Clinical and experimental rheumatology (CLIN EXP RHEUMATOL)

Journal description

Clinical and Experimental Rheumatology is a bi-monthly journal which publishes original papers on clinical or experimental research pertinent to the rheumatic diseases; work on connective tissue diseases and other immune disorders also are within the journal's scope.

Current impact factor: 2.72

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 2.724
2013 Impact Factor 2.973
2012 Impact Factor 2.655
2011 Impact Factor 2.148
2010 Impact Factor 2.358
2009 Impact Factor 2.396
2008 Impact Factor 2.364
2007 Impact Factor 2.27
2006 Impact Factor 2.189
2005 Impact Factor 2.366
2004 Impact Factor 1.504
2003 Impact Factor 1.919
2002 Impact Factor 1.284
2001 Impact Factor 1.614
2000 Impact Factor 1.638
1999 Impact Factor 1.348
1998 Impact Factor 1.27
1997 Impact Factor 1.152
1996 Impact Factor 0.925
1995 Impact Factor 0.987
1994 Impact Factor 1.342
1993 Impact Factor 1.59
1992 Impact Factor 1.481

Impact factor over time

Impact factor

Additional details

5-year impact 2.43
Cited half-life 6.40
Immediacy index 0.34
Eigenfactor 0.01
Article influence 0.57
Website Clinical & Experimental Rheumatology website
Other titles Clinical and experimental rheumatology, Rheumatology
ISSN 0392-856X
OCLC 9404208
Material type Periodical
Document type Journal / Magazine / Newspaper

Publications in this journal

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    ABSTRACT: Objectives: Nowadays, the recommended measures for optimal monitoring of axial Spondyloarthritis (ax-SpA) disease activity are either BASDAI and CRP, or ASDAS-CRP. However, there could be a gap between recommendations and daily practice. We aimed to determine the measures collected by rheumatologists in an ax-SpA follow-up visit, and to determine the impact of a meeting (where rheumatologists reached a consensus on the measures to be collected) on the collection of such measures. Methods: A consensual meeting of a local network of 32 rheumatologists proposed, four months later, to report at least the BASDAI score in the medical file of every ax-SpA patient at every follow-up visit. An independent investigator reviewed the medical files of 10 consecutive patients per rheumatologist, seen twice during the year (e.g. before and after the meeting). The most frequently collected measures were assessed, and then, the frequency of collection before and after the meeting was compared. Results: A total of 456 medical files from 228 patients were reviewed. Treatment (>60%), CRP (51.3%) and total BASDAI (28.5%) were the most reported measures in medical files. Before/After the meeting, the frequencies of collected measures in medical files were 28.5%/51.7%, 51.3%/52.2%, 16.7%/31.6% and 0.9%/6.1% for BASDAI, CRP, BASDAI + CRP and ASDAS, respectively reaching a statistically significance for BASDAI, ASDAS and BASDAI+CRP (p<0.05). Conclusions: This study revealed a low rate of systematic report of the recommended outcome measures in ax-SpA. However, it suggests that a consensual meeting involving practicing rheumatologists might be relevant to improve the implementation of such recommendations.
    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Patients with rheumatoid arthritis are increasingly being treated with different drugs (both non-biologic and biologic disease-modifying anti-rheumatic drugs - DMARDs) that may have immunomodulatory, cytotoxic, or immunosuppressive effects; in particular, anti-tumour necrosis factor (TNF) agents are raising major concern as regards safety issues. An increased risk of infections has been extensively reported during anti-TNF treatment, owing to the primary role of TNF in host defense and immune responses. Although in clinical practice cases of reactivation of varicella zoster virus (VZV) infections during therapy with TNF inhibitors commonly occur, the knowledge on this topic deriving from randomised clinical trials is limited. In this narrative review we focus on the pathophysiology of VZV infection and the role of TNF, and report the available data about VZV outbreaks recorded on Registries of rheumatic patients treated with anti-TNF agents. Finally, we discuss screening strategies and promising preventive measures against VZV infection.
    Clinical and experimental rheumatology 09/2015;
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    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Objectives: To test the hypothesis that classical phagocytic functions are constitutively stimulated in patients with Behçet's disease (BD). Methods: Four study groups were analysed: active BD (aBD; n=30), inactive BD (iBD; n=31); septic patients (SP; n=25); healthy controls (HC; n=30). Microbicide activity against Streptococcus pneumoniae, Streptococcus sanguinis and Candida albicans was determined by means of 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) reduction and absorbance read by ELISA. Flow cytometry analysis evaluated phagocytosis (zymosan particles and microrganisms) and oxidative burst by dihidrorhodamine oxidation before and after stimulation with phorbol myristate acetate (PMA). The supernatant of PBMC cultures under TLR or microbial stimuli and of neutrophil cultures under PMA, LPS or microbial stimuli were used for determination of cytokine production by ELISA. Results: We found no significant differences between the BD patient groups and control groups with regard to oxidative burst, phagocytic activity, microbicide activity or cytokine production. However, the cells from patients with severe BD (based on clinical manifestation) exhibit significantly higher oxidative burst activity, both before and after PMA stimulation, compared to cells from patients with mild BD. Furthermore, we found significant correlations between the BD patients' scores on the simplified Behçet's Disease Current Activity Form adapted for Portuguese (BR-BDCAFs) and Streptococcus sanguinis-stimulated production of IL23 by PBMC and IL8 by neutrophils, and between BR-BDCAFs score and constitutive production of TNF-α, IFNγ, IL6 and IL23 by PBMC. Conclusions: Patients with severe active BD do exhibit phagocytic dysfunction and some evidence of constitutive activation regarding oxidative burst and cytokine production.
    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Objectives: To distinguish patients (pts) with enthesitis having spondyloarthritis (SpA) from pts with enthesitis without SpA by ultrasound (US) enthesitis score. Methods: The study sample included 127 pts with enthesitis (76 pts with SpA, 26 pts with rheumatoid arthritis, 25 pts with mechanically-related enthesitis). The entheses of plantar fascia, Achilles, patellar, quadriceps and common extensor tendon on lateral epicondyle were examined by US. Two operators, blinded to clinical diagnosis and enthesitis symptoms, assessed enthesis thickness, echogenicity, enthesophytes, power Doppler signal and erosions. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine the predictive value of each enthesitis lesion for diagnosis of SpA. The best predictive value for SpA was accomplished when absence and presence of increased thickness, hypoechogenicity and enthesophytes were scored as 0 and 1; absence and presence of PD and erosions were scored as 0 and 4. Belgrade Ultrasound Enthesitis Score (BUSES) represents a cumulative score of derived enthesitis lesion scores at examined entheses. Independent-samples t-test was used for BUSES comparison between pts with and without SpA. Validity of BUSES for SpA diagnosis was evaluated by sensitivity and specificity. Cut-off point was chosen as the smallest value with specificity of at least 90%. The reliability was analysed by intra-class-correlation coefficient (ICC). Results: BUSES was 9.9±12.4 (mean±SD) in SpA pts and 3.1±4.2 in pts without SpA (p<0.001). BUSES cut-off point ≥7 achieved excellent specificity (90.2%) and fair sensitivity (47.4%). ICC was 0.99. Conclusions: BUSES is highly specific, valid and reliable to identify patients with SpA.
    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Objectives: Fatigue is an important aspect of rheumatoid arthritis (RA). The objective was to assess fatigue levels and its determinants over the first 4 months of tocilizumab (TCZ) treatment in RA patients. Methods: We performed a multicentre prospective study of RA patients treated with intravenous TCZ in open-label prescription conditions. The first 5 infusions (4 months) were assessed. The primary endpoint was the percentage of patients with variation of the FACIT fatigue scale from inclusion to 4 months, above the minimal clinically important difference (MCID) of 4 points. Fatigue was also assessed by the patient acceptable symptom state for fatigue (PASS) question. Variables related with fatigue and with fatigue improvement including other patient reported outcomes, depression and anxiety, and disease activity, were assessed before and after treatment. Analyses: univariate and multivariate logistic regressions. Results: Of 719 patients, 610 had evaluable data: mean age 56±13 years, disease duration 12±10 years, 490 (81%) women. At baseline, fatigue levels were high: 73% patients had unacceptable fatigue. At 4 months, 378 patients (62%) reached MCID improvement for fatigue. Fatigue reduction was rapid, seen as early as after 2 weeks. Fatigue was mainly related to functional status (HAQ score), depression and anxiety, both before and after TCZ treatment. Moderate predictors of fatigue improvement were evidenced. Conclusions: In these long-standing RA patients, fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity. The pathophysiological basis of RA fatigue should be further explored.
    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Autoantibodies targeting the melanoma-differentiation-associated gene-5 (MDA5)-encoded ribonucleic acid helicase are associated with clinically amyopathic dermatomyopathy (CADM). Marked systemic inflammation, skin ulcers and severe interstitial lung disease seem frequent. DM treatment consists of immunosuppressants and/or intravenous immunoglobulins, but evidence-based knowledge is lacking. Anakinra (an interleukin-1 receptor antagonist (IL-1RA)) use in this setting has never been reported. Herein, we report on a case of anakinra dramatic and rapid efficacy against general and extramuscular (e.g. calcinosis, arthritis, skin ulcers) in a patient with severe and refractory CADM. Unfortunately, short-term follow-up prevented efficacy evaluation against interstitial lung disease. IL-1RA could be a promising treatment for refractory CADM.
    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Objectives: To estimate the frequency of malignancy among patients with idiopathic inflammatory myopathies (IIM) in Jordan. Methods: This was a retrospective review of case records of patients with IIM in Jordan. Results: We identified 94 cases of IIM, (47 polymyositis (PM) and 47 dermatomyositis (DM)). Sixty-seven (71%) were females and 27 (29%) were males. The mean age at diagnosis was 39.7± 15.7 years (range 17-72), median 40 years and the mean follow-up was 5.05±4.03 years (0.2-19). Malignancy was diagnosed in only 4 patients (4.25%) with IIM. Among patients with DM, malignancy was found in three patients (6.4%).The age-standardised rate was 2.7% (95% confidence interval: 0. 6% to 7.1%). The standardised incidence ratio was 0.998. Diagnosis of associated malignancy was made close to the time of IIM diagnosis. Two male patients had nasopharyngeal carcinoma at the ages of 51 and 59 years, while the other two were female with breast and ovarian cancer at the ages of 40 and 45 years, respectively. Conclusions: Malignancy in association with IIM was found to be low in our cohort in comparison to reports from other countries. The observed number of cancer cases in this group of patients is similar to the expected number of cases that would occur in general population of Jordan. This could be related to younger age of disease onset. The benefits of long-term screening for malignancy in our population are not clear.
    Clinical and experimental rheumatology 09/2015;
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    ABSTRACT: Objectives: Behçet's disease (BD) is a chronic inflammatory disorder characterised by aphthous stomatitis, genital ulcerations, erythema nodosum-like manifestations and papulopustular lesions. While a neutrophilic vasculitis accompanies most skin lesions it is usually regarded that the papulopustular lesions in BD are similar to acne vulgaris (AV). The aim of our current study was to further assess the clinical and histopathological features of papulopustular lesions in BD and how these features compared to those of AV. Methods: To analyse the histopathological features of BD and AV, 89 punch biopsies were taken from 58 BD (52 male, 6 female) and 31 AV patients (26 male, 5 female). Sections were evaluated in a blind manner by two different pathologists. A dermatologist who was blind to the patients' diagnosis counted the number of papules, pustules, comedones, folliculitis, cysts and nodules on the face, chest, back, upper and lower extremities. Results: The number of papules, pustules and comedones was higher on the face in the AV group, whereas in the BD group, both number of papules and folliculitis on the back and that of folliculitis were higher on the lower extremities in the AV group. With the exception of comedone formation, which was more frequent among the AV patients [20/31 (64.5%) vs. 23/58 (39.6%), p=0.025] the presence of suppurative folliculitis/perifolliculitis, intrafollicular abscess formation, leukocytoclastic vasculitis or microorganisms were not useful in differentiating BD from AV. However, the interobserver agreement for histologic assessment was low. Kappa was 0.17 for suppurative foliculitis/perifol¬liculitis; 0.39 for intrafollicular abscess formation; 0.51 for leukocytoclastic vasculitis. Conclusions: In the BD group, although the inflammatory lesions located on the face were less than those in the AV group inflammatory lesions such as folliculitis on the legs were only seen, again in the BD group. The papulopustular lesions of BD could not be distinguished from AV by histology. Some of this might be due to high interobsever variation in interpretation. Acne is an inherent manifestation of BD.
    Clinical and experimental rheumatology 09/2015;
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    Clinical and experimental rheumatology 09/2015; 33 Suppl 91(4):195.
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    ABSTRACT: Objectives: This study describes clinical characteristics, prognostic factors, and quality of life in patients with newly diagnosed (incident) digital ulcers (DU). Methods: Observational cohort study of 189 consecutive SSc patients with incident DU diagnosis identified from the EUSTAR database (22 centres in 10 countries). Data were collected from medical charts and during one prospective visit between 01/2004 and 09/2010. Results: Median age at DU diagnosis was 51 years, majority of patients were female (88%), and limited cutaneous SSc was the most common subtype (61%). At incident DU diagnosis, 41% of patients had one DU and 59% had ≥2 DU; at the prospective visit 52% had DU. Pulmonary arterial hypertension (PAH) and multiple DU at diagnosis were associated with presence of any DU at the prospective visit (odds ratios: 4.34 and 1.32). During the observation period (median follow-up was 2 years) 127 patients had ≥1 hospitalisation. The event rate of new DU per person-year was 0.66, of DU-associated complications was 0.10, and of surgical or diagnostic procedures was 0.12. At the prospective visit, patients with ≥1 DU reported impairment in daily activities by 57%, those with 0 DU by 37%. The mean difference between patients with or without DU in the SF-36 physical component was 2.2, and in the mental component 1.4. DU patients were not routinely prescribed endothelin receptor antagonists or prostanoids. Conclusions: This real world cohort demonstrates that DU require hospital admission, and impair daily activity. PAH and multiple DU at diagnosis were associated with future occurrence of DU.
    Clinical and experimental rheumatology 09/2015; 33 Suppl 91(4):47-54.
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    ABSTRACT: Objectives: To test the acceptability, feasibility, reliability and validity of the Italian translated version of the UCLA Scleroderma Clinical Trial Consortium GIT (UCLA-SCTC GIT) 2.0. Gastrointestinal tract (GIT) involvement is frequent in systemic sclerosis (SSc). The UCLA-SCTC GIT 2.0 is a validated instrument for measuring the presence and impact of GIT symptoms in SSc patients. Methods: Acceptability and feasibility of the questionnaire were evaluated based on the input from the patients. Internal consistency was evaluated by Cronbach's alpha. External consistency was measured by comparing with the Short Form (SF)-36 and EQ-5D by Spearman's rho, meaningful if ≥0.30. Results: Sixty-two consecutive SSc patients (mean age 60.6) were recruited, 88.5% were female. The UCLA-SCTC GIT 2.0 was well accepted. Percentage of missing data in UCLA-SCTC GIT total score was 2 %. Internal consistency was acceptable (alpha ≥0.70) for all domains. Cronbach's alpha was ≥0.70 for all domains. UCLA-SCTC GIT 2.0 discriminated between patients with or without gastroesophageal reflux disease whether diagnosed clinically or by objective testing (p<0.01 for both). UCLA-SCTC GIT emotional well-being was correlated with the conceptually equivalent SF-36 mental health domains (correlation coefficient >0.35) and with the EQ-5D usual activities domain (0.38), thus reflecting the impact on everyday activities. The distention/bloating domain strongly correlated with the EQ-5D anxiety/depression domain (0.51) and reflux domain with role emotional of SF-36 (0.44). Conclusions: This is the first validation study of the Italian version of UCLA-SCTC GIT 2.0. Our data support its feasibility, reliability, and validity in Italian SSc patients.
    Clinical and experimental rheumatology 09/2015; 33 Suppl 91(4):55-60.
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    ABSTRACT: Objectives: To describe the non-pharmacological care in systemic sclerosis (SSc) provided by European health professionals (HPs) including referrals, treatment targets, interventions, and educational needs. Methods: In this observational study, European HPs working in SSc care were invited to complete an online survey through announcements by EUSTAR (European League Against Rheumatism (EULAR) Scleroderma Trials and Research) and FESCA (Federation of European Scleroderma Associations), the EULAR HPs' newsletter, websites of national patient and HP associations, and by personal invitation. Results: In total, 56 HPs, from 14 different European countries and 7 different disciplines, responded to the survey. A total of 133 specific indications for referral were reported, 72% of which could be linked to the International Classification of Functioning, Disability and Health domain "body functions and structures". Of the 681 reported treatment targets 45% was related to "body functions and structures". In total, 105 different interventions were reported as being used to address these treatment targets. Almost all (98%) respondents reported having educational needs, with the topics of management of stiffness (67%), pain (60%), and impaired hand function (56%) being mentioned most frequently. Conclusions: Non-pharmacological care in SSc varies in Europe with respect to the content of interventions, reasons for referral, and treatment targets. Reasons for referral to HPs are not well-aligned to HPs subsequent treatment targets in SSc care suggesting suboptimal communication between physicians and HPs. The wide variations reported indicate a need to consolidate geographically disparate expertise within countries and to develop and improve standards of non-pharmacological care in SSc.
    Clinical and experimental rheumatology 09/2015; 33 Suppl 91(4):153-159.
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    ABSTRACT: To identify factors indicating exercise-induced oxygen desaturation during the 6-minute walk test (6MWT) in patients with diffuse systemic sclerosis (SSc) and initial interstitial lung disease (ILD). The study involved 121 consecutive adult anti-Scl 70 autoantibody-positive SSc patients with initial ILD, 93 of whom were followed up for five years. Before enrolment and then annually, the patients underwent high-resolution computed tomography (HRCT), functional lung tests, with carbon monoxide diffusion capacity of the lung (DLCO) and its components (alveolar-capillary membrane [Dm] and pulmonary blood volume [Vc]), the evaluation of dyspnea before and after the 6MWT using the Borg scale, and transthoracic echocardiography. A decrease in peripheral capillary oxygen saturation (SpO2) of ≥4% during the 6MWT was used to define desaturation, the appearance of which led to the patient being withdrawn from follow-up. There were no significant differences in HRCT score during the follow-up, but 32 patients (35%) desaturated during the 6MWT, including 12 (37%) who experienced a severe decrease SpO2 to ≤88%, indicating a high risk of mortality. At baseline, there was no statistically significant difference in any considered clinical characteristics between the desaturating and non-desaturating patients but, at the time of desaturation, the desaturators had lower minimum SpO2% levels during the 6MWT (p<0.0001), and lower DLCO (p<0.0001) and Dm (p<0.0001). Comparison of the desaturators defined on the basis of a reduction in SpO2 to ≤88% and those defined on the basis of a decrease in SpO2 of ≥4% showed that, at baseline, the former had lower minimum SpO2% levels during 6MWT (p<0.001), lower DLCO (p=0.01), a lower DLCO/VA ratio (p=0.05), lower Dm (p<0.005) and Vc values (p<0.5), and higher RVsystP (p=0.01). At the time of desaturation, the desaturators' minimum SpO2 levels during the 6MWT correlated with their DLCO (r=0.78; p<0.001), Dm (r=0.65; p<0.01), Vc (r=0.52;p<0.05) and RV-systP values (r = -0.53; p<0.05). Our data seem to confirm the close interdependence between pulmonary diffusion and oxygen desaturation during exercise. In SSc combined 6MWT, DLCO and its components may indicate patients at increased risk of developing pulmonary hypertension.
    Clinical and experimental rheumatology 09/2015; 33 Suppl 91(4):142-147.