Silvia Rossi

Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardy, Italy

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Publications (9)42.04 Total impact

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    ABSTRACT: OBJECTIVES: To investigate whether children with juvenile idiopathic arthritis (JIA) in clinical remission have subclinical synovial disease on ultrasound, and whether ultrasound abnormalities predict an early flare of synovitis. METHODS: Thirty-nine consecutive children who had clinically defined inactive disease (ID) for a minimum of 3 months underwent ultrasound assessment of 52 joints. All joints were scanned for synovial hyperplasia, joint effusion, power Doppler (PD) signal and tenosynovitis. Patients were then followed clinically for up to 2 years until a flare of synovitis occurred in one or more joints, or until the 2-year visit if the disease remained in clinical remission. RESULTS: Synovial hyperplasia, joint effusion, PD signal and tenosynovitis in at least one joint were detected in 76.9%, 66.7%, 33.3% and 15.4% of patients, respectively. During the 2-year follow-up, 24 patients (61.5%) experienced sustained ID, whereas 15 patients (38.5%) had a flare of synovitis in a total of 45 joints after a median of 10.6 months (range 6.3-13.7 months). At study entry, the rate of synovial hyperplasia, joint effusion and tenosynovitis was comparable between patients with persistent ID and patients with synovitis flare, whereas patients with persistent ID had a greater frequency of PD signal than patients with synovitis flare. Only 17 of the 45 flared joints had ultrasound abnormalities at study entry. CONCLUSION: The authors found that ultrasound-detected synovial abnormalities are common in children with JIA in clinical remission. However, the presence of ultrasound pathology did not predict an early flare of synovitis in the affected joints.
    Annals of the rheumatic diseases 06/2012; · 8.11 Impact Factor
  • Annals of the rheumatic diseases 04/2012; 71(4):625-6. · 8.11 Impact Factor
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    ABSTRACT: To assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments. Inclusion criteria were age 18-65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred. 258 subjects were prospectively observed between October 2004 and October 2008. The mean ± SD follow-up was 35.0 ± 11.9 months (range 1-48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively). Hypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.
    Annals of the rheumatic diseases 02/2011; 70(6):1083-6. · 8.11 Impact Factor
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    ABSTRACT: ABSTRACT Objective: To evaluate safety of mud-bath therapy in mild-moderately rheumatoid arthritis [RA]. Methods: We planned a randomized, double-blinded, placebo-controlled trial in patients with moderate active RA, treated with active or placebo mud applied for 15 to 20 minutes at 39 to 40°C and followed by a shower and thermal bath at 37 to 38°C for 10 to 12 minutes. The first 50 patients were evaluated for an interim analysis and considered “treated patients” without blinding breakdown. Patients were evaluated before treatment [visit 1], at the end of the treatment [visit 2], after four weeks [visit 3], and after six months [visit 4, end of the study] for flare, Disease Activity Score [DAS], C-reactive protein, swollen joints, Health Assessment Questionnaire, and adverse reactions. As a control group, 50 matched RA patients were enrolled at the same outpatient clinic and evaluated four weeks apart. Results: The baseline characteristics of the two groups were similar. No significant differences were noted as for disease flares. Thirty-three [66 percent] treated and 12 [24 percent] control patients had an improvement of more than 0.6 on the DAS [p<.001]. Concerning the treated patients, DAS, C-reactive protein, swollen joints, and the Health Assessment Questionnaire showed a significant reduction at visit 2 when compared to the baseline, lasting until visit 4. No significant side effects were noted. Conclusions: A negative effect of hot application in mild to moderately active RA seems to be excluded. The observed improvement in disease activity should be the subject of further studies.
    03/2010; 18(1):81-87.
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    ABSTRACT: To compare clinical evaluation and ultrasonography (US) in the assessment of joint synovitis in children with juvenile idiopathic arthritis (JIA). Thirty-two patients underwent clinical evaluation of 52 joints by 2 pediatric rheumatologists. Joints were assessed for swelling, tenderness/pain on motion, and restricted motion. The same joints were scanned independently by an experienced sonographer for synovial hyperplasia, joint effusion, and power Doppler (PD) signal. In total, 1,664 joints were assessed both clinically and with US. On clinical examination, 98 joints (5.9%) were swollen, 59 joints (3.5%) were tender, and 40 joints (2.4%) had restricted motion. On US evaluation, 125 joints (7.5%) had synovial hyperplasia, 153 joints (9.2%) had joint effusion, and 53 joints (3.2%) had PD signal. A total of 104 (6.3%) and 167 (10%) joints had clinical and US synovitis, respectively. Of the 1,560 clinically normal joints, 86 (5.5%) had subclinical synovitis (i.e., had synovitis on US). US led to classifying 5 patients as having polyarthritis who were classified as having oligoarthritis or were found to have no synovitis on clinical evaluation. US variables were moderately correlated with clinical measures of joint swelling, but poorly correlated with those of joint tenderness/pain on motion and restricted motion. Overall, correlations were lower for PD signal than for synovial hyperplasia and joint effusion. We found that subclinical synovitis as detected by US is common in children with JIA. This finding may have important implications for patient classification and may affect the choice of the optimal therapeutic strategy in individual patients.
    Arthritis & Rheumatology 11/2009; 61(11):1497-504. · 7.48 Impact Factor
  • Arthritis & Rheumatology 12/2005; 37(5):777 - 778. · 7.48 Impact Factor
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    ABSTRACT: To investigate the clinical, serologic, radiologic and immunogenetic characteristics of rheumatoid arthritis (RA) occurring in patients with beta-thalassemic trait as compared with RA in control patients from the same geographical area. Twenty-eight patients with beta-thalassemic trait fulfilling the American College of Rheumatology (ACR) criteria for RA were compared with a control group of twenty-eight RA patients matched for age, sex, disease duration and place of birth. Clinical and routine laboratory assessment, including anti-keratin antibodies and anti-citrullinated peptide antibodies, was carried out in the two groups. The patients were also evaluated for HLADRB1 alleles and radiologic damage. No differences were found with regard to clinical indexes of disease activity, laboratory parameters, and joint erosions. The immunogenetic analysis did not show any significant difference, the percentage of patients with alleles encoding for the shared epitope being similar in the two groups (61% vs. 57%). As for the extra-articular features, we found a trend for a lower prevalence of sicca syndrome in the beta-thalassemic group (14% vs. 39%; P = 0.06). Rheumatoid nodules were not found in beta-thalassemic patients while they were present in two RA patients in the control group. The chronic polyarthritis occurring in beta-thalassemic trait carriers can be regarded as a true RA similar to that found in Mediterranean countries, possibly characterized by a low prevalence of extra-articular features.
    Joint Bone Spine 04/2004; 71(2):117-20. · 2.75 Impact Factor
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    ABSTRACT: Objectives. – To investigate the clinical, serologic, radiologic and immunogenetic characteristics of rheumatoid arthritis occurring in patients with beta-thalassemic trait as compared with rheumatoid arthritis in control patients from the same geographical area.Materials and methods. – Twenty-eight patients with beta talassemic trait fulfilling the American College of Rheumatology criteria for rheumatoid arthritis were compared with a control group of twenty-eight rheumatoid arthritis patients matched for age, sex, disease duration and place of birth. Clinical and routine laboratory assessment, including anti-keratin antibodies and anti-citrullinated peptide antibodies, was carried out in the two groups. The patients were also evaluated for HLADRB1 alleles and radiologic damage.Results. – No differences were found with regard to clinical indexes of disease activity, laboratory parameters, and joint erosions. The immunogenetic analysis did not show any significant difference, the percentage of patients with alleles encoding for the shared epitope being similar in the two groups (61% vs 57%). As for the extra-articular features, we found a trend for a lower prevalence of sicca syndrome in the beta thalassemic group (14% vs 39%; P = 0.06). Rheumatoid nodules were not found in beta thalassemic patients while they were present in two rheumatoid arthritis patients in the control group.Conclusions. – The chronic polyarthritis occurring in beta thalassemic trait carriers can be regarded as a true rheumatoid arthritis similar to that found in Mediterranean countries, possibly characterized by a low prevalence of extra-articular-features.
    Revue du Rhumatisme. 01/2004;
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    ABSTRACT: Anti-Ro(SS-A) 52 kDa and 60 kDa specificities in undifferentiated connective tissue disease. — Objective. Autoantibodies to Ro(SS-A) may recognize two different polypeptides, of 52 kDa and 60 kDa, respectively. Methods. We used an ELISA with purified human recombinant antigens to conduct a detailed analysis of the specificities of anti-Ro(SS-A) antibodies from 170 patients with definite diagnoses (systemic lupus erythematosus [SLE], n = 55; primary Sjögren's syndrome [PSS], n = 39; systemic sclerosis, n = 9; rheumatoid arthritis [RA], n = 10) or undifferentiated connective tissue disease (UCTD, n = 57). Most of the patients with SLE or PSS had both anti-52 kDa and -60 antibodies; isolated anti-60 kDa antibodies were found in 13 % of the SLE patients and in none of the PSS patients, whereas high titers of anti-52 kDa were more common in the PSS than in the SLE patients. Results. In the UCTD patients, the anti-Ro(SS-A) profile showed no significant correlations with clinical features but was associated with the clinical outcome. Over the mean follow-up of five years, definite SLE developed in four of the five UCTD patients with isolated anti-60 kDa vs only one of the remaining 52 patients (p < 0.0001); progression to PSS was seen in seven of the 34 patients with both anti-52 kDa and anti-60 kDa vs none of the remaining 23 patients (ρ = 0.03); none of the 12 patients with isolated anti-52 kDa developed a definite connective tissue disease. Conclusion. Our study suggests that analysis of anti-Ro(SS-A) specificity may provide useful information for predicting the course of UCTD.
    Revue du Rhumatisme 04/2000; 67(3):197-202.

Publication Stats

92 Citations
42.04 Total Impact Points

Institutions

  • 2012
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      Milano, Lombardy, Italy
  • 2004–2012
    • Policlinico San Matteo Pavia Fondazione IRCCS
      • s.c. Pediatria
      Ticinum, Lombardy, Italy
  • 2010
    • University of Pavia
      Ticinum, Lombardy, Italy