[Vaccination against influenza in patients with rheumatoid arthritis: clinical and antibody response]. / La vaccinazione antiinfluenzale in soggetti affetti da artrite reumatoide: risposta clinica ed anticorpale.

The question whether influenza vaccine could lead to a clinical flare in patients with rheumatoid arthritis (RA), and whether it could induce an effectively protective antibody response to the infection is still much debated. Based on these data, we have performed an open study in 40 patients with RA. Patients were divided into two groups according to their disease activity (those with RA in remission and those with active RA, respectively), and their clinical and serum antibody response was assessed following the vaccine administration in the 1991-92 winter seasons. A group of age and sex matched, healthy controls were also vaccinated. Our results suggest that immunization against influenza does not modify the clinical picture of RA, even though some differences between the two groups mentioned above were noticed. In addition, side-effects or adverse reactions occurred with similar frequency in patients with RA and in the controls; as to the antibody response in patients with RA, in the majority of cases the immune response proved adequate to provide significant protection from the infection.

[A syndrome caused by separating rags in textile industry: a new clinical entity?]. / La sindrome degli sfoderatori di stracci: una nuova entità clinica?

A group of 104 workers were examined. They were employed in selecting rags and separating the lining from wollen fabrics to be used again as thread waste in the textile industry. The aim of the study was to point out tendon and joint related disorders of the upper limb due to repetitive and forced movements. Twenty-eight (26.9%) workers complained of hand and wrist echography and thermography. In 19 patients (67.8%) clinical carpal tunnel syndrome was diagnosed. Eight workers (28.5%) had Dupuytren's contracture. Swelling of the fingers was found in 23 (82.1%). 14.2% and 28.5% of the workers showed respectively acro-osteolysis and acrosclerosis. The textile industry of Prato shows peculiar characters: the workers employed in selecting rags out a manual job which causes soft tissues and skeletal disorders in a great number of them. The acro-osteolytic and acrosclerotic changes of the fingers seem alike the bone disorders of chronic inflammatory rheumatic diseases as seronegative spondyloarthritis.

Long-term i.v. Ig treatment in systemic lupus erythematosus.

OBJECTIVE: Treatment of SLE exacerbations with intravenous gammaglobulins has been shown to be safe and effective, leading to both clinical and serological improvement. In this study we test the hypothesis that intravenous immunoglobulins (IVIg), administered over a long period, would also be effective in patients with chronically active SLE. DESIGN AND PATIENTS: An open trial was carried out on 12 patients with SLE refractory to conventional treatments, administering monthly infusions of intravenous immunoglobulins at a dose of 400 mg/kg/day for 5 consecutive days. The therapy (400 mg/kg for 5 days) lasted from 6 up to 24 months. RESULTS: Progressive clinical improvement was observed in 11 patients during the entire treatment course. This improvement was associated with an increase in hemoglobin, total serum hemolytic complement activity and C3 and C4 components, and in 2 thrombocytopenic patients in the platelet count, as well as a progressive reduction of ESR, serum immunocomplexes and antinuclear antibodies. A marked improvement in serum urea, creatinine clearance and proteinuria was also observed in those patients with renal involvement. We did not observe any adverse effects. CONCLUSION: The results obtained suggest that IVIg therapy may be a promising option in the treatment of chronically active SLE; however, further evaluation of this therapy is essential.

[Long-term treatment with i.v. immunoglobulin in the therapy of systemic lupus erythematosus]. / Trattamento a lungo termine con immunoglobulina e.v. nel terapia del lupus eritematoso sistemico.

BACKGROUND: Treatment of several autoimmune diseases with intravenous gammaglobulins (IvIg) has been demonstrated to be safe and effective in determining clinical improvement and decreasing autoantibody titer. We tested the hypothesis that IvIg would be effective in patients with Systemic Lupus Erythematosus (SLE). METHODS: We conducted an open trial involving 12 patients with SLE refractory to conventional treatments with monthly infusion of IvIg at a dosage of 400 mg/kg/day for 5 consecutive days. The duration of the therapy with the same dose every 4 weeks was from 16 to 24 months. RESULTS: A progressive clinical improvement was observed in 11 patients during IvIg therapy, and it persisted during the all period of treatment. The clinical improvement was associated with an increase of haemoglobin, albumin levels, total serum complement and C3 and C4 components, platelets count in 2 thrombocytopenic patients, and a progressive reduction of ESR, plasma immunocomplexes and antinuclear antibodies. A marked improvement in serum urea, creatinine clearance and proteinuria was also observed in the patients with renal involvement. We have not observed any adverse effects with the long-term use of this treatment. Several mechanisms have been postulated to explain the effect of IVIg in the treatment of autoimmune diseases. Many experimental and clinical data support the interesting hypothesis that IVIg may be effective in some autoimmune diseases by restoring a normal function or the physiological immune network through the same regulatory mechanisms leading to a suppression of autoimmune disorders in normal individuals. The presence of a wide spectrum of anti-idiotypic antibodies in IVIg could regulate T and B-cell activities preventing the emergence of B-cell clones with specificity for autoantigens epitopes and down-regulating autoantibodies production. CONCLUSION: The results obtained suggest that IvIg therapy seems to be a promising and beneficial approach in the treatment of SLE. However, double-blind studies are necessary to confirm the results obtained particularly to ascertain the optimal dosage, the schedule of infusion and the duration of maintenance therapy with IVIg, and to determine their long-term effectiveness, the reduction in late morbidity and mortality and the effect on the quality of life of patients with SLE. Moreover, because of the high cost of IVIg, their use seems to be especially indicated for patients non responders to conventional treatments and for these with infectious complications.

[Efficacy and tolerability of flunoxaprofen in the treatment of rheumatoid arthritis. A cross-over clinical study using naproxen]. / Efficacia e tollerabilità del flunoxaprofene nella terapia dell'artrite reumatoide. Studio clinico in cross-over con naproxene.

The efficacy and safety of the new non-steroidal antiinflammatory drug flunoxaprofen were compared with those of naproxen in a cross over clinical study in patients with classical or definite rheumatoid arthritis (RA). Twenty female out-patients in the active phase of the disease were randomly assigned to one of the two groups studied; one group (A: 10 patients, mean age 51 years) received flunoxaprofen 400 mg/day p.o. for 30 days, followed by a 7-day wash-out period before starting the second treatment, with naproxen 500 mg/day p.o. for 30 days. Another group (B: 10 patients, mean age 58 years) received naproxen before flunoxaprofen and followed the same schedule of group A. The results showed that flunoxaprofen and naproxen have essentially equivalent therapeutical effects in controlling painful and functional symptoms of RA: both treatments resulted in a significant relief of spontaneous diurnal and nocturnal pain, pain on active and passive motion, morning stiffness, and in a significant improvement of grip strength and Richtie's index. None of the two drugs modified biochemical parameters of inflammation (ESR, CPR) or the laboratory variables measured to assess the tolerability of flunoxaprofen (hepatorenal function tests; haematological parameters). Flunoxaprofen was found to be very well tolerated: this feature together with the good therapeutic efficacy makes flunoxaprofen a very safe and useful tool in the management of severe chronic disease such as RA.