Publications by authors named "A. Iagnocco"

Objectives: To assess the lung involvement in patients with Still's disease, an inflammatory disease assessing both children and adults. To exploit possible associated factors for parenchymal lung involvement in these patients.

Methods: A multicentre observational study was arranged assessing consecutive patients with Still's disease characterized by the lung involvement among those included in the AIDA (AutoInflammatory Disease Alliance) Network Still's Disease Registry.

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Difficult-to-treat rheumatoid arthritis (D2TRA) identifies patients with insufficient response to biological or targeted-synthetic disease-modifying drugs (b/ts DMARDs), heralding a more severe phenotype. Musculoskeletal ultrasound (MSK-US) provides information on MSK inflammatory load and damage, being widely used in RA and inflammatory arthritides, yet the US patterns of D2TRA and correlation with clinical parameters have not been unanimously described so far. Here we investigated MSK-US patterns and their prognostic value in D2TRA through a systematic literature review (SLR) across MEDLINE (through PubMed), Scopus and Ovid (Embase) electronic databases.

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  • The study aimed to explore gender differences in the phenotypical expression of Behçet's disease (BD) using data from the International AIDA Network Registry, focusing on damage index, disease manifestations, and cardiovascular risk.
  • A total of 1024 patients (567 males and 457 females) were examined, revealing that males had a significantly higher overall damage index and more frequent occurrences of uveitis and vascular involvement, while females showed higher instances of arthralgia, arthritis, and CNS involvement.
  • Key factors associated with major organ involvement included male gender, treatment with biologic agents, origin from endemic regions, and longer disease duration, indicating a more severe course of BD in males compared to females.
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  • Lung transplantation (LuTx) is a crucial treatment for patients with systemic sclerosis (SSc) and severe lung disease, aiming to improve survival and overall health outcomes.
  • A study of 13 SSc patients who underwent LuTx showed significant improvements in lung function, skin involvement, and overall disease activity over a two-year period.
  • The survival rate at two years post-transplant was 92.3%, indicating LuTx is a promising option for SSc patients in advanced stages of the disease, with no unexpected adverse events reported.
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Objective: The journey to a diagnosis of spondyloarthritis (SpA) can be difficult for women, who often experience delays in receiving the correct diagnosis as their symptoms are frequently misinterpreted due to other conditions like osteoarthritis, fibromyalgia, or other psychosomatic disorders. The purpose of this article is to examine the challenges in the diagnosis of SpA in women and the possible role of musculoskeletal ultrasound in early diagnosis and in avoiding misdiagnosis.

Methods: We have performed a narrative review of the currently available literature on the subject.

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  • Clinical remission is the main goal for managing rheumatoid arthritis (RA), but studies have found that some patients in remission still show signs of synovitis detected by ultrasound.
  • The UPARAREMUS study observed the effects of upadacitinib, a selective Janus kinase 1 inhibitor, showing it resulted in significantly higher rates of remission at 24 weeks compared to other treatments like adalimumab and abatacept.
  • In this study, 63.6% of patients achieved both clinical and ultrasound remission after 24 weeks, with the likelihood of achieving this higher among bio-naïve patients, indicating that the drug may be more effective in patients who haven't received prior biological treatments.
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Objectives: Conflicting results about clinical and subclinical atherosclerosis in systemic sclerosis (SSc) and the associated risk factors have been reported. Hence, we aimed to determine the prevalence of clinical and subclinical atherosclerosis in a large number of Italian SSc patients and the associated risk factors.

Methods: This study included 613 SSc patients from 11 Italian tertiary Rheumatologic Units.

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  • The study aimed to analyze the disease, demographic, and imaging characteristics linked to different types of calcium pyrophosphate deposition (CPPD) disease, focusing on recurrent acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and crowned dens syndrome (CDS).
  • Researchers utilized data from an international cohort of 618 individuals to investigate the phenotypic traits of each type of CPPD and performed multivariable logistic regression to assess associations between risk factors and inflammatory phenotypes.
  • Key findings indicated that longer disease duration correlated with recurrent acute arthritis, while chronic arthritis was linked to specific joint issues and less associated with metabolic risks, and CDS was more common in males with greater joint involvement. *
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Inflammatory rheumatic diseases are different pathologic conditions associated with a deregulated immune response, codified along a spectrum of disorders, with autoinflammatory and autoimmune diseases as two-end phenotypes of this continuum. Despite pathogenic differences, inflammatory rheumatic diseases are commonly managed with a limited number of immunosuppressive drugs, sometimes with partial evidence or transferring physicians' knowledge in different patients. In addition, several randomized clinical trials, enrolling these patients, did not meet the primary pre-established outcomes and these findings could be linked to the underlying molecular diversities along the spectrum of inflammatory rheumatic disorders.

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We aimed to examine the drug retention rate (DRR) of the interleukin-17 inhibitor ixekizumab in a real-world monocentric cohort of psoriatic arthritis (PsA) patients and to assess the predictors of drug discontinuation. Consecutive PsA patients who underwent treatment with ixekizumab from October 2019 to February 2023 were enrolled in this observational, retrospective, monocentric study. Clinical records were assessed at baseline and throughout the follow-up period.

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: To date, the literature concerning real-world data on the retention rate and safety of Janus kinase inhibitors (JAKis) is limited. To retrospectively evaluate the overall drug retention rate (DRR) of different JAKis in a monocentric cohort of patients with rheumatoid arthritis (RA). : Patients diagnosed with RA and treated with JAKis who were evaluated at our outpatient clinic from March 2017 to December 2023 were included in the study.

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Aim: To compare synovial blood flow scoring between different technologies and ultrasound (US) systems in active and inactive rheumatoid arthritis (RA).

Material And Methods: Fifty-nine RA patients underwent B-mode, power Doppler (PD), colour Doppler (CD), B-Flow and High-Resolution (High-Res) PDI assessments of 6 joints with two US systems at two European centres. Each joint was semi-quantitatively scored for all ultrasound parameters.

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Objective: Tinnitus Retraining Therapy (TRT) is a rehabilitation approach for tinnitus that is currently considered an effective treatment with an elevated response rate. TRT is usually delivered through sound generators; however, they are often difficult to find and expensive. Recently, mobile apps have been proposed for TRT.

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Purpose: The clinical relevance of human leukocyte antigen (HLA) subtypes such as HLA-B51 on Behçet's disease (BD)-related uveitis and non-infectious uveitis (NIU) unrelated to BD remains largely unknown.

Methods: Data were prospectively collected from the International AIDA Network Registry for BD and for NIU. We assessed differences between groups (NIU unrelated to BD and positive for HLA-B51, BD-related uveitis positive for HLA-B51 and BD-related uveitis negative for HLA-B51) in terms of long-term ocular complications, visual acuity (VA) measured by best corrected visual acuity (BCVA), anatomical pattern, occurrence of retinal vasculitis (RV) and macular edema over time.

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Objectives: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system.

Methods: The study consisted of a stepwise process.

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  • This study evaluated the effectiveness of a systemic score in predicting severe outcomes in patients with Still disease, including the risk of mortality and severe complications like macrophage activation syndrome.
  • Involving 597 patients, the study found that a higher systemic score significantly correlated with life-threatening outcomes, with scores of 7 or above indicating a greater risk.
  • Key components that were most predictive of severe outcomes included liver and lung involvement, emphasizing the importance of these factors in managing Still disease.
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Objective: New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA.

Methods: Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined.

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Objectives: Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images.

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Objective: This post-hoc analysis was carried out on data acquired in the longitudinal Sonographic Tenosynovitis/arthritis Assessment in Rheumatoid Arthritis Patients in Remission (STARTER) study. Its primary aim was to determine the predictive clinical and MSUS features factors for disease flare in RA patients in clinical remission, whilst its secondary aim was to evaluate the probability of disease flare based on clinical and MSUS features.

Methods: The analysis included a total of 389 RA patients in DAS28-defined remission.

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Objective: To formulate evidence-based recommendations and overarching principles on the use of imaging in the clinical management of crystal-induced arthropathies (CiAs).

Methods: An international task force of 25 rheumatologists, radiologists, methodologists, healthcare professionals and patient research partners from 11 countries was formed according to the EULAR standard operating procedures. Fourteen key questions on the role of imaging in the most common forms of CiA were generated.

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Background: The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology.

Methods: In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology.

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Article Synopsis
  • Research shows a link between rheumatoid arthritis (RA), insulin resistance (IR), and type 2 diabetes (T2D), with pro-inflammatory cytokines worsening β-cell apoptosis, leading to potential treatments using JAK inhibitors like tofacitinib.
  • A study involved 40 RA patients with T2D, evaluating changes in insulin resistance after 6 months of tofacitinib treatment, targeting improvements in metabolic and inflammatory markers.
  • Results indicated a significant decrease in insulin resistance and an improvement in insulin sensitivity, alongside reduced RA disease activity and favorable clinical responses in a majority of patients.
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Introduction: The effectiveness of canakinumab may change according to the different times it is used after Still's disease onset. This study aimed to investigate whether canakinumab (CAN) shows differences in short- and long-term therapeutic outcomes, according to its use as different lines of biologic treatment.

Methods: Patients included in this study were retrospectively enrolled from the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to Still's disease.

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  • Psoriatic arthritis (PsA) is a long-lasting disease that affects people's joints and can cause various other health problems.
  • A group of 38 doctors in Italy looked at recent studies to come up with helpful tips on how to manage PsA.
  • They created 49 important statements that cover early diagnosis, different types of PsA, related health issues, and goals for treatment.
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