Rheumatoid Arthritis: Bazzichi L

Baldini C, Giusti L, Bazzichi L, Lucacchini A, Bombardieri S. · Department of Internal Medicine, Rheumatology Unit, University of Pisa, Via Roma 67, 56126 Pisa, Italy. · Autoimmun Rev. · Pubmed #18190876 No free full text.

Abstract: The clinical entity of secondary Sjögren's syndrome (SS) is controversial and the relationship with primary SS and other systemic autoimmune diseases is still far from being completely understood. In the last few years, proteomic approaches have been applied with a growing interest in the search for diagnostic biomarkers for many rheumatic diseases and it is possible that, in the near future, proteomic analysis of human saliva could help in distinguishing also primary from secondary SS. This review summarizes the state of the art of proteomic analysis of human saliva in the diagnosis of connective diseases focusing its advantages, limits and future perspectives.

Giusti L, Baldini C, Bazzichi L, Bombardieri S, Lucacchini A. · University of Pisa, Department of Psychiatry, Neurobiology, Pharmacology & Biotechnology, Via Bonanno 6, 56126 Pisa, Italy. · Expert Rev Proteomics. · Pubmed #18067414 No free full text.

Abstract: In the last few years, a growing interest has arisen in the application of proteomic analysis to rheumatic disease. Sjögren's syndrome is a systemic disease that affects exocrine glands directly, and is therefore expected to influence the composition of the whole human saliva and lachrymal fluid. Therefore, a rising number of studies have been performed in an attempt to characterize the salivary and lachrymal protein profiles of patients with Sjögren's syndrome by using a proteomic approach. This review summarizes the state of the art and the potential application of proteomics in the systematic search for diagnostic biomarkers in Sjögren's syndrome.

Mosca M, Carli L, d'Ascanio A, Tani C, Talarico R, Baldini C, Bazzichi L, Tavoni A, Migliorini P, Bombardieri S. · Department of Internal Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy. · Clin Rheumatol. · Pubmed #18509714 No free full text.

Abstract: Studies have demonstrated a familial aggregation of systemic and organ-specific autoimmune diseases. The aim of the present survey was to obtain, by patient interviews, a preliminary estimate of the prevalence of systemic and organ-specific autoimmune diseases among the first- and second-degree relatives of Caucasian patients with connective tissue diseases (CTD) or inflammatory arthritis followed at our unit. Between June 2007 and January 2008, 626 patients and 85 controls (patients with osteoarthritis, osteoporosis, or fibromyalgia) were interviewed. Three hundred ten patients (50%) versus 21 controls (25%) were found to have at least one relative affected with an autoimmune condition (p < 0.0001). The most common conditions were organ-specific autoimmune diseases: 160 (34%) autoimmune thyroid (AT) disease, 112 (24%) psoriasis, 21 vitiligo, and 19 insulin-dependent diabetes mellitus. Systemic autoimmune diseases were reported in 126 relatives: rheumatoid arthritis (66 cases, 14%), 16 sacroileitis, and CTD (43 cases). A significant difference was observed in the prevalence of AT disease between the relatives of the patients and controls (3% versus 0.5%). In conclusion, these data confirm the high prevalence of autoimmune conditions, particularly of AT disease, among the relatives of patients.

Bazzichi L, Giuliano T, Rossi A, Mazzoni A, Grazzini T, De Feo F, Giacomelli C, Scatena F, Bombardieri S. · Department of Internal Medicine, Division of Rheumatology, S. Chiara Hospital, Pisa, Italy. · Rheumatol Int. · Pubmed #17684748 No free full text.

Abstract: We report on a female case of rheumatoid arthritis (RA) with hepatitis C virus comorbidity. The patient was treated once weekly over ten consecutive weeks with Adacolumn device. Clinical assessment and HCV-RNA concentration were monitored at weeks-1, 4, 9, 14 and during follow-up over 6 months. At the end of the treatment: the number of tender and swollen joints, patient's global assessment of disease activity (VAS), physician's VAS, C-reactive protein (CRP) decreased, respectively; ACR response was >20. This improvement was maintained for over 2 months. At week 38, the patient was re-treated achieving again an ACR response >20.

Giusti L, Baldini C, Bazzichi L, Ciregia F, Tonazzini I, Mascia G, Giannaccini G, Bombardieri S, Lucacchini A. · Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy. · Proteomics. · Pubmed #17436266 No free full text.

Abstract: Sjögren's syndrome (pSS) is a systemic disease that affects salivary glands directly, and is therefore expected to influence the composition of human whole saliva (WS) fluid. The aim of this study was to characterize the WS proteins of pSS patients using a proteomic approach to assess a valid procedure to examine the global changes of the salivary protein profiles in connective tissue disorders. The WS proteins expressed in patients affected by pSS and healthy volunteers were analyzed using the 2-DE technique. The WS protein pattern was altered in pSS patients compared to controls, with a decrease in some of the typical salivary proteins. Particularly, a remarkable alteration of carbonic anhydrase VI was observed. Moreover, a comparison of WS protein profile of pSS patients with the one obtained from controls revealed a set of differentially expressed proteins. These proteins were related to acute and chronic inflammation while some others were involved in oxidative stress injury. These findings are in line with the systemic immuno-inflammatory aspects of pSS and open the possibility for a systematic search of diagnostic biomarkers and targets for therapeutic intervention in pSS.

Piccinni A, Maser JD, Bazzichi L, Rucci P, Vivarelli L, Del Debbio A, Catena M, Bombardieri S, Dell'Osso L. · Department of Psychiatry, Pharmacology and Biotechnology, Psychiatry II Unit, University of Pisa, 56100 Pisa, Italy. · Compr Psychiatry. · Pubmed #16635649 No free full text.

Abstract: BACKGROUND: Previous studies suggested that rheumatoid arthritis (RA) is associated with depressive and anxiety symptomatology. The well-being and functioning of patients with RA may be significantly influenced by subthreshold psychiatric comorbidity. Health-related quality of life (HRQoL) of patients with RA, compared with the Italian norms and patients with diabetes, was assessed by the influence of lifetime mood and panic-agoraphobic spectrum symptoms and demographic and clinical variables. METHODS: Ninety-two patients were consecutively recruited at the Department of Rheumatology at the University Hospital of Pisa, Italy. All patients met diagnostic criteria of RA according to the American College of Rheumatology. Health-related quality of life was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (MOS SF-36). Mood and panic-agoraphobic spectra were assessed by two different structured self-report instruments: the Mood Spectrum (MOODS-SR) and the Panic-Agoraphobic Spectrum (PAS-SR), respectively. RESULTS: Patients with RA were compared, as regards the MOS SF-36 scale scores, with the Italian normative population and patients with diabetes. Compared with the Italian population, patients with RA showed significantly lower MOS SF-36 scale scores, except for role emotional. Moreover, patients with RA scored significantly lower on the role physical, bodily pain, and social functioning scales compared with patients with diabetes and higher on role emotional and mental health. A significant worsening of all MOS SF-36 scale scores was related to higher scores of the depressive domains of MOODS-SR, except for social functioning and bodily pain. A statistically significant negative association was also found between PAS-SR total score and the MOS SF-36 scales physical functioning, vitality, role emotional, and mental health. There were no statistically significant correlations between MOS SF-36 scales and the manic MOODS spectrum. In the multivariate models, the negative correlations between depressive MOODS, role emotional, and mental health were confirmed and the severity of arthritis showed a significant impact on all MOS SF-36 areas with the exception for social functioning; moreover, manic MOODS was associated with better general health. CONCLUSIONS: The present report shows that lifetime depressive spectrum symptoms negatively affects HRQoL of patients with RA and subthreshold mania improves the perception of general health. Diagnosis and appropriate clinical management of depression, including subthreshold symptoms, might enhance HRQoL in these patients.

Bazzichi L, Maser J, Piccinni A, Rucci P, Del Debbio A, Vivarelli L, Catena M, Bouanani S, Merlini G, Bombardieri S, Dell'Osso L. · Department of Internal Medicine, Rheumatology Unit, University of Pisa, Pisa, Italy. · Clin Exp Rheumatol. · Pubmed #16396695 No free full text.

Abstract: OBJECTIVE: The aim of this study was to investigate the impact of disability and lifetime subthreshold depressive symptoms on Health-Related Quality of Life (HRQoL) among patients with rheumatoid arthritis (RA). METHODS: Ninety-two subjects with a diagnosis of RA according to the American College of Rheumatology (ACR) criteria were recruited at the Department of Rheumatology of the University Hospital, Pisa, Italy. Participants who met DSM-IV-TR diagnostic criteria for current or previous Axis I disorders were excluded. Assessments of functional status and disability was conducted using both the ACR classification and the Stanford Health Assessment Questionnaire (HAQ). Health-related Quality of Life was assessed using the Medical Outcomes Study Short Form 36 health survey questionnaire (MOS-SF36) and lifetime depressive spectrum symptomatology using the Mood Spectrum Questionnaire, Self-Report version (MOODS-SR). RESULTS: Comparison with MOS-SF36 Italian normative values indicated that RA patients were significantly impaired on mental and physical HRQoL areas. Correlations between MOODS-SR depressive scores and ACR severity (Spearman rho = 0.15, p = 0.07) and HAQ score (Spearman rho = 0.20, p = 0.05) were modest in absolute value and borderline significant. Lifetime mood depressive spectrum was related with impaired HRQoL levels, both in physical (except for bodily pain) and mental (except for social functioning) domains. Associations of mood depressive spectrum and general health, vitality, role emotional and mental health continued to be significant after controlling for functional status, duration of illness, age and gender. CONCLUSIONS: Because lifetime mood depressive symptoms significantly contribute to impairment in HRQoL in RA patients without a past psychiatric history, even after controlling for functional status, duration of illness and demographic characteristics, these symptoms should be assessed for an accurate clinical evaluation and appropriate clinical management of RA patients.

Manfredini D, Tognini F, Melchiorre D, Bazzichi L, Bosco M. · Department of Neuroscience, University of Pisa, Italy. · Oral Surg Oral Med Oral Pathol Oral Radiol Endod. · Pubmed #16200679 No free full text.

Abstract: OBJECTIVE: The objective of the study was to compare findings from ultrasonography (US) of the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and temporomandibular disorders (TMD). STUDY DESIGN: US assessment of the temporomandibular joints was bilaterally performed in 68 patients (22 with RA, 11 with PsA, and 35 with TMD). All the TMJs were assessed for the presence of disc displacement, effusion, and changes of the condylar profile, and the prevalence of such abnormalities was compared across the 3 groups of patients. To confirm generalizability of results, US findings were also compared with those of magnetic resonance (MR), taken as the standard of reference. RESULTS: Prevalence of disc displacement and changes in condylar profile were similar between patients with rheumatic diseases and temporomandibular disorders, while effusion was significantly more present in TMJs of TMD patients. Sensitivity of US to detect TMJ abnormalities was acceptable, while specificity was low for condylar alterations. CONCLUSIONS: Temporomandibular joint involvement in patients with rheumatic diseases seems to be similar to that described in subjects with temporomandibular disorders. Ultrasonography confirmed to be an accurate technique to detect disc displacement and effusion within the temporomandibular joint, but not to detect condylar abnormalities.

Giusti L, Betti L, Giannaccini G, Mascia G, Bazzichi L, Lucacchini A. · Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy. · Clin Biochem. · Pubmed #14675564 No free full text.

Abstract: OBJECTIVE: The objectives of this study were to evaluate the [3H]PK11195 binding parameters in a model of acute inflammation, the N-formylmethionine-leucine-phenylalanine (fMLP)-stimulated neutrophil cell membranes, and to analyze if alterations of peripheral-type benzodiazepine receptor (PBR) characteristics occurred in neutrophil cell membranes of patients affected by osteoarthritis (OA), rheumatoid arthritis (RA), and psoriasic arthritis (PA). DESIGN AND METHODS: Neutrophils were obtained from 15 patients with OA, 15 patients with RA, and 15 patients with PA. fMLP stimulation was performed to aliquots of neutrophils from six healthy individuals. Evaluation of kinetic parameters of PBR was performed using [3H]PK11195, as specific radioligand compared with 15 healthy volunteers. RESULTS: The results showed a significant decrease of Kd and Bmax in fMLP-stimulated neutrophil membranes. Moreover, an increase of PBR binding sites and affinity value was observed in neutrophils membranes from PA patients. CONCLUSIONS: Our data suggested a fMLP modulation on [3H]PK11195 binding in human neutrophils. Moreover, our results showed an up-regulation of PBR in neutrophils of PA patients.

Melchiorre D, Calderazzi A, Maddali Bongi S, Cristofani R, Bazzichi L, Eligi C, Maresca M, Ciompi M. · Department of Medical and Surgical Critical Care, Rheumatology Unit, University of Florence, Italy. · Rheumatology (Oxford). · Pubmed #12709544 links to  free full text

Abstract: OBJECTIVE: To define the diagnostic value of ultrasonographic (US) examination in comparison with magnetic resonance imaging (MRI) for the assessment of temporomandibular joint (TMJ) involvement in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS: MRI and US examinations were performed in 33 patients (22 with RA and 11 with PsA). Alterations of the disc, alterations of the condyle and joint effusion were evaluated. RESULTS: Pathological changes of the TMJ were observed by MRI in 24 patients and by US in 31 patients. The sensitivity and specificity of US were calculated in comparison with MRI. The sensitivity was 72.2% and the specificity was 60% in the assessment of pathological changes of the TMJ. The sensitivity was 69.6% with specificity of 30.0% in the assessment of alterations of the disc; the sensitivity was 70.6% with specificity of 75.0% in the assessment of joint effusion. Significant concordance was not observed in the assessment of condylar alterations. CONCLUSIONS: US imaging appears able to detect different pathological changes of the TMJ and may be considered an important diagnostic tool for clinical evaluation of the TMJ in RA and PsA.

Bazzichi L, Betti L, Giannaccini G, Rossi A, Lucacchini A. · Rheumatic Diseases Unit, Medica Santa Chiara Hospital, University of Pisa, Italy. · Clin Biochem. · Pubmed #12554061 No free full text.

Abstract: OBJECTIVES: The objective of this study was to evaluate the kinetic parameters at equilibrium of peripheral benzodiazepine receptors (PBR) in human mononuclear cells from patients affected by osteoarthritis (OA), rheumatoid arthritis (RA) and psoriasic arthritis (PA). DESIGN AND METHODS: Mononuclear cells were obtained from 10 patients with OA, 10 patients with RA and 10 patients with PA. Evaluation of kinetic parameters of PBR was performed using [(3)H]PK 11195, a specific radioligand for this receptor, and compared with 10 healthy controls. RESULTS: The results show a statistically significant decrease (37.5%, as an absolute percentage) in the maximal number of binding sites (B(max)) of patients with OA, compared with healthy controls; however, the values of the dissociation constant (K(d)) at equilibrium do not show any statistically significant variations. CONCLUSIONS: These data further confirm the presence of peripheral biochemical alterations in OA. As peripheral benzodiazepine receptors appear to be involved in the immune function, and in the protection of hematopoietic cells against oxygen radical damage, the observed decrease in B(max) might be related to cellular protection.

Bazzichi L, Ciompi ML, Betti L, Rossi A, Melchiorre D, Fiorini M, Giannaccini G, Lucacchini A. · Rheumatic Diseases Unit, Medica Santa Chiara Hospital, University of Pisa, Pisa, Italy. · Clin Exp Rheumatol. · Pubmed #12508766 No free full text.

Abstract: OBJECTIVE: To test the activity of elastase, collagenase and glutathione reductase in the synovial fluid (SF) of patients with rheumatoid arthritis (RA) and in patients with osteoarthritis (OA); to correlate the elastase and collagenase activity with the glutathione reductase activity, which is important for the inactivation of oxygen free radicals. METHODS: 24 patients affected by osteoarthrosis and 24 patients affected by rheumatoid arthritis took part in the study. We measured elastase activity towards the substrate metoxysuccinyl-alanyl-alanyl-prolyl-valyl-p-nitroanilide (MeOSuc-ala-ala-proval-p-NA) which is highly specific for elastase, and insensitive to the other serine proteases, such as cathepsin G; collagenase activity was measured using [14C]-acetylated collagen as the substrate. Glutathione reductase activity was measured following the oxidation of nicotinamide adenine dinucleotide phosphate reduced (NADPH) in the presence of oxidized glutathione (GSSG). RESULTS: The concentrations of elastase, collagenase and glutathione reductase were statistically higher in patients with RA than in patients with OA. Moreover, in the SF of patients with RA we found positive correlation between enzyme activity levels. CONCLUSION: These results confirm a high activity of collagenase and elastase in the SF of patients with RA, which is about 30 times higher than that found in the SF of patients with OA. These data underline the synergic action of these enzymes in the pathogenesis of joint damage. RA patients also exhibit higher levels of glutathione reductase, which is important for the detoxification pathway of oxygen free radicals. However, compared with findings for collagenase and elastase, the increase in glutathione reductase is only three times higher than level found in the SF of OA patients. The limited increase in glutathione reductase activity during the inflammatory process might lead to an insufficient protective effect at the joint level in rheumatoid arthritis.