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Objective To evaluate if the timing of appearance with respect to disease onset may influence the arthritis presentation pattern in antisynthetase syndrome (ASSD). Methods The patients were selected from a retrospective large international cohort of ASSD patients regularly followed-up in centres referring to AENEAS collaborative group. Patients were eligible if they had an antisynthetase antibody testing positive in at least two determinations along with arthritis occurring either at ASSD onset (Group 1) or during the course of the disease (Group 2). Results 445 (70%; 334 females, 110 males, 1 transsexual) out of the 636 ASSD we collected had arthritis, in the majority of cases (367, 83%) from disease onset (Group 1). Patients belonging to Group 1 with respect to Group 2 had an arthritis more commonly polyarticular and symmetrical (p=0.015), IgM-Rheumatoid factor positive (p=0.035), erosions at hands and feet plain x-rays (p=0.036) and more commonly satisfying the 1987 revised classification criteria for rheumatoid arthritis (RA) (p=0.004). Features such as Raynaud's phenomenon, mechanic's hands and fever (e.g. accompanying findings) were more frequently reported in Group 2 (p=0.005). Conclusion In ASSD, the timing of appearance with respect to disease onset influences arthritis characteristics. In particular, RA features are more common when arthritis occurs from ASSD onset, suggesting an overlap between RA and ASSD in these patients. When arthritis appears during the follow-up, it is very close to a connective tissue disease-related arthritis. Also, the different prevalence of accompanying features between these two groups is in line with this possibility

Objective: Renal sympathetic denervation (RDN) has been largely studied, but the still poor knowledge of the nerves distribution in the thickness of renal artery could lead to procedural inefficacy, that, as recently suggested by some experimental studies, could explain unsatisfactory response to renal denervation. Recent evidences show that proportion of fibers available for RDN is small in proximal portion of renal artery but increases towards its distal part. Our aim was to assess whether in clinical practice there were differences in effectiveness between make ablations only at the level of the main arterial trunk or even at the level of peripheral branches. Design and Method: A total of 12 consecutive patients with resistant hypertension were included. The first 5 patients were treated with unipolar catheter; for the last 7 patients, the multi-electrode catheter was used. The first group (A) was treated with 4 to 5 ablation points for artery in the main trunk only. The second group (B) was treated with 10 to 14 ablation points for artery distributed among the main trunk plus distal branches. Office BP and ABPM was measured at baseline, 1, 3, 6 and 12 months after RDN. Results: Office and 24-hours SBP and DBP decreased at 1, 3, 6 and 12 months in all 12 patients. While office SBP decreased in Group A likewise in the Group B (−24 and −22 mmHg, respectively; Fig.1), the reduction in office DBP was stronger in Group B than Group A (−23 vs −14 mmHg). Similarly, Group B 24-hours SBP and DBP values decreased more than in Group A (A: −12/−6, B: −19/−10, mmHg). Conclusions: Our data confirm the results of recent studies and suggest that ablation of main trunk plus distal branch of the artery may be more effective in reducing BP in clinical practice as much as shown in controlled clinical studies.

Aims: It is increasingly important to determine the economic consequences of diseases considering the policy of limited health–care budgets. In this study we evaluated the annual direct and indirect costs of Systemic Sclerosis (SSc) and we tried also to identify any cost predictors. Methods: We studied 106 patients (103 female, 3 male), 57 affected by Limited Systemic Sclerosis (LSSc) and 49 affected by Diffuse Systemic Sclerosis (DSSc). Mean age was 57 years (SD±13,8) and mean disease duration was 8,9 years (SD±7,2). Direct costs: data were calculated referring to DRG (Disease Related Group) expenses for the in-patients. We referred to national pharmacopoeia to calculate the pharmaceutical cost for the out-patients. Indirect costs: we estimated the expense comparing our cases to literature data. Intangible costs: these are attributable to pain and psychological suffering. It is very difficult to express the intangible costs in monetary terms and they are often conveyed as disability and poorer quality-of-life. We used the Health Assessment Questionnaire “HAQ” and the Short Form-36 “SF-36” to evaluate this issues. Results: Our study confirms, the extremely high costs caused by Systemic Sclerosis (total cost’s 2001 year is € 1.173.842,93, and average yearly patient cost is € 11.073,99). Considering an estimated prevalence of 375 cases/106, the total yearly economic impact of SSc in Italy should be € 249.000.000,00. Intangible costs were calculated as modifications of the health status. Average value of the HAQ was significantly higher than the control population (0,94±0,72), average values in the SF-36 were significantly lower than the control population (49,99±19,16 for physical dimension and 58,42±27,71 for mental dimension). The diffuse form of SSc, positivity for anti-Scl 70 antibodies, high skin score and a poor health status (HAQ and SF-36) were found to be cost predictors. Conclusions: As reported in the literature, our study confirms, the extremely high costs for total and single patients caused by Systemic Sclerosis. The DSSc are more expensive than the LSSc approximately 11% (p=0,0067). The direct costs are 30% higher in the DSSc than the LSSc (p

To evaluate the quality of life of patients affected by systemic sclerosis (SSc) through the application of the Medical Outcome Survey Short-Form 36 (SF-36) questionnaire and to correlate the results with the disability index of the health assessment questionnaire (HAQ-DI) and the systemic involvement.We studied 95 (3 M, 91 F) patients affected by SSc (mean age 60 years, range 39-83, mean duration of disease 6 years, range 1-34). The organ system involvement was evaluated by skin score, chest High Resolution Computed Tomography (HRCT), electrocardiography according to Holter, Doppler-echocardiography and esophagogram.Considering the values of the 8 question groups of the SF-36 the most different between the patients and the control population are the values relevant to the physical dimension. The general health values estimating the physical and social dimension are significantly lower in the patients than in the control population (t=9,324; p0,0001). A very good correlation was found between the DI (r = -0,7903; p0.0001) and all the scores of SF-36. The skin involvement showed a statistically significant correlation with the DI (r=0.3709; p=0.0002) and the PA score of the SF- 36 (r =0.2853; p=0.0051). No other statistically significant correlation was found between any of the SF-36 dimensions and involvement of a specific organ.SF-36 showed to be a valid instrument to evaluate the quality of life and the disability of patients with SSc and it seems to correlate with extent of skin involvement.

Aims: to evaluate the quality of life of patients affected by systemic sclerosis (SSc) through the application of the Medical Outcome Survey Short-Form 36 (SF-36) questionnaire and to correlate the results with the disability index of the health assessment questionnaire (HAQ-DI) and the systemic involvement. Methods: we studied 95 (3 M, 91 F) patients affected by SSc (mean age 60 years, range 39-83, mean duration of disease 6 years, range 1-34). The organ system involvement was evaluated by skin score, chest High Resolution Computed Tomography (HRCT), electrocardiography according to Holter, Doppler-echocardiography and oesofagogram. Results: considering the values of the 8 question groups of the SF-36 the most different between the patients and the control population are the values relevant to the physical dimension. The general health values estimating the physical and social dimension are significantly lower in the patients than in the control population (t=9,324; p

Background Objectives To evaluate the quality of life of patients affected by systemic sclerosis (SSc) through the application of SF-36 questionnaire and to correlate the results with the disability index of HAQ (DI) and the systemic involvement. Methods We studied 100 (3 M, 97 F) patients affected by SSc (mean age 60 years, range 39–83, mean duration of disease 6 years, range 1–34). The organic involvement was evaluated by skin score, chest HRCT, electrocardiography according to Holter, Doppler-echocardiography and oesofagogram. Results In the Table 1 are shown the results of the mean values of the 8 question groups in the control population and in the patients. The 8 question groups are: PA = physical activity, RP = role of physical activity, BP = bodily pain, GH = general health, VT = vitality, SA = social activities, EP = emotional problems, MH = mental health. A very good correlation was found between the DI and all the scores of SF-36. The skin involvement showed a statistically significant correlation with both the DI (r = 0.3304; p = 0.0008) and the PA score of the SF-36 (r = 0.2635; p = 0.0081). No other statistically significant correlation was found between any of the SF-36 dimensions and involvement of a specific organ. Conclusion SF-36 showed to be a valid instrument to evaluate the quality of life and the disability of patients with SSc and it seems to correlate with extent of skin involvement. References Apolone G, et al. Questionario sullo stato di salute SF-36; manuale d?uso e guida all?interpretazione dei risultati. Guerini e Associati. Milano, 1997 Poole JL, Steen VD. Arthritis Care Res. 1991;4:27–31 Ruof J, et al. Rheumatology 1999;38:535–42 Silman A, et al. J Rheumatol. 1998;25:79–83 Steen VD, Medsger TA. Arthritis Rheum. 1997;40:1984–91 Stewart Al, et al. J Am Med Ass. 1989;262:907–13 Steward AL, et al. Med Care 1988;26:724–35 Ware JE, et al. Med Care 1992;30:473–83