Filippo Fagni

Filippo Fagni
Friedrich-Alexander-University Erlangen-Nürnberg | FAU · Rheumatology and Immunology Clinic

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73
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Publications

Publications (73)
Article
Full-text available
Purpose of Review Psoriatic arthritis (PsA) is a complex heterogeneous inflammatory disease that affects about one-third of patients with psoriasis. PsA leads to significant physical impairment and reduced quality of life. Therefore, early diagnosis and intervention are critical for improving long-term outcomes. The purpose of this review is to hig...
Article
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Objectives Although patients with immune-mediated inflammatory diseases (IMID) are thought to be more susceptible to viral infections, it is unclear whether their presentation differs between patients with IMID and healthy controls. This study aimed to investigate the symptom pattern of common viral infections in patients with IMID and compare it w...
Article
Full-text available
Objective We assessed and compared molecular tissue changes at the entheses in patients with psoriasis (PsO) and psoriatic arthritis (PsA) and in healthy controls (HCs) in vivo using multispectral optoacoustic tomography (MSOT) and described their relationship with clinical and ultrasound findings of enthesitis. Methods A cross‐sectional study (MS...
Article
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Objectives To train, test and validate the performance of a convolutional neural network (CNN)-based approach for the automated assessment of bone erosions, osteitis and synovitis in hand MRI of patients with inflammatory arthritis. Methods Hand MRIs (coronal T1-weighted, T2-weighted fat-suppressed, T1-weighted fat-suppressed contrast-enhanced) of...
Article
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Objectives To assess the presence and anatomical distribution of activated fibroblasts in the joints and entheses of patients with psoriasis with arthralgia and to test how fibroblast activation visualised by ⁶⁸ gallium-labelled fibroblast activation protein inhibitor-04 ( ⁶⁸ Ga-FAPI-04)-positron emission tomography (PET)/CT correlates with clinica...
Conference Paper
Background It is estimated that a diagnostic delay of as little as 6 months can lead to the development of joint erosions and worse long-term outcomes in PsA [1]. Structural damage is usually monitored with conventional radiography, but this lacks sensitivity for the subtle bone changes which emerge during the early stages of disease progression. H...
Conference Paper
Background Subglottic Stenosis (SGS) is a rare and possibly life-threatening manifestation of Granulomatosis with Polyangiitis (GPA) carrying a significant risk of mortality and morbidity. Few data are available in the literature on SGS optimal treatment and the risk factors for relapses are currently unknown. Interim results of the STOP GPA study...
Conference Paper
Background Synovial fibroblasts play a crucial role in shaping the joint microenvironment and actively contribute to the initiation and progression of inflammatory arthritis [1]. Notably, distinct subsets of fibroblast activation protein (FAP)-positive synovial fibroblasts have been implicated in inflammation and bone erosion as well as resolution...
Conference Paper
Background Anti-citrullinated protein antibodies (ACPA), are associated with a more severe course of rheumatoid arthritis (RA).[1] There are currently no therapies to efficiently halt autoantibody production and restore immune tolerance in these patients. Both B cell-targeting therapy (Rituximab) and T cell-targeting therapy (Abatacept) have been s...
Conference Paper
Background Measuring disease activity in patients with inflammatory arthritis remains challenging and is mainly based on physician-dependent assessments, subjective measures and just one blood biomarker of inflammation with no indication of the subclinical or functional state of the patients [1, 2]. Patients with rheumatoid arthritis (RA) and psori...
Conference Paper
Background Enthesitis is a hallmark feature of psoriatic arthritis (PsA) course. So far, most of the data on enthesitis in PsA are based on clinical assessment as well as MRI or ultrasound examinations, due to the challenge in retrieving good quality entheseal tissue for molecular analysis. However, pre-clinical studies as well as surgical invasive...
Conference Paper
Background Autoimmune diseases such as systemic lupus erythematosus (SLE), idiopathic inflammatory myositis (IIM) and systemic sclerosis (SSc) often require long-term immune suppression. In some cases, the disease can be severe, progressive and does not adequately respond to standard immunosuppressive drug treatment. We and others have previously s...
Conference Paper
Background Mesenchymal tissue activation plays a key role already in the early phases of development of synovitis and enthesitis. PET/CT imaging with ⁶⁸Gallium-labelled Fibroblast Activation Protein Inhibitor-04 (⁶⁸Ga-FAPI-04) enables the visualization of fibroblast activation in vivo and has already been used to track disease activity in inflammat...
Conference Paper
Background Bi-specific T-cell engagers (BiTEs) kill B cells by engaging T cells. BITEs are highly effective in acute lymphoblastic leukemia but have not yet been tested in autoimmune disease. Multi-drug resistant rheumatoid arthritis patients represent a considerable challenge and require new approaches to treat their underlying autoimmune patholog...
Conference Paper
Background Janus Kinase inhibitors (JAKi), like baricitinib (BARI), are effective in the treatment of rheumatoid arthritis (RA) and are used as monotherapy or in combination with conventional DMARDs (csDMARDs). While effective in reducing the signs and symptoms of RA, the safety of the treatment with BARI is of key interest. In contrast to clinical...
Article
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Background: The accruing evidence about the efficacy of anti-IL-1 agents in Familial Mediterranean Fever (FMF) patients led to their widespread off-label use. Therefore, identifying precise indications and clinical characteristics of IL-1i-warranting patients are important. This study investigated the clinical characteristics and treatment indicati...
Article
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Bispecific T cell engagers (BiTEs) kill B cells by engaging T cells. BiTEs are highly effective in acute lymphoblastic leukemia. Here we treated six patients with multidrug-resistant rheumatoid arthritis (RA) with the CD19xCD3 BiTE blinatumomab under compassionate use. Low doses of blinatumomab led to B cell depletion and concomitant decrease of T...
Article
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Objective Subjects with subclinical psoriatic arthritis (PsA), defined as the presence of arthralgia in psoriasis (PsO), are at higher risk of PsA but scant real-world data exist. Our aims were to (1) estimate the probability of PsA development in subclinical PsA, (2) characterise subclinical PsA symptoms and (3) determine the clinical patterns at...
Article
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It is known that metabolic shifts and tissue remodelling precede the development of visible inflammation and structural organ damage in inflammatory rheumatic diseases such as the inflammatory arthritides. As such, visualising and measuring metabolic tissue activity could be useful to identify biomarkers of disease activity already in a very early...
Article
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Objectives To assess the impact of low to moderate biomechanical stress on entheses in patients with psoriasis and psoriatic arthritis (PsA). Methods We conducted a prospective interventional study on a cohort of psoriasis and PsA patients who underwent a 60 min badminton training session. Pain assessment by Visual Analogue Scale (VAS), physical e...
Article
Dear Editor, The development of effective screening strategies for psoriatic arthritis (PsA) is a challenge yet to be overcome. Established screening questionnaires are widely used for their high sensitivity but result in a high numbers of patients who are unnecessarily referred to rheumatologists due to their fairly poor specificity [1]. Grobelski...
Article
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Plain language summary Improving outcomes in Psoriatic Arthritis Psoriatic Arthritis (PsA) is a form of arthritis which is found in approximately 30% of people who have the skin condition, Psoriasis. Frequently debilitating and progressive, achieving a good outcome for a person with PsA is made difficult by late diagnosis, disease clinical features...
Article
Imaging techniques such as ultrasonography and MRI have gained ground in the diagnosis and management of inflammatory arthritis, as these imaging modalities allow a sensitive assessment of musculoskeletal inflammation and damage. However, these techniques cannot discriminate between disease subsets and are currently unable to deliver an accurate pr...
Article
Objectives: To investigate the effects of passive immunization with the anti-SARS-CoV-2 monoclonal antibodies tixagevimab/cilgavimab on humoral responses and on COVID-19 outcomes in vaccine-refractory patients with immune-mediated inflammatory diseases (IMID) at high risk of severe COVID-19. Methods: A prospective cohort study was performed on a...
Article
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Background Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS) [1] is used to manually assess severity of disease activity and monitor treatment response, but it is dependent on observer variability and is time-consuming. Deep learning techniques have the potential to improve the reproducibility and efficiency of RAMR...
Article
Background Rheumatic diseases result in joint destruction and impaired physical function [1]. We recently showed, that hand function based on objective tests may serve as a biomarker representing subclinical inflammation in psoriasis (Pso) patients and thus could support the early detection of psoriatic arthritis (PsA) onset [2]. Hand function test...
Article
Background Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PsA) are characterized by a deterioration of bone mass, bone microstructure and biomechanics [1, 2]. However, little evidence is available on the long-term evolution of these bone properties and the impact of autoimmunity, disease activity and targeted anti-inflammatory therapy. Objecti...
Article
Background In the clinical routine patient reported outcome measures (PROMs) such as the ‘Disability of the Arm, Shoulder and Hand Questionnaire’ (Quick-DASH) [1], ‘Score for the Assessment and quantification of Chronic Rheumatic Affections of the Hands’ (SF-SACRAH) [2] and the ´Health Assessment Questionnaire´ (HAQ) [3] are common for assessing fu...
Article
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Background Musculoskeletal inflammation is a frequent and debilitating feature of Systemic Lupus Erythematosus (SLE) that can involve all components of the joint, including extra-synovial sites such as the entheses¹. In previous reports, enthesitis could be clearly demonstrated by musculoskeletal ultrasound (US) in small cohorts of patients with SL...
Conference Paper
Full-text available
Background Behçet’s syndrome (BS) is a rare systemic vasculitis hallmarked by oral, genital and ocular involvement, often accompanied by articular, cutaneous, vascular, neurological, and gastrointestinal manifestations [1, 2]. Articular involvement is present in up to 80% of BS patients [3], and, from a clinical point of view, it may resemble seron...
Article
Full-text available
Behçet’s syndrome (BS) is a rare systemic vasculitis characterized by different clinical manifestations. As no specific laboratory tests exist, the diagnosis relies on clinical criteria, and the differential diagnosis with other inflammatory diseases can be challenging. Indeed, in a relatively small proportion of patients, BS symptoms include only...
Article
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Nail psoriasis occurs in about every second psoriasis patient. Both, finger and toe nails can be affected and also severely destroyed. Furthermore, nail psoriasis is associated with a more severe course of the disease and the development of psoriatic arthritis. User independent quantification of nail psoriasis, however, is challenging due to the he...
Article
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Objectives: To assess the prevalence of ultrasound (US)-confirmed enthesitis in a cohort of patients with systemic lupus erythematosus (SLE) and to analyze the clinical associations to enthesitis during the course of SLE. Methods: In a retrospective analysis of the SLE cohort of the Lupus Unit of the Careggi University Hospital, US examinations...
Article
Objective MicroRNAs (miRNAs) are small non-coding RNAs that control gene expression. Specific intra-and extracellular miRNA signatures have been identified in various diseases. Whether certain miRNA signatures are associated with psoriasis (PsO) and psoriatic arthritis (PsA) is currently unknown. We aimed to search for circulating miRNA signatures...
Article
Objective: MicroRNAs (miRNAs) are small non-coding RNAs that control gene expression. Specific intra- and extracellular miRNA signatures have been identified in various diseases. Whether certain miRNA signatures are associated with psoriasis (PsO) and psoriatic arthritis (PsA) is currently unknown. We aimed to search for circulating miRNA signatur...
Article
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Treat-to-target (T2T) is a main therapeutic strategy in rheumatology; however, patients and rheumatologists currently have little support in making the best treatment decision. Clinical decision support systems (CDSSs) could offer this support. The aim of this study was to investigate the accuracy, effectiveness, usability, and acceptance of such a...
Article
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Purpose of review: To provide an overview of existing literature on pathogenetic and clinical aspects of cardiac and vascular involvement in eosinophilic granulomatosis with polyangiitis (EGPA). Recent findings: In EGPA, cardiac and vascular involvement are more common than previously thought. However, no international recommendations on the top...
Article
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Background Patient education is crucial for successful chronic disease management. Current education material for rheumatic patients however rarely includes images of disease pathologies, limiting patients’ disease understanding. Cinematic rendering (CR) is a new tool that allows segmentation of standard medical images (DICOMs) into pictures that i...
Article
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Patients with immune-mediated diseases (IMID) such as systemic sclerosis (SSc), who are treated with B cell depleting treatments, are at risk for developing severe COVID-19 due to inadequate humoral immune response. During B cell depletion, therapeutic substitution of neutralizing monoclonal antibodies against the SARS-CoV-2 spike protein (mAbs) mi...
Article
Background Concerns have been raised about the reduced immunogenicity of vaccines against SARS-CoV-2 in patients with immune-mediated inflammatory diseases and the higher risk of breakthrough infections. The objective of our study was to investigate the intensity and longevity of SARS-CoV-2 vaccination responses in patients with immune-mediated inf...
Article
Objective To explore the metabolic characteristics of arthritis and enthesitis using multispectral opto-acoustic tomography (MSOT), a technology using near-infrared multispectral laser to stimulate tissues and detect the emitted acoustic energy, enabling non-invasive quantification of tissue components in vivo based on differential absorbance at mu...
Article
Background An in-depth metabolic characterization of joints and entheses at the tissue level can help in the early diagnosis and treatment selection for patients with inflammatory arthritis [1]. However, current knowledge about the metabolic profiles of synovitis and enthesitis is limited. Multispectral optoacoustic tomography (MSOT), a novel metab...
Article
Background The first vaccine against SARS-CoV-2 was approved in December 2020. Immunogenicity of SARS-CoV2 vaccines in patients with immune-mediated inflammatory disease (IMID) have so far been evaluated in the 2-6 weeks following complete vaccination and risk groups for poor early vaccine response have been identified leading to specific vaccinati...
Article
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Background While MRI evaluation of joints has been primarily used to quantify inflammation at a cross-sectional and longitudinal level, less is known about the potential of MRI in distinguishing different patterns of inflammation in the various forms of arthritis. Objectives To evaluate (i) whether deep learning using neural networks can be traine...
Article
Full-text available
Background MicroRNAs (miRNAs) are small non-coding RNAs that control gene expression. Specific miRNA signatures have been identified in numerous diseases and may serve as potential biomarkers or new drug targets. Whether certain miRNA signatures are associated with psoriatic joint disease is currently unknown. Objectives To search for circulating...
Article
Background Patients with immune-mediated inflammatory diseases (IMID), particularly if treated with B-cell depleting therapies, show reduced humoral responses to SARS-CoV-2 vaccines and increased risk of severe COVID-19 (1,2). Since pre-exposure prophylaxis (PrEP) with monoclonal antibodies against SARS-CoV-2 proved effective in preventing infectio...
Preprint
Full-text available
Objectives To investigate the intensity and longevity of SARS-CoV-2 vaccination response in patients with immune-mediated inflammatory disease (IMID) by diagnosis, treatment and adapted vaccination schedules. Methods SARS-CoV-2 IgG antibody response after SARS-CoV-2 vaccination was measured longitudinally in a large prospective cohort of healthy c...
Article
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Objectives: To evaluate whether neural networks can distinguish between seropositive rheumatoid arthritis (RA), seronegative RA and psoriatic arthritis (PsA) based on inflammatory patterns from hand MRI and to test how psoriasis patients with subclinical inflammation fit into such patterns. Methods: ResNet neural networks were utilized to compar...
Article
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Objective To investigate the impact of biologic disease‐modifying antirheumatic drug (bDMARD) treatment on the prevalence, seroconversion rate, and longevity of the humoral immune response against SARS–CoV‐2 in patients with immune‐mediated inflammatory diseases (IMIDs). Methods Anti–SARS–CoV‐2 IgG antibodies were measured in a prospective cohort...
Article
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Introduction An increasing number of digital tools, including dedicated diagnostic decision support systems (DDSS) exist to better assess new symptoms and understand when and where to seek medical care. The aim of this study was to evaluate patient's previous online assessment experiences and to compare the acceptability, usability, usefulness and...
Article
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Objective Mepolizumab proved to be an efficacious treatment for eosinophilic granulomatosis with polyangiitis (EGPA) at a dose of 300 mg every 4 weeks in the randomized, controlled MIRRA trial. In a few recently reported studies, successful real‐life experiences with the approved dose for treating severe eosinophilic asthma (100 mg every 4 weeks) w...
Article
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Objectives To test whether patients with immune-mediated inflammatory disease (IMIDs), who did not respond to two doses of the SARS-CoV-2 vaccine, develop protective immunity, if a third vaccine dose is administered. Methods Patients with IMID who failed to seroconvert after two doses of SARS-CoV-2 vaccine were subjected to a third vaccination wit...
Article
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Objective B cell depletion is an established therapeutic principle in a wide range of autoimmune diseases. However, B cells are also critical for inducing protective immunity after infection and vaccination. We undertook this study to assess humoral and cellular immune responses after infection with or vaccination against SARS–CoV‐2 in patients wit...
Article
Full-text available
Psoriatic arthritis (PsA) is a chronic inflammatory disease that develops in up to 30% of patients with psoriasis. In the vast majority of cases, cutaneous symptoms precede musculoskeletal complaints. Progression from psoriasis to PsA is characterized by subclinical synovio-entheseal inflammation and often non-specific musculoskeletal symptoms that...
Article
At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases were considered to be at high risk for SARS-CoV-2 infection and the development of severe COVID-19. Data collected over the past year, however, suggest that a diagnosis of inflammatory arthritis, psoriasis, or inflammatory bowel diseases does not increase...
Article
Full-text available
The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints u...
Article
Objectives: We aimed to assess the prevalence of SARS-CoV-2 infection among Behçet's syndrome (BS) patients, evaluating the possible association between demographic and clinical features and the risk of infection. Moreover, we aimed to evaluate the possible association between BS disease activity and treatment, and the risk of SARS-CoV-2 infection...
Article
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Background Studies on SARS-Cov-2 in Behçet’s syndrome (BS) patients are limited to two small case series from European centres.[1,2] Objectives We aimed to assess the prevalence of SARS-CoV-2 infection among Italian BS patients referring to Careggi University Hospital (Florence, Italy) and to evaluate the possible association between BS disease ac...
Article
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Objectives: To better understand the factors that influence the humoral immune response to vaccination against SARS-CoV-2 in patients with immune-mediated inflammatory diseases (IMIDs). Methods: Patients and controls from a large COVID-19 study, with (1) no previous history of COVID-19, (2) negative baseline anti-SARS-CoV-2 IgG test and (3) SARS...
Article
Full-text available
Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare multisystemic disease classified both amongst hypereosinophilic disorders and ANCA-associated vasculitis. Vessel inflammation and eosinophilic proliferation are the hallmarks of the disease and main effectors of organ damage. Two distinct disease phenotypes have classically been describ...
Article
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Objective To evaluate the effectiveness and safety of secukinumab in patients with a mucosal and articular Behçet’s phenotype resistant to conventional and biologic treatment. Methods A multicentre retrospective study was performed on 15 patients with a mucosal and articular phenotype of Behçet’s syndrome fulfilling the International Criteria for...
Article
A 42-year-old man who had received multiple treatments for rhinosinusitis over the preceding 4 years presented to the clinic with a 3-month history of worsening cough, shortness of breath, and fever. He had no history of cocaine use. Physical examination showed a saddle-nose deformity (Panel A) with inflamed nasal mucosa and nasal crusting. Auscult...

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