Manuela Di Franco

Manuela Di Franco
Sapienza University of Rome | la sapienza · Department of Internal and Specialized Medicine

About

195
Publications
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3,606
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Additional affiliations
January 2001 - present
Sapienza University of Rome
Position
  • Manuela Di Franco
January 1999 - December 2010
Università degli Studi di Roma "La Sapienza"

Publications

Publications (195)
Article
Full-text available
Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disease. Modifications of gut microbiota seem to be associated with the disease, but the impact of gut microbiota on therapies’ outcome remains unclear. A role of T cells in RA pathogenesis has been addressed, particularly on the Th17/Treg cells balance. Our study aimed to evaluate in early...
Article
Objectives: Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome of unknown aetiopathogenesis. Its development and maintenance are related to the interplay of biological, psychological, and contextual factors. Among the contextual factors, sociodemographic aspects are poorly elucidated. This study aimed to evaluate the relationships betwee...
Article
Background Tumor necrosis factor (TNF)-α is one of principal proinflammatory cytokines involved in pathogenesis of different inflammatory arthropathies as Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS). Biotechnological drugs, represented among others by monoclonal antibodies directed against TNF-α, lead to a r...
Article
Background The quality of sexual life (QSL) is a complex and multimodal experience influenced by endogenous and external factors, including age, gender, and cultural environment. Rheumatic diseases, with their burden of pain, fatigue, organ damage, and disability, can severely impair sexual life and this is true also for Sjögren’s Syndrome, where s...
Article
Background With the outbreak of the SARS-CoV-2 pandemic, the rheumatologists’ attention was directed at understanding whether infected patients could have a less favorable outcome. Available data seem to indicate that the course in rheumatic patients is not dissimilar from that in the general population. However, data on the outcome of COVID-19 in...
Article
Full-text available
Introduction Objectives Fibromyalgia (FM) is a common rheumatic disorder characterized by chronic, widespread pain associated with several not painful symptoms. The contribution of gender to the manifestation of the disease may influence the higher prevalence of FM among women. In spite of this, how patients’ gender influences the clinical manifes...
Article
Objectives: Fibromyalgia is a severe and disabling chronic pain syndrome affecting millions of people worldwide. Various patients' subgroups were identified using different atheoretical measures, hardly effective to tailor treatments. Previous literature findings showed the relevance of fibromyalgia patients' illness perceptions in adjusting to th...
Article
Objectives: The use of biosimilars is constantly growing, prompting healthcare payers to encourage the switch to these drugs which are less expensive than the reference bio-originator. While switching from a bio-originator to a biosimilar is supported by increasing evidence, data on the switch between different biosimilars of the same reference pr...
Article
Objectives: The aim of this study was to assess the real-life adherence of Italian rheumatologist to the 2013 EULAR recommendations and treatment outcome in rheumatoid arthritis (RA) patients who started a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD). Methods: The MITRA study is an Italian multicentre observational coho...
Preprint
Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with a significantly increased risk of cardiovascular mortality, mainly attributed to accelerated atherosclerosis. Methods: Thirty-two women (aged more than 18 years) with RA, and 25 age-matched healthy women were included in this study. Biomarkers of inflammation, red blood cells...
Article
Full-text available
Background: Fibromyalgia is a chronic pain syndrome which occurs in the absence of an organic damage, whom causes is still unclear. Aims of this pilot study were to investigate the neural correlates of fibromyalgia in response to pain-related visual stimuli and explore the psychological differences among fibromyalgia, chronic low back pain (CLBP) a...
Article
Background: In rheumatoid arthritis (RA), females usually have a worse prognosis. To date, the influence of physician gender in the evaluation of RA activity is still largely unknown. Objectives: To investigate the discrepancy in RA disease activity assessment between male and female physicians and to compare patient and evaluator perception of...
Article
Objectives: In this longitudinal study, we assessed the role of musculoskeletal ultrasound (US) in predicting the efficacy of JAK inhibitors (JAKi) in rheumatoid arthritis (RA) patients. Methods: We enrolled RA patients starting baricitinib or tofacitinib. All patients were evaluated at baseline and after 4, 12, 24, 48 weeks. Disease activity wa...
Article
Background Fibromyalgia (FM) is a common rheumatic disease characterized by chronic widespread pain, sleep and mood disorders. A higher prevalence of FM in women compared with men is well known, although the specific differences in clinical manifestations related to gender are still poorly defined. Brain-Derived Neurotrophic Factor (BDNF) is an end...
Article
Background Conflicting results have been published regarding the risk of infection with SARS-CoV-2 and development of severe COVID-19 among patients affected by rheumatic musculoskeletal diseases (RMDs). [1-4] Taking into account the lack of effective drugs to treat the COVID-19 and despite the burdensome and costly lockdown measures adopted to cou...
Article
Background Fibromyalgia (FM) patients report chronic widespread pain, fatigue, cognitive difficulties and sleep disturbances, often associated with anxiety and/or depression (1). FM syndrome more frequently affects women and many papers describe gender-related differences in the perception, description and expression of pain (2), but up to now, the...
Article
Background Abatacept (ABA) is a biological drug approved for the treatment of rheumatoid arthritis (RA) patients that, by working on CTLA4, can inhibit T-cell activation. Randomized controlled trials have demonstrated both the efficacy and a good safety profile, characterized by a lower infectious risk in comparison with other biological DMARDs, in...
Article
Background By the beginning of March 2020, the pandemic of the novel coronavirus disease (COVID-19) imposed severe lockdown measures opposing the viral spread, limiting non-COVID patients’ access to hospitals. Previous reports suggest that Rheumatoid Arthritis (RA) patients may experience a worsening of self-reported disease activity following natu...
Article
Background Fibromyalgia syndrome (FM) is characterised by a complex symptom spectrum, dominated by the presence of chronic widespread pain, fatigue and unrefreshing sleep. FM affects between 2 and 3% of the general population. It is a condition that mainly involves middle-aged women, although it is increasingly being diagnosed in younger people. Th...
Article
Background The severe measures of lockdown imposed in Italy to limit the SARS coronavirus 2 disease (COVID-19) spread caused an increase of reported anxiety, depression and suicidal rate among general population. Patients affected by rheumatic disorders feature an increased risk of mood disorders for the chronic course of the disease itself and for...
Article
Full-text available
Fibromyalgia syndrome is one of the most common causes of chronic widespread pain, but pain accompanies a wide range of ancillary symptoms. To date, its aetiopathogenesis remains elusive, and diagnosis is exquisitely clinical, due to the lack of biomarkers or specific laboratory alterations in fibromyalgia patients. This position paper has the purp...
Article
Objectives: The COVID-19 pandemic severely increased the stress levels in the population. The aim of present study was to investigate the impact of the lockdown measures on emotional well-being and disease activity in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) through a telemedicine approach. Methods: An on-line survey, includ...
Article
Full-text available
Early diagnosis and timely and appropriate treatments positively influence the history of fibromyalgia syndrome (FM), with favourable repercussions at clinical, psychological, social and economic levels. Notwithstanding, there are still significant problems with timeliness of diagnosis, access to pharmacological therapies - particularly to innovati...
Article
Full-text available
Objective Various studies have shown that overweight and obesity are central features of fibromyalgia syndrome (FM), but the real impact of a high body mass index (BMI) on clinical severity in patients with FM is still controversial. The aim of this study was to analyse the relationships between BMI categories and measures of symptom severity and f...
Article
Objectives: Baricitinib is a Janus-kinase (JAK) 1/2 inhibitor, approved for the treatment of moderate-to-severe rheumatoid arthritis (RA) patients with inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). We report the first real-life experience with baricitinib in a monocentric cohort of unselected RA p...
Article
Objectives: To assess the delay between the disease onset and the beginning of methotrexate (MTX) treatment in RA patients and to evaluate the Italian rheumatologists' adherence to the EULAR 2013 recommendations. Methods: MITRA is an Italian multicentre observational study carried out on DMARD-naïve RA patients recruited in an 18-month period st...
Article
Objective: To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. Methods: Consecutive FM patients were evaluated with the three cl...
Article
We aimed to investigate whether small-fibre pathology, a common skin biopsy finding in patients with fibromyalgia, implies clinically important abnormalities of somatosensory system function and verify whether it is associated with voltage-gated sodium channel variants. In 57 consecutively enrolled patients with fibromyalgia, we used skin biopsy to...
Article
Full-text available
Lung involvement is related to the natural history of anti-citrullinated proteins antibodies (ACPA)-positive rheumatoid arthritis (RA), both during the pathogenesis of the disease and as a site of disease-related injury. Increasing evidence suggests that there is a subclinical, early lung involvement during the course of the disease, even before th...
Article
Full-text available
The aim of the study was to investigate the presence of subclinical vascular damage in polymyalgia rheumatica (PMR). We enrolled PMR patients having major cardiovascular risk factors (MCVRF) and, as controls, patients with MCVRF. All underwent: color Doppler ultrasound to evaluate the common carotid intima-media thickness (IMT), the anterior–poster...
Article
Full-text available
Lung involvement is related to the natural history of anti-citrullinated proteins antibodies (ACPA)-positive rheumatoid arthritis (RA), both during the pathogenesis of the disease and as a site of disease-related injury. Increasing evidence suggests that there is a subclinical, early lung involvement during the course of the disease, even before th...
Article
Background Pain control is considered a treatment priority from most patients with Rheumatoid Arthritis (RA). Despite the treat to target approach, residual pain is commonly reported by patients with RA. Treatment with JAK inhibitors (JAKi) has been associated to a rapid control of pain. Objectives To investigate the effect of JAKi on pain and qua...
Article
Background Therapeutic approach of rheumatoid arthritis (RA) patients has been enriched by the introduction of small molecules. In particular Jak inhibitors (JAKi), baricitinib and tofacitinib, demonstrated their efficacy in patients naïve or resistant to biological treatments in randomized controlled trials. Moreover, these drugs seem to be able t...
Article
Full-text available
Background Carbamylation is a post-translational modification occurring under several conditions such as uremia, smoking and chronic inflammation as in rheumatoid arthritis (RA). Low-density lipoproteins (LDL) represent a target of carbamylation. Carbamylated-LDL (cLDL) have an increased inflammatory and atherogenic potential. Growing evidence supp...
Article
Background Glucocorticoids (GCs) are a milestone of Rheumatoid Arthritis (RA) treatment; EULAR recommendations on the management of medium to high dose glucocorticoids remind to evaluate comorbidities and risk factors for adverse events when planning GCs treatment. Tofacitinib and Baricitinib are Janus kinases inhibitors (JAKi) registered for RA tr...
Article
Full-text available
Rheumatoid arthritis (RA) is a systemic, autoimmune disease characterized by joint involvement, with progressive cartilage and bone destruction. Genetic and environmental factors determine RA susceptibility. In recent years, an increasing number of studies suggested that diet has a central role in disease risk and progression. Several nutrients, su...
Article
Full-text available
Fibromyalgia (FM) diagnosis follows the American College of Rheumatology (ACR) criteria, based on clinical evaluation and written questionnaires without any objective diagnostic tool. The lack of specific biomarkers is a tragic aspect for FM and chronic pain diseases in general. Interestingly, the endogenous opioid system is close to the immune one...
Article
Fibromyalgia (FM) is a frequently encountered syndrome that is characterised by chronic widespread pain, fatigue, sleep disturbances, and many other symptoms that impair the quality of life. Its aetiopathogenesis is still unclear but, although there is no specific therapy, a number of pharmacological and non-pharmacological therapies are available....
Article
Reactive arthritis is a group of inflammatory joint diseases triggered by a previous infection, often associated with extra-articular features. The clinical course and consequently the treatment are complicated by the variability of the disease evolution in the single patient. In some patients, the disease assumes a chronic and destructing course,...
Article
Introduction: Clinicians involved in pain management can finally include cannabis or cannabis-related products in their therapeutic armamentarium as a growing number of countries have approved them for pain relief. Despite the several benefits attributed to analgesic, anti-inflammatory and immunomodulatory properties of cannabinoids, there are stil...
Article
Introduction/objective Apremilast, PDE4 competitive inhibitor, has been recently introduced in the treatment of adult psoriatic arthritis (PsA) patients, but only preliminary data are available on imaging evaluation. Thus, we evaluated the response to apremilast in PsA patients by ultrasonographic (US) assessment. Methods Thirty-four patients (M/F...
Conference Paper
Background Rheumatoid arthritis (RA) is more prevalent in women than men (F:M=4:1), due to hormonal, genetic and environment factors. Women present higher disease activity markers as Disease Activity Score-28 (DAS28) and Health Assessment Questionnaire (HAQ), at the onset and after c-DMARDs therapy, without correlation with radiographic damage. Ob...
Conference Paper
Background Rheumatoid Arthritis (RA) is more prevalent among female individuals. Sex and gender differences may influence disease’s progression and prognosis. To date, the influence of physicians’ gender in the evaluation of RA activity is still largely unknown. Objectives: aim of the study was to investigate a possible discrepancy in the assessmen...
Conference Paper
Background The introduction of TNF inhibitors have revolutionized the outcome of patients affected by Rheumatoid Arthritis (RA). In the last years, pharmaco-economic implications determined the introduction of biosimilar as alternative to originator biological drugs. Phase I and head-to-head phase III clinical studies demonstrated pharmacokinetic e...
Article
Full-text available
Background Autophagy has emerged as a key mechanism in the survival and function of T and B lymphocytes, and its activation was involved in apoptosis resistance in rheumatoid arthritis (RA). To investigate whether the relationship between autophagy and apoptosis may impact the response to the therapy, we analyzed ex vivo spontaneous autophagy and a...
Article
Fibromyalgia is characterised by chronic pain, fatigue and functional symptoms. Its aetiopathogenesis is still a matter of debate, but various pharmacological and non-pharmacological therapies are currently available for its treatment. We review the literature concerning the most recent findings related to the aetiopathogenesis, diagnosis, clinical...
Data
Fig. S1. Analysis of data from two rheumatoid arthritis (RA) patient cohorts: RA patients treated with Methotrexate and RA patients treated with anti‐TNF‐alfa.
Article
Full-text available
Rheumatoid arthritis (RA) is a chronic inflammatory disease with increased risk of cardiovascular events and mortality that can be attributed to accelerated atherosclerosis. This pilot study aimed to investigate if changes in blood parameters were compatible with atherosclerotic events in RA patients. To this aim, 45 RA women (aged more than 18 yea...
Article
Full-text available
Objectives: Autophagy is a homeostatic and physiological process that promotes the turnover of proteins and organelles damaged in conditions of cellular stress. We previously demonstrated that autophagy represents a key processing event creating a substrate for autoreactivity, which is involved in post-translational changes and generation of citru...
Article
Objective Several evidences suggested a link between human microbiome and Rheumatoid Arthritis (RA) development. Porphyromonas gingivalis (P. gingivalis) seems involved in RA initiation and progression, as supported by the high occurrence of periodontitis. In this case‐control study, we analyzed tongue P. gingivalis presence and quantification in a...
Article
Full-text available
Autophagy is a degradation mechanism by which cells recycle cytoplasmic components to generate energy. By influencing lymphocyte development, survival, and proliferation, autophagy regulates the immune responses against self and non-self antigens. Deregulation of autophagic pathway has recently been implicated in the pathogenesis of several autoimm...
Conference Paper
Background In Rheumatoid Arthritis (RA) pathogenesis T helper17 (Th17) and T regulatory cells (Treg) are largely represented.¹ Recent studies highlighted the role of intestinal mucosa environment in modulation of T cells function. The composition of gut microbiota influences the Th17/Treg cells balance and the host immune response,² so the exposure...
Article
In a previous report of two married cohabiting couples affected by polymyalgia rheumatica (PMR), we noticed that the wife of one couple and both members of the other couple suffered from symptomatic diverticular disease (DD), whose diagnosis was made before the onset of PMR. We investigated whether DD might be a risk factor for the development of P...
Article
Full-text available
Cardiovascular disease is the main cause of morbidity and mortality in rheumatoid arthritis (RA). Despite the advent on new drugs targeting the articular manifestations, the burden of cardiovascular disease is still an unmet need in the management of RA. The pathophysiology of accelerated atherosclerosis associated to RA is not yet fully understood...
Article
Full-text available
This work was aimed at investigating the circulating microRNA (miRNA) profiles in serum and saliva of patients affected by fibromyalgia syndrome (FM), correlating their expression values with clinical and clinimetric parameters and to suggest a mathematical model for the diagnosis of FM. A number of 14 FM patients and sex- and age-matched controls...
Conference Paper
Background The ACPA-positive Rheumatoid Arthritis (RA) is a complex disease. Signs of immune activity against citrullinated proteins may be present years before the onset of clinical manifestations. Recent findings suggest that the lung may represent an early site of autoimmune-related injury in ACPA-positive patients without signs of arthritis. O...
Conference Paper
Full-text available
Background Fatigue and sleep disturbances are prominent symptoms in Fibromyalgia (FM) and significantly affect the level of the patients' impairment. Some studies reported a synergic interaction of depression and poor sleep quality associated with fatigue (e.g. [1]); while Marques et al. [2] showed a significant association of the fatigue severity...
Conference Paper
Background The association of chronic inflammatory rheumatic disorders with an increased risk of vascular disease, especially cardiovascular and cerebrovascular disease, is a consolidated matter, but data on polymyalgia rheumatica (PMR) are still inconsistent. Objectives The aim of our cross-sectional study was to investigate the presence of vascu...
Conference Paper
Background Fibromyalgia (FM) is one of the main causes of chronic widespread pain (CWP). It is characterized by CWP, which is the cardinal symptom, and the presence of more than 11 tender points (hyperalgesia). [1] Other symptoms such as fatigue, sleep disturbances, difficulties with memory and concentration, irritable bowel syndrome, headache, dep...
Conference Paper
Background P. gingivalis is a Gram-negative anaerobic bacterium usually located in the oral cavity, as component of microbiome. Next to the established association with oral cavity diseases, such as periodontitis and halitosis, in the last years a growing interest has been addressed to its implication in the development of autoimmune diseases, such...
Article
Objectives: Neuropeptide Y (NPY) is a neurotransmitter released by sympathetic neurons, which is probably involved in pain modulation. Acupuncture is increasingly used as an alternative or complementary means of controlling pain in rheumatic diseases such as fibromyalgia (FM), a chronic widespread pain syndrome accompanied by allodynia and hyperal...
Article
Full-text available
Background Rheumatoid arthritis (RA) patients carry a high risk of cardiovascular morbidity and mortality. The excess of cardiovascular disease cannot be entirely explained by traditional risk factors and the immune system contributes to the development of atherosclerosis. Moreover, post-translational modifications such as citrullination and carbam...
Article
Full-text available
Fibromyalgia (FM) is a complex syndrome characterised by chronic pain, fatigue and functional symptoms. Widespread pain is often its most typical feature, whereas other manifestations may be associated to various extents. Its aetiopathogenesis is still a matter of debate, but various pharmacological and non-pharmacological therapies are currently a...