Piercarlo Sarzi-Puttini

• MD
• University of Milan

Ibuprofen arginine (IBA) combines well-established analgesic and anti-inflammatory properties with enhanced pharmacokinetics. The addition of arginine significantly improves solubility and absorption, leading to a faster onset of action compared to conventional ibu-profen. Clinical studies consistently demonstrate that IBA achieves meaningful pain...

Background: This study investigates the psychological underpinnings of chronic pain conditions, specifically fibromyalgia, chronic headache, vulvodynia, and mixed condition (consisting of fibromyalgia in comorbidity with chronic headache and/or vulvodynia), with a focus on nociplastic pain mechanisms.Objective: The aim of the study is to better und...

Objectives To assess the lung involvement in patients with Still’s disease, an inflammatory disease assessing both children and adults. To exploit possible associated factors for parenchymal lung involvement in these patients. Methods A multicentre observational study was arranged assessing consecutive patients with Still’s disease characterized b...

Background Geographic origin may represent a variable capable of influencing health status. This study aims to investigate the presence of differences of disease severity in Italian patients with fibromyalgia from different macro‐regions. Methods This retrospective, cross‐sectional study involved patients included in the Italian Fibromyalgia Regis...

Pain is a significant issue in rheumatoid arthritis (RA) and psoriatic arthritis (PSA) and can have a negative impact on patients’ quality of life. Despite optimal control of inflammatory disease, residual chronic pain remains a major unmet medical need in RA. Pain in RA can be secondary to inflammation but can also generate neuroendocrine response...

Purpose of Review This review aims to summarize current knowledge on the pathophysiology of pain and the role of neuro-immune crosstalk in the development of acute and chronic pain (CP). Specifically, the review focuses on the role of immune cells involved in the innate and acquired immune response, emphasizing their bidirectional interactions with...

Symptoms of fibromyalgia (FM) fluctuate and vary in severity. The current study aimed to evaluate the efficacy of palmitoylethanolamide (PEA) and acetyl-L-carnitine (ALC) in FM patients over a 24-month period and to investigate the mediating function of pain catastrophizing subdomains in unfavorable relationships with disease severity levels in pat...

Introduction: This review delves into Fibromyalgia Syndrome (FMS), a chronic pain condition demanding thorough understanding for precise diagnosis and treatment. Yet, a definitive pharmacological solution for FMS remains elusive. Areas covered: In this article, we systematically analyze various pharmacotherapeutic prospects for FMS treatment, or...

Background Calcium pyrophosphate deposition (CPPD) is a multifaceted condition that could remain asymptomatic or evolve in various types of arthritis, ranging from acute monoarthritis to severe forms of polyarticular involvement. However, pathogenetic mechanisms and especially prognostic factors for the evolution of CPPD have not been identified ye...

Background Calcium pyrophosphate (CPP) crystals are frequently observed in patients with osteoarthritis (OA). However, the processes underlying their formation and their role in OA pathogenesis remain unclear, and basic studies have predominantly focused on hyaline cartilage (HC), providing partial and contrasting data. On the other hand, imaging s...

Background Fibromyalgia (FM) patients frequently experience multiple chronic pain (CP) comorbidities, including tension-type or migraine headache, irritable bowel syndrome, and low back pain. FM and all these conditions have been included among chronic nociplastic syndromes [1]. The term “nociplastic pain” (NP) describes pain that results from alte...

Background Fibromyalgia (FM) is a chronic pain (CP) syndrome with a prevalence rate ranging between 0.2% and 6.6%, with significant higher rates in women (2.4% - 6.8%) [1]. From 39% to 76% of FM patients suffers from multiple CP comorbidities primarily: tension-type or migraine headache, irritable bowel syndrome, lower back pain, myofascial pain sy...

Fibromyalgia (FM) remains a condition with a pathogenesis that is not completely understood, affecting a significant portion of the global population. This article summarises the main advances in FM during the last year. Even in 2023, research on FM was notably active. From a clinimetric perspective, studies have been conducted to evaluate the poss...

Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diagnostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of...

Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition that affects the spine and peripheral joints, characterized by the progressive ossification of ligaments and tendons. It is a non-inflammatory degenerative disease that affects predominantly the elderly population. It has been associated with reduced mobility and chronic pain, wh...

Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diag-nostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of...

Objectives: Central sensitivity (CS) is defined as an increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold inputs. CS has recently been linked to the psychological burden associated with chronic pain, such as fibromyalgia (FM). The primary objective of this study is to investigate the impact of sp...

Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions that complicate care. “Overlapping symptoms” describe conditions that can occur concomitantly with fibromyalgia and include migraine, irritable bowel syndrome, obesity, and pelvic...

Pain is a significant issue in Rheumatoid Arthritis (RA) and can have a negative impact on patients' quality of life. Despite optimal control of inflammatory disease, residual chronic pain remains a major unmet medical need in RA. Pain in RA can be secondary to inflammation but can also generate neuroendocrine responses that initiate neurogenic inf...

Fibromyalgia (FM) is a multifactorial syndrome which includes not only widespread pain and stiffness, now recognized as major symptoms, but also numerous other somatic, emotional, and neuropsychic manifestation. The lack of specific validated biological and instrumental biomarkers has made FM a condition of unexplained medical significance, and its...

Objective Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first‐ever validated classification criteria for symptomatic CPPD disease. Methods Supported...

Objective Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. Methods Supported...

Objective Fibromyalgia (FM) is a complex syndrome whose hallmark features are chronic widespread pain, sleep disturbances, fatigue and cognitive dysfunctions. However, it is still difficult to apply validated diagnostic criteria. The aim of this study is to examine the accuracy of a previous diagnosis/diagnostic hypothesis of FM according to the 20...

Objectives: Fibromyalgia (FM) is a chronic syndrome characterised by widespread musculoskeletal pain associated with symptoms such as fatigue, sleep disturbances and cognitive impairment. Prevalence is higher in females but the application of the 2010/2011 and 2016 revision of the American College of Rheumatology (ACR) criteria reduced prevalence...

Objectives: Fibromyalgia (FM) is characterised by a form of debilitating pain that is unresponsive to standard analgesics. The aim of this study was to evaluate the efficacy of supplementing ongoing pregabalin (PGB) and duloxetine (DLX) treatment with palmitoylethanolamide (PEA) and acetyl-L-carnitine (ALC) for 24 weeks in FM patients. Methods:...

This article proposes a historical recontextualisation of the mind-body relationship and offers some evidence-based reflections on the current clinical appropriateness of psyche-soma dichotomy and psychosomatics. The debate concerning the mind-body relationship has a long medical, philosophical, and religious history, with psyche-soma dichotomy and...

Background Fibromyalgia (FM) is characterized by debilitating pain that is unresponsive to standard analgesics and the multi-modal approach, including drugs’ combination, represents the standard of care. Combination therapeutic strategies also include the integration of drugs and nutraceuticals. Both palmitoylethanolamide (PEA) and acetyl-L-carniti...

Background Nearly four million people worldwide are affected by Inflammatory Bowel Diseases (IBD) and approximately 25-40% of them develop extra-intestinal manifestations, such as arthritis and enthesitis. Enthesis inflammation is a cornerstone in Spondyloarthritis (SpA) but there are few data concerning prevalence, clinical presentation and progno...

Background The Feldenkrais Method is a form of awareness through movement (ATM) which aims at increasing awareness about spatial and kinesthetic relationships among body segments and the environment thought verbally guided movements [1]. Fibromyalgia syndrome (FM) is a form of chronic widespread pain associated to a variety of ancillary symptoms, a...

Background Fibromyalgia syndrome (FMS) is a widespread chronic pain syndrome with many associated symptoms. It is frequently related to a traumatic event (1), strong and of short duration, or slight but protracted over time. A multidisciplinary therapeutic approach is recommended by international guidelines. The transformative experience (TE) allow...

Objectives: To determine the cut-off values of Patient Acceptable Symptom State (PASS) for the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromyalgia Assessment Scale (FASmod), and the Polysymptomatic Distress scale (PSD) and to determine the predictors of PASS in patients with fibromyalgia (FM). Methods: FM patients belongi...

Objectives To identify the prevalence of calcium pyrophosphate crystal deposition (CPPD) using ultrasound and conventional radiology at peripheral joints in patients with suspected or definite CPPD. Methods A systematic literature search was performed in PubMed and Embase using pre-defined search strategies from inception to April 2021 to identify...

Objective To assess the reliability and diagnostic accuracy of new radiographic imaging definitions developed by an international multidisciplinary working group for identification of calcium pyrophosphate deposition (CPPD). Methods Patients with knee osteoarthritis scheduled for knee replacement were enrolled. Two radiologists and 2 rheumatologis...

Understanding of the basis of osteoarthritis (OA) has seen some interesting advancements in recent years. It has been observed that cartilage degeneration is preceded by subchondral bone lesions, suggesting a key role of this mechanism within the pathogenesis and progression of OA, as well as the formation of ectopic bone and osteophytes. Moreover,...

Objective: The goal of the present study was to explore additional evidence of convergent and discriminant validity of the Central Sensitization Inventory (CSI) in a large sample of subjects with fibromyalgia (FM). Methods: Patients were consecutively enrolled for a cross-sectional assessment comprehensive of three FM-specific measures (the revi...

Rheumatoid arthritis (RA) is a chronic inflammatory disease whose natural history leads to articular and extra-articular damage. Both cardiovascular risk and malignancy risk results higher in RA patients, compared to general population. Janus kinase inhibitors (JAKis) are oral targeted synthetic disease modifying antirheumatic drugs (tsDMARDs) that...

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...

Fibromyalgia syndrome (FM) is a chronic widespread pain syndrome characterised by fatigue, sleep disturbances and many idiopathic pain symptoms. The aim of this review is to describe and summarise the most recent findings concerning the diagnosis, aetiopathogenesis and treatment of fibromyalgia syndrome published between January 2021 and January 20...

Background Patients with fibromyalgia (FM) complain many symptoms besides musculoskeletal pain: e.g. fatigue, sleep difficulties, a swollen feeling in tissues, paresthesia, cognitive dysfunction, dizziness, and symptoms of overlapping conditions such as irritable bowel syndrome, headaches and restless legs syndrome. These conditions can be grouped...

Background Patients suffering from FM are challenged by symptoms such as chronic pain, fatigue, sleep disturbance and emotional distress. These symptoms lead to a physical capacity impairment, and FM patients report consequences on their activities of daily life and difficulties in fulfilling their work roles, resulting in reduced work capacity, pr...

Background Musculoskeletal ultrasonography (MSUS) is a useful tool for the diagnosis of several Rheumatic and Musculoskeletal Diseases (RMDs) but its role in the diagnostic pathways in clinical practice is still unclear as feasibility issues limit its application as a bed side technique. Objectives To optimize the use of US in clinical practice, t...

Background Conventional radiography (CR) is widely used as the first-line investigation for calcium pyrophosphate deposition (CPPD) disease, given its widespread use and the low cost. Next to it a series of advanced imaging techniques have been evaluated for accuracy and reliability. Among them, ultrasound (US) has been thoroughly tested and demons...

Background Fibromyalgia (FM) is a common chronic disorder characterized by widespread pain, fatigue, sleep disturbances and functional symptoms, reaching a prevalence of 2–3% worldwide. It can present as a comorbidity in patients with concomitant chronic disease and can have a significant impact on the quality of life. There are very few studies on...

Background Ultrasound (US) demonstrated to be reliable and accurate for the diagnosis of crystal induced arthropathies, especially gout and calcium pyrophosphate deposition disease (CPPD) and validated definitions for uric acid and calcium pyrophosphate deposition in joints were released by the Outcome Measures in Rheumatology (OMERACT) US group. L...

Background Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome of unknown etiopathogenesis. Its development and maintenance are related to a complex interplay of biological, psychological, and contextual factors. Among the contextual factors, sociodemographic aspects are poorly elucidated. Objectives This study aimed to evaluate the relat...

Background Ultrasound (US) has proven to be an excellent imaging technique for detecting calcium pyrophosphate (CPP) deposition disease (CPPD); it is also widely available and inexpensive and can be performed during the clinic visit making it the preferred imaging modality for many rheumatologists. However, no validated grading systems have yet bee...

Background: To measure quantitative autofluorescence (qAF) in patients under treatment with hydroxychloroquine (HCQ) and at risk of retinal toxicity but with no apparent signs of retinal toxicity and to compare it with that of untreated subjects. Methods: Consecutive patients at risk for the development of HCQ retinal toxicity (duration of treat...

Objectives: Fibromyalgia (FM) is a complex syndrome whose hallmark features are chronic widespread pain, sleep disturbances, fatigue and cognitive dysfunctions. However, it is still difficult to apply validated diagnostic criteria. The aim of this study is to examine the accuracy of a previous diagnosis/diagnostic hypothesis of FM according to the...

Objectives: The revised Fibromyalgia Impact Questionnaire (FIQR) is a widely used fibromyalgia severity assessment tool that was introduced in 2009 prior to the publication of the American College of Rheumatology (ACR) preliminary fibromyalgia criteria in 2010 and its revision in 2016. In 2020, the modified Fibromyalgia Assessment Scale (FASmod) w...

Objectives: Despite the considerable research efforts being made to learn more about COVID-19, little is known about the presence of SARS-CoV-2 genetic material in biological fluids other than respiratory droplets, blood, and feces. The aim of this post-mortem study was to assess the presence of SARS-CoV-2 RNA in the knee synovial fluid, synovial...

Objectives: Fibromyalgia (FM) is a syndrome of unknown aetiology characterised by chronic widespread musculoskeletal pain and associated with high rates of psychiatric comorbidities, mainly mood and anxiety disorders.This study aims to determine the age at onset (AAO) and temporal sequencing patterns of FM and its frequent and distinguishable psyc...

Objectives: The aim of this study was to evaluate the prevalence and severity of overactive bladder syndrome (OAB) and sexual dysfunction in fibromyalgia (FM) patients, as well as their relationship with disease severity. Methods: Consecutive adult female patients with FM were enrolled. Patients filled in a comprehensive questionnaire package in...

Objectives: To assess (a) the impacts of fibromyalgia (FM) symptoms on patients' ability to work and (b) the relationship between FM severity states and lost productivity from the perspective of patients. Methods: FM female patients were retrospectively evaluated for this cross-sectional study. FM severity was determined using the revised Fibrom...

Objective: To create a prediction model of the risk of severe/critical disease in patients with Coronavirus disease (COVID-19). Methods: Clinical, laboratory, and lung computed tomography (CT) severity score were collected from patients admitted for COVID-19 pneumonia and considered as independent variables for the risk of severe/critical disease i...

Background and aim: To evaluate the convergent and discriminative validity of many continuous composite disease activity indices and patient-reported outcome measures (PROMs) in rheumatoid arthritis (RA). Methods: In consecutive RA patients in moderate or high disease activity, according to the Simplified Disease Activity Index (SDAI) definition...

Acetyl-L-carnitine (ALC) is an endogenous molecule that not only plays a role in energy metabolism, but also has antioxidant properties, protects from oxidative stress, modulates brain neurotransmitters such as acetylcholine, serotonin and dopamine, and acts on neurotrophic factors such as nerve growth factor (NGF) and metabotropic glutamate (mGlu)...

Background The close relationship between joints and gut inflammation has long been known and several data suggest that dysbiosis could link spondyloarthritis (SpA) to inflammatory bowel diseases (IBD). The introduction of biological drugs, in particular tumour necrosis factor inhibitors (TNFi), revolutionised the management of both these diseases....

Although psoriatic arthritis (PsA) primarily leads to joint and skin damage, it is associated with higher prevalence of metabolic syndrome (MetS) and its components, namely hypertension, dyslipidemia, obesity, and type II diabetes. Additionally, chronic inflammation is known to aggravate these cardiometabolic factors, thus explaining the enhanced c...

Almost totality of fibromyalgia patients complain of disturbed sleep, but to date, this topic is at the centre of many controversies. First of all, subjective sleep complaints can be found in all patients, but not all studies observed altered objective parameters when investigating sleep using polysomnography; therefore, currently, no disease-speci...

Clinimetrics consists in the transformation of the clinical experience into measurable variables, a process which is particularly helpful for the diagnosis, prognosis and monitoring of patients with chronic musculoskeletal diseases. In particular, the complexity of the symptoms of fibromyalgia syndrome and their multisystem origins lead to an intri...

Fibromyalgia or fibromyalgia syndrome (FMS) is defined as a central sensitization syndrome characterized by the dysfunction of neurocircuits detecting, transmitting and processing nociceptive stimuli; the prevalent manifestation is musculoskeletal pain. In addition to pain, there are multiple accompanying symptoms, in common with other algo-dysfunc...

Medical cannabis (MC) describes the usually inhaled or ingested use of a cannabis plant or cannabis extract for medicinal purposes. The action of whole cannabis plants is extremely complex because their large number of active compounds not only bind to a plethora of different receptors but also interact with each other both synergistically and othe...

Background and Aim Since the outbreak of COVID-19, concerns have been raised as to whether IBD patients under biologic therapy may be more susceptible to the disease. This study aimed to determine the incidence and outcomes of COVID-19 in a large cohort of IBD patients on biologic therapy. Methods This observational retrospective multicenter study...

Objectives: The role of age in influencing the severity of fibromyalgia (FM) is still controversial. The aim of this study is to define the contribution of age in the severity of FM from data from a large national database. Methods: This cross-sectional study included adult patients with FM diagnosed according to the 2010/2011 American College o...

Background Conventional Radiography (CR) has been widely used in the assessment of knee chondrocalcinosis (CC) and is still considered one of the most important diagnostic methods for the diagnosis. However, there are no studies on the reliability of CR for CC. Objectives To assess the reliability of CR of the knee in the assessment of chondrocalc...

Background the close relationship between joints and gut inflammation has long been known and several data suggest that the dysbiosis could represents the link between Spondyloarthritis (SpA) and Inflammatory Bowel Diseases (IBD). To date, the manipulation of the intestinal microbiota is considered the key to the cure or control of the natural hist...

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...

Background Conventional Radiography (CR) has been widely used in the assessment of knee chondrocalcinosis (CC) and is still considered one of the most important diagnostic methods for the diagnosis. However, there are very few studies that examine the diagnostic accuracy of CR compared to histology of the knee tissues. Objectives To assess the dia...

Background Imaging has been extensively used for the Calcium Pyrophosphate Deposition Disease (CPPD) diagnosis but the prevalence of joint calcifications at imaging in CPPD patients has not been thoroughly assessed. Objectives This systematic literature review (SLR) is aimed to estimate the prevalence of calcium crystal deposition in peripheral jo...

Background Despite the considerable research efforts being made to learn more about COVID-19, little is known about the presence of SARS-CoV-2 genetic material in biological fluids other than respiratory droplets, blood, and feces 1,2 . In particular, little is known about the presence of SARS-CoV-2 in the joints either post mortem ³ or in vivo 4 ....

Background Hydroxychloroquine (HCQ) is a relatively safe and effective drug widely used as primary or adjunctive treatment for several rheumatological and dermatological disorders ¹ . HCQ modulates immune response through several mechanisms and has a tropism for pigmented ocular tissues, particularly retinal pigment epithelium (RPE) ² . Its accumul...

Background Synovial fluid analysis (SFA) via compensated polarized light microscopy is still considered the gold standard for the identification and diagnosis of Calcium Pyrophosphate Deposition disease (CPPD)-related arthropathies[1], but very few studies have been published about its diagnostic accuracy. Objectives The aim of this study was to e...

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...

Background: There is a lack of real-life clinical data for biosimilar etanercept, an anti-TNF blocking fusion protein. We describe the comparable efficacy and safety of originator and biosimilar etanercept in rheumatoid arthritis (RA) patients in a real-life clinical setting. Our data confirm that a biosimilar etanercept can be safely used as firs...

Fibromyalgia (FM) is a syndrome of unknown aetiology characterised by chronic pain, fatigue, and disturbed sleep. This review presents and summarises the 2020 literature on FM by retrieving all articles indexed in PubMed between 1 January 2020 and 31 December 2020. The attention of the scientific community towards FM is constantly growing, and this...

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...

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) is a rare syndrome characterised by acute onset of symmetrical distal synovitis and tenosynovitis, associated with severe pitting edema of the dorsum of the hands and feet, seronegativity for autoimmunity and dramatic response to glucocorticoids. First described by McCarty . in...

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...