Novel autoantibodies in rheumatoid arthritis.

Rheumatoid factor and antibodies against cyclic citrullinated peptides represent a diagnostic hallmark in rheumatoid arthritis (RA). However, over the last decades many other autoantibodies have been identified. Several proteins can trigger an aberrant autoimmune response in their native form while others acquire this feature after post-translational modifications such as citrullination, carbamylation or acetylation. It is of interest that also the enzymes catalyzing such post-translational modifications (e.g. the protein arginine deiminases) can transform themselves into autoantibodies in RA. The purpose of this review article is to provide an overview of relevant literature published over the last years regarding novel autoantibodies and their possible diagnostic and prognostic significance in RA.

Extra-articular rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease that mainly affects the joints, though a consistent proportion of patients may also display extra articular manifestations (EAMs). From rheumatoid nodules to interstitial lung disease, from cardiovascular events to vasculitis, the spectrum of EAMs encompasses various conditions with different prognoses. EAMs may also occur as first RA manifestation, therefore the coordination with other health professionals, including general practitioners, is needed. The aim of this article is to provide an overview on EAMs in RA with particular focus on the recognised risk factors and the available recommendations for managing them, as well as comorbidities in RA patients.

Role of Inflammatory Diseases in Hypertension.

Chronic inflammatory diseases (CID) are characterized by an increased risk of cardiovascular (CV) morbidity and mortality. Several mechanisms, including early acceleration of subclinical atherosclerotic damage, inflammatory markers and immune system deregulation factors, have been demonstrated to strictly interplay for development and progression of atherosclerosis. Moreover, traditional CV risk factors are likely to explain at least some of the excess of CV risk in these patients. Among traditional CV risk factors, compelling evidence suggests a higher incidence and prevalence of hypertension in patients with CID in comparison to the general population. Moreover, hypertension represents an important predictor of CV events in these patients. Pathogenic mechanisms underlying the rise of blood pressure in CID are multifactorial and still poorly investigated. Indeed, multiple disease-related factors may affect blood pressure control in these patients and hypertension may affect disease prognosis and increase CV risk. Better knowledge of the complex interplay between hypertension and CID will be important to elucidate pathogenic mechanisms and to improve CV outcome in these patients. Aim of this review is to highlight available evidence on the relationship between hypertension and CID and to elucidate the multiple factors that may affect blood pressure control in these disorders.

[Incidence of occupational accident in Sicilian University Hospital]. / Andamento del fenomeno infortunistico nel quinquennio 2002-06 in una Azienda Universitaria Ospedaliera Sicliana.

The evolution of the disease accident has been analysed in a University Hospital in Sicily (approx. 2500 employees/year) for the time period between 2002 and 2006. The industrial injuries index has shown a swing in course (from a value of 3.80% in 2002 to 5.17% in 2003 to 4.49% in 2004), affecting the categories of nurses and health social workers most. The phenomenon shows a constant course within the same period for medical staff, technical assistants and administrative staff. Biological risk industrial injuries have the highest frequency compared to all others (62.5% in 2002 down to 42.3% in 2006). The most interesting datum is the relative scarce entity of the phenomenon when compared to other similar hospital situations and the progressive reduction of biological risk incidents.

["Barber's hair sinus": new clinical observation]. / "Barber's hair sinus": recente osservazione clinica.

The AA describe an unusual case of pilonidal sinus in a barber. The clinical analysis showed the presence, in all digital spaces, of erythemateous areas irregularly infiltrated by small fistular tracts and a keratinization area. In the first interdigital space of the left hand, the discharge of a bristle from the apex of a papule was also visibly evident. The histological examination showed the presence of a foreign body granuloma, with giant cells, lymphocyte and plasma cells, centered on a bristle fragment immersed in a collagenous matrix with abundant keratine, skin thickening and fibrous dermis. Using a probe, it was possible to follow the fistular path and obtain the discharge of several hair fragments, conglutinated by corneous scales, but it was not possible to achieve clinical cure of the lesion. The solution to the problem therefore required surgical therapy.

[Usefulness of HbCO level determination in chronic exposure to low environmental concentrations of CO. Study of a group of exposed workers]. / Utilità del dosaggio della HbCO nell'esposizione cronica a basse concentrazioni ambientali di CO. Indagine su un campione di esposti.

This research is based on consideration that HbCO sampling, routinely effected on environmental physician demand for workers' biological monitoring, has a low significance. To confirm or reject this statement, we considered two population groups: n. 583 exposed workers and n. 334 not exposed subjects as control group. The habit of smoking (either as number of cigarettes or as time elapsed between the drawn and the last smoked cigarette) was obviously considered on both groups. The results have shown that it isn't possible to acknowledge the effect of a low CO occupational pollution by using HbCO haematic sampling. The A.A. affirm that it's due to low pollution level in work place and to wrong praxis of haematic sampling performed after a long time from the end of working turn. The research showed a direct correlation between HbCO level and smoking habit and a strong association between time elapsed from last smoked cigarette and haematic sampling.

[Shift-work seniority increases the severity of sleep disorders. Comparison of different categories of shift-workers]. / L'anzianità di turnismo aumenta la gravità dei disturbi del sonno. Confronto fra diverse categorie di turnisti.

Shift-work disrupts the sleep-wake cycle and could bring about sleep disorders and excessive daytime sleepiness. We studied two samples of shift-workers, a group of 178 nurses and one of 174 police officers, all working in the town of Palermo (Italy); their answers to a sleep disorder questionnaire were scored and added in order to create a Sleep Disorder Score (SDS). The SDS cut-off value, discrimining pathological values from physiological ones, was settled a-priori. In both groups SDS did not depend on sex, age, weight, height nor on working seniority, but it increased non linearly (cubic form) with shift-work seniority. In nurses this mathematical description of SDS exceeded the cut-off value after 15 years of shift-work seniority; in police officers it settled asymptotically under the critical value. This could be ascribable both to the different composition in sex of the two samples (nurses: 49% F-51% M vs. police officers: 6% F-94% M) both to the self-selection process that seems to undergo police officers (nurses do not leave shift-work because of salary incentives).

[Primary prevention: environmental modification and changes in chronic respiratory pathology in workers in a metallurgical industry]. / In tema di prevenzione primaria: modifiche ambientali e variazioni della patologia respiratoria cronica in lavoratori di una industria metalmeccanica.

The authors analyse the data connected with chronic pulmonary diseases (mainly bronchitis) of two groups of workers, both belonging to the same metallurgical factory. The data is taken in two different periods, before and after the introduction of measures for primary prevention in the factory. The results confirm that the overall cases of pulmonary diseases are greatly reduced by a correct improvement in the working environment. Moreover, they confirm that a dangerous working environment affects the breathing system more prominently then other factors such as smoking, etc.

[Possible etiologic role of occupational exposure to arsenic anhydride in a case of bladder carcinoma]. / Possible ruolo eziologico dell'esposizione professionale ad anidride arseniosa in un caso di carcinoma vescicale.

It has long been known that occupational or environmental exposure to arsenic (As) may cause skin and lung cancer. Moreover, several epidemiological studies on populations exposed to inorganic As by ingestion indicate an increased risk for cancer at other sites and, particularly, for bladder cancer. We describe the case of a petrol chemical worker, who died of metastasized bladder cancer at the age of 52, after being employed for over 30 years in a hydrogen production unit. Analysis of the technological cycle and biological monitoring data revealed an excessive, prolonged exposure to arsenic trioxide (As2O3) vapours and fumes; a solution of this compound was utilized to absorb the CO2 produced by oxidation of the synthesis gas. Careful anamnesis indicated a prolonged contact between the carcinogen and the bladder mucosa, due to the presence of severe urethral stenosis with chronic urinary obstruction. It also appears likely that synergism between As exposure and smoking (5-10 cigarettes per day until 46 years) occurred. This case suggests the opportunity to extend to the occupational setting future epidemiological research on the relationship between inorganic As exposure and bladder cancer.

[Normal spirometric values in the Sicilian population]. / Valori spirometrici "normali" nella popolazione siciliana.

Principal spirometric parameters have been measured in a sample group of 1641 male subjects. Due to the significant difference in values often found when using the standards proposed by CECA (1983) (particularly in the medico-legal field) in order to obtain reference values as close as possible to the local norm the chosen subjects are clinically and functionally healthy and come from different parts of Sicily. The regression plots obtained using three independent variables (age, weight, height) other than demonstrating a good affinity with the original sample and an elevated predictivity level, underline the difference between obtained reference values and European ones (higher for VC and FEV 1; lower for FRC and RV) even though evolutive trend and ageing overlap. The above mentioned difference, found also for some parameters (VC and FEV 1) using normal Italian standards can be explained; not only by different evaluations of normal conditions, respiratory risk, smoking etc., but also by the existence of a different ethnic constitution which influences in various ways the ventilatory parameters.

[Usefulness of specific bronchial provocation tests in the diagnosis of compensable occupational allergic pneumopathies]. / Utilità dei tests di provocazione bronchiale specifici nella diagnostica delle pneumopatie allergiche professionali indennizzabili.

The A.A studied the bronchial reactivity of 309 subjects accusing a working respiratory disease. It had been valued the utility of specific provocation bronchial test for diagnosis of allergic bronchopneumopathies. The test, performed with working antigens pool, not only confirms the low percentage of allergic respiratory disease among considered workers (joiners, painters and millers) it also shows its sensibility only in subjects with a sure story of bronchial asthma. The A.A. say, that it's not really necessary to perform the test in all subjects that submit to diagnostic screening for industrial insurance reasons.