enthesopathy complications, Enthesopathy diagnostic imaging, Female, Fibromyalgia diagnostic imaging, Humans, Male, Middle Aged, Psoriasis diagnostic imaging, Severity of Illness Index, Ultrasonography, Doppler, Arthritis, Psoriatic complications, Enthesopathy diagnosis, Fibromyalgia complications, Psoriasis complications
- Abstract
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.
- Published
- 2019
- Full Text
- View/download PDF
17. Analysis of potential determinants for a treat-to-target strategy in psoriatic arthritis patients from a real-world setting.
- Author
-
Lubrano E, Scriffignano S, De Socio A, and Perrotta FM
- Subjects
- Humans, Remission Induction, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy
- Published
- 2019
18. Validation of the Italian version of proposed GRAPPA flare questionnaire for patients with psoriatic arthritis.
- Author
-
Scriffignano S, Perrotta FM, De Socio A, Altobelli A, Sessa P, Scrivo R, Valesini G, and Lubrano E
- Subjects
- Cross-Sectional Studies, Humans, Italy, Reproducibility of Results, Translating, Arthritis, Psoriatic, Surveys and Questionnaires standards, Symptom Flare Up
- Abstract
Objectives: The aim of the present study was to validate an Italian version of the GRAPPA flare instrument to identify patients with psoriatic arthritis (PsA) with a possible disease flare., Methods: This was a cross-sectional study enrolling consecutively PsA patients classified with CASPAR criteria. Inclusion criteria were: age ≥18 years and stable treatment (at least six months of follow-up) with conventional synthetic or biological DMARDs. The flare questionnaire was administered at baseline and within a two-week interval. Internal consistency of the questionnaire was evaluated with Cronbach's alpha coefficient. Construct validity of flare questionnaire was assessed using the correlation between flare score and disease activity indices, HAQ and serum C-reactive protein. Cohen's κ was performed to assess the agreement level between the patient's perception of flare and the score of the questionnaire. Finally, test-retest was performed to assess the reliability of the instrument., Results: 46 PsA patients were enrolled in this study. Of these, 30.4% reported a status of flare of their disease. The questionnaire was internally consistent (alpha=0.81). Moreover, the questionnaire score correlated with the main disease activity indices (Spearman Rho ranging from 0.30 to 0.66; p<0.01). The score of flare questionnaire showed a moderate agreement with the perception of flare from the patients (Cohen's κ=0.54). Test-retest reliability showed a good intra-class correlation., Conclusions: This initial validation of the Italian version of the GRAPPA flare instrument was favourable. Our results confirm the utility of this questionnaire in the assessment of flare in PsA.
- Published
- 2019
19. Role of comorbidities in spondyloarthritis including psoriatic arthritis.
- Author
-
Scriffignano S, Perrotta FM, De Socio A, and Lubrano E
- Subjects
- Arthritis, Psoriatic therapy, Cardiovascular Diseases epidemiology, Comorbidity, Humans, Osteoporosis epidemiology, Quality of Life, Spondylarthritis classification, Spondylarthritis therapy, Spondylitis, Ankylosing therapy, Arthritis, Psoriatic epidemiology, Spondylarthritis epidemiology, Spondylitis, Ankylosing epidemiology
- Abstract
Spondyloartrhitis (SpA) are a group of diseases characterized by inflammation at articular and entheseal sites. Moreover, patients with SpA suffer from impaired articular function and reduced quality of life. Beyond the articular involvement, SpA and in particular psoriatic arthritis (PsA) are associated with extra-articular manifestations and comorbidities that might increase the burden of the disease. The aim of this article was to review the available evidences on the presence of comorbidities in SpA, including PsA, focusing the attention on the cardiovascular, metabolic aspects, as well as other comorbidities, and their possible management in an integrated manner. Comorbidities in SpA should be carefully evaluated because of their important impact.
- Published
- 2019
- Full Text
- View/download PDF
20. What Should Be the Primary Target of "Treat to Target" in Psoriatic Arthritis?
- Author
-
Coates LC, Lubrano E, Perrotta FM, Emery P, Conaghan PG, and Helliwell PS
- Subjects
- Arthritis, Psoriatic diagnosis, Female, Humans, Male, Middle Aged, Severity of Illness Index, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Biological Products therapeutic use, Remission Induction methods
- Abstract
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.
- Published
- 2019
- Full Text
- View/download PDF
21. Abatacept for the treatment of psoriatic arthritis.
- Author
-
Lubrano E, Scriffignano S, and Perrotta FM
- Subjects
- Animals, CTLA-4 Antigen metabolism, Cell Communication drug effects, Clinical Trials as Topic, Drug Evaluation, Preclinical, Humans, Abatacept therapeutic use, Antigen-Presenting Cells immunology, Arthritis, Psoriatic drug therapy, Lymphocytes immunology
- Abstract
Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by the presence of psoriasis, arthritis, and enthesitis, with the association of other musculoskeletal and extra-articular manifestations. Current treatment of PsA is based on the use of conventional, biological and targeted synthetic disease modifying anti-rheumatic drugs; however, patients may not respond or have a loss of response to these agents. Recently, a deeper understanding of the pathogenetic mechanisms has made possible the development of new drugs that actively interact with the activation of immune system, inhibiting the co-stimulation between antigen-presenting cells and lymphocytes. Areas covered: The aim of this paper is to review the role of the activation of the immune system in the pathogenesis and treatment of PsA, with a discussion on the emerging CTLA4Ig drugs (abatacept) for PsA. A search in PubMed and EMBASE was performed with the keywords: 'abatacept', 'CTLA4,' and 'Psoriatic Arthritis.' We considered preclinical studies, phase I, II and III clinical trials. Expert commentary: The inhibitors of co-stimulation may represent an effective treatment strategy by acting on the very early phase of the immunological process that brought about the development of inflammation and activation of the immune system, mainly for patients with peripheral joint involvement and mild psoriasis.
- Published
- 2018
- Full Text
- View/download PDF
22. From clinical remission to residual disease activity in spondyloarthritis and its potential treatment implications.
- Author
-
Perrotta FM, De Socio A, Scriffignano S, and Lubrano E
- Subjects
- Cytokines metabolism, Disease Progression, Humans, Molecular Targeted Therapy, Remission Induction, Signal Transduction, Treatment Outcome, Anti-Inflammatory Agents therapeutic use, Arthritis, Psoriatic drug therapy, Spondylitis, Ankylosing drug therapy
- Abstract
Introduction: Remission or low disease activity should be the target of therapy in spondyloarthritis (SpA). Due to the complexity of the disease, several composite indices that assess all disease domains were proposed to define a status of low disease activity/remission in both axial and peripheral SpA. With the introduction, in the past years, of effective biologic and targeted synthetic treatments aimed at inhibiting key cytokines and intracellular pathways, the goal of clinical remission has become an achievable target in these conditions. However, residual disease activity may occur in some domains and the management of patients that achieve the target of remission is still an unmet need. Areas covered: This manuscript aimed to review the current evidence on clinical remission and residual disease activity in SpA (both axial SpA and psoriatic arthritis), and its potential treatment implications. Expert commentary: Progress in our understanding of the pathogenesis of SpA will lead to a rapid increase in the number of available treatments, with the possibility for patients to achieve a status of remission. However, the topic of residual disease activity should be taken into consideration.
- Published
- 2018
- Full Text
- View/download PDF
23. Incidence of rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica in an inland area of central Italy: results of the CAMPO-RHE study.
- Author
-
De Socio A, Perrotta FM, Grasso GM, and Lubrano E
- Subjects
- Adolescent, Adult, Age Distribution, Aged, Ambulatory Care, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic therapy, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid therapy, Cohort Studies, Female, Humans, Incidence, Italy, Male, Middle Aged, Polymyalgia Rheumatica diagnosis, Polymyalgia Rheumatica therapy, Rural Population, Sex Distribution, Young Adult, Arthritis, Psoriatic epidemiology, Arthritis, Rheumatoid epidemiology, Polymyalgia Rheumatica epidemiology
- Abstract
Objective: 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 1
st of June 2014 and the 31st of 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.- Published
- 2018
- Full Text
- View/download PDF
24. Psoriatic arthritis: is it time to treat-to-target or target to treat?
- Author
-
Lubrano E and Perrotta FM
- Subjects
- Arthritis, Psoriatic diagnosis, Disease Progression, Humans, Severity of Illness Index, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Remission Induction
- Abstract
Treat-to-target recommendations provide physicians a useful strategy to reduce the probability of disease progression and in general to manage PsA patients. However, it could be difficult to apply in real life, since PsA is a very heterogeneous disease with different manifestations to be treated. In fact, depending on the patient's expectation, some aspects of the disease could be prominent or not, beyond the mere achievement of the target of remission or low-disease activity. In this context, the concept of a "target to treat" strategy should be taken in to account.
- Published
- 2017
- Full Text
- View/download PDF
25. Comparison of Composite Indices Tailored for Psoriatic Arthritis Treated with csDMARD and bDMARD: A Cross-sectional Analysis of a Longitudinal Cohort.
- Author
-
Lubrano E, De Socio A, and Perrotta FM
- Subjects
- Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Remission Induction, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Biological Products therapeutic use
- Abstract
Objective: In a complex disease such as psoriatic arthritis (PsA), several methods are available to define remission or low disease activity (LDA), including the assessment of different clinical features. The aim of this study was to compare the composite indices tailored for PsA in patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and biological DMARD (bDMARD)., Methods: Patients with PsA classified with the ClASsification criteria for Psoriatic ARthritis criteria and with > 6 months followup treated with first csDMARD and bDMARD were consecutively enrolled. To assess disease activity, composite indices tailored for PsA were used, such as the Disease Activity Index for Psoriatic Arthritis (DAPSA), clinical DAPSA (cDAPSA), Psoriatic Arthritis Disease Activity Score (PASDAS), minimal disease activity (MDA) 5/7, and MDA 7/7. DAPSA and cDAPSA score ≤ 4, MDA 7/7, and PASDAS ≤ 1.9 identified remission. MDA 5/7, DAPSA score ≤ 14, cDAPSA score ≤ 13, and PASDAS < 3.2 identified the MDA and LDA criteria., Results: One hundred nine patients with PsA were enrolled: 79 patients were receiving stable treatment with bDMARD and 30 with csDMARD. Overall, 28 (25.6%), 23 (21.1%), 19 (17.4%), and 13 patients (11.9%) were in cDAPSA remission, DAPSA remission, MDA 7/7, and PASDAS ≤ 1.9, respectively. Moreover, 54 (49.5%), 80 (73.3%), 79 (72.3%), and 38 patients (34.8%) were in MDA 5/7, DAPSA LDA, cDAPSA LDA, and PASDAS LDA. Patients treated with bDMARD had significantly lower median DAPSA, cDAPSA, and PASDAS score than patients treated with csDMARD., Conclusion: Patients with PsA receiving bDMARD are more likely to achieve a status of MDA and remission when compared with csDMARD. PASDAS ≤ 1.9 and MDA 7/7 seem to be stringent remission criteria.
- Published
- 2017
- Full Text
- View/download PDF
26. Elderly psoriatic arthritis patients on TNF-α blockers: results of an Italian multicenter study on minimal disease activity and drug discontinuation rate.
- Author
-
Costa L, Lubrano E, Ramonda R, Chimenti MS, Vezzù M, Perrotta FM, Del Puente A, Peluso R, Bottiglieri P, Lorenzin M, Sunzini F, Darda MA, Fiocco U, Perricone R, Punzi L, Scarpa R, and Caso F
- Subjects
- Adalimumab therapeutic use, Aged, Arthritis, Psoriatic diagnosis, Etanercept therapeutic use, Female, Humans, Infliximab therapeutic use, Italy, Male, Middle Aged, Remission Induction, Severity of Illness Index, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Biological Products therapeutic use, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with skin and/or nail psoriasis. Real world data on efficacy and safety of TNF-α blockers in the elderly with PsA are lacking. The aim of this study was to evaluate the effectiveness, through the achievement of minimal disease activity (MDA), drug discontinuation rate, and safety in elderly patients with PsA on TNF-α blockers. A multicenter, observational study was carried out in four Italian centers. The assessment of disease activity and safety were performed at the start of anti-TNF-α (T0), at 6 months (T6) and at 12 months (T12). A total of 145 PsA patients were included in the study. At baseline 68 (46.9%) patients were on etanercept, 60 (41.3%) on adalimumab, 11 (7.6%) on golimumab, and 6 (4.1%) on infliximab. All the variables concerning PsA activity showed a statistically significant improvement when comparing T6 and T12 with T0. After 6 and 12 months of therapy, respectively, 31 (22.6%) and 71 (51.8%) patients achieved MDA (p < 0.001). The drug discontinuation rate was 5.5% with a mean of 6.8 months (range 2-10 months), and it was due to lack of efficacy, adverse events, and lost to follow-up. Nine patients (6.2%) reported the onset of mild infections resolved with antimicrobial specific oral regimen without therapy interruption. TNF-α blockers are effective in the achievement of a low disease status and safe in elderly patients with PsA. Therefore, age should not be considered a limitation to their use.
- Published
- 2017
- Full Text
- View/download PDF
27. The role of IL-17 in the treatment of psoriatic arthritis.
- Author
-
Lubrano E and Perrotta FM
- Subjects
- Animals, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic immunology, Drug Resistance, Humans, Interleukin-17 immunology, Randomized Controlled Trials as Topic, Th17 Cells drug effects, Arthritis, Psoriatic therapy, Biological Products therapeutic use, Immunotherapy methods, Interleukin-17 therapeutic use, Th17 Cells immunology
- Abstract
Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory articular disease characterized by psoriasis, synovitis and enthesitis. Current treatment of PsA is mainly based on the use of classical and biological DMARDs; however, 30-40% of patients could not respond to these or have a loss of response. Areas covered: Recently, the discovery of new pathogenic mechanisms have made possible the development of new drugs that target the IL-17 with the possibility to interfere with the Th17 cells that are considered the cell type mainly involved in the development of the inflammation in PsA. New molecules have shown efficacy and safety over the various components of the disease in randomized clinical trials. These drugs have been recently approved for the treatment of PsA and included in the newest treatment recommendations. Other molecules are currently being tested in phase III clinical trials and are potential new treatment options for PsA. Expert Commentary: The aim of this paper is to review the role of IL-17 in the pathogenesis and treatment of PsA, with a discussion on the emerging anti-IL-17 drugs for PsA.
- Published
- 2017
- Full Text
- View/download PDF
28. An ultrasonographic study of enthesis in early psoriatic arthritis patients naive to traditional and biologic DMARDs treatment.
- Author
-
Perrotta FM, Astorri D, Zappia M, Reginelli A, Brunese L, and Lubrano E
- Subjects
- Achilles Tendon diagnostic imaging, Adult, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Arthritis, Psoriatic drug therapy, Enthesopathy drug therapy, Female, Humans, Male, Medial Collateral Ligament, Knee diagnostic imaging, Middle Aged, Patellar Ligament diagnostic imaging, Severity of Illness Index, Arthritis, Psoriatic diagnostic imaging, Enthesopathy diagnostic imaging, Ultrasonography, Doppler
- Abstract
The aim of this study was to evaluate the rate of power Doppler ultrasound (PDUS) abnormalities at entheseal sites in patients with early psoriatic arthritis (PsA) naïve to traditional and biologic DMARDs and to compare the PDUS findings with clinical examination. PsA patients with early disease and naïve to traditional and biologic DMARDs were consecutively enrolled in this study. Patients underwent PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its insertion at the tibial tuberosity; medial collateral ligament at its proximal insertion and Achilles tendon at its insertion at the calcaneus. The Leeds enthesitis index (LEI) was used to assess clinical entheseal involvement. Twenty-one early PsA patients completed the clinical and PDUS examinations. Clinical entheseal involvement was found in 9 (42.9 %) and PDUS abnormalities in 20 (95.5 %) of the 21 early PsA patients. Achilles tendon insertion was the site with the major entheseal abnormalities. Active (power Doppler positive) entheseal lesions were found in 4.7, 9.5, 14.3 and 14.3 % of patients at the lateral humeral epicondyle; quadriceps tendon, patellar tendon insertions, and Achilles tendon insertions, respectively. Concordance between clinical (LEI) and PDUS was poor. The present study confirms that PDUS allows detecting structural and inflammatory abnormalities of enthesis in early PsA patients. Our study shows that, in early disease, active abnormalities seem to have a low prevalence.
- Published
- 2016
- Full Text
- View/download PDF
29. Defining Low Disease Activity States in Psoriatic Arthritis Using Novel Composite Disease Instruments.
- Author
-
Lubrano E and Perrotta FM
- Subjects
- Humans, Severity of Illness Index, Antirheumatic Agents, Arthritis, Psoriatic
- Published
- 2016
- Full Text
- View/download PDF
30. Subcutaneous anti-TNF alfa induced sustained minimal disease activity and remission in psoriatic arthritis patients: a retrospective study.
- Author
-
Perrotta FM and Lubrano E
- Subjects
- Antirheumatic Agents administration & dosage, Antirheumatic Agents adverse effects, Drug Monitoring methods, Female, Humans, Italy epidemiology, Male, Middle Aged, Remission Induction methods, Retrospective Studies, Severity of Illness Index, Treatment Outcome, Tumor Necrosis Factor-alpha antagonists & inhibitors, Adalimumab administration & dosage, Adalimumab adverse effects, Antibodies, Monoclonal administration & dosage, Antibodies, Monoclonal adverse effects, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic drug therapy, Arthritis, Psoriatic epidemiology, Etanercept administration & dosage, Etanercept adverse effects
- Abstract
Objective: The aim of the present study was to assess the rate of sustained Minimal Disease Activity (MDA) and remission in a group of psoriatic arthritis (PsA) patients treated with TNFα blockers., Methods: We perform a retrospective study on our database of PsA patients treated with adalimumab, etanercept and golimumab, with a minimum of 12 months of follow up. Patients were considered in sustained MDA when they met at least 5/7 of the criteria previously defined for at least 12 months of follow up. DAS28-CRP < 2.6, DAPSA score ≤ 4 and patient global assessment (PGA) ≤ 20 mm were also evaluated as remission criteria. Concordance between the remission criteria and MDA was also performed., Results: Of the 81 patients treated with TNFα blockers, at baseline no patients were in MDA or had a DAPSA score ≤ 4, while 17 (20.9%) had a DAS28-CRP score < 2.6. PGA ≤ 20 was recorded in 6 patients (7%). Sustained MDA was achieved in 35 (43.2%) patients while sustained DAPSA, DAS28-CRP and PGA remission were obtained respectively in 19.7%, 35.8% and 44.4% of patients. No difference was found between the three anti-TNFα in respect to the probability of achieve MDA., Conclusions: In this retrospective study, sustained MDA was achieved in 43.2% of patients treated with TNFα blockers. Moreover, sustained remission was achieved in a consistent number of patients, configuring this as an achievable target for PsA patients.
- Published
- 2016
- Full Text
- View/download PDF
31. Assessment of Response to Treatment, Remission, and Minimal Disease Activity in Axial Psoriatic Arthritis Treated with Tumor Necrosis Factor Inhibitors.
- Author
-
Lubrano E, Parsons WJ, and Perrotta FM
- Subjects
- Adalimumab therapeutic use, Adult, Age Factors, Aged, Antibodies, Monoclonal therapeutic use, Arthritis, Psoriatic diagnosis, Etanercept therapeutic use, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Remission Induction methods, Severity of Illness Index, Sex Factors, Treatment Outcome, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Objective: To assess the response to treatment, remission, and minimal disease activity (MDA) in a group of patients with predominant axial psoriatic arthritis (axPsA). Predictors of response were also evaluated., Methods: Patients fulfilling the ClASsification of Psoriatic ARthritis (CASPAR) criteria and treated with anti-tumor necrosis factor (anti-TNF) agents adalimumab, etanercept, and golimumab were enrolled and prospectively followed every 4 months for 1 year in a clinical practice setting. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 was assessed as a set of response criteria to treatment; Composite Psoriatic Disease Activity Index (CPDAI) < 4, Disease Activity Index for Psoriatic Arthritis (DAPSA) score ≤ 3.3, and partial remission (PR) were also evaluated as remission criteria. Patients were considered in MDA when they met at least 5/7 of the criteria previously defined. Patients achieving BASDAI 50, PR, and MDA were compared to identify outcome predictor factors. Concordance between the outcome measures was also performed., Results: Of the 58 patients treated with anti-TNF, at baseline no patients were in PR or MDA. No patients had a CPDAI < 4 or a DAPSA score ≤ 3.3. After 12 months, BASDAI 50 was achieved in 15/48 patients (31.2%). CPDAI < 4, DAPSA score ≤ 3.3, PR, and MDA were achieved, respectively, in 17/48 (35.4%), 11/48 (22.9%), 11/48 (22.9%), and 24/48 (50%) patients. No difference was found among the 3 anti-TNF. Predictors for MDA were male sex, young age, low disease duration, low Health Assessment Questionnaire score, and absence of enthesitis., Conclusion: This longitudinal observational study, based on a clinical practice setting, showed that remission and MDA are achievable targets in axPsA treated with anti-TNF. Predictors of remission and MDA were also identified.
- Published
- 2016
- Full Text
- View/download PDF
32. Beyond TNF Inhibitors: New Pathways and Emerging Treatments for Psoriatic Arthritis.
- Author
-
Lubrano E and Perrotta FM
- Subjects
- Anti-Inflammatory Agents, Non-Steroidal pharmacology, Humans, Tumor Necrosis Factor-alpha antagonists & inhibitors, Tumor Necrosis Factor-alpha metabolism, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Arthritis, Psoriatic drug therapy
- Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by psoriasis, synovitis, enthesitis, spondylitis and association with other extra-articular manifestations. Chronic inflammation of involved tissues possibly leads to structural damage and to a reduction in function and quality of life. The treatment of PsA dramatically changed with the introduction of anti-tumor necrosis factor (TNF)-α drugs, which have been shown to reduce the symptoms and signs of the disease, and slow radiographic progression. However, some patients do not respond to anti-TNFα or have a loss of response. Recently, the discovery of new pathogenic mechanisms have made possible the development of new drugs that target pro-inflammatory cytokines, such as interleukin (IL)-12, IL-23 and IL-17, or interfere with cellular pathways involved in skin, joint and entheseal inflammation. New molecules, namely ustekinumab, secukinumab, and apremilast have shown efficacy and safety over the various components of the disease in randomized clinical trials. These drugs have been recently approved for the treatment of PsA and included in new treatment recommendations. Other molecules are currently being tested in phase III clinical trials and are potential new treatment options for PsA. The aim of this review is to update the new pathways involved in the development of the disease and the emerging treatments for PsA beyond TNFα inhibition.
- Published
- 2016
- Full Text
- View/download PDF
33. Minimal Disease Activity and Remission in Psoriatic Arthritis Patients Treated with Anti-TNF-α Drugs.
- Author
-
Perrotta FM, Marchesoni A, and Lubrano E
- Subjects
- Adult, Aged, Arthritis, Psoriatic diagnosis, Cyclosporine therapeutic use, Drug Therapy, Combination, Female, Humans, Male, Methotrexate therapeutic use, Middle Aged, Prognosis, Prospective Studies, Remission Induction, Severity of Illness Index, Sulfasalazine therapeutic use, Treatment Outcome, Adalimumab therapeutic use, Antibodies, Monoclonal therapeutic use, Antirheumatic Agents therapeutic use, Arthritis, Psoriatic drug therapy, Etanercept therapeutic use, Immunologic Factors therapeutic use, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Objective: A state of remission is the target of therapy in chronic arthritis. The aim of the present study was to assess the rate of minimal disease activity (MDA) and remission in patients with psoriatic arthritis (PsA) treated with tumor necrosis factor (TNF-α) blockers. Disease characteristics and predictors of MDA were also evaluated., Methods: Patients fulfilling the ClASsification for Psoriatic ARthritis (CASPAR) criteria and treated with TNF-α blockers adalimumab, etanercept, or golimumab were enrolled and prospectively followed every 4 months for 1 year in a clinical practice setting. Patients were considered in MDA when they met at least 5/7 of the criteria previously defined. Other remission criteria evaluated were 28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6 and Disease Activity in Psoriatic Arthritis (DAPSA) score ≤ 3.3. Patients achieving MDA were compared to non-MDA to identify outcome predictor factors., Results: Of the 75 patients treated with TNF-α blockers, at baseline no patients were in MDA or had a DAPSA score ≤ 3.3, while 25 (21.3%) had a DAS28-CRP score < 2.6. Five patients (6%) discontinued treatment because of side effects or inefficacy during followup. After 12 months, MDA was achieved in 46 patients (61.3%). No difference was found among the 3 anti-TNF-α drugs. Predictors for MDA were found to be male sex, high CRP, high erythrocyte sedimentation rate, and low Health Assessment Questionnaire., Conclusion: In our prospective observational study, based on a clinical practice setting, MDA was achieved in 61.3% of patients treated with TNF-α blockers, identifying this as an achievable target for patients with PsA. Predictors of remission were also identified.
- Published
- 2016
- Full Text
- View/download PDF
34. Patient's Global Assessment as an Outcome Measure for Psoriatic Arthritis in Clinical Practice: A Surrogate for Measuring Low Disease Activity?
- Author
-
Lubrano E, Perrotta FM, Parsons WJ, and Marchesoni A
- Subjects
- Adult, Arthritis, Psoriatic physiopathology, Cohort Studies, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Selection, Recurrence, Remission Induction, Retrospective Studies, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, Treatment Outcome, Antirheumatic Agents administration & dosage, Arthritis, Psoriatic classification, Arthritis, Psoriatic drug therapy, Biological Products administration & dosage
- Abstract
Objective: To assess the low disease activity (LDA) in a group of patients with psoriatic arthritis (PsA) receiving antitumor necrosis factor-α (TNF-α) by using the patient's global assessment (PtGA) in clinical practice, and to compare PtGA with minimal disease activity (MDA) and other outcome measures., Methods: Patients with PsA classified by the ClASsification for Psoriatic ARthritis (CASPAR) criteria and consecutively admitted to an outpatient clinic dedicated to biologic therapy were assessed during their routine followup. The primary outcome measure was the proportion of patients achieving a PtGA ≤ 20 at 4-, 8-, and 12-month followups. Secondary outcome measures included the proportion of patients achieving MDA and other outcome measures. Correlation of PtGA with MDA and other process and outcome measures were also performed., Results: During the period of observation, 124 patients were evaluated. PtGA ≤ 20 was achieved in 25.7% at 4 months, 48.9% at 8 months, and 65.3% at 12 months of followup. The percentage of PtGA ≤ 20 statistically improved throughout the 3 timepoint assessments and it was statistically correlated to MDA. A significant correlation with the Disease Activity index for PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index, and Health Assessment Questionnaire was also observed. MDA, DAPSA, and Disease Activity Score at 28 joints with C-reactive protein remission were achieved at 12 months in 64%, 36%, and 71% of patients, respectively., Conclusion: PtGA can estimate the LDA status and could be considered as a surrogate of outcome measures for the assessment of global disease activity in patients with PsA receiving anti-TNF therapy during routine clinical practice. These data suggest that PtGA might be used in outpatient settings, being a simple, reliable, and not time-consuming instrument.
- Published
- 2015
- Full Text
- View/download PDF
35. An overview of low disease activity and remission in psoriatic arthritis.
- Author
-
Lubrano E, Perrotta FM, and Kavanaugh A
- Subjects
- Arthritis, Psoriatic immunology, Endpoint Determination, Health Status, Health Status Indicators, Humans, Predictive Value of Tests, Remission Induction, Severity of Illness Index, Treatment Outcome, Tumor Necrosis Factor-alpha antagonists & inhibitors, Tumor Necrosis Factor-alpha immunology, Anti-Inflammatory Agents therapeutic use, Arthritis, Psoriatic diagnosis, Arthritis, Psoriatic drug therapy, Biological Products therapeutic use
- Abstract
Psoriatic arthritis (PsA) is a complex, multisystem and potentially disabling disease with musculoskeletal and skin manifestations. In PsA, as well as in the other chronic rheumatic conditions, a state of low disease activity or remission should be the target of treatment but to reach this objective, in the assessment of PsA patients, is still an unmet need due to the heterogeneity of disease manifestations. With the introduction of anti-TNF treatment, low disease activity or remission become an achievable and suitable state that could be reached by 50%-60% of PsA patients. The aim of this paper is to briefly summarise the concept of low disease activity and remission in PsA, with particular focus on anti-TNF therapy.
- Published
- 2015
36. Power Doppler ultrasonographic evaluation of enthesitis in psoriatic arthritis. A multi-center study.
- Author
-
Iagnocco A, Spadaro A, Marchesoni A, Cauli A, De Lucia O, Gabba A, Takanen S, Montepaone M, Perrotta FM, D'Agostino MA, Mathieu A, and Valesini G
- Subjects
- Arthritis, Psoriatic epidemiology, Humans, Prevalence, Prospective Studies, Tendinopathy epidemiology, Arthritis, Psoriatic diagnostic imaging, Tendinopathy diagnostic imaging, Ultrasonography, Doppler methods
- Published
- 2012
- Full Text
- View/download PDF
37. Patient-reported impact of spondyloarthritis on work disability and working life: the ATLANTIS survey
- Author
-
Ramonda, Roberta, Marchesoni, Antonio, Carletto, Antonio, Bianchi, Gerolamo, Cutolo, Maurizio, Ferraccioli, Gianfranco, Fusaro, Enrico, De Vita, Salvatore, Galeazzi, Mauro, Gerli, Roberto, Matucci-Cerinic, Marco, Minisola, Giovanni, Montecucco, Carlomaurizio, Pellerito, Raffaele, Salaffi, Fausto, Paolazzi, Giuseppe, Sarzi-Puttini, Piercarlo, Scarpa, Raffaele, Bagnato, Gianfilippo, Triolo, Giovanni, Valesini, Guido, Punzi, Leonardo, Olivieri, Ignazio, Ortolan, Augusta, Lorenzin, Mariagrazia, Frallonardo, Paola, Giollo, Alessandro, Locaputo, Antonella, Paolino, Sabrina, Simone, Davide, Quartuccio, Luca, Bartoloni, Elena, Luca, Rossella De, Bartoli, Francesca, Sensi, Felice, Caporali, Roberto, Carlo, Marco Di, Roberto, Bortolotti, Atzeni, Fabiola, Costa, Luisa, Ciccia, Francesco, Perrotta, Fabio, Gilio, Michele, ATLANTIS study group, Ramonda, R., Marchesoni, A., Carletto, A., Bianchi, G., Cutolo, M., Ferraccioli, G., Fusaro, E., De Vita, S., Galeazzi, M., Gerli, R., Matucci-Cerinic, M., Minisola, G., Montecucco, C., Pellerito, R., Salaffi, F., Paolazzi, G., Sarzi-Puttini, P., Scarpa, R., Bagnato, G., Triolo, G., Valesini, G., Punzi, L., Olivieri, I., Ortolan, A., Lorenzin, M., Frallonardo, P., Giollo, A., Locaputo, A., Paolino, S., Simone, D., Quartuccio, L., Bartoloni, E., Luca, R. D., Bartoli, F., Sensi, F., Caporali, R., Carlo, M. D., Roberto, B., Atzeni, F., Costa, L., Ciccia, F., Perrotta, F., Gilio, M., Ramonda, Roberta, Marchesoni, Antonio, Carletto, Antonio, Bianchi, Gerolamo, Cutolo, Maurizio, Ferraccioli, Gianfranco, Fusaro, Enrico, DE SIMONE, David, Galeazzi, Mauro, Gerli, Roberto, Matucci Cerinic, Marco, Minisola, Giovanni, Montecucco, Carlomaurizio, Pellerito, Raffaele, Salaffi, Fausto, Paolazzi, Giuseppe, Sarzi Puttini, Piercarlo, Scarpa, Raffaele, Bagnato, Gianfilippo, Triolo, Giovanni, Valesini, Guido, Punzi, Leonardo, Olivieri, Ignazio, Ortolan, Augusta, Lorenzin, Mariagrazia, Frallonardo, Paola, Giollo, Alessandro, Locaputo, Antonella, Paolino, Sabrina, Simone, Davide, Quartuccio, Luca, Bartoloni, Elena, Luca, Rossella De, Bartoli, Francesca, Sensi, Felice, Caporali, Roberto, Carlo, Marco Di, Roberto, Bortolotti, Atzeni, Fabiola, Costa, Luisa, Ciccia, Francesco, Perrotta, Fabio, and Gilio, Michele
- Subjects
Male ,Absenteeism ,Presenteeism ,Spondyloarthritis ,Survey ,WPI ,Adult ,Aged ,Arthritis, Psoriatic ,Employment ,Female ,Humans ,Italy ,Middle Aged ,Self Report ,Spondylitis, Ankylosing ,Surveys and Questionnaires ,Disability Evaluation ,Quality of Life ,Rheumatology ,Immunology and Allergy ,Immunology ,Settore MED/16 - REUMATOLOGIA ,Alternative medicine ,Psoriatic ,0302 clinical medicine ,Surveys and Questionnaire ,030212 general & internal medicine ,Working life ,Work disability ,Spondyloarthritis, Survey, Absenteeism, Presenteeism, WPI ,Research Article ,Human ,Ankylosing ,musculoskeletal diseases ,medicine.medical_specialty ,03 medical and health sciences ,Quality of life (healthcare) ,medicine ,Self report ,030203 arthritis & rheumatology ,business.industry ,Arthritis ,Family medicine ,Spondyloarthriti ,business ,Spondylitis - Abstract
Background The aim was to establish how patients experience the impact of spondyloarthritis (SpA) on work disability and working life. Methods The survey was performed in 17/20 regions in Italy (1 January to 31 March 2013). A multiple-choice questionnaire was published on the official website of the sponsor - the National Association of Rheumatic Patients (ANMAR) - and hard-copies were distributed at outpatient clinics for rheumatic patients. Results Respondents (n = 770) were of both sexes (56 % men), educated (62 % at high school or more), of working age (75 % aged ≤60 years), and affected by SpA. The most common types diagnosed were ankylosing spondylitis (AS) (39 %) and psoriatic arthritis (PsA) (36 %). Respondents were working full-time (45 %), part-time (8 %) or had retired (22 %); 15 % were unemployed (for reasons linked to the disease or for other reasons, students or housewives). Patients reported disability (39 %), were receiving disability benefits (34 %), were experiencing important limitations that were hindering their professional development/career (36 %) and some had to change/leave their job or lost it because of SpA (21 %). Employed respondents (n = 383) had worked on average 32.2 h in the last 7 days. More hours of work were lost over the last 7 days due to SpA (2.39 h vs 1.67 h). The indirect costs of the disease amounted to €106/week for patients reporting well-being/good physical conditions/improvement and €216/week for those reporting permanent impairment. Conclusions Most patients were in the midst of their productive years and were experiencing considerable difficulties in carrying out their job because of the disease: half of them reported disability and one third were experiencing important limitations in their career perspective. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-0977-2) contains supplementary material, which is available to authorized users.
- Published
- 2016
38. Elderly psoriatic arthritis patients on TNF-α blockers: results of an Italian multicenter study on minimal disease activity and drug discontinuation rate
- Author
-
Leonardo Punzi, Roberto Perricone, Maria Sole Chimenti, Rosario Peluso, Flavia Sunzini, Mariagrazia Lorenzin, Abud Darda, Luisa Costa, Ugo Fiocco, Antonio Del Puente, Fabio Massimo Perrotta, Francesco Caso, Ennio Lubrano, M. Vezzù, Raffaele Scarpa, Paolo Bottiglieri, Roberta Ramonda, Costa, Luisa, Lubrano, Ennio, Ramonda, Roberta, Chimenti, Maria Sole, Vezzù, Maristella, Perrotta, Fabio M, DEL PUENTE, Antonio, Peluso, Rosario, Bottiglieri, Paolo, Lorenzin, Mariagrazia, Sunzini, Flavia, Darda, Md Abud, Fiocco, Ugo, Perricone, Roberto, Punzi, Leonardo, Scarpa, Raffaele, and Caso, Francesco
- Subjects
Male ,MDA ,Inflammatory arthritis ,Psoriatic ,Severity of Illness Index ,Etanercept ,0302 clinical medicine ,030212 general & internal medicine ,TNF-α blockers ,Elderly PsA patient ,Remission Induction ,General Medicine ,Middle Aged ,Treatment Outcome ,Italy ,Antirheumatic Agents ,Elderly PsA patients ,Female ,medicine.drug ,medicine.medical_specialty ,Drug discontinuation rate ,TNF-α blockers ,Rheumatology ,03 medical and health sciences ,Psoriatic arthritis ,Internal medicine ,medicine ,Adalimumab ,Humans ,Adverse effect ,Aged ,030203 arthritis & rheumatology ,Biological Products ,Tumor Necrosis Factor-alpha ,business.industry ,Arthritis ,Arthritis, Psoriatic ,medicine.disease ,Infliximab ,Golimumab ,Surgery ,Settore MED/16 - Reumatologia ,Regimen ,business - Abstract
Psoriatic arthritis (PsA) is an inflammatory arthropathy, associated with skin and/or nail psoriasis. Real world data on efficacy and safety of TNF-α blockers in the elderly with PsA are lacking. The aim of this study was to evaluate the effectiveness, through the achievement of minimal disease activity (MDA), drug discontinuation rate, and safety in elderly patients with PsA on TNF-α blockers. A multicenter, observational study was carried out in four Italian centers. The assessment of disease activity and safety were performed at the start of anti-TNF-α (T0), at 6 months (T6) and at 12 months (T12). A total of 145 PsA patients were included in the study. At baseline 68 (46.9%) patients were on etanercept, 60 (41.3%) on adalimumab, 11 (7.6%) on golimumab, and 6 (4.1%) on infliximab. All the variables concerning PsA activity showed a statistically significant improvement when comparing T6 and T12 with T0. After 6 and 12 months of therapy, respectively, 31 (22.6%) and 71 (51.8%) patients achieved MDA (p
- Published
- 2017
39. An ultrasonographic study of enthesis in early psoriatic arthritis patients naive to traditional and biologic DMARDs treatment
- Author
-
Marcello Zappia, Ennio Lubrano, Davide Astorri, Fabio Massimo Perrotta, Luca Brunese, Alfonso Reginelli, Perrotta, Fabio Massimo, Astorri, Davide, Zappia, Marcello, Reginelli, Alfonso, Brunese, Luca, and Lubrano, Ennio
- Subjects
musculoskeletal diseases ,Adult ,Male ,medicine.medical_specialty ,Power Doppler ultrasound ,Immunology ,Medial Collateral Ligament, Knee ,Enthesopathy ,Achilles Tendon ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Psoriatic arthritis ,0302 clinical medicine ,Rheumatology ,Patellar Ligament ,Enthesitis ,medicine ,Immunology and Allergy ,Humans ,Enthesiti ,030203 arthritis & rheumatology ,Achilles tendon ,Common extensor tendon ,business.industry ,Patellar ligament ,Early disease ,Psoriatic arthriti ,Anti-Inflammatory Agents, Non-Steroidal ,Arthritis, Psoriatic ,Ultrasonography, Doppler ,Middle Aged ,medicine.disease ,Enthesis ,musculoskeletal system ,Surgery ,medicine.anatomical_structure ,Female ,Quadriceps tendon ,medicine.symptom ,business - Abstract
The aim of this study was to evaluate the rate of power Doppler ultrasound (PDUS) abnormalities at entheseal sites in patients with early psoriatic arthritis (PsA) naive to traditional and biologic DMARDs and to compare the PDUS findings with clinical examination. PsA patients with early disease and naive to traditional and biologic DMARDs were consecutively enrolled in this study. Patients underwent PDUS examination of the following bilateral entheseal sites: common extensor tendon at its insertion at the lateral humeral epicondyle; quadriceps tendon at its insertion at the superior pole of the patella; patellar tendon at its insertion at the tibial tuberosity; medial collateral ligament at its proximal insertion and Achilles tendon at its insertion at the calcaneus. The Leeds enthesitis index (LEI) was used to assess clinical entheseal involvement. Twenty-one early PsA patients completed the clinical and PDUS examinations. Clinical entheseal involvement was found in 9 (42.9 %) and PDUS abnormalities in 20 (95.5 %) of the 21 early PsA patients. Achilles tendon insertion was the site with the major entheseal abnormalities. Active (power Doppler positive) entheseal lesions were found in 4.7, 9.5, 14.3 and 14.3 % of patients at the lateral humeral epicondyle; quadriceps tendon, patellar tendon insertions, and Achilles tendon insertions, respectively. Concordance between clinical (LEI) and PDUS was poor. The present study confirms that PDUS allows detecting structural and inflammatory abnormalities of enthesis in early PsA patients. Our study shows that, in early disease, active abnormalities seem to have a low prevalence.
- Published
- 2016
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.