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  1. Article ; Online: The latest advances in the use of biological DMARDs to treat Still's disease.

    Di Cola, Ilenia / Ruscitti, Piero

    Expert opinion on biological therapy

    2024  Volume 24, Issue 1-2, Page(s) 63–75

    Abstract: Introduction: Currently, the therapeutic management of Still's disease, a multisystemic inflammatory rare disorder, is directed to target the inflammatory symptoms and signs of patients. The treatment varies from glucocorticoids to disease-modifying ... ...

    Abstract Introduction: Currently, the therapeutic management of Still's disease, a multisystemic inflammatory rare disorder, is directed to target the inflammatory symptoms and signs of patients. The treatment varies from glucocorticoids to disease-modifying antirheumatic drugs (DMARDs), both conventional synthetic and biological (bDMARDs). Usually, in refractory patients, bDMARDs are administered.
    Areas covered: Among bDMARDs, IL-1 and IL-6 inhibitors are frequently used, as data reported from both clinical trials and 'real-life' experiences. Recently, innovative therapeutic strategies have suggested an early administration of bDMARDs to increase the rate of clinical response and drug-free remission. Some new targets have been also proposed targeting IL-18, IFN-γ, and JAK/STAT pathway, which could be applied to Still's disease and its life-threatening evolution.
    Expert opinion: Many lines of evidence improved the knowledge about the therapeutic management of Still's disease with bDMARDs. However, many unmet needs may be still highlighted which could provide the basis to arrange further specific research in increasing the rate of clinical response. In fact, Still's disease remains a highly heterogeneous disease suggesting possible diverse underlying pathogenic mechanisms, at least partially, and consequent different therapeutic strategies. A better patient stratification may help in arranging specific studies to improve the long-term outcome of Still's disease.
    MeSH term(s) Humans ; Janus Kinases/therapeutic use ; STAT Transcription Factors/therapeutic use ; Signal Transduction ; Antirheumatic Agents/adverse effects ; Arthritis, Juvenile/drug therapy ; Still's Disease, Adult-Onset/drug therapy
    Chemical Substances Janus Kinases (EC 2.7.10.2) ; STAT Transcription Factors ; Antirheumatic Agents
    Language English
    Publishing date 2024-02-04
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2052501-1
    ISSN 1744-7682 ; 1471-2598
    ISSN (online) 1744-7682
    ISSN 1471-2598
    DOI 10.1080/14712598.2024.2307340
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  2. Article: Editorial: Comorbidities in Psoriatic Arthritis and Their Impact on Therapeutic Strategies.

    Pantano, Ilenia / Ruscitti, Piero

    Frontiers in medicine

    2022  Volume 8, Page(s) 830179

    Language English
    Publishing date 2022-02-03
    Publishing country Switzerland
    Document type Editorial
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2021.830179
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  3. Article ; Online: Ferritin and myalgic encephalomyelitis/chronic fatigue syndrome in post COVID-19, an unexpected facet of the hyperferritinemic syndrome?

    Ruscitti, Piero / Ursini, Francesco / Shoenfeld, Yehuda

    Journal of psychosomatic research

    2023  Volume 169, Page(s) 111231

    MeSH term(s) Humans ; Fatigue Syndrome, Chronic ; Ferritins ; COVID-19
    Chemical Substances Ferritins (9007-73-2)
    Language English
    Publishing date 2023-03-15
    Publishing country England
    Document type Editorial
    ZDB-ID 80166-5
    ISSN 1879-1360 ; 0022-3999
    ISSN (online) 1879-1360
    ISSN 0022-3999
    DOI 10.1016/j.jpsychores.2023.111231
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  4. Article ; Online: Editorial

    Ilenia Pantano / Piero Ruscitti

    Frontiers in Medicine, Vol

    Comorbidities in Psoriatic Arthritis and Their Impact on Therapeutic Strategies

    2022  Volume 8

    Keywords psoriatic arthritis ; comorbidities ; BDMARDs ; cardiovascular disease ; obesity ; Medicine (General) ; R5-920
    Language English
    Publishing date 2022-02-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Recent advances and evolving concepts in Still's disease.

    Ruscitti, Piero / Cantarini, Luca / Nigrovic, Peter A / McGonagle, Dennis / Giacomelli, Roberto

    Nature reviews. Rheumatology

    2024  Volume 20, Issue 2, Page(s) 116–132

    Abstract: Still's disease is a rare inflammatory syndrome that encompasses systemic juvenile idiopathic arthritis and adult-onset Still's disease, both of which can exhibit life-threatening complications, including macrophage activation syndrome (MAS), a secondary ...

    Abstract Still's disease is a rare inflammatory syndrome that encompasses systemic juvenile idiopathic arthritis and adult-onset Still's disease, both of which can exhibit life-threatening complications, including macrophage activation syndrome (MAS), a secondary form of haemophagocytic lymphohistiocytosis. Genetic insights into Still's disease involve both HLA and non-HLA susceptibility genes, suggesting the involvement of adaptive immune cell-mediated immunity. At the same time, phenotypic evidence indicates the involvement of autoinflammatory processes. Evidence also implicates the type I interferon signature, mechanistic target of rapamycin complex 1 signalling and ferritin in the pathogenesis of Still's disease and MAS. Pathological entities associated with Still's disease include lung disease that could be associated with biologic DMARDs and with the occurrence of MAS. Historically, monophasic, recurrent and persistent Still's disease courses were recognized. Newer proposals of alternative Still's disease clusters could enable better dissection of clinical heterogeneity on the basis of immune cell profiles that could represent diverse endotypes or phases of disease activity. Therapeutically, data on IL-1 and IL-6 antagonism and Janus kinase inhibition suggest the importance of early administration in Still's disease. Furthermore, there is evidence that patients who develop MAS can be treated with IFNγ antagonism. Despite these developments, unmet needs remain that can form the basis for the design of future studies leading to improvement of disease management.
    MeSH term(s) Adult ; Humans ; Arthritis, Juvenile/drug therapy ; Antirheumatic Agents/therapeutic use ; Macrophage Activation Syndrome/drug therapy ; Macrophage Activation Syndrome/etiology ; Still's Disease, Adult-Onset/complications ; Still's Disease, Adult-Onset/drug therapy ; Lymphohistiocytosis, Hemophagocytic/drug therapy
    Chemical Substances Antirheumatic Agents
    Language English
    Publishing date 2024-01-11
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2491532-4
    ISSN 1759-4804 ; 1759-4790
    ISSN (online) 1759-4804
    ISSN 1759-4790
    DOI 10.1038/s41584-023-01065-6
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  6. Article ; Online: Rheumatoid Arthritis Treatment Options and Type 2 Diabetes: Unravelling the Association.

    Di Muzio, Claudia / Cipriani, Paola / Ruscitti, Piero

    BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy

    2022  Volume 36, Issue 6, Page(s) 673–685

    Abstract: Multiple lines of evidence have increasingly suggested a pathogenic connection between rheumatoid arthritis (RA) and the mechanisms of type 2 diabetes (T2D) in a vicious circle perpetuated by glucose derangement and inflammatory mediators. These findings ...

    Abstract Multiple lines of evidence have increasingly suggested a pathogenic connection between rheumatoid arthritis (RA) and the mechanisms of type 2 diabetes (T2D) in a vicious circle perpetuated by glucose derangement and inflammatory mediators. These findings have been further reinforced by clinical studies showing that the inhibition of interleukin (IL)-1 and IL-6 may allow the treatment of RA and concomitant T2D at the same time. Interestingly, IL-1 inhibition induced a more evident reduction of glycated haemoglobin (HbA1c) in patients with concomitant RA and T2D than in previous studies on IL-1 inhibition in patients with this metabolic disease alone. Thus, the inflammatory pathogenic mechanisms of T2D could be exaggerated in the context of a rheumatic disease, possibly explaining these findings. In fact, IL-1 inhibition could not only palliate glycaemia, but also decrease the progressive decline in insulin secretion associated with T2D, interfering with apoptosis of β-cells, improving their function, and ameliorating the peripheral insulin resistance. Moreover, the maintenance of clinical remission of rheumatic disease could further improve the glucose derangement and reduce the occurrence of T2D in RA. On these bases, the presence of T2D may allow the physicians to perform a better profile of patients with RA according to the principles of precision medicine, tailoring the medical treatment to the individual characteristics. In this context, the benefits of targeting the inflammatory process, mainly by IL-1 inhibition, may be suggested in patients with RA and concomitant T2D.
    MeSH term(s) Humans ; Diabetes Mellitus, Type 2/drug therapy ; Arthritis, Rheumatoid/drug therapy ; Blood Glucose/metabolism ; Interleukin-1 ; Glucose/therapeutic use
    Chemical Substances Blood Glucose ; Interleukin-1 ; Glucose (IY9XDZ35W2)
    Language English
    Publishing date 2022-11-02
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 1364202-9
    ISSN 1179-190X ; 1173-8804
    ISSN (online) 1179-190X
    ISSN 1173-8804
    DOI 10.1007/s40259-022-00561-7
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  7. Article ; Online: Perspectives on the use of non-biological pharmacotherapy for adult-onset Still's disease.

    Di Cola, Ilenia / Cipriani, Paola / Ruscitti, Piero

    Expert opinion on pharmacotherapy

    2022  Volume 23, Issue 14, Page(s) 1577–1587

    Abstract: Introduction: The treatment of the patients with adult-onset Still's disease (AOSD) remains largely empirical and it is based on the administration of immunosuppressive drugs. In this work, we described the use of non-biological pharmacotherapies for ... ...

    Abstract Introduction: The treatment of the patients with adult-onset Still's disease (AOSD) remains largely empirical and it is based on the administration of immunosuppressive drugs. In this work, we described the use of non-biological pharmacotherapies for AOSD.
    Area covered: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are employed during the diagnostic phase, glucocorticoids (GCs) are the first-line therapy, administered at the beginning of the disease. As second-line therapy, conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are used when GCs do not fully control the disease and/or to reduce the dosage of concomitant GCs. Methotrexate (MTX) is the most commonly administered csDMARDs whereas calcineurin inhibitors (CNIs) are used in severe patients. The lack of achievement of clinical response may lead to the administration of biologic DMARDs, with or without csDMARDs.
    Expert opinion: The management of AOSD may benefit from the administration of non-biological pharmacotherapies, including GCs, MTX, and CNIs. These therapies showed efficacy in inducing a clinical response, in managing life-threatening complications, and may be well tolerated in combination with biologic DMARDs. However, further specific studies are needed to fully clarify the specific role of such drugs in clinical practice to improve the management of AOSD and to provide a more tailored treatment.
    MeSH term(s) Adult ; Humans ; Still's Disease, Adult-Onset/drug therapy ; Still's Disease, Adult-Onset/diagnosis ; Methotrexate/therapeutic use ; Calcineurin Inhibitors/therapeutic use ; Antirheumatic Agents/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Glucocorticoids/therapeutic use
    Chemical Substances Methotrexate (YL5FZ2Y5U1) ; Calcineurin Inhibitors ; Antirheumatic Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Glucocorticoids
    Language English
    Publishing date 2022-09-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2001535-5
    ISSN 1744-7666 ; 1465-6566
    ISSN (online) 1744-7666
    ISSN 1465-6566
    DOI 10.1080/14656566.2022.2126764
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  8. Article ; Online: The clinical heterogeneity of adult onset Still's disease may underlie different pathogenic mechanisms. Implications for a personalised therapeutic management of these patients.

    Ruscitti, Piero / Berardicurti, Onorina / Giacomelli, Roberto / Cipriani, Paola

    Seminars in immunology

    2022  Volume 58, Page(s) 101632

    Abstract: Adult-onset Still's disease (AOSD) is a rare inflammatory disease of unknown aetiology usually affecting young adults and manifesting with a clinical triad of spiking fever, arthritis, and evanescent cutaneous rash. AOSD may be considered a highly ... ...

    Abstract Adult-onset Still's disease (AOSD) is a rare inflammatory disease of unknown aetiology usually affecting young adults and manifesting with a clinical triad of spiking fever, arthritis, and evanescent cutaneous rash. AOSD may be considered a highly heterogeneous disease, despite a similar clinical presentation, the disease course may be completely different. Some patients may have a single episode of the disease whereas others may evolve toward a chronic course and experience life-threatening complications. On these bases, to dissect the clinical heterogeneity of this disease, four different subsets were identified combining the manifestations at the beginning with possible diverse outcomes over time. Each one of these derived subsets would be characterised by a prominent different clinical feature from others, thus proposing dissimilar underlying pathogenic mechanisms, at least partially. Consequently, a distinct management of AOSD may be suggested to appropriately tailor the therapeutic strategy to these patients, according to principles of the precision medicine. These findings would also provide the rationale to recognise a different genetic and molecular profile of patients with AOSD. Taking together these findings, the basis for a precision medicine approach may be suggested in AOSD, which would drive a tailored therapeutic approach in these patients. A better patient stratification may also help in arranging specific designed studies to improve the management of patients with AOSD. Behind these different clinical phenotypes, distinct endotypes of AOSD may be suggested, probably differing in pathogenesis, outcomes, and response to therapies.
    Language English
    Publishing date 2022-07-01
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1018141-6
    ISSN 1096-3618 ; 1044-5323
    ISSN (online) 1096-3618
    ISSN 1044-5323
    DOI 10.1016/j.smim.2022.101632
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  9. Article ; Online: Tofacitinib may improve insulin resistance in patients with rheumatoid arthritis and diabetes, implications for disease management and precision medicine approach.

    Di Muzio, Claudia / Ursini, Francesco / Iagnocco, Annamaria / Cipriani, Paola / Giacomelli, Roberto / Ruscitti, Piero

    Autoimmunity reviews

    2023  Volume 22, Issue 8, Page(s) 103373

    MeSH term(s) Humans ; Insulin Resistance ; Precision Medicine ; Arthritis, Rheumatoid/drug therapy ; Methotrexate/therapeutic use ; Diabetes Mellitus/drug therapy ; Disease Management ; Antirheumatic Agents/therapeutic use ; Treatment Outcome
    Chemical Substances tofacitinib (87LA6FU830) ; Methotrexate (YL5FZ2Y5U1) ; Antirheumatic Agents
    Language English
    Publishing date 2023-06-08
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2144145-5
    ISSN 1873-0183 ; 1568-9972
    ISSN (online) 1873-0183
    ISSN 1568-9972
    DOI 10.1016/j.autrev.2023.103373
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    Zs.A 5913: Show issues Location:
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  10. Article: Ferritin and Severe COVID-19, from Clinical Observations to Pathogenic Implications and Therapeutic Perspectives.

    Ruscitti, Piero / Giacomelli, Roberto

    The Israel Medical Association journal : IMAJ

    2020  Volume 22, Issue 8, Page(s) 516–518

    Abstract: Background: A virally-induced cytokine storm syndrome, associated with a massive and overwhelming systemic inflammation, burdens a subgroup of patients with severe coronavirus disease-2019 (COVID-19), which leads to pulmonary inflammation and extensive ... ...

    Abstract Background: A virally-induced cytokine storm syndrome, associated with a massive and overwhelming systemic inflammation, burdens a subgroup of patients with severe coronavirus disease-2019 (COVID-19), which leads to pulmonary inflammation and extensive lung damage. These severe COVID-19 patients are characterized by high ferritin levels. These findings mirror what was previously reported about the prognostic role of this iron storage protein in other inflammatory diseases included in the hyperferritinemic syndrome. The latter suggests that ferritin could be a further pathogenic mediator in enhancing the inflammatory process, stimulating inflammatory pathways, and thus perpetuating a vicious pathogenic loop. Considering its activity as an immune activator, a therapeutic approach targeting ferritin may be also postulated in these diseases. Considering these observations, high ferritin levels characterize severe COVID-19 and other diseases included in the hyperferritinemic syndrome. Because ferritin could enhance the inflammatory process, it could be tested as a possible new therapeutic target to improve the outcome of these patients.
    MeSH term(s) COVID-19/blood ; COVID-19/complications ; Cytokine Release Syndrome/blood ; Cytokine Release Syndrome/virology ; Ferritins/blood ; Humans ; Hyperferritinemia/blood ; Hyperferritinemia/therapy ; Hyperferritinemia/virology ; Patient Acuity ; SARS-CoV-2
    Chemical Substances Ferritins (9007-73-2)
    Language English
    Publishing date 2020-11-24
    Publishing country Israel
    Document type Editorial
    ZDB-ID 2008291-5
    ISSN 1565-1088 ; 0021-2180
    ISSN 1565-1088 ; 0021-2180
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