Integration with Spilanthes Achmella in fibromyalgia syndrome: open-label study six months after the treatment

Fibromyalgia, also known as fibromyalgia syndrome (FM), is a rheumatic syndrome which is currently considered idiopathic and multifactorial. It causes an increase in muscle tension associated with stiffness, asthenia (loss of strength with fatigue), cognitive impairment, insomnia or sleep disorders and impaired sensitivity to stimuli. We performed a prospective evaluation of 149 patients suffering from fibromyalgia syndrome according to the 2010 ACR Criteria. Patients were clinically assessed at baseline and after 1-3-6 months, using the patient-reported outcomes thermometer - 5-item scale (5TPROs). In addition to their therapy, all patients received a supplementation with Spilanthes Achmella. This food supplement is characterized by synergy of bioactive compounds, such as Acmella oleracea extract, and has neurotrophic, anti-inflammatory and pain-relieving effects. All patients were randomized at baseline to receive Spilanthes Achmella, 2 tablets per day for one month and subsequent tapering to 1 tablet per day for 5 months. At six months, a statistically significant difference in the following parameters was shown: pain P<0.001, fatigue P<0.001, physical function P<0.001, depression: P<0.001, general health P<0.001. Conversely, the post-hoc analysis data did not report any significant difference for the parameters between the third and sixth month. A drug-sparing effect was observed (P<0.001). The posthoc analysis revealed a significant difference between T0 and T3 P=0.00066 and between T0 and T6 P=0.00008. Our data indicate that supplementation with Spilanthes Achmella may lead to a significant improvement in pain, fatigue, physical function, depression and general health in fibromyalgia syndrome.

A case report of calcific aterosclerosis demonstrated on 18-F-fluorodeoxyglucose positron emission tomography/computed tomography

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG-PET/CT) is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases, such as large vessel vasculitis (LVV). In the last few years, it is known that atherosclerotic lesions with inflammation, detected by FDG-PET, are high-risk structural features and more likely to lead to subsequent progression of atherosclerosis with more clinical complications.

Prevalence of osteoporosis and osteoporotic fractures in postmenopausal women with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) and osteoporosis are chronic diseases with increasing prevalence. The aim of this study was to determine the prevalence of osteoporosis and osteoporotic fracture in women with T2DM and to identify predictive factors of fracture occurrence. The prevalence of osteoporosis and fractures in postmenopausal women with T2DM was 23.1% and 16.9%, respectively. 46.2% of T2DM patients had normal bone mineral density (BMD) (P<0.01) and 58.5% of control subjects had osteopenia (P<0.01). Incidence of fracture in T2DM patients with osteopenia was significantly increased versus control subjects when stratified according the BMD (P=0.009). By stratifying T2DM patients according to fractures, factors that were significantly associated with occurrence included T2DM duration (P=0.038), use of insulin (P=0.017), and lower BMD (P=0.048). Our study suggests that there was a higher prevalence of fracture in T2DM patients compared to control subjects and a significant difference in BMD was found between the groups. We also showed that insulin use, low BMD, and long duration of T2DM are factors associated with an increased risk of bone fracture.

Remitting seronegative symmetrical synovitis with pitting edema and polymyalgia-like syndromes following cancer immunotherapy with checkpoint inhibitors: causal link, potential association or else?

Not available.

Rheumatic immune-related adverse events from checkpoint inhibitor therapy: a case series

Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and its ligand PD-L1 are established cancer immunotherapies for solid tumor and hematologic malignancies. These therapies are involved in immune-related adverse events (irAE), both general and rheumatic ones. In general, immune-related adverse events (irAE) management includes drug-holding, tapering doses of corticosteroids, and specific immunosuppression for clinically severe cases, such as infliximab or mycophenolate.

Correlation between pain and weakness of vastus medialis evaluated by ultrasound in total knee arthroplasty

Osteoarthritis leads to articular cartilage destruction. The treatments reduce pain and improve function by using physical therapy, anti-inflammatory drugs, and surgical intervention, when necessary. Several studies suggest that 30% of patients undergoing knee replacement are not satisfied with results, thus highlighting a possible correlation with quadriceps strength and activities of daily living performance. Some authors studied the connection between clinical and radiological variables and quadriceps thickness, measured by ultrasound in patients with knee replacement. We conducted a cross-sectional study, enrolling 28 patient submitted to the same rehabilitation protocol (4 weeks), after knee arthroplasty, evaluated at admission (T0) and discharge, (TF), using ultrasound for measurement of vastus medialis thickness, and functional scales for abilities and pain. We noted that patients with a cross-sectional diameter of vastus medialis larger than 10 millimetres at the admission manifested less pain and improved their function and abilities values at TF compared to patients with a cross-sectional diameter smaller than 10 millimetres, and showed a better recovery process. Our study demonstrates that the weakness of vastus medialis could be an independent factor which can impact the outcome of patients submitted to arthroplasty of knee, and that it can be evaluated using ultrasound.

Evaluation of aseptic technique used in interventional rheumatology: survey among Moroccan and Tunisian rheumatologists

The objective of our study was to evaluate the aseptic technique used in interventional rheumatology by Moroccan and Tunisian rheumatologists. We performed an online survey among rheumatologists from Morocco and Tunisia. The questionnaire included 15 questions with single and multiple-choice answers and three open sections for freetext comments. An online survey was prepared and sent to 380 rheumatologists. One hundred and four rheumatologists (27.36%) replied to the survey. More than half of the participants (56.7%) were from Tunisia and 43.3% were from Morocco. Interventional procedures on superficial joints were performed by all participants. Ultrasonography was used by 41.3% of respondents to guide interventional procedures. Regarding the aseptic precautions taken to avoid infection, the majority of participants used povidone iodine to clean the skin and only 8.7% wore a mask. Hand washing alone without gloves wearing was done by 19.2% of participants. 2.9% of participants reported a history of iatrogenic septic arthritis and the duration of practice was the only factor associated with its occurrence (P=0.007). Our study showed that aseptic technique used during interventional rheumatologic procedures is heterogeneous. However, the majority of participants were aware of its necessity to avoid iatrogenic septic arthritis.

Serum calprotectin: emerging marker of rheumatoid arthritis

Not available

Sjögren syndrome diagnosis in a cohort of patients with breast cancer: a single-center experience

The association between estrogen receptor (ER) positive breast cancer (BC) and autoimmune disorders has been recently recognized. In particular exposure to aromatase inhibitors is associated with a significant increased risk of rheumatological autoimmune disorders. The purpose of this study was to investigate Sjögren syndrome (SjS) occurrence in patients with ER-positive BC. This is a prospective study analyzing 110 consecutive patients with ER-positive BC treated with anti-hormonal therapy. New 2016 American College of Rheumatology/European League against Rheumatism (ACR-EULAR) classification criteria were used to identify patients with SjS. Ultrasonography of salivary glands (SG) was used to screen patients with negative disease biomarkers, to candidate them to SGs biopsy. Sicca syndrome was detected in 51 patients (46%), whereas a true primary SjS was diagnosed in 11 patients (10%). Even if the evaluation of incidence and prevalence of primary SjS vary widely, to the best of our knowledge, the data from the present study emphasize a previously unsuspected high prevalence of defined pSjS that causes BC sicca symptoms complaints. Hypothesis, explanation of this link and even possible biases are discussed.

An unusual dyspnea in an 87-year old woman affected by Sjögren’s syndrome

Primary Sjögren’s syndrome (pSS) is a progressive autoimmune disease and is characterized by eye and mouth dryness due to lymphocytic infiltration in lacrimal and salivary glands leading to tissue destruction, but it can also present systemic manifestations including lung involvement. Respiratory manifestations in pSS have a prevalence of 9-20% and can be due to airway and/or lung parenchyma involvement, such as in particular in interstitial lung diseases like lymphocytic interstitial pneumonia (LIP). LIP is an inflammatory diffuse parenchymal lung disease, which is almost invariably associated with other conditions, such as autoimmune diseases and immunodeficiency states, and usually affects women with a mean age of 50 years. We described a case of patient with LIP who was referred to our Internal Medicine Unit and the diagnostic issues related to the patient age and comorbidities.