- http://www.univpm.it/michele.maria.luchetti
https://www.researchgate.net/profile/Michele_Luchetti
- 1993-1996. Medical Hospital Doctor in the Emergency Room Department, “Umberto I - Torrette”, University Clinic Region... more1993-1996. Medical Hospital Doctor in the Emergency Room Department, “Umberto I - Torrette”, University Clinic Regional Hospital, Ancona, Italy.
1996-2004. Medical Hospital Doctor in the Department of Internal Medicine, Institute of Internal Medicine, Haematology and Clinical Immunology, “Umberto I - Torrette”, University Clinic Regional Hospital, Ancona, Italy.
2005 to present. Assistant Professor in Internal Medicine, Institute of Internal Medicine, Institute of Internal Medicine, Dept. of Medical and Surgical Sciences, University Clinic Regional Hospital “Umberto I - Torrette”, Ancona, Italy.
Since 1993 he has had a permanent position as Medical Hospital Doctor in the Emergency Room Department, and thereafter since 1996 he has got a tenure as Medical Hospital Doctor in the Department of Internal Medicine of the same Hospital.
In these years he has been in charge of :
- Out-patients examination clinic of Internal Medicine and Rheumatology;
- Internal Medicine and Rheumatology Senior Consultant Referee Physician for all the in-patients of the “Umberto I–G. Lancisi-G.M.Salesi”, University Clinic Regional Hospital, Ancona, Italy and of other important hospitals of the same region, such as the Cardiology Hospital and Paediatric & Gynaecologic Hospital of Ancona, Italy.
2012. MD in Charge for the Medical Area of the PEIMAF for the organization of the medical activities of the “Umberto I–G. Lancisi-G.M.Salesi”, University Clinic Regional Hospital, Ancona, Italy, in case of a massive admissions of injured patients.
Since 2013 to present. Head of the out-patients’ examination clinic of Gastro-Rheumatologic, IBD UNIT, “Umberto I–G. Lancisi-G.M.Salesi”, University Clinic Regional Hospital, Ancona, Italy
Since 2013 to present. Head of the out-patients’ examination clinic of Dermo-Rheumatologic, “Umberto I–G. Lancisi-G.M.Salesi”, University Clinic Regional Hospital, Ancona, Italyedit
Systemic sclerosis (scleroderma) is a complex disease characterized by excessive deposition of collagen and abnormalities of blood vessels. In addition, activation of the immune system is a central feature of scleroderma as shown by... more
Systemic sclerosis (scleroderma) is a complex disease characterized by excessive deposition of collagen and abnormalities of blood vessels. In addition, activation of the immune system is a central feature of scleroderma as shown by mononuclear cell infiltration of the skin, autoantibody production and release of inflammatory cytokines. The pathogenesis of the disease is poorly understood and the molecular events underlying the main clinical features are not known. The detection of agonistic autoantibodies targeting PDGF receptor in serum of patients with scleroderma may indicate a novel link between phenotypic features of the disease and a specific signalling pathway. Agonistic PDGF receptor antibodies induce in vitro the scleroderma phenotype in normal human fibroblasts and, thus, link autoimmunity to fibrosis. These findings pave the way to novel therapeutic strategies.
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OBJECTIVES To investigate the diagnostic performance of dual-energy computed tomography (DECT) in detection bone marrow oedema (BME) in patients with sacroiliitis associated with axial spondyloarthritis (axial SpA). METHODS Patients with... more
OBJECTIVES To investigate the diagnostic performance of dual-energy computed tomography (DECT) in detection bone marrow oedema (BME) in patients with sacroiliitis associated with axial spondyloarthritis (axial SpA). METHODS Patients with axial SpA according to the ASAS criteria underwent DECT and 1.5-T magnetic resonance imaging (MRI). DECT was post-processed for generating virtual non-calcium (VNCa) images. The presence of abnormal bone marrow attenuation was scored on DECT VNCa images and MRI using a four-point classification system: 0-1 = absent or non-significant oedema, 2 = oedema present in a third of the articular surface, 3 = oedema present in 2/3 of the articular surface, 4 = diffuse oedema throughout the articular surface. Diagnostic accuracy values for BME were calculated for DECT images (quantitative assessment) by using receiver operating characteristic (ROC) curves analysis, applying MRI as gold standard. RESULTS Eighty sacroiliac joints from 40 axial SpA patients were included for study analysis, and 36 sacroiliac joints (45%) were classified as having BME at MRI and compared to DECT. Sensitivity, specificity, and positive likelihood ratio (LR+) in the identification of BME at DECT were 90.0%, 92.8%, and 12.6 respectively. Negative LR was 0.11, positive predictive value 93.1%, and negative predictive value 89.7%. The area under the curve (AUC) was 0.953 in the differentiation of the presence of BME. A cut-off value of -1.6 HU (Youden's index = 0.828) yielded a sensitivity of 90.0% and specificity of 92.8%, with an LR+ of 12.6, in the detection of BME in the sacroiliac joints. CONCLUSIONS DECT VNCa images had good diagnostic performance in the evaluation of the extent of BME in patients with sacroiliitis associated with axial SpA.
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ABSTRACT Introduction Spondyloarthropathies (SpA) are a group of inflammatory arthritis that can involve the spine and/or peripheral joints. Extra-articular manifestations, such as inflammatory bowel disease (IBD), are frequently observed... more
ABSTRACT Introduction Spondyloarthropathies (SpA) are a group of inflammatory arthritis that can involve the spine and/or peripheral joints. Extra-articular manifestations, such as inflammatory bowel disease (IBD), are frequently observed within the clinical manifestations of SpA and are part of the SpA classification criteria. Evidence of IBD is observed in about 6–7% of SpA patients, and a silent, microscopic gut inflammation, could be present in up to 50% of patients. From a pathogenetic point of view, dysregulated microbiome and migration of T lymphocytes and other cells from gut to the joint (‘gut-joint’ axis) has been recognized, in the context of a common genetic background. Areas covered The aim of this paper is to narratively review the recent evidences on the epidemiology, classification, clinical findings, pathogenesis, diagnosis, and treatment of IBD in patients with SpA and to provide advices for both rheumatologist and gastroenterologist in the management of IBD in SpA. Expert opinion IBD manifestations in SpA frequently increase the burden of the disease and represent a clinical challenge, especially for the diagnosis, assessment, and treatment of patients affected by those conditions. New treatment strategies targeting both articular and intestinal manifestations are now available and may lead to a better outcome.
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Background Experimental data are consistent with the hypothesis that activation of the PDGF receptor (PDGFR) is characteristic of scleroderma (SSc) fibroblasts and may contribute to their activation. We have recently demonstrated that... more
Background Experimental data are consistent with the hypothesis that activation of the PDGF receptor (PDGFR) is characteristic of scleroderma (SSc) fibroblasts and may contribute to their activation. We have recently demonstrated that fibroblasts from SSc patients contain high Ha Ras and ROS (Reactive Oxygen Species) levels and constitutive activation of ERK1/2 (Svegliati et al: JBC in press). Furthermore, SSc patients have circulating auto-antibodies against the PDGFR which induce type I collagen gene expression in normal human fibroblasts through the Ha Ras-ERK1/2- ROS pathway (Svegliati et al: Submitted). These findings suggest that anti PDGFR auto-antibodies play a pivotal role in the pathogenesis of scleroderma. Clinical chronic graft-versus-host disease (cGVHD) can show manifestations that are very similar to those of SSc. Although it is conceivable that the two diseases can share a similar pathophysiological mechanism there are no data supporting this assumption. In view of these considerations we tested the hypothesis that patients with cGVHD have serum auto-antibodies that stimulate PDGFR and activate collagen gene expression in fibroblasts. Methods Serum from 7 patients with extensive cGVHD showing scleroderma-like features either in the skin or in the lung was analyzed for the presence of stimulatory autoantibodies to PDGFR. Patients receiving allogeneic transplantation, but without any signs of cGVHD were used as controls. The median F-U after transplant was 23 months (range 16–36) in patients with cGVH and 42 (range 9–51) in the control group. The assay was carried by incubating purified IgG of the patients with mouse embryo fibroblasts carrying inactive copies of PDGFR α or β chains (PDGFR −/−) or the same cells expressing PDGFR α or β, respectively. Production of reactive oxygen species was assayed in the presence or absence of specific PDGFR inhibitors. The antibodies were characterized by immunoprecipitation, immunoblotting and absorption experiments in primary human fibroblasts and endothelial cells. Result Stimulatory antibodies to the PDGFR were selectively found in all patients with cGVHD and fibrotic lesions. The antibodies specifically recognized PDGFR, induced tyrosine phosphorylation and ROS accumulation. Their activity was completely and selectively abolished by pre-incubation with cells expressing PDGFR α or β chains or by PDGF receptor tyrosine kinase inhibitor. Anti-PDGFR antibodies induced selectively Ha-Ras-ERK1/2 and ROS cascade and stimulated the expression of type I collagen gene and myofibroblast phenotype conversion in normal human primary fibroblasts. Antibodies were absent in all controls. Conclusions Stimulatory auto-antibodies against PDGFR represent a specific hallmark of patients with cGVHD. Their biological activity on fibroblasts strongly argues for a causal role in the pathogenesis of the disease.
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Research Interests: Complementary and Alternative Medicine, Rheumatoid Arthritis, Medicine, Humans, Animals, and 14 moreMonoclonal Antibodies, Clinical Sciences, Rituximab, Tumor necrosis factor-alpha, Anakinra, Adalimumab, Etanercept, Infliximab, Tocilizumab, biological therapy, Secukinumab, Pharmacology and pharmaceutical sciences, Inflammation Mediators, and Ustekinumab
Research Interests: Gene expression, Humans, Autoimmune diseases, Collagen, Female, and 15 moreAnimals, Blood, Fibrosis, Clinical Sciences, Aged, Fibroblast, Antibody, Adult, Connective Tissue Disease, Human Fibroblasts, Biological Assay, Autoantibodies, Case Control Studies, fibroblasts, and Cardiovascular medicine and haematology
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Research Interests: Gastroenterology, Integrated assessment, Medicine, Inflammatory Bowel Disease, Internal Medicine, and 11 moreDiagnosis, Patient Reported Outcomes, Clinimetrics, Cohort, Ankylosing Spondylitis, Clinical Sciences, Spondyloarthritis, Observational Study, Inflammatory Bowel Diseases, Adalimumab, and Infliximab
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BackgroundPsoriatic arthritis (PsA) is a chronic systemic inflammatory musculoskeletal disease whose heterogeneous manifestations are classified in multiple domains; moreover, PsA negatively influence many comorbid diseases.[1]As growing... more
BackgroundPsoriatic arthritis (PsA) is a chronic systemic inflammatory musculoskeletal disease whose heterogeneous manifestations are classified in multiple domains; moreover, PsA negatively influence many comorbid diseases.[1]As growing evidence suggests, it is important to research drugs active on multiple domains, trying to target therapy for every PsA manifestations.Upadacitinib (UPA) is a selective JAK inhibitor effective in many PsA domains according to randomized controlled trials.[2]However, real-world data on UPA performance in everyday clinical practice are currently lacking.ObjectivesThis observational study aims to evaluate real-life efficacy and safety of UPA in the treatment of PsA in a large multicentre cohort.Secondary objectives are:a.to obtain the ideal patient profile for UPA therapy;b.to stratify clinimetric and laboratoristic responses according to patient manifestation and comorbidities.MethodsPatients with either peripheral and/or axial PsA, classified accordi...
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Objective.Spondyloarthritis (SpA) is among the most frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). In this study, we aimed to validate the DETection of Arthritis in Inflammatory boweL diseases (DETAIL)... more
Objective.Spondyloarthritis (SpA) is among the most frequent extraintestinal manifestations of inflammatory bowel diseases (IBD). In this study, we aimed to validate the DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire in a multicenter cohort of patients with IBD enrolled at 11 gastroenterology units.Methods.From October 2018 to March 2019, consecutive adult patients with IBD, either Crohn disease or ulcerative colitis, independently filled out the DETAIL questionnaire in the outpatient waiting room. Within 2 weeks a blinded rheumatologist assessed all the patients, irrespective of the DETAIL results, and classified them to be affected or not by SpA. The performance of the questions was evaluated through Bayesian analysis.Results.Overall, 418 patients with IBD filled out the DETAIL questionnaire. Upon rheumatological evaluation, 102 (24.4%) patients received a diagnosis of SpA. Of the 6 questions, the best performances were found in question 6 [positive l...
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Background:Limited data on early Psoriatic Arthritis (PsA) are available1,2.Objectives:To describe baseline data of PsA patients naive to any DMARDs.Methods:SIRENA study is an Italian, prospective Registry of Spondyloarthritis patients... more
Background:Limited data on early Psoriatic Arthritis (PsA) are available1,2.Objectives:To describe baseline data of PsA patients naive to any DMARDs.Methods:SIRENA study is an Italian, prospective Registry of Spondyloarthritis patients diagnosed according to ASAS criteria and naïve to any DMARDs. Data on demographic and clinical characteristics of PsA cohort were collected and analysed, also by gender.Results:203/350 (58%) subjects included in SIRENA Registry had PsA (mean age 51.9 years) and in 190/203 (94%) CASPAR classification criteria were fulfilled. In 70% of patients the diagnosis was performed within 24 months from symptom onset. At baseline, 194/203 (95.6%) had mainly peripheral manifestations, 74.4% of patients had skin psoriasis, 40% nail psoriasis, 39.3% clinical enthesitis and 25.9% dactylitis. Mean SJC66 and TJC68 were, respectively, 3 and 7.2; mean PhGA was 46.3; 14.7% of patients were in MDA.The higher tender joint count in women (mean TJC68 9.3 in women vs 5.3 in me...
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<p>Correlation analysis between the change in plasma fHb (X axis) and changes in: (A) total small vessel density, (B) perfused vessel density, (C) De Backer score, (D) tissue haemoglobin index, (E) tissue oxygen saturation (Y... more
<p>Correlation analysis between the change in plasma fHb (X axis) and changes in: (A) total small vessel density, (B) perfused vessel density, (C) De Backer score, (D) tissue haemoglobin index, (E) tissue oxygen saturation (Y axis).</p
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Introduction: Data about the clinical presentation and management of early and mild spondyloarthritis (SpA) are limited.Objectives: The objective of this study was to describe the baseline characteristics of disease-modifying... more
Introduction: Data about the clinical presentation and management of early and mild spondyloarthritis (SpA) are limited.Objectives: The objective of this study was to describe the baseline characteristics of disease-modifying antirheumatic drug (DMARD)-naïve patients with axial or peripheral SpA.Methods: The Spondyloarthritis Italian Registry: Evidence from a National Pathway (SIRENA) study is an ongoing, Italian, multicenter, prospective registry of patients with a first or newly confirmed diagnosis of SpA according to the Assessment of SpondyloArthritis International Society (ASAS) criteria. To be included, patients had to be naïve to conventional, targeted, and biological DMARDs for SpA. Patients were enrolled between June 2017 and June 2019 and classified into groups according to disease presentation: predominantly axial or peripheral manifestations. The study is ongoing, and patients are being followed for 2 years, with an evaluation every 6 months according to clinical practic...
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Objective.To evaluate the prevalence and factors associated with the neuropathic pain features in a cohort of patients with psoriatic arthritis (PsA).Methods.A cross-sectional evaluation was conducted in consecutive patients having PsA... more
Objective.To evaluate the prevalence and factors associated with the neuropathic pain features in a cohort of patients with psoriatic arthritis (PsA).Methods.A cross-sectional evaluation was conducted in consecutive patients having PsA with prevalent peripheral joint involvement, referred to 3 rheumatological centers. For each patient, a comprehensive assessment of disease activity, physical function, and disease effect was carried out. The presence of comorbid fibromyalgia syndrome (FMS) was evaluated. Acute-phase reactants were also recorded. The neuropathic pain features were investigated through the PainDETECT Questionnaire (PDQ). A logistic regression analysis was therefore conducted using the PDQ as the dependent variable.Results.The final evaluation included 118 patients. A comorbid FMS was detectable in 30 of the 118 patients with PsA (25.4%). Probable characteristics of neuropathic pain (PDQ ≥ 19) were found in 30 (25.4%) patients overall, ambiguous (PDQ > 12 and < 19...
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An important applications of the Dual energy computed tomography DECT in the field of musculoskeletal radiology is the detection of bone marrow edema (BME), using a post-processing software to remove calcium in trabecular bone by using a... more
An important applications of the Dual energy computed tomography DECT in the field of musculoskeletal radiology is the detection of bone marrow edema (BME), using a post-processing software to remove calcium in trabecular bone by using a “virtual non-calcium (VNCa)” subtraction process DECT have been successfully employed in the evaluation of the extent of BME in patients with sacroiliitis (1)The aims of this study were i)to evaluate the discriminating capacity of DECT versus MRI in the detection of BME of the sacroiliac joints in patients with axial-SpA and to define the optimal cutoff; ii) to define of inter-observer agreement between radiologistsAll patients underwent a pelvic DECT examination, within 30 days of the MRI imaging, (Somatom Force; Siemens Healthineers, Enlangen, Germany). Each exam was evaluated by two operators: an experienced radiologist and a radiologist in training. The dedicated software also allows the precise calculation of the attenuation values in the region of interest (ROI). On the reformatted color-coded dual-energy virtual non-calcium images bone marrow signal is depicted in green and corresponding to high signal intensity on T2-weighted fat suppression MR images (Fig. 1). With the consent of the two operators, three ROIs were manually positioned for each side of the sacroiliac joints in the subchondral region of the proximal, middle and distal thirds of each joint head, respectively. The interobserver agreement analysis was carried out in the semi-quantitative evaluation of the scores assigned in CT. The accuracy of DECT for the detection of BME compared to MRI was analyzed using the Receiver Operating Characteristics (ROC) curve methodFigure 1.Patient with SpA A. Short tau inversion recovery MR image demonstrating extensive BME in both iliac and sacral subchondral bone, indicating active sacroiliitis. B. CT Semicoronal multiplanar reformatted grayscale image shows signs of structural change. C. Semicoronal multiplanar reformatted color-coded dual-energyVNCaimage reveals bone marrow signal involving both sacroliliac joints, corresponds toBMEon the MR image56 axial-SpA patients have been evaluated, 30 males and 26 females, a mean age of 48.6 ± 12.3 years, a mean disease duration of 5.5 ± 2.9 years, a mean C-reactive protein level of 3.0 ± 2.5 mg/dl. The inter-rater agreement of readers showed a high statistical significance greater than 0.80, in particular the weighted kappa is 0.815, with a standard error of 0.04 and a 95% variability coefficient between 0.73 and 0.89. Sensitivity, specificity, and positive likelihood ratio in the identification of BME at DECT were 95.8%, 83.3% and 6.67, respectively. The differences in mean CT number (HU) among the four levels of edema category were significant (p<0.0001). The AUC was 0.905 in the differentiation of the presence of BME from no edema (Fig. 2). A cutoff value of –14.8 HU yielded overall sensitivity of 82.86% and specificity of 90.48%, with an LR+ of 8.70, in the detection of BMEFigure 2.Graph shows ROC curves from CT numbers (in Hounsfield units) derived from DECT images in the detection of sacroiliitis with and without BME. AUC was 0.905We confirm the potential of DECT for the detection of BME of the sacroiliac joints in patients affected by SpA. This new method appears to be very useful, not only in the diagnostic phase, but also for the monitoring of patients.[1]Carotti M, Salaffi F, Beci G, Giovagnoni A. The application of dual-energy computed tomography in the diagnosis of musculoskeletal disorders: a review of current concepts and applications. Radiol Med. 2019;124(11):1175-1183.None declared
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Objectives Gut microbiota has been widely reported to be involved in systemic inflammation through microbial translocation and T cell activation in several diseases. In this work we aimed to investigate bacterial infiltration and... more
Objectives Gut microbiota has been widely reported to be involved in systemic inflammation through microbial translocation and T cell activation in several diseases. In this work we aimed to investigate bacterial infiltration and epithelial impairment in the gut of patients with IBD-associated SpA (SpA-IBD), as well as the relationship of microbial translocation with immune system activation and their putative role in the pathogenesis of joint inflammation in IBD patients. Methods Tight-junction proteins (TJPs) occludin and claudin-1/-4 and bacteria were assessed by real-time PCR analysis and immunohistochemical staining of the ileum. Intestinal fatty acid binding protein (I-FABP), lipopolysaccharides (LPS), soluble CD14 (sCD14), sclerostin and anti-sclerostin antibodies (anti-sclerostin-IgG) were assayed with ELISAs and peripheral mononuclear blood cells with flow cytometry. LPS and sCD14 were used in vitro to stimulate a human osteoblast cell line. Results Compared with IBD, ileal...
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ObjectiveSeveral advanced therapies have been licensed across the related conditions of psoriatic arthritis (PsA), Crohn disease (CD), ulcerative colitis (UC), and noninfectious uveitis. We sought to summarize results from randomized... more
ObjectiveSeveral advanced therapies have been licensed across the related conditions of psoriatic arthritis (PsA), Crohn disease (CD), ulcerative colitis (UC), and noninfectious uveitis. We sought to summarize results from randomized controlled trials (RCTs) investigating the efficacy and safety of advanced therapies for these related conditions in patients with PsA.MethodsWe updated the previous systematic search conducted in 2013 with literature reviews of MEDLINE, Embase, and the Cochrane Library (from February 2013 to August 2020) on this subject; only those new studies are presented here. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.ResultsThe number of RCTs meeting eligibility criteria were 12 for CD, 15 for UC, and 5 for uveitis. The tumor necrosis factor inhibitor (TNFi) class appears to be efficacious and safe across CD, UC, and uveitis, with the exception of etanercept. Interleukin 12/23...
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Objective. To evaluate the prevalence and factors associated with the neuropathic pain features in a cohort of patients with psoriatic arthritis (PsA). Methods. A cross-sectional evaluation was conducted in consecutive patients suffering... more
Objective. To evaluate the prevalence and factors associated with the neuropathic pain features in a cohort of patients with psoriatic arthritis (PsA). Methods. A cross-sectional evaluation was conducted in consecutive patients suffering from PsA with prevalent peripheral joint involvement, referring to three rheumatological centers. For each patient a comprehensive assessment of disease activity, physical function, and disease impact was carried out. The presence of comorbid fibromyalgia syndrome (FMS) was evaluated. Acute phase reactants were also recorded. The neuropathic pain features were investigated through the PainDETECT Questionnaire (PDQ). A logistic regression analysis was therefore conducted using the PDQ as dependent variable. Results. The final evaluation included 118 patients. A comorbid FMS was detectable in 30 of the 118 PsA patients (25.4%). Probable characteristics of neuropathic pain (PDQ ≥19) were found in 30 (25.4%) patients overall, ambiguous (PDQ >12 and &...
Scleroderma is a chronic fibrotic disease which can affect skin and internal organs, such as lung and kidney, resulting in significant morbidity. Fibroblasts from lesional areas of scleroderma patients show excessive oxygen species... more
Scleroderma is a chronic fibrotic disease which can affect skin and internal organs, such as lung and kidney, resulting in significant morbidity. Fibroblasts from lesional areas of scleroderma patients show excessive oxygen species production, activated MERK/ERK cascade, and increased a-smooth muscle actin and type I collagen expression. Our group has identified stimulatory anti-PDGF receptor autoantibodies in the serum of scleroderma patients capable of converting normal fibroblasts into scleroderma-like cells. In this study, we want to investigate whether scleroderma autoantibodies are involved in other biological effects, such as matrix contraction, proliferation and migration and to assess whether these effects are mediated by PDGFR pathway. ABBREVIATIONS SSc: Scleroderma; N: Normal; Fbs: Fibroblasts; ECM: Extracellular Matrix; α-SMA: α-Smooth Muscle Actin INTRODUCTION Systemic sclerosis or scleroderma (SSc) is characterized by immunologic abnormalities, injury of endothelial ce...
In the last decades, the comprehension of the pathophysiology of bone metabolism and its interconnections with multiple homeostatic processes has been consistently expanded. The branch of osteoimmunology specifically investigating the... more
In the last decades, the comprehension of the pathophysiology of bone metabolism and its interconnections with multiple homeostatic processes has been consistently expanded. The branch of osteoimmunology specifically investigating the link between bone and immune system has been developed. Among molecular mediators potentially relevant in this field, vitamin D has been recently pointed out, and abnormalities of the vitamin D axis have been described in both in vitro and in vivo models of inflammatory bowel diseases (IBD) and arthritis. Furthermore, vitamin D deficiency has been reported in patients affected by IBD and chronic inflammatory arthritis, thus suggesting the intriguing possibility of impacting the disease activity by the administration vitamin D supplements. In the present review, the complex interwoven link between vitamin D signaling, gut barrier integrity, microbiota composition, and the immune system was examined. Potential clinical application exploiting vitamin D pa...
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Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune arthritis, occurring in patients with psoriasis (Pso), that may affect the whole musculoskeletal system but also nails, eye, and gastrointestinal tract. Dermatologists and... more
Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune arthritis, occurring in patients with psoriasis (Pso), that may affect the whole musculoskeletal system but also nails, eye, and gastrointestinal tract. Dermatologists and rheumatologists usually manage Pso and PsA separately, but early diagnosis and integrated management could achieve better outcomes of both skin and musculoskeletal manifestations, thus improving the health-related quality of life (HRQoL) of patients. In this work, we have described a model of integrated dermo-rheumatologic approach for the early diagnosis of PsA and to present the outcomes of the multidisciplinary management of PsA patients after 48 weeks of follow-up. Pso patients complaining musculoskeletal symptoms were enrolled in a DErmo-Rheumatologic Clinic (DERC) in order to screen, classify, and treat patients with PsA, employing an operative working procedure and a specific flowchart. The integrated dermatologic and rheumatologic management of...
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Biologic drugs, introduced in clinical practice almost twenty years ago, represent nowadays a prominent treatment option in patients with chronic inflammatory arthritis, such as Rheumatoid Arthritis, Psoriatic Arthritis and... more
Biologic drugs, introduced in clinical practice almost twenty years ago, represent nowadays a prominent treatment option in patients with chronic inflammatory arthritis, such as Rheumatoid Arthritis, Psoriatic Arthritis and Spondyloarthritis, that include ankylosing spondylitis and non-radiographic axial spondyloarthritis. Several compounds targeting different pathways have been marketed and approved for the treatment of inflammatory arthritis, with a significant impact on the clinical outcomes and the natural history of the diseases. There are currently seven classes of biologics that are available for the treatment of inflammatory arthritis, each inhibiting a different aspect of the immune-driven inflammatory pathway. They include: • Tumor Necrosis Factor (TNF) inhibitors (infliximab, adalimumab, etanercept, golimumab and certolizumab pegol); • Interleukin-1 (IL-1) receptor antagonists (anakinra); • Interleukin-6 (IL-6) inhibition (tocilizumab); • Interleukin-12/23 (IL23) inhibiti...
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The early diagnosis of inflammatory bowel disease (IBD)-associated spondyloarthritis (SpA/IBD) in patients affected by IBD represents a major topic in clinical practice; in particular, to date there are no available serum biomarkers... more
The early diagnosis of inflammatory bowel disease (IBD)-associated spondyloarthritis (SpA/IBD) in patients affected by IBD represents a major topic in clinical practice; in particular, to date there are no available serum biomarkers revealing the presence of joint inflammation in these patients. Sclerostin (SOST), an antagonist of the Wnt/β-catenin pathway, and antisclerostin-immunoglobulin G (anti-SOST-IgG) have been recently studied in patients with ankylosing spondylitis (AS) as a putative marker of disease activity. SOST and anti-SOST-IgG serum levels were assayed in 125 patients with IBD, 85 with axial or peripheral SpA, and in control groups (patients with AS and rheumatoid arthritis, and healthy individuals). The diagnostic performance in discriminating the presence of SpA/IBD was assessed for both candidate biomarkers. Patients affected by SpA/IBD with axial involvement displayed significantly lower levels of SOST and higher levels of anti-SOST-IgG compared to patients with ...
Research Interests: Immunology, Gastroenterology, Biomarkers, Medicine, Bone Morphogenetic Proteins, and 15 moreMultivariate Analysis, Antibodies, Inflammatory Bowel Disease, Prospective studies, Humans, Internal Medicine, Female, Male, Ankylosing Spondylitis, Clinical Sciences, Middle Aged, Adult, Genetic Markers, immunoglobulin G, and Inflammatory Bowel Diseases
To validate in a multicentric cohort of patients a self-administered PsA screening tool, called Simple Psoriatic Arthritis Screening (SiPAS) questionnaire, to screen psoriasis patients for signs and symptoms of PsA. The SiPAS... more
To validate in a multicentric cohort of patients a self-administered PsA screening tool, called Simple Psoriatic Arthritis Screening (SiPAS) questionnaire, to screen psoriasis patients for signs and symptoms of PsA. The SiPAS questionnaire was validated in a multicentric Italian cohort of psoriasis patients referred to two rheumatological centres. A total of 202 psoriasis patients were screened with SiPAS in the validation study. Sixty-two psoriasis patients (30.7%) were diagnosed with PsA. The five screening questions (1. Have you ever had a finger or a toe and/or another joint swollen and painful without any apparent reason?; 2. Occasionally, has an entire finger or toe become swollen, making it look like a 'sausage'?; 3. Do you wake up at night because of low back pain?; 4. Have you had pain in your heels?; 5. Has a doctor ever diagnosed you with psoriatic arthritis?) with a dichotomous response, demonstrated high sensitivity and specificity for predicting PsA. Likelihood...
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To report adalimumab (Ada) efficacy on articular-gastrointestinal disease and health-related quality of life (HRQoL) in patients with enteropathic spondyloarthritis (ES). A cohort of 52 patients with ES was evaluated in the departments of... more
To report adalimumab (Ada) efficacy on articular-gastrointestinal disease and health-related quality of life (HRQoL) in patients with enteropathic spondyloarthritis (ES). A cohort of 52 patients with ES was evaluated in the departments of gastroenterology and internal medicine. At baseline, all patients underwent assessment by an integrated gastro-rheumatologic evaluation of articular and gastrointestinal activity, as well patient reported outcomes (PROs) of the HRQoL questionnaires. After this integrated evaluation and following a specific working flowchart, the Ada anti-tumor necrosis factor (TNF)-inhibitor was assigned to a cohort of 30 patients and its clinical efficacy was evaluated at baseline and after 6-mo and 12-mo treatment by the following tests: (1) Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis M...
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BackgroundDysbiosis has been recently demonstrated in patients with ankylosing spondylitis (AS) but its implications in the modulation of intestinal immune responses have never been studied. The aim of this study was to investigate the... more
BackgroundDysbiosis has been recently demonstrated in patients with ankylosing spondylitis (AS) but its implications in the modulation of intestinal immune responses have never been studied. The aim of this study was to investigate the role of ileal bacteria in modulating local and systemic immune responses in AS.MethodsIleal biopsies were obtained from 50 HLA-B27+ patients with AS and 20 normal subjects. Silver stain was used to visualise bacteria. Ileal expression of tight and adherens junction proteins was investigated by TaqMan real-time (RT)-PCR and immunohistochemistry. Serum levels of lipopolysaccharide (LPS), LPS-binding protein (LPS-BP), intestinal fatty acid-BP (iFABP) and zonulin were assayed by ELISA. Monocyte immunological functions were studied in in vitro experiments. In addition the effects of antibiotics on tight junctions in human leukocyte antigen (HLA)-B27 transgenic (TG) rats were assessed.ResultsAdherent and invasive bacteria were observed in the gut of patient...