Rossella De Angelis

University of Milan, Milano, Lombardy, Italy

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Publications (44)101.65 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Ultrasound (US) is a cost-effective, noninvasive, accessible imaging modality that clinicians use at the point of care to assess disease activity and therapeutic efficacy in different rheumatic conditions. However, its utility has been prevalently demonstrated in the field of chronic arthritides. Only in the last few years there was an interest to explore the potential of US beyond the musculoskeletal area. In this way, preliminary US data about the assessment of the different targets involved in systemic sclerosis such as joints, tendons, skin, vessels, and lung have been provided. The main purpose of this US review is to provide an overview of the potential role of US in the multi-target assessment of SSc and to discuss the current evidence supporting its relevance and applications in daily clinical practice.
    Clinical Rheumatology 02/2014; · 2.04 Impact Factor
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    ABSTRACT: To determine the prevalence of fibromyalgia (FM) in patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) characterized by axial involvement (axial-PsA), and to assess the discriminative ability of different versions of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) in measuring disease activity in three different cohorts of patients with axial spondyloarthritis (axial-SpA), FM, or both (axial-SpA + FM), this study was divided into two phases: (1) 402 patients with definite AS or axial-PsA were examined to diagnose FM and estimate its prevalence; and (2) 419 patients (111 with axial-SpA, 248 with FM, and 60 with aSpA + FM) were evaluated using the different versions of the ASDAS and BASDAI to assess the effect on disease activity. The overall prevalence of FM in the axial-SpA population was 14.9 %, significantly higher among women (p < 0.0001); the estimated prevalence in AS was 12.7 % and in axial-PsA was 17.2 %. Although the BASDAI scores correlated with those of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) (p < 0.0001), only ASDAS had sufficient discriminatory ability to assess disease activity. The addition of only one marker of inflammation led to an adequate level of significance (ASDAS-CRP, p = 0.0018; ASDAS-ESR, p = 0.003). FM is common in axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS is better than BASDAI in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.
    Rheumatology International 02/2014; · 2.21 Impact Factor
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    ABSTRACT: Objective. To determine the sensitivity, specificity and accuracy of ultrasound (US) in the detection of cartilage calcification at knee level in patients with calcium pyrophosphate deposition (CPPD) and to assess the inter-observer reliability. Methods. Seventy-four CPPD disease patients and 83 controls with other chronic arthritis were included. All patients underwent a clinical examination, synovial fluid analysis and X-ray assessment of the knee. US examinations were performed aimed to detect hyperechoic spots within the hyaline cartilage layer and hyperechoic areas within the meniscal fibrocartilage. Twenty patients were assessed by two operators in order to calculate the inter-observer reliability. Results. A total of 314 knees in 157 patients (74 with CPPD disease, 19 with RA, 17 with SpA, 32 with OA and 15 with gout) were assessed. In patients with CPPD disease, hyaline cartilage spots were detected by US in at least one knee of 44 out of 74 (59.5%) whereas 34 out of 74 (45.9%) were detected by X-ray (p < 0.001). Meniscal fibrocartilage calcifications were detected by US in at least one knee of 67 out of 74 (90.5%) whereas 62 out of 74 (83.7%) were detected by conventional radiography (p = 0.011). The criterion validity expressed as percentage of sensitivity, specificity and accuracy of US in the detection of articular cartilage calcification was high. Both κ values and overall agreement percentages showed moderate to excellent agreement.
    Arthritis care & research. 10/2013;
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    ABSTRACT: Nailfold capillaroscopy has been extensively applied in a broad spectrum of pathologic conditions, but very few data have been published in healthy individuals. The aim of this study was to describe the nailfold capillary findings on a large series of healthy subjects using the video-capillaroscopy technique. Nailfold capillaries were studied based on their morphology, dimensions and density. Then, to evaluate jointly the association between different capillary findings groups of subjects which were homogeneous for their characteristics, cluster analysis was performed. The results (median) of capillary measurements were as follows: loop length 207 μm, external diameter 39 μm, internal diameter 17 μm, apical diameter 17 μm, intercapillary distance 143 μm. Based on the cluster analysis three major "normal" morphologic capillaroscopic patterns were depicted: 1) the "perfect normal" pattern mainly with 2 to 5 U shaped loops /mm and≤2 tortuous loops /mm; 2) the "normal" pattern with≥5 U shaped loops /mm and 3) the "unusual normal" with at least 1 meandering or bushy loop, or at least 1 microhaemorrhage, or with >4 crossed loops /mm. Regarding the loop measurements, the majority of subjects had a median of 7 capillaries/mm with a median length of 198 micron.
    Microvascular Research 07/2013; · 2.93 Impact Factor
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    ABSTRACT: To test the learning curve of rheumatologists with different experience in videocapillaroscopy (VCP) attending an intensive training program focused on interpretation of the main capillary nailfold abnormalities, the scleroderma (systemic sclerosis, SSc) pattern, and the normal pattern, and to determine their interreader agreement with an experienced investigator. Five investigators (1 senior, 1 junior, and 3 beginners) participated in the exercise. The study was composed of 2 steps. First, an independent investigator selected representative VCP images of normal patterns and capillary abnormalities. The second step included the training program, which ran 4 hours per day for 7 days. The senior rheumatologist taught investigators to recognize and interpret the normal pattern, the capillary abnormalities, and the different types of SSc pattern. These abnormalities were considered: homogeneously enlarged capillaries, giant capillaries, irregularly enlarged capillaries, microhemorrhages, neoangiogenesis, avascular areas, and capillary density. A total of 300 VCP images were read from all the investigators. Both κ values and overall agreement percentages of qualitative and quantitative assessments showed progressive improvement from poor to excellent from the beginning to the end of the exercise. The sensitivity and specificity of the participants in the assessment of SSc pattern at the last lecture session were high. Our pilot study suggests that after an intensive 1-week training program, novice investigators with little or no experience in VCP are able to interpret the main capillary abnormalities and SSc pattern and to achieve good interreader agreement rates.
    The Journal of Rheumatology 04/2012; 39(6):1248-55. · 3.26 Impact Factor
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    ABSTRACT: To observe for changes in capillary morphology and architecture by tight sequential videocapillaroscopic (VCP) assessment in patients with dermatomyositis (DM) and systemic sclerosis (SSc). VCP examination was performed in 6 patients with DM and 9 with SSc, at baseline and after one month for three times. Four consecutive fields were examined bilaterally for any single finger (from 2nd to 5th). The best visible image per each digit was selected and images from baseline and follow-up were analysed as a sequence, to allow the same capillaries to be tracked and re-assessed. The following abnormalities were identified: homogeneous enlarged capillaries, giant capillaries, irregularly enlarged capillaries, microhaemorrhages, microaneurysms and neoangiogenesis. Capillary density was also considered. A significant progressive change of the following abnormalities was detected in DM patients with respect to SSc patients: microhaemorrhages (p=0.009), avascular areas (p=0.024), neoangiogenesis (p=0.001), microaneurysms (0.001), and irregular enlarged capillaries (p=0.044). No significant differences were found for homogeneous enlarged capillaries (p=0.140), giant capillaries (p=1.0) and hairpin/crossed capillaries (0.516). Our preliminary study demonstrated a rapid change of the capillary morphology and architecture in DM with respect to SSc patients. Additional investigations involving larger series of patients may be useful to support more strongly our observations.
    Clinical and experimental rheumatology 01/2012; 30(2 Suppl 71):S67-70. · 2.66 Impact Factor
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    W Grassi, R De Angelis
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    ABSTRACT: Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate (MSU) crystals in the joints and soft tissues, consisting of a self-limited acute phase characterized by recurrent attacks of synovitis and a chronic phase in which inflammatory and structural changes of the joints and periarticular tissues may lead to persistent symptoms. Acute gout is characterized by a sudden monoarthritis of rapid onset, with intense pain, mostly affecting the big toe (50% of initial attacks), the foot, ankle, midtarsal, knee, wrist, finger, and elbow. Acute flares also occur in periarticular structures, including bursae and tendons. The presence of characteristic MSU crystals in the joint fluid, appearing needle-like and showing strong negative birefringence by polarized microscopy, is pivotal to confirm the diagnosis of gout. The time interval separating the first attack from subsequent episodes of acute synovitis may be widely variable, ranging from a few days to several years. During the period between acute attacks the patient is asymptomatic even if MSU deposition may continue to increase silently. The factors that control the rate, location, and degree of ongoing deposition in gouty patients are not well defined. Chronic gout is the natural evolution of untreated hyperuricemia in patients with gouty attacks followed by pain-free intercritical periods. It is characterized by the deposition of solid MSU crystal aggregates in a variety of tissues including joints, bursae and tendons. Tophi can occur in a variety of locations including the helix of the ear, olecranon bursa, and over the interphalangeal joints. Their development is usually related with both the degree and the duration of hyperuricemia. About 20% of patients with gout have urinary tract stones and can develop an interstitial urate nephropathy. There is a strong association between hyperuricaemia and the metabolic syndrome (the constellation of insulin resistance, hypertension, obesity and dyslipidaemia), and gouty patients often have a medical history of kidney disease, diabetes mellitus and signs of vascular illness such as coronary artery disease, heart failure and stroke, resulting with a poor overall quality of life.
    Reumatismo 01/2012; 63(4):238-45.
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    ABSTRACT: The main aim of the present study was to determine the prevalence of subclinical entheseal involvement at lower limbs by ultrasound (US) in patients with psoriasis. The secondary aim was to determine the interobserver reliability of the Glasgow Ultrasound Enthesitis Scoring System (GUESS) and power Doppler (PD) technique in the assessment of enthesopathy. The study was conducted on 45 patients with psoriasis and 45 healthy sex- and age-matched controls. All patients with no clinical evidence of arthritis or enthesitis underwent an US examination. All US findings were identified according to GUESS. The interobserver reliability was calculated in 15 patients with psoriasis. A total of 450 entheses in 45 patients with psoriasis were evaluated by US. In 148 of 450 (32.9%) entheses, grayscale US found signs indicative of enthesopathy. In 4/450 (0.9%) entheses PD signal was detected. In the healthy population, US found signs of enthesopathy in 38 of 450 (8.4%) entheses and no PD signal was detected. The GUESS score was significantly higher in patients with psoriasis than in healthy controls (P < 0.0001). Both concordance correlation coefficient and unweighted κ values for US findings showed an excellent agreement (0.906 and 0.890, respectively). Our results indicate that both grayscale US and PD findings indicative of enthesopathy were more frequent in patients with psoriasis. The US ability to detect signs of subclinical enthesopathy should be the object of longitudinal investigations to define its value in predicting the clinical onset of psoriatic arthritis.
    Seminars in arthritis and rheumatism 04/2011; 40(5):407-12. · 4.72 Impact Factor
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    ABSTRACT: There is a growing number of papers investigating the diagnostic potential of ultrasonography in the assessment of patients with psoriatic arthritis and supporting its higher sensitivity over clinical examination in the diagnosis of synovitis, enthesitis and tenosynovitis. Less attention has been paid on both skin and nail, frequently involved in this condition. The aim of this paper is to show the potential of ultrasound in a multi-target assessment (joints, tendons, entesis, skin and nails) in patients with psoriatic arthritis, using the last generation ultrasound equipment.
    Reumatismo 01/2011; 61(4):309-15.
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    ABSTRACT: To investigate the role of elastosonography to improve the reliability of the ultrasound in the measurement of the dermal thickness at finger level in systemic sclerosis (SSc). Twenty-two patients with a diagnosis of SSc were consecutively recruited. In all patients at the second finger level of the dominant hand the dorsal aspect of proximal and middle phalanx was assessed in grey-scale and also using the elastosonography by an experienced musculoskeletal sonographer. The first step of the study was directed to explore the correlation between measurements of the dermal thickness using the grey-scale and elastosonography. Subsequently, the intra and the inter-reader reliability (between the sonographer who performed the ultrasound study and another sonographer) in the ultrasound measurements of the dermal thickness was assessed. Intra and inter-reader reliability was calculated using intra-class correlation coefficient (ICC) and illustrated by Bland-Altman plots. The ICC values were 0.904 and 0.979 for the intra-observer agreement, and 0.726 and 0.881 for the inter-observer agreement, using only the grey-scale and also the elastosonography, respectively. An excellent correlation was obtained between measurements in grey-scale and adopting the elastosonography by the experienced sonographer (rho=0.99), while the rho values between the two readers were 0.59 and 0.88, using the conventional technique and also the elastosonography, respectively. Elastosonography can improve the reliability of the US measurements of the dermal thickness at finger level in patients with SSc, helping for the identification of the interface dermis/hypodermis.
    Clinical and experimental rheumatology 01/2011; 29(6):926-32. · 2.66 Impact Factor
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    Arthritis & Rheumatology 12/2010; 62(12):3829. · 7.48 Impact Factor
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    Rheumatology (Oxford, England) 10/2010; 49(10):1994-6. · 4.24 Impact Factor
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    ABSTRACT: To date, the diagnosis of psoriasis is based on both clinical history and physical examination, and its severity is assessed by the Psoriasis Area and Severity Index (PASI). Continuous technological advances in the field of sonography have led to the development of equipment with high power Doppler frequency, which allows for very detailed morphological information regarding the dermal blood flow. To compare power Doppler sonography (PDS) with clinical and histological findings before and after etanercept treatment in patients with psoriasis. Twelve patients with a clinical diagnosis of psoriasis were enrolled in this study. The PASI, PDS and histological examinations were assessed in all patients on the same day at baseline, and after 12 weeks of biological treatment. PDS examination was performed by an experienced sonographer, using a sonographic system equipped with transducer ranging from 6 to 18 MHz and Doppler frequency ranging from 7 to 14 MHz. At follow up there was a significant decrease in PASI. A significant change was also detected for the PDS findings (P = 0·005). At baseline the median value for factor VIII staining was 1·5, and the median value for vascular endothelial growth factor (VEGF) staining was also 1·5. At follow up there was a significant decrease in both factor VIII and VEGF staining scores. Moreover, a positive correlation between reduction in PDS score and improvement in clinical and histological scores was found: Spearman's ρ = 0·639, P = 0·0022; Spearman's ρ = 0·619, P = 0·0013; Spearman's ρ = 0·765, P = 0·0002, respectively. Our results show a significant correlation between PDS findings and both PASI and histological degree of vascularization before and after etanercept treatment. These data provide evidence in favour of the validity of PDS in the assessment of dermal perfusional changes in patients with psoriatic plaques.
    British Journal of Dermatology 09/2010; 164(1):33-7. · 3.76 Impact Factor
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    ABSTRACT: The purpose of this study was to show the potential of the latest sonographic equipment using high-frequency probes and a very sensitive power Doppler (PD) technique in depicting both skin and nail changes in patients affected by psoriasis. The study was conducted in 30 patients with a diagnosis of psoriasis clinically performed by an experienced dermatologist and 15 healthy participants, using a currently available sonography system equipped with a variable-frequency transducer ranging from 6 to 18 MHz and a Doppler frequency ranging from 7 to 14 MHz. The images illustrated in this presentation are representative examples of the ability of sonography to show and characterize even minimal morphostructural and blood flow changes in patients with both psoriatic plaques and onychopathy. This report provides pictorial evidence that high-resolution gray scale sonography with a PD technique is a real-time and noninvasive imaging technique that can be used as an adjunct to the clinical evaluation in assessing psoriatic disease.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2009; 28(11):1569-74. · 1.40 Impact Factor
  • Rheumatology (Oxford, England) 10/2009; 49(2):400. · 4.24 Impact Factor
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    ABSTRACT: Ultrasound is a rapidly evolving technique that is gaining an increasing success in the assessment of psoriatic arthritis. Most of the studies have been aimed at investigating its ability in the assessment of joints, tendons, and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nail. The aim of this pictorial essay was to show the main high-frequency grayscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin, and nail level.
    Clinical Rheumatology 10/2009; 29(2):133-42. · 2.04 Impact Factor
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    ABSTRACT: Over the last decade, ultrasound has been increasingly used in rheumatology for assessing soft tissue involvement in patients with chronic arthritis. In spite of the high number of studies supporting the role and the validity of ultrasound in the assessment of patients with rheumatoid arthritis, the potential of ultrasound imaging in patients with psoriatic arthritis still waits to be adequately investigated. Our report illustrates the most relevant sonographic findings obtainable with the latest generation ultrasound equipment in patients with psoriatic arthritis.
    Journal of Rheumatology Supplement 09/2009; 83:35-8.
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    Rossella De Angelis, Walter Grassi, Maurizio Cutolo
    Arthritis & Rheumatology 03/2009; 61(3):405-10. · 7.48 Impact Factor
  • Rossella De Angelis, Fausto Salaffi, Walter Grassi
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    ABSTRACT: To assess health-related quality of life (HRQL) in patients with primary Raynaud phenomenon (RP). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire and the EQ-5D questionnaire were administered to 81 patients with primary RP who had been referred to a rheumatological department. The scores were compared with data of control subjects. In the physical dimensions of the SF-36, the subjects who had RP had significantly lower scores (worse HRQL) than controls (47.6 +/- 9.8 vs. 52.2 +/- 9.3, P = 0.021). The physical component score (PCS) was correlated with age (P = 0.003) and the number of comorbidities (P = 0.004). The mental health component score (MCS) was significantly lower in RP subjects than in controls (41.9 +/- 9.4 vs. 46.1 +/- 10.7, P = 0.006). As regards anxiety/depression (of the EQ-5DA/D), considerably more RP patients (77.7%) reported at least some related problems as compared with controls (60.0%) (chi = 7.93; P = 0.005). Fifty-two RP patients (64.2%) and 178 controls (57.8%) described themselves as moderately anxious/depressed, whereas 11 RP patients (13.5%), and 7 controls (2.2%) reported extreme anxiety/depression (P < 0.0001). This study shows a reduction of the HRQL in patients with primary RP, compared with control subjects. The psychologic wellbeing represents the most involved area, whereas physical functioning and symptoms are significantly influenced by age and comorbidities. Moreover, these patients are more anxious/depressed (EQ-5DA/D). Longitudinal studies are needed to validate our findings, to explore the causal relationship between primary RP and emotional factors, and to possibly lead to encouraging behavioral therapies.
    Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 08/2008; 14(4):206-10. · 1.19 Impact Factor
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    Juan Pablo Restrepo, Rossella De Angelis, Walter Grassi
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    ABSTRACT: Summary Nailfold capillaroscopy is a simple, non-invasive, inexpensive and useful method for the analysis of microvascular abnormalities that can be found in rheumatic disorders. The well-known Raynaud's phenomenon represents a clinical condition that should promptly lead to a microvascular analysis, in order to distinguish its primary form from the secondary. Capillaroscopy has an exceptional predictive value for the diagnosis of early systemic sclerosis and this may be the best advantage this technique can offer. Microvascular damage is a typical feature of systemic sclerosis and a great number of this patients present architectural disorganization, tortuositis, giant capillaries, neovascularization haemorrhages, loss of capi-
    Revista Colombiana de Reumatología. 07/2008; 15(3).

Publication Stats

517 Citations
101.65 Total Impact Points

Institutions

  • 2013
    • University of Milan
      • Department of Clinical Sciences and Community Health
      Milano, Lombardy, Italy
  • 2005–2013
    • Università Politecnica delle Marche
      • • Chair of Rheumatology
      • • Department of Molecular Pathology and Innovative Therapies
      Ancona, The Marches, Italy