Carlo Palazzi

Ospedale Madonna Delle Grazie, Matera, Matera, Basilicate, Italy

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Publications (84)281.26 Total impact

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    ABSTRACT: Introduction: The current pharmacological therapy of spondyloarthritis (SpA) includes several drugs: Non-steroidal anti-inflammatory drugs, corticosteroids, traditional disease-modifying antirheumatic drugs and biologic drugs. Areas covered: A systematic literature search was completed using the largest electronic databases (Medline, Embase and Cochrane), starting from 1995, with the aim to review data on traditional and biologic agents commercialised for SpA treatment. Randomised controlled trials and large observational studies were considered. In addition, studies performed in SpA patients treated with other, still unapproved, drugs (rituximab, anti-IL6 agents, apremilast, IL17 inhibitors and anakinra) were also taken into account. Expert opinion: Biologic agents, especially anti-TNF drugs, have resulted in significant progress in improving clinical symptoms and signs, reducing inflammatory features in laboratory tests and imaging findings, and recovering all functional indexes. Anti-TNF drugs have radically changed the evolution of radiographic progression in peripheral joints; the first disappointing data concerning their efficacy on new bone formation of axial SpA has been recently challenged by studies enrolling patients who have been earlier diagnosed and treated. The opportunity to extend the interval of administration or to reduce the doses of anti-TNF agents can favourably influence the costs. Ustekinumab, the first non-anti-TNF biologic drug commercialised for psoriatic arthritis, offers new chances to patients that are unresponsive to anti-TNF.
    Expert Opinion on Pharmacotherapy 06/2015; 16(10):1-10. DOI:10.1517/14656566.2015.1052744 · 3.53 Impact Factor
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    ABSTRACT: Background Therapeutic approach of Behçet's disease (BD) depends on the clinical presentation and organ involved. The conventional immunosuppressive therapy is still the first approach to the treatment of disease and is aimed to improve the quality of life and prevent irreversible organ damage. However a variable percentage of patients with BD do not respond to traditional immunosuppressive agents or withdraw from treatment due to inefficacy or adverse events. Objectives To identify the clinical factors predicting a good clinical response to Infliximab (IFX) therapy after 12 months in patients BD refractory to conventional therapy. Methods Patients receiving IFX (5 mg/kg intravenously at weeks 0, 2, 6, and every 6-8 weeks subsequently) for BD unresponsive to conventional therapy (corticosteroids plus at least two different immunosuppressive drugs) were prospectively included. Clinical response to IFX therapy was based on the expert opinion and was graded as follows: remission, response, no response and worsening. Remission was defined as the complete disappearance of symptoms and signs of inflammation and response as at least 50% of improvement. Univariate and multivariate analyses were performed to identify factors associated with IFX good response (remission, response) at 12 months. Logistic regression analysis was performed to analyse which of the following measures at the start of treatment were associated with a good response: sex; age; disease duration; HLA-B51 status; indication for IFX treatment including uveitis, CNS involvement, severe mucocutaneous manifestations or others including arthritis, intestinal and vascular involvement; concomitant drugs including steroids (Ster), colchicine (Col), azathioprine (AZA) or cyclosporine (CSA). Results The study included 73 BD patients (47 M/26 F; mean age 33.6±10.7 yrs; mean disease duration 12.3±9.3 yrs; 71.2% HLA-B51 positive). Indication for IFX treatment were uveitis in 38 patients, severe mucocutaneous manifestations in 13, CNS involvement in 16, intestinal involvement in 2, arthritis in 2, vascular involvement in the remaining 2.At 12 months, 56 patients (76.7%) had a good response to IFX, 4 (5.5%) patients had stopped for adverse events, and 13 (17.8%) had stopped for primary or secondary inefficacy. In the univariate analysis concomitant use of AZA (95.8% vs 67.3%, p<0.01) was the only factor associated with a good response. In a multivariate logistic regression analysis concomitant use of AZA was independently associated with a good therapeutic response (OR =34.2; 95% CI 2.7-435.8; p=0.007). None of the other variables analysed predicted response to treatment. Conclusions This study has, for the first time, shown that concomitant use of AZA at the start of IFX treatment is a factor that seems to influence the probability of achieving a good therapeutic response in patients with refractory BD. Further support from larger studies is necessary so as to optimize the management of BD patients treated with IFX. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):516.3-517. DOI:10.1136/annrheumdis-2015-eular.3751 · 10.38 Impact Factor
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    ABSTRACT: Background The spondyloarthritis (SpA) complex also includes forms that do not meet criteria for the definite forms and are called undifferentiated SpA (uSpA). Recently the Assessment in SpondyloArthtritis international Society (ASAS) suggested criteria for axial and peripheral SpA that have substituted the Amor and the European Sondylarthropathy Study Group (ESSG) criteria for all forms of SpA. In the ASAS criteria for axial disease the entry criterion is chronic low back pain in a patient with an age less than 45 years. Only 15% of the patients included in the study for the ASAS criteria for peripheral disease were older than 45 years. Objectives The objective of our study was to evaluate the sensitivity of the ASAS criteria for axial and peripheral SpA in a cohort of consecutive patients with HLA-B27 positive uSpA with onset of disease after the age of 45 (late onset uSpA) consecutively recruited in a 12-year period in comparison with a cohort of consecutive patients with HLA-B27 positive uSpA with onset before age 45 (ordinary onset uSpA) recruited in the same period. Methods Patients HLA-B27 positive with at least one clinical manifestation of SpA and not meeting the New York criteria for ankylosing spondylitis (AS) and with a negative personal history for psoriasis, inflammatory bowel disease and preceding infection seen since January 2001 were entered in a special register and were followed prospectively. Each patient was examined at 6-month interval even if asymptomatic. Results During the 12-year recruitment period, 93 patients (35 M, 58 F; age 58.4±9.8) with late onset uSpA were seen. The first 93 consecutive patients (54 M, 39 F; age 29.6±8.6) with ordinary onset uSpA seen in the same period were evaluated for comparison. Compared to the 93 patients with ordinary onset uSpA, the 93 patients with late onset uSpA were more frequently females (62.4% vs. 41.9%, p<0.05) had a significant shorter diagnostic delay (time elapsed between the day of onset and the day of diagnosis) (24.2±45.6 vs. 65.1±97 months, p<0.05) and showed more frequently increased levels of ESR (Erythrocite Sedimentation Rate)(57% vs. 33.3%, p<0.05) and CRP (C-reactive proteine) (62,4% vs. 48,4%, p=0,07). In addition, patients with late onset uSpA developed more frequently inflammatory extremity swelling with pitting edema (IESPE) over the dorsum of hands and/or of the feet (25.8% vs. 4.3%, p<0.01) and peripheral enthesitis (48.4% vs.31.2%, p<0.05). In contrast, patients with ordinary onset uSpA showed more frequently acute anterior uveitis (20.4% vs. 7.5%, p<0.05). The sensitivity of the ASAS criteria was similar in the ordinary onset (90.3%) and the late onset (91.4%) cohorts of patients with uSpA. Conclusions The ASAS classification criteria for axial and peripheral SpA showed a similar high sensitivity in patients with ordinary and late onset uSpA. In addition, this study confirms that some clinical and laboratory features of SpA may differ with the age at onset of the disease. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1159.4-1160. DOI:10.1136/annrheumdis-2015-eular.3402 · 10.38 Impact Factor
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    ABSTRACT: Introduction: Hepatitis C virus (HCV)-related arthritis is an uncommon disease belonging to the autoimmune disorders due to the chronic stimulus exerted by the virus on the immune system. It shows two clinical subsets: a symmetrical polyarthritis resembling rheumatoid arthritis but less aggressive and an intermittent mono-oligoarthritis involving the lower limbs. Areas covered: We extensively review the current literature using the largest electronic databases (MEDLINE, EMBASE and COCHRANE) with regard to HCV-related arthritis (HCVrA) and studies focusing on the co-existence of HCV and other kinds of arthritides. Expert opinion: The therapeutic approach to HCVrA remains largely empirical, because few studies have been published on this topic. Mainstream treatment based on the administration of hydroxychloroquine and low doses of corticosteroid is still largely preferred. Cyclosporine represents a useful alternative due to its antiviral properties. Anti-TNF agents are safe, but their hypothetic use appears excessive for a mild disorder such as HCVrA. IFN-α (and more recently pegylated IFN-α) when administered as a component of the combined (IFN-α + ribavirin) anti-HCV therapy can promote the appearance or the worsening of several autoimmune HCV-related disorders, including arthritis. New and forthcoming antiviral molecules will be used in the near future for a revolutionary IFN-free treatment.
    Expert Opinion on Pharmacotherapy 08/2014; 15(14). DOI:10.1517/14656566.2014.946404 · 3.53 Impact Factor
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    ABSTRACT: Psoriatic arthritis (PsA), which affects musculoskeletal structures, skin and nails, is a heterogeneous chronic inflammatory disease with a wide clinical spectrum and variable course. Patients with PsA are more likely than healthy individuals to have metabolic syndrome or cardiovascular disease. To include these comorbidities, 'psoriatic disease' has been suggested as an umbrella term. The management of PsA has changed tremendously over the past decade owing to early diagnosis and improvement in treatment strategies, including, early referral from dermatologists and primary-care physicians to rheumatologists, early initiation of therapy, treating to the target of remission or low disease activity, and advances in pharmacological therapy. Outcome assessment is also improving, because of validated instruments for clinical disease manifestations. The commercialization of TNF blockers, including adalimumab, etanercept, golimumab and infliximab, is representative of a revolution in the treatment of PsA. A new anti-TNF agent, certolizumab pegol, and a fully human monoclonal antibody against IL-12 and IL-23, ustekinumab, are approved for the treatment of active PsA. The efficacy of ustekinumab suggests that inhibiting the type 17 T helper pathway might be an alternative to blocking TNF. PsA management must now use improved measures to predict patient outcomes and define remission, and develop better-targeted therapies.
    Nature Reviews Rheumatology 07/2014; 10(9). DOI:10.1038/nrrheum.2014.106 · 9.85 Impact Factor
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    ABSTRACT: Objectives To evaluate the efficacy and safety of long-term administration of Infliximab in BD patients refractory to conventional therapy. Methods In this ongoing, prospective, longitudinal and observational study BD patients unresponsive to conventional therapy with corticosteroids plus at least two different immunosuppressive drugs were treated with Infliximab therapy (5 mg/kg intravenously at weeks 0, 2, 6, and every 6-8 weeks subsequently). Response to anti-TNF therapy was based on the expert opinion and was graded as follows: remission, response, no response and worsening. Remission was defined as the complete disappearance of symptoms and signs of inflammation and response as at least 50% of improvement. Results Since 2003, 68 BD patients (45 M/23 F; mean age 33.9±11.2 yrs; mean disease duration 12.4±9.5 yrs; 67% HLA-B51 positive) were enrolled. Indication for Infliximab treatment were uveitis in 35 patients, severe mucocutaneous manifestations in 14, CNS vasculitis in 11, optic neuritis in 1, intestinal involvement in 2, arthritis in 2, seizure in 2, vascular involvement in the remaining 1. The median duration of infliximab treatment was 25.5 months (range 1-106 months). Infliximab therapy resulted in a remission in 20 patients with uveitis, in 6 with CNS involvement, in 3 with severe mucocutaneous manifestations, in 1 with optic neuritis, in 1 with arthritis and in 1 with vascular involvement. A response was observed in 4 patients with mucocutaneous manifestations. The drug was stopped for lack of efficacy in 4 patients with severe mucocutaneous manifestations, 2 with uveitis, 2 with CNS vasculitis, 1 with seizure. Seventeen BD patients stopped infliximab therapy for loss of efficacy. Six BD patients discontinuated infliximab treatment for serious adverse events (5 for infusion reactions, 1 for bacterial pneumonia). Adverse events not requiring drug discontinuation were observed in 7 patients (mild infusion reactions in 2, upper respiratory tract infection in 6, urinary tract infection in 1). Conclusions In our experience infliximab has been showed effective and safe in a long-term follow-up in patients with refractory BD. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A638-A638. DOI:10.1136/annrheumdis-2013-eular.1894 · 10.38 Impact Factor
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    ABSTRACT: Background Till now the debate on the relationship between Behçet’s disease (BD) and spondyloarthritis (SpA) has been limited to whether the frequency of sacroiliitis and ankylosing spondylitis (AS) is greater or not in patients with BD than in controls. But if BD and SpA occur together more frequently than by change, it should be possible to find patients with BD showing different forms of SpA. In actual fact, some patients with BD and undifferentiated SpA were reported in the last two decades. Recently, the Assessment of SpondyloArthritis international Society (ASAS) developed and validated classification criteria for axial and peripheral SpA that are going to substitute the Amor criteria and the European Spondylarthropathy Study Group (ESSG) criteria for all forms of SpA. Objectives The aim of our study was to evaluate the frequency of Italian patients with BD meeting the ASAS classification criteria for SpA. Methods Consecutive patients attending the outpatient clinic for BD of the Rheumatology Department of Lucania and meeting the International Study Group (ISG) criteria were assessed. Each patient was asked about the presence of SpA or related diseases, such as psoriasis and inflammatory bowel disease (IBD), in his first-degree relatives. Each patient was evaluated for clinical manifestations of SpA including, inflammatory low back pain, spinal limitation and deformity, peripheral arthritis, peripheral enthesitis, dactylitis and acute anterior uveitis. Pelvic plain films were obtained in all patients and examined blindly and independently for sacroiliac joint changes by two observers. HLA typing was performed by PCR-SSP. Results During a 6-month period, 74 consecutive patients (49 M, 25 F; mean age 39.8±11.4 yrs; mean disease duration 17.8±8.9 yrs; 64% HLA-B51 positive) with BD were recruited. Seven (9.4%) out of them met the ASAS classification criteria for SpA. Of these, 1 had axial disease with the feature of AS and 6 peripheral SpA. In 2 of these 6, acute anterior uveitis without posterior involvement was essential for the diagnosis of SpA. The remaining 4 had psosiasis, dactylitis, enthesitis or inflammatory chronic low back pain in addition to peripheral arthritis. Two of the 7 patients with SpA features were HLA-B27 positive. Conclusions Italian patients with BD show a higher frequency of SpA, as defined by the ASAS criteria, than that expected in the general population. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A638-A639. DOI:10.1136/annrheumdis-2013-eular.1895 · 10.38 Impact Factor
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    ABSTRACT: The ASAS (Assessment in SpondyloArtrhritis international Society) classification criteria for axial and peripheral spondyloarthritis permit to classify patients with age at disease onset less than 45 years. Nevertheless, these two forms of spondyloarthritis may begin after the age of 45. With the longer duration of the life expectancy, patients with this late-onset form of spondyloarthritis may be more frequently recognized in the near future. A small percentage (ranging from 3.5 to 6 %) of patients with axial SpA, as defined by the modified New York criteria, have onset of their disease after 45 years of age. Relatively more frequent is the late onset form of peripheral spondyloarthritis with the characteristics of undifferentiated spondyloarthritis. Its clinical spectrum is as broad as it is in children and very young adults. Psoriatic arthritis frequently begins over the age of 45 and occasionally after the age of 60. Some old studies had suggested than elderly-onset psoriatic arthritis is more severe than younger-onset disease, but a recent study found no such difference, and further studies are needed.
    Current Rheumatology Reports 12/2013; 15(12):374. DOI:10.1007/s11926-013-0374-7 · 2.87 Impact Factor
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    ABSTRACT: Introduction: Tumor necrosis factor (TNF) blockers have represented a real revolution in the treatment of rheumatoid arthritis and spondyloarthritides (SpAs). In the case of psoriatic arthritis (PsA), anti-TNF agents are much more effective than conventional disease modifying antirheumatic drugs on all manifestations of the disease, that is, axial involvement, peripheral arthritis, peripheral enthesitis, dactylitis and skin lesions. A complete understanding of their safety is fundamental in clinical practice. Areas covered: This article addresses the safety of anti-TNF therapy in PsA. A systematic literature review was performed using the largest electronic databases (MEDLINE, EMBASE and COCHRANE). The reported data were derived from randomized controlled trials, open-observational studies and meta-analyses. Useful information derived from the experiences in rheumatoid arthritis has also been reported. Expert opinion: Anti-TNF therapies are as safe as conventional disease-modifying antirheumatic drugs in the management of psoriatic arthritis when the candidate patients are accurately selected. An adverse event could still occur when the patient is managed according to current national and/or international recommendations; therefore, tight controls aimed to detect adverse events early is mandatory.
    Expert Opinion on Drug Safety 11/2013; 13(2). DOI:10.1517/14740338.2014.857655 · 2.91 Impact Factor
  • The Journal of Rheumatology 08/2013; 40(8):1251-3. DOI:10.3899/jrheum.130647 · 3.19 Impact Factor
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    ABSTRACT: Objectives: This paper aims to estimate the prevalence of Behçet's disease (BD) in the city of Potenza, the regional capital of Basilicata (or Lucania) Region, in southern Italy. Methods: Patients with BD living in Potenza for at least 12 months prior to diagnosis were identified through the following sources: general practitioners, community-based specialists, San Carlo Hospital specialists, the Basilicata centralised index and the Basilicata database for rare diseases. All identified patients were contacted by phone and were recalled to our outpatient clinic for re-evaluation. Patients were classified as having complete BD if they met the International Study Group (ISG) criteria for BD. Results: By surveying a population of 69.060 subjects, 13 patients with a diagnosis of BD were identified. All were white and Italian by descendent. Eleven out of these satisfied the ISG criteria and allowed us to obtain a prevalence rate of 15.9 per 100.000 (95%CI 8.9-28.5), which is the highest ever found value in Europe. Conclusions: This cross-sectional population-based study suggests that BD is more frequent in the southern part than in the northern part of Italy and confirms that the prevalence of the disease increases in a north-to-south manner within the European continent.
    Clinical and experimental rheumatology 04/2013; 31(3 Suppl 77). · 2.72 Impact Factor
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    ABSTRACT: The spondyloarthritis (SpA) complex includes ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, arthritis related to inflammatory bowel disease and forms that do not meet established criteria for these definite categories which are designated as undifferentiated SpA. In the early 1990s, two sets of classification criteria were suggested with the purpose to cover the whole clinical spectrum of SpA: the Amor criteria and the European Spondylarthropathy Study Group (ESSG) criteria...
    Reumatismo 03/2013; 65(1):1-3. DOI:10.4081/reumatismo.2013.1
  • Rheumatology (Oxford, England) 01/2013; 52(5). DOI:10.1093/rheumatology/kes396 · 4.48 Impact Factor
  • Clinical and experimental rheumatology 11/2012; 31(1). · 2.72 Impact Factor
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    ABSTRACT: TNF blockers have revolutionized the management of spondyloarthritis (SpA). To date, four anti-TNFα agents (etanercept, infliximab, adalimumab, golimumab) have been approved for the management of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The first objective in the management of AS and PsA with TNF inhibitors is to reduce disease activity to clinical remission or low disease activity. After remission has been achieved, this state should be maintained as long as possible. However, the financial burden associated with the cost of anti-TNF agents as well as concerns about their long-term safety suggest reducing the dosage of the drug or discontinuing the therapy in the hopes of drug-free remission. The aim of this review is to examine what has, till now, been published on this topic in axial SpA, which includes AS and non-radiographic axial SpA (nr-axSpA), peripheral SpA and PsA. Discontinuation of therapy in axial SpA is not possible in the majority of patients, while on the contrary, reducing the dosage often is. In some patients with peripheral SpA and PsA it is also possible to discontinue therapy and to achieve drug-free remission.
    Autoimmunity reviews 08/2012; 12(7). DOI:10.1016/j.autrev.2012.08.013 · 7.93 Impact Factor
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    ABSTRACT: Therapies for psoriatic arthritis were inadequate until a short time ago. Nonsteroidal antiinflammatory drugs are helpful in relieving symptoms but do not prevent joint damage. Traditional disease-modifying antirheumatic drugs are used to control symptoms, but there is no evidence that they prevent or significantly slow the progression of structural damage in peripheral joints. The introduction of tumor necrosis factor-α (TNF-α) blocking agents has opened new horizons. These drugs lessen signs and symptoms of inflammation, enhance functional capacity and quality of life, and inhibit structural joint damage. On the other hand, TNF-α blockers are very costly and not easily available to all patients, whether they rely on a national health system or on private insurance. Pharmacoeconomic studies on these drugs so far have shown that they are cost-effective on both the musculoskeletal and skin manifestations of psoriatic disease, offering good value for money.
    Journal of Rheumatology Supplement 07/2012; 89:103-5. DOI:10.3899/jrheum.120258
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    ABSTRACT: This article summarizes the state of radiological assessment of axial involvement in psoriatic arthritis (PsA). The definition and measurement of axial disease in PsA remain problematic and this situation in turn could affect the choice of approach to evaluate radiological findings of the spine. At present, the radiological assessment has been evaluated by using scoring systems borrowed from ankylosing spondylitis (AS). In particular, the Bath AS Radiology Index (BASRI) and the modified Stoke AS Spine Score (m-SASSS) have been validated for axial PsA. A recent study showed that BASRI and m-SASSS were valid instruments; however, neither score encompassed all radiological features of PsA. Therefore, a new index for assessing radiological axial involvement in PsA was developed--the PsA Spondylitis Radiology Index (PASRI). This new index encompassed a greater range of the spinal radiological features of PsA, providing a greater score range, and it correlated well with anthropometric and patient-reported outcomes. Recently, a study assessed the sensitivity to change of BASRI, m-SASSS, and PASRI, and showed that these 3 instruments provided a moderate sensitivity to change but high specificity to detect the true changes.
    Journal of Rheumatology Supplement 07/2012; 89:54-6. DOI:10.3899/jrheum.120244
  • C. Palazzi · S. D'angelo · I. Olivieri
    The Journal of Rheumatology 07/2012; 39(7):1483-1483. DOI:10.3899/jrheum.120272 · 3.19 Impact Factor
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    ABSTRACT: Since the 1970s, asymptomatic involvement of several musculoskeletal structures was described in patients with psoriatic arthritis (PsA). We recently designated this clinical condition as occult PsA. This concept addresses an "underground" inflammatory process that can eventually cause structural damage. The percentage of PsA cases occurring in an occult manner remains to be determined but it does not seem small. From a teaching perspective, we suggest differentiating occult PsA into 3 subsets: real occult PsA, characterized by a continuous asymptomatic course; temporary occult PsA, in which the clinical course remains asymptomatic for a period; and limited occult PsA, which occurs asymptomatically in some areas of the body but is clinically evident in others. Some serum biomarkers could identify patients to be studied with imaging techniques to discover real occult PsA. Since an asymptomatic course was also reported for other spondyloarthropathies, the concept of occult arthritis could be expanded to the whole field of such conditions.
    Journal of Rheumatology Supplement 07/2012; 89:22-3. DOI:10.3899/jrheum.120236
  • Source
    S D'Angelo · C Palazzi · I Olivieri
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    ABSTRACT: The traditional management of psoriatic arthritis (PsA) includes NSAIDs, corticosteroids and DMARDs. Advancement in the knowledge of the immunopathogenesis of PsA has been associated with the development of biologic agents which have revolutionized the management of the disease. Among biologics drugs, there are the 4 currently availablee anti-TNFα blocking agents (etanercept, infliximab, adalimumab and golimumab) which are more effective than traditional DMARDs on symptoms/signs of inflammation, quality of life, function, and in inhibiting the progression of the structural joint damage. Despite of the high cost, TNF inhibitors are costeffective on both the musculoskeletal and skin manifestations of psoriatic disease.
    Reumatismo 06/2012; 64(2):113-21. DOI:10.4081/reumatismo.2012.113

Publication Stats

681 Citations
281.26 Total Impact Points


  • 2005–2015
    • Ospedale Madonna Delle Grazie, Matera
      Matera, Basilicate, Italy
  • 2011–2013
    • Ospedale San Carlo di Potenza
      Potenza, Basilicate, Italy
  • 2003–2013
    • Azienda Ospedaliera San Carlo Borromeo Milano
      • Department of Radiology
      Milano, Lombardy, Italy
  • 2003–2012
    • Santo Spirito Hospital, Casale Monferrato
      Casale, Piedmont, Italy
  • 1995
    • Spedali Civili di Brescia
      Brescia, Lombardy, Italy