Search PubMed⌕ Search

Biomedical subjects

S Bombardieri

Publications and source records attributed to S Bombardieri.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Development of a functional disability measurement tool to assess early arthritis: the Recent-Onset Arthritis Disability (ROAD) questionnaire.

OBJECTIVE: To develop a self-administered questionnaire, the ROAD (Recent-Onset Arthritis Disability), to probe physical disability in Italian patients with early arthritis (EA) of less than one year's duration. METHODS: The development of the ROAD follows a series of major steps: (1) identification of a specific patient population, (2) item pool development, (3) item reduction, (4) internal consistency, (5) pre-testing of the prototype instrument, and (6) a validation study which results in determination, reliability, validity and responsiveness. In this study we have verified the first five steps. Pre-defined areas of disability were culled from eight existing Italian version arthritis-specific questionnaires, and three generic global health measurement tools. Semi-structured interviews helped to derive a 76-item pool from an initial group of 122 items. This questionnaire was administered to 78 EA patients. RESULTS: For scale generation, a combination of frequency importance product (FIP = frequency x mean relevance score) and factor analysis was applied. The top 20 items based on the FIP were then subjected to further analysis. Each question was correlated with every other question. This allowed us to eliminate 8 questions that were therefore highly correlated and were measuring the same concept. The final instrument has 12 items, representing a combination of symptoms that are common, frequently recurring and of general importance to EA patients. Factor analysis provides a 3-factor health status model explaining 70.1% of the variance. The upper extremity function (5 items) is loaded on the first factor, which explains 45.4% of the total measured variance. The lower extremity function (4 items) formed the second factor (14.2% of the total variance). The third factor was determined by activities of daily living/work (3 items) and explain 10.5% of the total variance. The score of the different subscales can be presented graphically as a ROAD profile. CONCLUSION: Using a traditional development strategy, we have constructed a self-administered instrument for measuring physical functioning in patients with EA. The next stage includes reliability, validity and responsiveness testing of the 12-item questionnaire.

Activities of Daily Living↗
PubMedDate not supplied

Measuring functional disability in early rheumatoid arthritis: the validity, reliability and responsiveness of the Recent-Onset Arthritis Disability (ROAD) index.

OBJECTIVE: Disability has been identified as a core outcome measure in rheumatoid arthritis (RA). The aim of this study was to test the Recent-Onset Arthritis Disability (ROAD) questionnaire for validity, reliability and responsiveness in Italian patients with early RA. METHODS: The psychometric properties of ROAD were tested in 159 patients with early RA, mean age 54.7 (+/- 8.8), 74.3% women, mean disease duration 14.5 months (+/- 1.9 months). All completed the ROAD, the Medical Outcomes Study SF-36 Health Survey (SF-36), the Health Assessment Questionnaire (HAQ) and the patient global assessment (PGA) of functional disability twice, in order to test for validity and responsiveness. Of the 159 patients who completed the health status instruments on two occasions, 121 were included in the responsiveness analyses. The test-retest reliability of the ROAD questionnaire was calculated using intraclass correlation coefficients (ICCs) and the Bland and Altman method on 77 patients who completed the questionnaire twice over an interval of one week. Construct validity was assessed using Spearman's correlations, while responsiveness was evaluated by 3 different methods: (1) effect size (the mean difference between the baseline scores and thefollow-up scores divided by the standard deviation of the baseline scores); (2) standardized response mean (the mean change in scores divided by the standard deviation of the change in scores); (3) receiver operating characteristics (ROC) curve analysis. RESULTS: ROAD fulfilled the established criteria for validity, reliability and responsiveness. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, thus supporting the convergent construct validity. Significant correlations were seen between ROAD scores and HAQ scores (rho = 0.372), SF-36 physical component summary (PCS) (rho = -0.413), PGA functional disability (rho = 0.417), pain (rho = 0.639), Ritchie index (rho = 0.357), number of swollen joints (rho = 0.387), patient and physician assessment of disease activity (rho = 0.467 and 0.323, respectively), and Disease Activity Score (rho = 0.476). Test-retest reliability was satisfactory, with ICCs of 0.927 (upper extremity function), 0.892 (lower extremity function), and 0.851 (activity of daily living/work). Bland-Altman plots confirmed this finding. The results of responsiveness analysis indicate that the ROAD subscales were slightly more sensitive to perceived change in functional disability than those of HAQ, SF-36 PCS, and PGA offunctional disability. CONCLUSION: Our data suggest that the ROAD index is a reliable, valid and responsive tool for measuring physical functioning in patients with early RA, and is suitable for use in clinical trials and daily clinical practice. Its generalizability and utility for assessing aggressive treatment and functional outcomes must now be evaluated in broader settings.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Quality of life in rheumatoid arthritis: impact of disability and lifetime depressive spectrum symptomatology.

OBJECTIVE: The aim of this study was to investigate the impact of disability and lifetime subthreshold depressive symptoms on Health-Related Quality of Life (HRQoL) among patients with rheumatoid arthritis (RA). METHODS: Ninety-two subjects with a diagnosis of RA according to the American College of Rheumatology (ACR) criteria were recruited at the Department of Rheumatology of the University Hospital, Pisa, Italy. Participants who met DSM-IV-TR diagnostic criteria for current or previous Axis I disorders were excluded. Assessments of functional status and disability was conducted using both the ACR classification and the Stanford Health Assessment Questionnaire (HAQ). Health-related Quality of Life was assessed using the Medical Outcomes Study Short Form 36 health survey questionnaire (MOS-SF36) and lifetime depressive spectrum symptomatology using the Mood Spectrum Questionnaire, Self-Report version (MOODS-SR). RESULTS: Comparison with MOS-SF36 Italian normative values indicated that RA patients were significantly impaired on mental and physical HRQoL areas. Correlations between MOODS-SR depressive scores and ACR severity (Spearman rho = 0.15, p = 0.07) and HAQ score (Spearman rho = 0.20, p = 0.05) were modest in absolute value and borderline significant. Lifetime mood depressive spectrum was related with impaired HRQoL levels, both in physical (except for bodily pain) and mental (except for social functioning) domains. Associations of mood depressive spectrum and general health, vitality, role emotional and mental health continued to be significant after controlling for functional status, duration of illness, age and gender. CONCLUSIONS: Because lifetime mood depressive symptoms significantly contribute to impairment in HRQoL in RA patients without a past psychiatric history, even after controlling for functional status, duration of illness and demographic characteristics, these symptoms should be assessed for an accurate clinical evaluation and appropriate clinical management of RA patients.

Affect↗
PubMedDate not supplied

From clinical trials to the bedside: how can we treat patients with rheumatoid arthritis and concurrent morbidities who are generally excluded from randomised controlled clinical trials?

In the last few years management of rheumatoid arthritis (RA) has changed substantially due to the availability of new drugs and newer therapeutical strategies. Controlled randomised clinical trials (RCT) have allowed us to analyse the efficacy and safety of all these innovative approaches. Unfortunately, these RCTs are not free from criticisms and their rigid inclusion and exclusion criteria may increase the differences between the ideal patients enrolled and the majority of patients seen in standard clinical care. This review focuses on actual clinical practice, with particular attention on patient comorbidities and all the conditions which have been designated as exclusion criteria in the most important registration RCTs. We will attempt to provide an overview of the most widely used strategies in RA therapy.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Lupus erythematosus and the skin.

Cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease. The most consistent environmental trigger factors so far recognized are exposure to ultraviolet light and certain drug classes known to be capable of inducing LE in otherwise healthy individuals. A classification system has been established including clinical, histologic, photobiologic, serologic, and immunogenetic findings to better define the different cutaneous subtypes of LE. During their clinical evolution, the cutaneous manifestations vary considerably, and, therefore, the diseases which should be considered in differential diagnosis are different, according to the stages of disease development. Furthermore, 25 years of experience worldwide have revealed that individuals whose disease presentation is dominated by subacute cutaneous LE skin lesions and the presence of circulating anti-Ro/SS-A antibodies represent a rather homogeneous immunogenetic subphenotype of LE that enjoys a good prognosis over time. Treatment should be individualized according to disease severity. The majority of patients with cutaneous manifestations of LE do not require systemic immuno-suppressive/ immunomodulatory therapy and the advent of recombinant biologicals has given hope to the small percentage of patients that suffer from particularly severe skin disease activity.

Humans↗
PubMedDate not supplied

Skin involvement and outcome measures in systemic autoimmune diseases.

This paper focuses on skin manifestations that can be observed in autoimmune diseases such as rheumatoid arthritis (RA), Sjögren syndrome (SS), dermatomyositis (DM) and Behçet syndrome (BS). In RA the most widely recognized skin lesion is the rheumatoid nodule. Other cutaneous manifestations can be observed either non-specific or related to the disease itself and/or to the commonly used drugs. Cutaneous manifestations are considered one of the most typical extraglandular features of primary SS, generally they are distinguished in vasculitic and non vasculitic lesions. Among non-vasculitc lesions, skin dryness (xerosis) has been shown to be very common in pSS while vasculitis lesions include typically flat and palpable purpura and urticarial vasculits. In DM the skin manifestations are also frequent and include a heliotrope rash (blue-purple discoloration) on the upper eyelids with edema, a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron rash). The most frequent mucocutaneous finding in BS is aphthous stomatitis which can not usually be differentiated from idiopatic reccurrent aphthous stomatitis on clinical grounds. The most typical skin manifestations are nodular lesions, which are commonly seen in BS and may be due to panniculitis [erythema nodosum (EN)-like lesions] or superficial thrombophlebitis.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist.

Over the last few years, technological advances have resulted in dramatic improvements in quality and resolution of ultrasonography (US), allowing it to become a very powerful tool in rheumatological clinical practice. Despite the fact that the impact of US on final diagnosis or therapeutic options for rheumatic patients has not yet been defined, there is now growing evidence that US improves clinical diagnosis and intervention skills. This review discusses the most important issues connected with the practice of US in rheumatology including: basic requirements, scanning technique, clinical applications, training and future developments. Moreover, it provides a general overview of both US anatomy and pathology relevant for the rheumatologist.

Humans↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist. I. Ultrasonography of the shoulder.

Ultrasonography (US) has proved to be a useful diagnostic tool in patients with shoulder pain and/or limited range of motion. It allows careful assessment of a wide range of changes involving many different anatomic structures of the shoulder girdle, such as the rotator cuff tendons (tendonitis, tendon tears and calcific deposits), the long head of the biceps tendon (tenosynovitis, tendonitis, tears, rupture and displacement), the bursae (bursitis), the soft tissues of the gleno-humeral (synovial proliferation, joint effusion) and acromioclavicular joints (synovial proliferation and joint effusion). In addition, it is also a reliable tool in the evaluation of bony profiles detecting the presence of erosions and osteophytes. The use of high quality equipment and the application of a standard scanning protocol are mandatory for reliable US assessment of shoulder pathology.

Humans↗
PubMedDate not supplied

Association between hepatitis C virus and mixed cryoglobulinemia [see comment].

The prevalence of hepatitis C virus (HCV) RNA and of antibodies to HCV in an unselected series of 42 mixed cryoglobulinemia patients was investigated in this study. HCV RNA was detected by the polymerase chain reaction technique, and HCV antibodies by two enzyme-linked immunosorbent assays (Chiron ELISA HCV, Second Generation, Emeryville CA, USA; Wellcome Diagnostic, England). HCV RNA was found in 86% of the mixed cryoglobulinemia patients. Using either the Chiron ELISA or the Wellcome ELISA, HCV antibodies were present in 90% of the same samples; anti-HCVAb seropositivity was confirmed in all cases by immunoblot assay (Chiron RIBA HCV, Second Generation Assay). A striking correlation between HCV RNA and anti-HCV antibody seropositivities was recorded. HCV RNA in mixed cryoglobulinemia patients was not correlated with the presence or absence of biopsy-proven liver involvement. These results suggest that the association between HCV and mixed cryoglobulinemia is not fortuitous, and therefore that HCV may have an etiopathogenetic role in this disorder.

Adult↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist II. Ultrasonography of the hand and wrist.

The hand is one of the anatomical regions most frequently explored by ultrasonography (US) in rheumatology. The last generation US systems equipped with high frequency probes allow for a quick and accurate assessment of even minimal pathological changes in patients with rheumatic conditions affecting the small joints and the soft tissues of the hand and wrist. Several studies have demonstrated the great value of US imaging of the hand and wrist in rheumatology but there are still controversial issues which yet have to be adequately addressed, particularly with regard to US semi-quantitative evaluation of synovitis and bone erosions in patients with chronic arthritis. This paper provides the basic knowledge, reviews the available evidence and discusses the potential of US in the evaluation of the hand and wrist.

Rheumatic Diseases↗
PubMedDate not supplied

A first study of cytokine genomic polymorphisms in CFS: Positive association of TNF-857 and IFNgamma 874 rare alleles.

OBJECTIVE: In the past two years we have developed a biological bank of genomic DNA, cDNA, serum and red blood cells of Italian patients with certified CFS from the two Italian referral centers for the syndrome. Recent studies have shown an imbalance in cytokine production in disease states similar to Chronic Fatigue Syndrome (CFS), such as sickness behavior, both in animals and in humans. However we notice that serum cytokine concentrations are often inconstant and degrade rapidly. With this in mind, we investigated cytokine gene polymorphisms in 80 Italian patients with CFS in order to ascertain whether in this group of patients it is possible to describe a genetic predisposition to an inflammatory response. METHODS: We analyzed the promoter polymorphisms of IL-10, IL-6 and the IFNgamma 874 T/A polymorphism in intron 1 with a PCR-SSP method (Cytogen One Lambda Inc. Canoga Park, CA, U.S.A) in 54 patients and TNF-308 G/A and -857 C/T promoter polymorphisms with a PCR-RFLP method (in 54 and 80 patients respectively). RESULTS: There is a highly significant increase of TNF -857 TT and CT genotypes (p = 0.002) among patients with respect to controls and a significant decrease of IFN gamma low producers (A/A) (p = 0.04) among patients with respect to controls. CONCLUSIONS: We hypothesize that CFS patients can have a genetic predisposition to an immunomodulatory response of an inflammatory nature probably secondary to one or more environmental insults of unknown nature.

Adolescent↗
PubMedDate not supplied

New aspects in the treatment of immunomediated diseases.

The following constitutes a summary of lectures delivered during the session "New aspects in the treatment of immunomediated diseases" which was held during the 25th Annual Scientific Meeting of the European Society for Clinical Investigation in Pisa, Italy on 6th April 1991. The aim of this session was to present and discuss some of the novel therapeutic modalities currently being employed either in experimental models or in phase I clinical studies.

Adjuvants, Immunologic↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist III. Ultrasonography of the hip.

Ultrasonography (US) is a reliable and useful diagnostic tool for the assessment of hip pathology. It depicts changes within the coxo-femoral joint (synovitis, erosions, osteophytes) and in the adjacent peri-articular tissues (calcifications, tendonitis, enthesitis, bursitis) in many rheumatic diseases (rheumatoid arthritis, spondyloarthritis, osteoarthritis, polymyalgia rheumatica ) and in some orthopaedic disorders (septic arthritis, trauma, abscess, painful hip after arthroplasty). It is commonly used both in adults and in children. In the assessment of hip joint pathology, US exerts considerable diagnostic supremacy over physical examination. In fact, by virtue of its size and position, reliable physical examination of the hip is often difficult thus making US particularly useful as a bedside tool for the evaluation of a painful hip. Hip US has also proven to be of great practical benefit when performing aspiration and injection within the joint and in the periarticular soft tissues. The relatively limited acoustic windows available to the US beam is the principal limitation to hip US thereby making detailed examination of some important structures impossible together with the interpretation of power Doppler signal sometimes unreliable. In addition, the deep location of the hip can confer further problems to US scanning in obese or particularly muscular subjects.

Hip Joint↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist IV. Ultrasonography of the knee.

Ultrasound examination of the knee is particularly useful in the detection of synovitis, early degenerative changes within the articular cartilage of the femoral condyles, calcifications within the articular cartilage layer and menisci, bursitis, and popliteal cysts. Also, important anatomical information about the structural integrity of the supporting tissues around the knee can be obtained by ultrasound in patients presenting with 'knee pain'. We review the available evidence about the use of ultrasound in knee examination, provide information on the technical equipment and scanning methods and discuss the still controversial issues.

Humans↗
PubMedDate not supplied

Assessing remission in systemic lupus erythematosus.

The past few decades have witnessed development and validation of indices to assess activity, damage, and quality of life (QoL) in patients with systemic lupus erythematosus (SLE). These indices are widely used in clinical research and randomised controlled clinical trials, but not in usual clinical care. Definitions of flares and response to therapy have been proposed on the basis of indices. However, criteria for disease remission have not been clearly established for these indices, except for the SLE Disease Activity Index (SLEDAI). Defining remission in SLE in an objective manner depends on reaching agreement on the relative importance of systemic activity, damage, QoL, and laboratory tests, as well as activity and damage of specific organs.

Clinical Trials as Topic↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist V. Ultrasonography of the ankle and foot.

Ultrasonography (US) is a useful tool for imaging, which can be used for the assessment of joints and periarticular structures in all rheumatological disorders. In patients with pain and/or swelling of the ankle and foot, US provides information about the presence of joint effusion, synovitis, tenosynovitis, tendinosis, and tendons tears, helping in the differential diagnosis between joint or tendon/enthesis involvement. Moreover, US allows clinicians to monitor and guide needle positioning to inject pharmaceutical substances more safely and effectively even in hard-to-reach sites. US represents an accurate, safe and low-cost technique that can be used for the examination of the ankle and foot in rheumatic disorders.

Ankle Joint↗
PubMedDate not supplied

Ultrasound imaging for the rheumatologist. VI. Ultrasonography of the elbow, sacroiliac, parasternal, and temporomandibular joints.

Ultrasound (US) examination of the elbow and parasternal joints is very useful to detect synovitis, degenerative changes, intrarticular calcification or soft tissue abnormalities. More recently new fields of research involving the sacroiliac and temporomandibular (TM) joints have evolved. Moreover, important information has been obtained about vascularization of the synovial joint in the sacroiliac region and structural modification such as internal derangement in the TM joint.. In this paper, we review and discuss the role of US in the evaluation of elbow, sacroiliac, parasternal and TM joint pathology.

Elbow↗