Rheumatoid Arthritis: Massafra U

Migliore A, Massafra U, Capuano A, Martin SM. · Department of Rheumatology, Ospedale S. Pietro, 00189 Rome, Italy. · Aging Clin Exp Res. · Pubmed #18180602 No free full text.

Abstract: Up to now, there have been no reports about the combined use of Teriparatide and Anti- TNFalpha blockers in patients affected by inflammatory bone diseases and osteoporosis. In this report, we evaluate the safety of the combined therapeutic use of Teriparatide and Anti-TNFalpha drugs in patients with inflammatory arthritis and severe osteoporosis. Six female patients were selected and treated with biological therapy (3 patients with Etanercept, 3 with Infliximab) for arthritis (2 RA, 4 SPA), having suffered at least 2 vertebral fragility fractures. The mean T-score value, tested by DEXA densitometry, was -2.8 SD - diagnostic for osteoporosis according to WHO criteria. All patients were treated with Teraparatide s.c. (20 microg daily), together with 1200 mg of calcium and 800 IU of vitamin D daily. Until the present time, we have observed no side-effects or therapeutic discontinuity. During the 9-month follow-up period, we did not observe any new symptomatic fractures or infections in treated patients, but we found a reduction in parameters indicating inflammation; no differences were found in biochemical parameters.

Manna R, Verrecchia E, Fonnesu C, Giovinale M, De Socio G, Curigliano V, Cerquaglia C, Soriano A, Granata M, Migliore A, Massafra U, Gasbarrini G. · Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy. · Eur Rev Med Pharmacol Sci. · Pubmed #19530514 No free full text.

Abstract: INTRODUCTION: In autoimmune disorders (ADs), if Hepatitis C Virus (HCV) is present, immunosuppressive treatment could increase virus replication. Cyclosporine A (CsA), in standard therapeutic doses, has been proven able to inhibit HCV cyclophilin in vitro. Therefore CsA could improve the therapy of HCV patients with ADs. AIM: In these patients, we started an open pilot study to evaluate the safety of 3 mg/kg CsA and the ability to reduce steroid therapy. PATIENTS AND METHODS: Five females and 1 male were recruited; mean age 66 +/- 8 years, mean disease duration 13 +/- 5 years. Three patients are affected by Psoriasic Arthritis, 1 by Rheumatoid Arthritis, 1 by Sjogren Syndrome, and 1 by Myasthenia Gravis. None of them had chronic active hepatitis. HCV genotypes were type 2 (in 3 cases) and type 1 (in 3 cases). Patients were treated with 3 mg/kg of CsA for a period of time ranging from 6 to 12 months. The starting mean dose of prednisone was 12.5 mg/day. Liver function tests were checked monthly and serum HCV-RNA load was checked by RT-PCR before and 2 months into the therapy. RESULTS: The prednisone dose was reduced from 12.5 mg/day to 7.5 mg/day. The aminotransferases levels were unchanged after 6 months. In patients with low HCV-RNA levels before treatment, no modifications of viral load were observed, whereas patients with increased levels at onset showed mild reduction 2 months into the treatment. CONCLUSIONS: Immunosuppressive treatment of ADs patients with HCV infection can be safely provided with the integration of CsA.

Migliore A, Bizzi E, Laganà B, Altomonte L, Zaccari G, Granata M, Canzoni M, Marasini B, Massarotti M, Massafra U, Ranieri M, Pilla R, Martin LS, Pezza M, Vacca F, Galluccio A. · UOS of Rheumatology, S. Pietro FBF Hospital, Research Center S. Pietro, Rome, Italy. · Int J Immunopathol Pharmacol. · Pubmed #19505394 No free full text.

Abstract: Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are commonly thought of as inflammatory diseases that affect younger individuals. Although the initial presentation of these diseases is common in a patients twenties or thirties, they usually persist for the duration of the patients life. In addition, up to one-third of patients with RA have disease onset after 60 years of age. Anti-TNF-a therapies now have well-recognized safety profiles that have been demonstrated in the usual clinical trial populations for these diseases, but such populations under-represent patients > or =65 years of age. This retrospective study aims to determine the safety profiles for etanercept, infliximab and adalimumab in patients of 65 years or more, undergoing anti-TNF treatment for an active inflammatory disease such as rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis, or skin disease like psoriasis. Our data show that admitting elderly patients into anti-TNF therapeutic regimens is a safe option and that it grants these patients access to the best current therapeutic option, possibly leading to better disease outcome. Quality of life in elderly patients affected by arthritis or psoriasis, often reduced by comorbidities, is as important as quality of life in younger patients. Applying the recommended screening before using biological treatment helps to reduce adverse events related to the therapy, and the application of the same screening in elderly patients seems to lead to comparable results.

Migliore A, Signore A, Capuano A, Bizzi E, Massafra U, Vacca E, Todino V, Chianelli M. · UOS of Rheumatology, Fatebenefratelli, S. Pietro Hospital, Rome, Italy. · Eur Rev Med Pharmacol Sci. · Pubmed #18575164 No free full text.

Abstract: We report the case of a 59 years old woman affected by lung and joint sarcoidosis, secondary Sjogren's syndrome refractory to common disease-modifying antirheumatic drugs (DMARDs) that regressed with infliximab and methotrexate. 99mTc-HYNIC-TOC scintigraphy was useful in diagnosis, choice of treatment and follow-up.

Migliore A, Bizzi E, Massafra U, Capuano A, Martin Martin LS. · Department of Rheumatology at San Pietro- Fatebenefratelli Hospital and Centro Ricerche, Association Fatebenefratelli for Research, Rome, Italy. · Arch Environ Occup Health. · Pubmed #17967752 No free full text.

Abstract: Multiple chemical sensitivity (MCS) is defined by multiple symptoms, affecting multiple organs, that wax and wane in response to varying chemical exposures at or below previously tolerated levels. Sjögren's syndrome (SS) is a common autoimmune disease affecting 3% of women aged over 55 years. Except for keratoconjunctivitis sicca (which is associated with SS not MCS), systemic features are common between the 2 diseases, leading to considerable morbidity and, occasionally, mortality. The authors report 3 cases of association between SS and MCS. Three women who were diagnosed with SS showed MCS symptoms and also were diagnosed with MCS. Further studies are needed to understand physiopathogenic mechanisms that eventually may be revealed as common to the 2 syndromes.