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Spinal Diseases: HELP
Articles by Fabiola Atzeni
Based on 31 articles published since 2009
(Why 31 articles?)
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Between 2009 and 2019, F. Atzeni wrote the following 31 articles about Spinal Diseases.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. 2017

Agca, R / Heslinga, S C / Rollefstad, S / Heslinga, M / McInnes, I B / Peters, M J L / Kvien, T K / Dougados, M / Radner, H / Atzeni, F / Primdahl, J / Södergren, A / Wallberg Jonsson, S / van Rompay, J / Zabalan, C / Pedersen, T R / Jacobsson, L / de Vlam, K / Gonzalez-Gay, M A / Semb, A G / Kitas, G D / Smulders, Y M / Szekanecz, Z / Sattar, N / Symmons, D P M / Nurmohamed, M T. ·Departments of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway. · College of Medical, Veterinary and Life Sciences, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Internal and Vascular Medicine, VU University Medical Center, Amsterdam, The Netherlands. · Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. · Department of Rheumatology, Paris Descartes University, Hôpital Cochin. Assistance Publique, Hôpitaux de Paris INSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France. · Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Vienna, Austria. · IRCCS Galeazzi Orthopedic Institute, Milan, Italy. · Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark. · Sygehus Sønderjylland (Hospital of Southern Jutland), Aabenraa, Denmark. · King Christian 10's Hospital for Rheumatic Diseases, Graasten, Denmark. · Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden. · PARE (patient research partners), Sint-Joris-Weert, Belgium. · Romanian League Against Rheumatism (Vice-President) and Board Member (General Secretary) of AGORA, the Platform of S-E organisations for patients with RMDs, Bucharest, Romania. · Oslo University Hospital, Ullevål, Center for Preventive Medicine and Medical Faculty, University of Oslo, Oslo, Norway. · Department of Rheumatology & Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg and Section of Rheumatology, Lund, Sweden. · Department of Clinical Sciences Malmö, Lund University, Lund, Sweden. · Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium. · University of Cantabria, IDIVAL, Santander, Spain. · Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK. · Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary. · Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK. · Department of Rheumatology and Musculoskeletal Epidemiology, Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK. · Department of Rheumatology Reade, Amsterdam Rheumatology and Immunology Center, Reade & VU University Medical Center, Amsterdam, The Netherlands. ·Ann Rheum Dis · Pubmed #27697765.

ABSTRACT: Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.

2 Editorial From Old to New Cardiovascular Complications in Ankylosing Spondylitis. 2017

Atzeni, Fabiola / Corda, Marco / Sarzi-Puttini, Piercarlo / Caso, Francesco / Turiel, Maurizio. ·IRCCS Galeazzi Orthopedic Institute, Milan, Italy. · Cardiology Unit, Brotzu Hospital, Cagliari, Italy. · Rheumatology Unit, Sacco University Hospital, Milan, Italy. · Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy. · Cardiology Unit, IRCCS Galeazzi Orthopedic Institute, Milan, Italy. ·Isr Med Assoc J · Pubmed #28825770.

ABSTRACT: -- No abstract --

3 Review The profiling of axial spondyloarthritis patient candidate to a biologic therapy: Consensus from a Delphi-panel of Italian experts. 2018

Favalli, Ennio Giulio / Becciolini, Andrea / Caporali, Roberto / Todoerti, Monica / Iannone, Florenzo / Dinoia, Liliana / Sebastiani, Marco / Spinella, Amelia / Gremese, Elisa / Cianci, Francesco / Atzeni, Fabiola / Bandinelli, Francesca / Ferraccioli, Gianfranco / Lapadula, Giovanni / Anonymous3521013. ·Department of Rheumatology, Gaetano Pini Institute, Milan, Italy. Electronic address: enniofavalli@me.com. · Department of Rheumatology, Gaetano Pini Institute, Milan, Italy. · Department of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. · Rheumatology Unit, Department of Emergence Medicine and Transplantation (DETO), University of Bari, Italy. · Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy. · Rheumatology Unit, Fondazione Policlinico Universitario A. Gemelli-Catholic University of the Sacred Heart, Rome, Italy. · Rheumatology, University of Messina, Italy. · Rheumatology Unit, Hospital S. Giovanni di Dio, Florence, Italy. ·Autoimmun Rev · Pubmed #30339886.

ABSTRACT: OBJECTIVE: The project aimed to collect expert consensus statements for the profiling of patients with axial spondyloarthritis (axSpA) candidate to biologic agents (bDMARDs) treatment, in order to better define the drivers for the best treatment choice. METHODS: The 6 more interesting topics about axSpA patient profiling were identified by the project steering committee and a panel of axSpA Italian experts. A systematic literature review (SLR) was performed for each of the selected topics according to the PICO format. Two rounds of a modified Delphi process were conducted. In the 1st round, the steering committee evaluated the results of the SLR in order to formulate statements for each topic. In the 2nd round, the experts panel discussed, rephrased when needed, and voted the level of agreement (on a 5-point Likert-type scale) for each statement. Consensus was defined as ≥66% agreement. RESULTS: The topics selected for the analysis were the differential efficacy of available bDMARDs on enthesitis/dactylitis, uveitis, radiographic progression and cardiovascular involvement, and the clinical response in non radiographic-axSpA and in patients receiving a second-line bDMARD. The Delphi rounds formulated 19 statements, all reaching the defined level of consensus in a second round including 25 rheumatologists highly skilled in the management of axSpA. CONCLUSION: Identified consensus statements can help clinicians to apply to routine-care settings the results from clinical studies and international recommendations, providing a guide for individualization of treatment strategy in axSpA patients.

4 Review Ankylosing Spondylitis Treatment after First Anti-TNF Drug Failure. 2018

Benucci, Maurizio / Damiani, Arianna / Bandinelli, Francesca / Grossi, Valentina / Infantino, Maria / Manfredi, Mariangela / Gobbi, Francesca Li / Sarzi-Puttini, Piercarlo / Atzeni, Fabiola. ·Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy. · Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Florence, Italy. · Rheumatology Unit, Sacco University Hospital, Milan, Italy. ·Isr Med Assoc J · Pubmed #29431309.

ABSTRACT: -- No abstract --

5 Review TNF inhibitors in rheumatoid arthritis and spondyloarthritis: Are they the same? 2018

Rubbert-Roth, Andrea / Atzeni, Fabiola / Masala, Ignazio Francesco / Caporali, Roberto / Montecucco, Carlomaurizio / Sarzi-Puttini, Piercarlo. ·Kantonsspital St Gallen, 9007 St Gallen, Switzerland. Electronic address: andrea.rubbert-roth@kssg.ch. · Rheumatology Unit, ASST Fatebenefratelli Sacco, Milan, Italy, Milan, Italy. Electronic address: atzenifabiola@hotmail.com. · Orthopedic and Trauma Unit, Santissima Trinità Hospital, Cagliari, Italy. · Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. · Rheumatology Unit, ASST Fatebenefratelli Sacco, Milan, Italy, Milan, Italy. ·Autoimmun Rev · Pubmed #29108829.

ABSTRACT: The advent of anti-tumour necrosis factor (TNF) drugs for rheumatoid arthritis (RA) or spondyloarthritis (SpA) has revolutionised the approach to patients with active disease who do not respond to conventional therapy. Although there are differences in their structure, morphology, pharmacokinetic properties and activity, all anti-TNF drugs ultimately neutralise the TNFα pathway of inflammation. However, despite their similar clinical efficacy, there are disagreements concerning drug survival and safety, with systematic reviews and meta-analyses confirming one result or the other. The fact that 20-30% of patients fail to respond to TNFα inhibitors indicates the possibility of primary resistance or the development of an immune response to the drugs themselves, which may act as antigens. The overall benefit of switching to another anti-TNF drug or a biological agent with a different mechanism of action, may be a valuable option in individual patients. There are few data concerning the use of anti-TNF drugs in patients with SpA but it seems that there are fewer adverse advents and higher drug survival in comparison with patients with RA.

6 Review Do Anti-TNF Blockers Increase the Risk of Lung Involvement in Patients with Ankylosing Spondylitis or Psoriatic Arthritis? A Systematic Review. 2016

Atzeni, Fabiola / Grillo, Elisabetta / Masala, Ignazio F / Sarzi-Puttini, Piercarlo / Jones, Gareth T. · ·Isr Med Assoc J · Pubmed #27228632.

ABSTRACT: Lung involvement is a well-recognized extra-articular manifestation of ankylosing spondylitis (AS). Anecdotal reports suggest that the use of anti-TNF drugs may be related to lung disease and pulmonary fibrosis. To examine the association between anti-TNF drugs and the development of lung disease in patients with AS or psoriatic arthritis (PsA) we conducted a systematic review. Of the 670 papers identified by means of key word and hand search, only one full-text paper was considered potentially relevant but had to be discarded as it did not meet the eligibility criteria. Although no conclusion was reached, this is the first systematic review to examine this problem which is becoming increasingly important as these drugs are widely prescribed in patients with spondyloarthritis.

7 Review Role of Agents other than Tumor Necrosis Factor Blockers in the Treatment of Psoriatic Arthritis. 2015

Atzeni, Fabiola / Costa, Luisa / Caso, Francesco / Scarpa, Raffaele / Sarzi-Puttini, Piercarlo. ·From the Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Galeazzi Orthopedic Institute, Milan; the Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples; and the Rheumatology Unit, Department of Clinical Medicine, DIMED, University of Padua, Padua, Italy.F. Atzeni, MD, PhD, IRCCS Galeazzi Orthopedic Institute; L. Costa, MD; F. Caso, MD, PhD, Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University Federico II, and Rheumatology Unit, Department of Clinical Medicine, DIMED, University of Padua; R. Scarpa, MD; P. Sarzi-Puttini, MD, Rheumatology Research Unit, Department of Clinical Medicine and Surgery, University Federico II. ·J Rheumatol Suppl · Pubmed #26523064.

ABSTRACT: Psoriatic arthritis (PsA) is a systemic inflammatory disease characterized by possible peripheral and axial joint involvement, enthesitis, dactylitis, and skin and nail disease. It affects up to one-third of psoriatic patients, and may be associated with comorbidities such as cardiovascular and metabolic diseases. The usually prescribed initial treatment of moderate-severe PsA is methotrexate, which may be accompanied or replaced by a tumor necrosis factor (TNF) inhibitor such as etanercept, infliximab, or adalimumab. However, some patients may become unresponsive (or have contraindications) to available anti-TNF agents and require alternative treatment. The aim of this review is to describe the potential role of some new immunomodulatory agents.

8 Review Psoriatic Arthritis Registries. 2015

Sarzi-Puttini, Piercarlo / Varisco, Valentina / Ditto, Maria Chiara / Benucci, Maurizio / Atzeni, Fabiola. ·From the Rheumatology Unit, L. Sacco University Hospital, and the Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Galeazzi Orthopedic Institute, Milan; and the Rheumatology Unit, San Giovanni di Dio Hospital, Florence, Italy.P. Sarzi-Puttini, MD, PhD, Consultant Rheumatologist and Head of Rheumatology Unit; V. Varisco, MD, Resident in Rheumatology; M.C. Ditto, MD, Specialist Rheumatologist, Rheumatology Unit, L. Sacco University Hospital; M. Benucci, MD, Consultant Rheumatologist, Rheumatology Unit, San Giovanni di Dio Hospital; F. Atzeni, MD, PhD, Clinical Research in Rheumatology, IRCCS Galeazzi Orthopedic Institute. ·J Rheumatol Suppl · Pubmed #26523052.

ABSTRACT: The introduction of new biological drugs for the treatment of rheumatoid arthritis and spondyloarthritis has led to the creation of a number of registries in Europe and the United States. Most of them are sponsored by national rheumatology societies, and provide information that is useful in clinical practice concerning the clinical characteristics, efficacy, and safety of all licensed biological drugs. Their findings also help to improve our understanding of the quality of life and working ability of patients receiving biological drugs, and suggest methods for allocating resources. However, there are only a few registries for psoriatic arthritis, and efforts should be made to increase their number to obtain further reliable and useful data.

9 Review Pain in systemic inflammatory rheumatic diseases. 2015

Atzeni, Fabiola / Masala, Ignazio Francesco / Salaffi, Fausto / Di Franco, Manuela / Casale, Roberto / Sarzi-Puttini, Piercarlo. ·IRCCS Galeazzi Orthopedic Institute, Milan, Italy. Electronic address: atzenifabiola@hotmail.com. · Orthopedic Unit, Santissima Trinità Hospital, Cagliari, Italy. · Chair of Rheumatology, Università Politecnica delle Marche, Italy. · Chair of Rheumatology, La Sapienza University, Rome, Italy. · Department of Clinical Neurophysiology and Pain Rehabilitation Unit (RC), Foundation Salvatore Maugeri IRCCS, Montescano, Italy. · Rheumatology Unit, L.Sacco University Hospital, Milan, Italy. ·Best Pract Res Clin Rheumatol · Pubmed #26266998.

ABSTRACT: The sometimes intense, persistent and disabling pain associated with rheumatoid arthritis (RA) and spondyloarthritis frequently has a multifactorial, simultaneously central and peripheral origin, and it may be due to currently active inflammation or joint damage and tissue destruction caused by a previous inflammatory condition. The symptoms of inflammatory pain symptoms can be partially relieved by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in central pain regulation mechanisms, as in the case of the chronic widespread pain (CWP) characterising fibromyalgia. The importance of distinguishing CWP from inflammatory pain is underlined by the fact that drugs such as tumour necrosis factor inhibitors are expensive, and direct costs are higher in patients with concomitant CWP than in those without. The management of pain requires a combination approach that includes pharmacological analgesia, and biological and non-biological treatments because, although joint replacement surgery can significantly improve RA-related pain, it may only be available to patients with the most severe advanced disease.

10 Review A possible link between ankylosing spondylitis and periodontitis: a systematic review and meta-analysis. 2015

Ratz, Tiara / Dean, Linda E / Atzeni, Fabiola / Reeks, Christopher / Macfarlane, Gary J / Macfarlane, Tatiana V. ·Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK, Department of Public Health, University of Bremen, Bremen, Germany, Rheumatology Unit, L. Sacco University Hospital, Milan, Italy and University of Aberdeen Dental School and Hospital, Aberdeen, UK. Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK, Department of Public Health, University of Bremen, Bremen, Germany, Rheumatology Unit, L. Sacco University Hospital, Milan, Italy and University of Aberdeen Dental School and Hospital, Aberdeen, UK. · Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK, Department of Public Health, University of Bremen, Bremen, Germany, Rheumatology Unit, L. Sacco University Hospital, Milan, Italy and University of Aberdeen Dental School and Hospital, Aberdeen, UK. · Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK, Department of Public Health, University of Bremen, Bremen, Germany, Rheumatology Unit, L. Sacco University Hospital, Milan, Italy and University of Aberdeen Dental School and Hospital, Aberdeen, UK. tatiana.macfarlane@abdn.ac.uk. ·Rheumatology (Oxford) · Pubmed #25213130.

ABSTRACT: OBJECTIVE: The aim of this study was to examine the link between AS and periodontitis. METHODS: Medline, Embase, AMED, CINAHL, Web of Science and Google Scholar were searched to identify eligible studies that were selected and reviewed independently by at least two authors. RESULTS: Six case-control studies were included in the review. Study size ranged from 90 to 40 926 participants. The prevalence of periodontitis ranged from 38% to 88% in AS patients and from 26% to 71% in controls. As there was low-level heterogeneity (I(2) = 13%), using fixed effects analysis the overall pooled estimate of the odds ratios for periodontitis was 1.85 (95% CI 1.72, 1.98). There was no evidence of publication bias. CONCLUSION: The results led to the need for a further large study with sufficient statistical power to detect the desired effect size, taking into account potential confounding factors and using validated measures of AS and periodontitis.

11 Review Chronic widespread pain in spondyloarthritis. 2014

Atzeni, F / Boccassini, L / Di Franco, M / Alciati, A / Marsico, A / Cazzola, M / Cassisi, G / Sarzi-Puttini, P. ·Rheumatology Unit, L. Sacco University Hospital, Milan. atzenifabiola@hotmail.com. ·Reumatismo · Pubmed #24938193.

ABSTRACT: The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

12 Review Rheumatic manifestations in inflammatory bowel disease. 2014

Atzeni, Fabiola / Defendenti, Caterina / Ditto, Maria Chiara / Batticciotto, Alberto / Ventura, Donatella / Antivalle, Marco / Ardizzone, Sandro / Sarzi-Puttini, Piercarlo. ·Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. ·Autoimmun Rev · Pubmed #23774109.

ABSTRACT: Musculoskeletal symptoms (articular, periarticular and muscular involvement, osteoporosis and related fractures, and fibromyalgia) are the most common frequent extra-intestinal manifestations of inflammatory bowel disease (IBD) and affect 6-46% of patients. IBD-related arthropathy is one of a group of inflammatory arthritides known as seronegative spondyloarthropathies (SpA), which also includes idiopathic ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, and undifferentiated SpA. The articular involvement in IBD significantly affects the patients' quality of the life. Although magnetic resonance imaging (MRI) is still the gold standard for assessing entheseal involvement, ultrasonography (US) is a non-invasive and easily reproducible means of detecting early pathological changes in SpA patients. It can identify characteristic features of SpA such as enthesitis, bone erosions, synovitis, bursitis, and tenosynovitis and is therefore helpful for diagnostic purposes. Anti-TNF drugs should be used to treat AS patients with axial and peripheral symptoms (arthritis and enthesitis) who have persistently high levels of disease activity despite conventional treatment, and adalimumab and infliximab can also be beneficially used in patients with IBD.

13 Review Fibromyalgia and arthritides. 2012

Atzeni, F / Sallì, S / Benucci, M / Di Franco, M / Alciati, A / Sarzi-Puttini, P. ·Rheumatology Unit, L. Sacco University Hospital of Milan, Italy. ·Reumatismo · Pubmed #23024973.

ABSTRACT: Fibromyalgia (FM) is a chronic pain syndrome that affects at least 2% of the adult population. It is characterised by widespread pain, fatigue, sleep alterations and distress, and emerging evidence suggests a central nervous system (CNS) malfunction that increases pain transmission and perception. FM is often associated with other diseases that act as confounding and aggravating factors, such as rheumatoid arthritis (RA), spondyloarthritides (SpA), osteoarthritis (OA) and thyroid disease. Mechanism-based FM management should consider both peripheral and central pain, including effects due to cerebral input and that come from the descending inhibitory pathways. Rheumatologists should be able to distinguish primary and secondary FM, and need new guidelines and instruments to avoid making mistakes, bearing in mind that the diffuse pain of arthritides compromises the patients' quality of life.

14 Review Cardiovascular involvement in psoriatic arthritis. 2011

Atzeni, F / Turiel, M / Boccassini, L / Sitia, S / Tomasoni, L / Battellino, M / Marchesoni, A / De Gennaro Colonna, V / Sarzi-Puttini, P. ·Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. ·Reumatismo · Pubmed #22257915.

ABSTRACT: Psoriasis is a chronic, genetically determined and immunomediated inflammatory skin disease that affects 2-3% of the Caucasian population. A considerable proportion of these patients develop a form of inflammatory arthritis known as psoriatic arthritis (PsA), although the prevalence of this has not been well defined. Patients with PsA have a higher mortality rate than the general population and the risk of mortality is related to disease severity at the time of presentation. Endothelial dysfunction and early atherosclerosis have been found in patients with PsA without any cardiovascular disease (CVD) risk factors, and experts believe that CVD is one of the leading causes of death, as it is in patients with rheumatoid arthritis (RA). Various disease-related mechanisms may be involved in the development of premature vascular damage in both cases, including an increased synthesis of proinflammatory mediators (such as cytokines, chemokines and adhesion molecules), autoantibodies against endothelial cell components, perturbations in T-cell subsets, genetic polymorphisms, hyperhomocysteinemia, oxidative stress, abnormal vascular repair, and iatrogenic factors. In a recent study of 22 patients with PsA without any signs of CVD, we found that the plasma concentration of asymmetric dimethylarginine (ADMA) levels were significantly high and coronary flow reserve (CFR) was significantly reduced. Moreover, there was a significant correlation between CFR and plasma ADMA levels in the PsA group. The significant correlation between the reduced CRF and increased ADMA levels suggests that, like patients with early RA, PsA patients suffer from endothelial dysfunction and impaired coronary microcirculation. Active PsA is a risk factor for CVD, and so PsA patients should be screened for subclinical forms of the disease and its risk factors, and an early treatment approach should be adopted.

15 Review Psoriatic arthritis: clinical improvement and correlation with hormone axes in etanercept-treated patients. 2010

Atzeni, Fabiola / Straub, Rainer H / Cutolo, Maurizio / Sarzi-Puttini, Piercarlo. ·Rheumatology Unit, University Hospital L. Sacco, Milan, Italy. ·Ann N Y Acad Sci · Pubmed #20398026.

ABSTRACT: In a chronic inflammatory disease, such as rheumatoid arthritis (RA), the hypothalamic-pituitary-adrenal axis is altered in three ways: (1) the inflammation-related spontaneous and stimulated secretion of cortisol is inadequate; (2) the inflammation-related secretion of adrenocorticotropic hormone (ACTH) is low; and (3) the levels of adrenal androgens decrease. In patients with RA, long-term therapy with anti-TNF therapy sensitizes the pituitary gland and improves adrenal androgen secretion. We have recently found that the mean serum levels of ACTH, cortisol, 17-hydroxyprogesterone (17OHP), and androstenedione (ASD) in 11 prednisolone-naïve patients with psoriatic arthritis did not markedly change during 12 weeks of etanercept treatment, nor did the serum cortisol/ACTH ratio. However, the greater increase in serum cortisol in comparison with serum 17OHP or ASD was related to clinical improvement, which indicates that the improvement was more related to the higher cortisol levels.

16 Review Extraspinal manifestations of diffuse idiopathic skeletal hyperostosis. 2009

Mader, Reuven / Sarzi-Puttini, Piercarlo / Atzeni, Fabiola / Olivieri, Ignazio / Pappone, Nicola / Verlaan, Jorrit-Jan / Buskila, Dan. ·Rheumatic Diseases Unit, Ha'Emek Medical Center, Afula 18101, Israel. mader_r@clalit.org.il ·Rheumatology (Oxford) · Pubmed #19783587.

ABSTRACT: DISH is a condition characterized by calcification and/or ossification of soft tissues, mainly entheses, ligaments and joint capsules. Its prevalence increases with age and, therefore, DISH is a relatively common entity in the elderly. The classical site of involvement is the spinal column with right anterolateral soft tissue ossification being the most characteristic feature. However, DISH is not limited to the spine, and may affect multiple peripheral sites independently. Extraspinal entheseal ossifications are common and observing their isolated presence may lead to the diagnosis of DISH. Furthermore, hypertrophic or atypical OA observed in joints usually not affected by primary OA has frequently been reported in DISH. Several metabolic derangements and concomitant diseases have been suggested to be associated with DISH including obesity, increased waist circumference, hypertension, dyslipidaemia, diabetes mellitus (DM), hyperuricaemia, metabolic syndrome and an increased risk for cardiovascular diseases. Witnessing the present increase in lifespan, obesity, DM and metabolic syndrome in the Western population, the prevalence of DISH should be expected to rise. In order to increase the awareness for DISH, this review focuses on the extraspinal features of the condition.

17 Article Rate of serious infections in spondyloarthropathy patients treated with anti-tumour necrosis factor drugs: a survey from the Italian registry GISEA. 2019

Atzeni, Fabiola / Sarzi-Puttini, Piercarlo / Sebastiani, Marco / Panetta, Valentina / Salaffi, Fausto / Iannone, Florenzo / Carletto, Antonio / Foti, Rosario / Gremese, Elisa / Govoni, Marcello / Marchesoni, Antonio / Favalli, Ennio / Gorla, Roberto / Ramonda, Roberta / Ferraccioli, Gianfranco / Lapadula, Giovanni / Anonymous4871360. ·Rheumatology Unit, University of Messina, Italy. atzenifabiola@hotmail.com. · Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. · University Hospital of Modena, Italy. · L'Altrastatistica Consultancy & Training, Biostatistics Office, Rome, Italy. · Polytechnic University of Marche, C. Urbani Hospital, Jesi, Italy. · Rheumatology Unit, University of Bari, Italy. · Rheumatology Unit, University of Verona, Italy. · Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Italy. · Division of Rheumatology, Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy. · Department of Medical Sciences, Division of Rheumatology, Santa Anna University Hospital, Ferrara, Italy. · G. Pini Orthopaedic Hospital, Milan, Italy. · Rheumatology and Immunology Unit, Spedali Civili, Brescia, Italy. · University of Padova, Italy. ·Clin Exp Rheumatol · Pubmed #30767865.

ABSTRACT: OBJECTIVES: To determine the incidence of serious infections (SIs) among the spondyloarthropathy (SpA) patients from the "Gruppo Italiano per lo Studio delle Early Arthritis" (GISEA) registry and treated with tumour necrosis factor (TNF) inhibitors (TNFIs), and to identify the factors associated with the development of the infections. METHODS: This observational study on 3321 GISEA-registered SpA patients collected real-world demographic and clinical data relating to their biological drug treatments. The overall incidence of infections was analysed by type of SpA. RESULTS: A total of 3321 SpA patients (1731 males, 52.2%; mean age 47±13 years; median disease duration 3 years, interquartile range [IQR] 0-8) were eligible for inclusion in the analysis. Two hundred and fifty-nine patients experienced at least one of 391 microbiologically diagnosed SIs, 32% of which were recorded during the first 12 months of treatment. The overall incidence of SIs was 43.9/1000 patient-years of follow-up (95% confidence interval [CI] 39.6-48.4): 29.9/1000 (95% CI 23.1-38.1) among those treated with adalimumab (ADA); 36.1/1000 (95% CI 30.0-43.1) among those treated with etanercept (ETN); and 61.4/1000 (95% CI 53.3-70.5) among those treated with infliximab (INF). The highest incidence was observed among the patients with psoriatic arthritis (PsA), but the difference was statistically significant only in comparison with the patients with undifferentiated SpA (p=0.002), whose incidence of SIs was also lower than in the patients with ankylosing spondylitis (AS) (p=0.034). Multivariate models showed that the number of comorbidities (hazard ratio [HR] 1.29, 95%CI 1.2-1.4; p<0.001), age at the start of TNFi treatment (HR 0.99, 95%CI 0.97-0.99; p=0.030), steroid use (HR 1.40, 95%CI 1.1-1.8; p=0.012) and male sex (HR 0.72, 95%CI 0.5-0.9; p=0.012) were all statistically significant predictors of infection. The factors independently associated with a lower risk of SIs were the use of ETN (HR 0.52, 95%CI 0.4-0.7; p<0.001) or ADA (HR 0.59, 95%CI 0.4-0.8; p=0.002) rather than INF. CONCLUSIONS: The incidence of SIs was higher among patients with PsA or AS than among those with undifferentiated SpA, and among patients treated with INF than among those treated with ADA or ETN. Male sex, steroid use and the number of comorbidities were all factors predictive of SIs.

18 Article Influence of co-morbid fibromyalgia on disease activity measures and response to tumour necrosis factor inhibitors in axial spondyloarthritis: results from a UK national register. 2018

Macfarlane, Gary J / MacDonald, Ross I R / Pathan, Ejaz / Siebert, Stefan / Gaffney, Karl / Choy, Ernest / Packham, Jon / Martin, Kathryn R / Haywood, Kirstie / Sengupta, Raj / Atzeni, Fabiola / Jones, Gareth T. ·Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK. · Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK. · Department of Rheumatology, Aberdeen Royal Infirmary, Aberdeen, UK. · Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK. · Department of Rheumatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK. · Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK. · Research Institute for Applied Clinical Sciences, Keele University, Keele, UK. · Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK. · Department of Rheumatology, Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath, UK. · IRCCS Galeazzi Orthopaedic Institute, Milan, Italy. ·Rheumatology (Oxford) · Pubmed #30053166.

ABSTRACT: Objective: To quantify the extent to which co-morbid FM is associated with higher disease activity, worse quality of life (QoL) and poorer response to TNF inhibitors (TNFis) in patients with axial SpA. Methods: A prospective study recruiting across 83 centres in the UK. Clinical information and patient-reported measures were available, including 2011 criteria for FM. Multivariable linear regression was used to model the effect of meeting the FM criteria on disease activity, QoL and response to TNFis. Results: A total of 1757 participants were eligible for analyses, of whom 22.1% met criteria for FM. Those with co-morbid FM criteria had higher disease activity [BASDAI average difference FM+ - FM- 1.04 (95% CI 0.75, 1.33)] and worse QoL [Ankylosing Spondylitis Quality of Life score difference 1.42 (95% CI 0.88, 1.96)] after adjusting for demographic, clinical and lifestyle factors. Among 291 participants who commenced biologic therapy, BASDAI scores in those with co-morbid FM were 2.0 higher at baseline but decreased to 1.1 higher at 12 months. There was no significant difference in the likelihood of meeting Assessment of SpondyloArthritis international Society 20 criteria at 12 months. Less improvement in disease activity and QoL over 3 months of TNFi therapy was most strongly related to high scores on the FM criteria symptom severity scale component. Conclusion: Fulfilling criteria for FM has a modest impact on the assessment of axial SpA disease activity and QoL and does not significantly influence response to biologic therapy. Those with a high symptom severity scale on FM assessment may benefit from additional specific management for FM.

19 Article Two-year retention rate of golimumab in rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: data from the LORHEN registry. 2017

Manara, Maria / Caporali, Roberto / Favalli, Ennio G / Grosso, Vittorio / Atzeni, Fabiola / Sarzi Puttini, Piercarlo / Gorla, Roberto / Bazzani, Chiara / Fusaro, Enrico / Pellerito, Raffaele / Rocchetta, Pier Andrea / Sinigaglia, Luigi. ·Department of Rheumatology, Gaetano Pini Institute, Milan, Italy. maria.manara@gmail.com. · Department of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. · Department of Rheumatology, Gaetano Pini Institute, Milan, Italy. · Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. · Rheumatology and Immunology Unit, Spedali Civili, Brescia, Italy. · Department of Rheumatology, Città della Salute e della Scienza, Torino, Italy. · Rheumatology Unit, Ospedale Mauriziano, Torino, Italy. · Rheumatology Unit, A.S.O. «SS.Antonio e Biagio e C.Arrigo», Alessandria, Italy. ·Clin Exp Rheumatol · Pubmed #28770712.

ABSTRACT: OBJECTIVES: We aimed to provide data on golimumab real-life use in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) from a multicentre observational registry of Northern Italy. METHODS: We extracted data of patients who started treatment with golimumab from October 2010, and who had at least one follow-up visit. Data were analysed until a maximum follow-up of 24 months. The two-year retention rate in the three diseases was assessed with Kaplan-Meier estimators. To compare crude survival between diagnoses and lines of treatment we used the log-rank test, while Cox proportional hazard models were used to adjust for confounders. RESULTS: Overall, 410 subjects were included: 180 patients with RA, 110 with PsA and 120 with AS. The two-year retention rate of patients with RA was 47.3%, 48% for PsA, and 62.8% for AS. Crude survival on treatment of patients with AS was significantly higher than that of RA patients (p=0.032), while no significant difference was found between AS and PsA and between RA and PsA. In patients with RA, subjects treated with concomitant sDMARDs showed a lower discontinuation rate than those receiving golimumab alone. The comparison between first and second line of treatment groups did not show any significant difference in mean survival time in patients with RA, PsA and AS. CONCLUSIONS: This is the first report of real-life data on two-year survival on treatment with golimumab in RA, PsA and AS. Golimumab showed a similar retention rate when given as first or second line of treatment.

20 Article Co-Occurrence and Characteristics of Patients With Axial Spondyloarthritis Who Meet Criteria for Fibromyalgia: Results From a UK National Register. 2017

Macfarlane, Gary J / Barnish, Maxwell S / Pathan, Ejaz / Martin, Kathryn R / Haywood, Kirstie L / Siebert, Stefan / Packham, Jonathan / Atzeni, Fabiola / Jones, Gareth T. ·University of Aberdeen, Aberdeen, UK. · University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, UK. · University of Warwick, Warwick, UK. · University of Glasgow, Glasgow, UK. · Keele University, Keele, UK. · L. Sacco University Hospital, Milan, Italy. ·Arthritis Rheumatol · Pubmed #28622461.

ABSTRACT: OBJECTIVE: To estimate the proportion of patients with axial spondyloarthritis (SpA) in a UK national biologics registry who met criteria for fibromyalgia (FM), and to delineate the characteristics of these patients. METHODS: Two cohorts of patients are prospectively recruited from across 83 centers in the UK for the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis (BSRBR-AS). All patients are required to meet Assessment of SpondyloArthritis international Society (ASAS) criteria for axial SpA. Patients are either newly starting biologic therapy (biologics cohort) or are naive to treatment with biologic agents (non-biologics cohort) at the time of recruitment, and all patients are followed up prospectively. At recruitment and follow-up, clinical information and measurements are recorded while patients complete the 2011 research criteria for FM and assessments of the level of disease activity and work impact. RESULTS: Of the patients registered in the BSRBR-AS, 1,504 (68% male) were eligible for the current analysis, of whom 311 (20.7%) met the 2011 research criteria for FM. Prevalence of FM was similar between patients who fulfilled the modified New York criteria for AS (19.7%) and those who fulfilled ASAS imaging criteria but not the modified New York criteria (25.2%); however, among those who fulfilled only the ASAS clinical criteria, the prevalence of FM was lower (9.5%). Patients who met FM criteria reported significantly worse disease activity, function, global severity scores, and quality of life, and were more likely to have moderate or severe levels of mood disorder and clinically important fatigue. Patients who met FM criteria reported experiencing work impairment around half their working time. Meeting FM criteria was not related to elevated C-reactive protein levels or most extraspinal manifestations, but was associated with a higher likelihood of having received biologic therapy. CONCLUSION: Developing management approaches that would address the significant unmet clinical needs of the 1 in 5 patients with axial SpA who meet criteria for FM should be a research priority.

21 Article Disease Severity in Never Smokers, Ex-Smokers, and Current Smokers With Axial Spondyloarthritis: Results From the Scotland Registry for Ankylosing Spondylitis. 2017

Jones, Gareth T / Ratz, Tiara / Dean, Linda E / Macfarlane, Gary J / Atzeni, Fabiola. ·University of Aberdeen, Aberdeen, UK. · University of Aberdeen, Aberdeen, UK, and University of Bremen, Bremen, Germany. · University of Aberdeen, Aberdeen, UK, and L. Sacco University Hospital, Milan, Italy. ·Arthritis Care Res (Hoboken) · Pubmed #27899002.

ABSTRACT: OBJECTIVE: To examine the relationship between smoking, smoking cessation, and disease characteristics and quality of life (QoL) in spondyloarthritis. METHODS: The Scotland Registry for Ankylosing Spondylitis collects data from clinically diagnosed patients with spondyloarthritis. Clinical data, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) scores, were obtained from medical records. Mailed questionnaires contained information on smoking status and QoL (Ankylosing Spondylitis QoL questionnaire [ASQoL]). Linear and logistic regression were used to quantify the effect of smoking, and smoking cessation, on various disease-specific and QoL outcomes, with adjustments for age, sex, deprivation, education level, and alcohol use. Results are presented as regression coefficients (β) or odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Data were obtained from 946 participants (73.5% male, mean age 52 years). Current smoking was reported by 22%, and 38% were ex-smokers. Ever smokers had poorer BASDAI (β = 0.5 [95% CI 0.2, 0.9]) and BASFI scores (β = 0.8 [95% CI 0.4, 1.2]), and reported worse QoL (ASQoL β = 1.5 [95% CI 0.7, 2.3]). Compared to current smokers, ex-smokers reported less disease activity (BASDAI β = -0.5 [95% CI -1.0, -0.04]) and significantly better QoL (ASQoL β = -1.2 [95% CI -2.3, -0.2]). They also were more likely to have a history of uveitis (OR 2.4 [95% CI 1.5, 3.8]). CONCLUSION: Smokers with spondyloarthritis experience worse disease than those who are never smokers. However, this study provides new evidence that, among smokers, smoking cessation is associated with lower disease activity and better physical function and QoL. Clinicians should specifically promote smoking cessation as an adjunct to usual therapy in patients with spondyloarthritis.

22 Article Safety, efficacy and immunogenicity of switching from innovator to biosimilar infliximab in patients with spondyloarthritis: a 6-month real-life observational study. 2017

Benucci, Maurizio / Gobbi, Francesca Li / Bandinelli, Francesca / Damiani, Arianna / Infantino, Maria / Grossi, Valentina / Manfredi, Mariangela / Parisi, Simone / Fusaro, Enrico / Batticciotto, Alberto / Sarzi-Puttini, Piercarlo / Atzeni, Fabiola / Meacci, Francesca. ·Rheumatology Unit, Azienda Sanitaria di Firenze, S. Giovanni di Dio Hospital, Via Torregalli 3, 50143, Florence, Italy. maubenucci@tiscali.it. · Rheumatology Unit, Azienda Sanitaria di Firenze, S. Giovanni di Dio Hospital, Via Torregalli 3, 50143, Florence, Italy. · Allergology and Immunology Laboratory, S.Giovanni di Dio Hospital, Florence, Italy. · Rheumatology Unit, Città della Salute e della Scienza di Torino University Hospital, Turin, Italy. · Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. ·Immunol Res · Pubmed #27449503.

ABSTRACT: Biosimilar infliximab (INX) was recently approved by the European Medicine Agency for the treatment of rheumatoid arthritis, ankylosing spondylitis (AS), Crohn's disease, ulcerative colitis, psoriatic arthritis (PsA), and psoriasis on the grounds that its pharmacokinetics, safety, and efficacy were comparable to those of innovator INX. The aim of this study was to investigate the real-life efficacy, safety, and immunogenicity of switching from innovator to biosimilar INX in patients with spondyloarthritis (SpA). Forty-one patients attending three Italian rheumatology centres with a previous diagnosis of SpA and clinically inactive or moderate disease activity (ASDAS-CRP < 2.1; 22 with AS, five with enteropathic arthritis, 10 with PsA, and four with undifferentiated SpA), who had been treated for more than 6 months with innovator INX in accordance with the ASAS/EULAR guidelines, were switched to biosimilar INX for pharmaco-economic reasons (Tuscany Law No. 450 of 7 April 2015) and followed up for 6 months. A record was kept of their BASDAI, BASFI, ASDAS-CRP, DAS28-CRP (in the presence of peripheral disease), MASES, VAS pain scores, the duration of morning stiffness, and adverse events (AEs). At the time of the switch, the patients had a median age of 50.9 years (range 23-80), a median disease duration of 124.5 months (range 14-372), and a median duration of treatment with innovator INX of 73.7 months (range 6-144). After 6 months of biosimilar INX therapy, there were no statistical differences in their median BASDAI (2.73 ± 1.5 vs. 2.6 ± 1.3, p = .27), BASFI (2.34 ± 1.3 vs. 2.17 ± 1.2, p = 0.051), ASDAS-CRP (1.35 ± 0.3 vs. 1.28 ± 0.2, p = 0.24), DAS28-CRP (2.66 ± 0.67 vs. 2.67 ± 0.35, p = 0.92), MASES (0.35 ± 0.7 vs. 0.17 ± 0.4, p = 0.08), or VAS pain scores (18 ± 14.7 vs. 16.7 ± 11.3, p = 0.55), whereas the median duration of morning stiffness had significantly decreased (7.2 ± 6.9 vs. 5.8 ± 6, p = 0.02). Furthermore, there was no change in circulating INX (4.22 ± 2.89 vs 4.84 ± 2.86 μg/mL, p = 0.80) or anti-INX antibody levels (27.76 ± 17.13 vs 27.27 ± 17.28 ng/mL, p = 0.98). The switch from innovator to biosimilar INX in this Italian multicentre SpA cohort was not associated with any statistically significance differences in efficacy, adverse events or anti-drug antibody level.

23 Article A Proposed Serum Calprotectin IgG Cut-Off Level for Diagnosing Inflammatory Arthritis. 2017

Grossi, Valentina / Infantino, Maria / Manfredi, Mariangela / Meacci, Francesca / Bellio, Emanuele / Bellio, Valerio / Gobbi, Francesca Li / Ugolini, Simone / Catani, Stefano / Sarzi-Puttini, Piercarlo / Atzeni, Fabiola / Benucci, Maurizio. ·Immunology and Allergology Laboratory Unit, San Giovanni di Dio Hospital, Via Torregalli 3, 50143 Florence, Italy. · Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Florence, Italy. · Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy. · Eurospital SpA, Trieste, Italy. · Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. · IRCCS Galeazzi Orthopedic Institute, Milan, Italy. ·Curr Rheumatol Rev · Pubmed #27363504.

ABSTRACT: BACKGROUND: The identification and validation of soluble markers provide significant opportunities for managing patients with rheumatic diseases, and calprotectin may be an alternative laboratory biomarker of inflammatory rheumatoid arthritis (RA) and psoriatic arthritis (PsA) even though its levels may vary considerably. The aim of this study was to propose a calprotectin cut-off value that would be useful for distinguishing patients with inflammatory arthritis or noninflammatory arthritis (NIA) in clinical practice. METHODS: A commercial enzyme-linked immunosorbent assay was used to measure serum calprotectin levels in patients with RA, ankylosing spondylitis (AS), PsA and controls with NIA. All of the patients had been treated with biological disease-modifying anti-rheumatic drugs (DMARDs) for about 12 months after previous failure on conventional DMARDs. RESULTS: Receiver operating characteristic (ROC) analysis showed that serum calprotectin levels significantly differentiated the samples of the patients with inflammatory rheumatic disease from those of the controls. A serum calprotectin level of > 0.9 μg/mL (the optimal predictive cut-off value in the ROC analysis) had a sensitivity of 95.3%, a specificity of 82.2%, a positive likelihood ratio (LR) of 5.35 and a negative LR of 0.057. CONCLUSIONS: Our findings suggest that serum calprotectin levels are useful in clinical practice to distinguish patients with inflammatory arthritis and NIA. Further studies of a larger population are suggested.

24 Article New biological treatments for psoriatic arthritis. 2014

Sarzi-Puttini, Piercarlo / Atzeni, Fabiola. · ·Isr Med Assoc J · Pubmed #25438457.

ABSTRACT: -- No abstract --

25 Article Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. 2014

Salaffi, Fausto / De Angelis, Rossella / Carotti, Marina / Gutierrez, Marwin / Sarzi-Puttini, Piercarlo / Atzeni, Fabiola. ·Department of Rheumatology, Polytechnic University of Marche, Ospedale "Carlo Urbani", Via dei Colli 52, 60035, Jesi, Ancona, Italy. ·Rheumatol Int · Pubmed #24509896.

ABSTRACT: To determine the prevalence of fibromyalgia (FM) in patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) characterized by axial involvement (axial-PsA), and to assess the discriminative ability of different versions of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) in measuring disease activity in three different cohorts of patients with axial spondyloarthritis (axial-SpA), FM, or both (axial-SpA + FM), this study was divided into two phases: (1) 402 patients with definite AS or axial-PsA were examined to diagnose FM and estimate its prevalence; and (2) 419 patients (111 with axial-SpA, 248 with FM, and 60 with aSpA + FM) were evaluated using the different versions of the ASDAS and BASDAI to assess the effect on disease activity. The overall prevalence of FM in the axial-SpA population was 14.9 %, significantly higher among women (p < 0.0001); the estimated prevalence in AS was 12.7 % and in axial-PsA was 17.2 %. Although the BASDAI scores correlated with those of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) (p < 0.0001), only ASDAS had sufficient discriminatory ability to assess disease activity. The addition of only one marker of inflammation led to an adequate level of significance (ASDAS-CRP, p = 0.0018; ASDAS-ESR, p = 0.003). FM is common in axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS is better than BASDAI in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.

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