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Objective To describe people with gout who were diagnosed with coronavirus disease 2019 (COVID-19) and hospitalized and to characterize their outcomes. Methods Data on patients with gout hospitalized for COVID-19 between March 12, 2020, and October 25, 2021, were extracted from the COVID-19 Global Rheumatology Alliance registry. Descriptive statistics were used to describe the demographics, comorbidities, medication exposures, and COVID-19 outcomes including oxygenation or ventilation support and death. Results One hundred sixty-three patients with gout who developed COVID-19 and were hospitalized were included. The mean age was 63 years, and 85% were male. The majority of the group lived in the Western Pacific Region (35%) and North America (18%). Nearly half (46%) had two or more comorbidities, with hypertension (56%), cardiovascular disease (28%), diabetes mellitus (26%), chronic kidney disease (25%), and obesity (23%) being the most common. Glucocorticoids and colchicine were used pre-COVID-19 in 11% and 12% of the cohort, respectively. Over two thirds (68%) of the cohort required supplemental oxygen or ventilatory support during hospitalization. COVID-19-related death was reported in 16% of the overall cohort, with 73% of deaths documented in people with two or more comorbidities. Conclusion This cohort of people with gout and COVID-19 who were hospitalized had high frequencies of ventilatory support and death. This suggests that patients with gout who were hospitalized for COVID-19 may be at risk of poor outcomes, perhaps related to known risk factors for poor outcomes, such as age and presence of comorbidity.

L’artirite reumatoide (AR) è la più diffusa patologia autoimmune in Italia con elevati costi terapeutici e previdenziali associati. Questa patologia colpisce circa lo 0.5-1% della popolazione adulta, prevalentemente di genere femminile. Essendo una patologia degenerativa, i cui danni sono frequentemente irreversibili, una diagnosi precoce così come un adeguato trattamento ed un elevato livello di compliance del paziente allo stesso, potrebbero rallentare il peggioramento della malattia. Inoltre sono poco noti i possibili effetti della malattia e del suo trattamento sulle gravidanze e i successivi outcome gravidici. I principali obiettivi della tesi quindi sono: i) valutare l’aderenza alle linee guida per il trattamento dell’ AR da parte dei clinici, ii) valutare l’aderenza al trattamento per AR da parte del paziente, iii) stimare costo ed efficacia delle cure erogate nelle cliniche specializzate per il trattamento di pazienti con AR, iv) analizzare gli esiti gravidici e il raggiungimento della gravidanza in donne con AR trattate con metotrexate (MTX). La prima tematica ha riguardato la valutazione di come sono state implementate le linee guida della European Alliance of Associations for Rheumatology (EULAR) per il trattamento dell’AR e l’impatto dell’aderenza a queste linee guida sulla probabilità di ospedalizzazione. I principali risultati di questo studio hanno mostrato come i pazienti con un’ottima aderenza alle linee guida, se confrontati con quelli con bassa aderenza, abbiano un rischio del 24% inferiore di incorrere in ospedalizzazione. La seconda tematica ha riguardato la valutazione dell’impatto dell’aderenza al trattamento con Disease-Modifying Anti-Rheumatic Drugs (DMARDs), terapia suggerita dall’EULAR, sul raggiungimento della remissione clinica di malattia. I dati provengono dal database ELECTRA (con informazioni cliniche e provenienti da database amministrativi) di pazienti con AR trattati presso l’IRCCS Policlinico San Matteo (Pavia). Si è osserva, Rheumatoid arthritis (RA) is, in Italy, the most widespread autoimmune disease with high associated costs for the National Health Service. This disease affects about 0.5-1% of the adult population, mainly of the female gender. Being a degenerative disease, whose damages are frequently irreversible, an early diagnosis as well as an adequate treatment and a high level treatment compliance of the patient, could slow down the worsening of the disease. Furthermore, the possible effects of RA and its treatment on pregnancies and subsequent pregnancy outcomes are not well known. The main objectives of the thesis are therefore: i) to evaluate the adherence to guidelines for the treatment of RA, ii) to evaluate the patient's adherence to RA treatment, iii) to estimate the cost and effectiveness of care provided in specialized clinics for the treatment of RA patients, iv) to analyze pregnancy outcomes and the likelihood of achieving pregnancy in women with RA treated with methotrexate (MTX). The first issue concerned the assessment of how the guidelines of the European Alliance of Associations for Rheumatology (EULAR) for the treatment of RA have been implemented, and the impact of adherence to these guidelines on the probability of hospitalization. The main results of this study showed that patients with excellent adherence to guidelines, when compared with those with low adherence, have a 24% lower risk of hospitalization. The second topic concerned the evaluation of the impact of adherence to treatment with Disease-Modifying Anti-Rheumatic Drugs (DMARDs), the therapy suggested by EULAR, on the achievement of disease clinical remission (defined as a substantial decrease or absence of symptoms). The ELECTRA database, which contains clinical information and information from administrative databases of RA patients treated at the IRCCS Policlinico San Matteo (Pavia), was considered for the analysis. The main finding showed that a 10-unit percentage increase in proportion of day

Objective As part of European League against Rheumatism (EULAR)/European Musculoskeletal Conditions Surveillance and Information Network, 20 user-focused standards of care (SoCs) for rheumatoid arthritis (RA) addressing 16 domains of care were developed. This study aimed to explore gaps in implementation of these SoCs across Europe.Methods Two cross-sectional surveys on the importance, level of and barriers (patients only) to implementation of each SoC (0-10, 10 highest) were designed to be conducted among patients and rheumatologists in 50 European countries. Care gaps were calculated as the difference between the actual and maximum possible score for implementation (ie, 10) multiplied by the care importance score, resulting in care gaps (0-100, maximal gap). Factors associated with the problematic care gaps (ie, gap >= 30 and importance >= 6 and implementation= 6) were further analysed in multilevel logistic regression models.Results Overall, 26 and 31 countries provided data from 1873 patients and 1131 rheumatologists, respectively. 19 out of 20 SoCs were problematic from the perspectives of more than 20% of patients, while this was true for only 10 SoCs for rheumatologists. Rheumatologists in countries with lower gross domestic product and non-European Union countries were more likely to report problematic gaps in 15 of 20 SoCs, while virtually no differences were observed among patients. Lack of relevance of some SoCs (71%) and limited time of professionals (66%) were the most frequent implementation barriers identified by patients.Conclusions Many problematic gaps were reported across several essential aspects of RA care. More efforts need to be devoted to implementation of EULAR SoCs.

Background: Multimorbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. A simple multisource comorbidity score (MCS) has been recently developed and validated. A very large real-world investigation was conducted with the aim of measuring inequalities in the MCS distribution across Italy. Methods: Beneficiaries of the Italian National Health Service aged 50-85 years who in 2018 were resident in one of the 10 participant regions formed the study population (15.7 million of the 24.9 million overall resident in Italy). MCS was assigned to each beneficiary by categorizing the individual sum of the comorbid values (i.e. the weights corresponding to the comorbid conditions of which the individual suffered) into one of the six categories denoting a progressive worsening comorbidity status. MCS distributions in women and men across geographic partitions were compared. Results: Compared with beneficiaries from northern Italy, those from centre and south showed worse comorbidity profile for both women and men. MCS median age (i.e. the age above which half of the beneficiaries suffered at least one comorbidity) ranged from 60 (centre and south) to 68 years (north) in women and from 63 (centre and south) to 68 years (north) in men. The percentage of comorbid population was lower than 50% for northern population, whereas it was around 60% for central and southern ones. Conclusion: MCS allowed of capturing geographic variability of multimorbidity prevalence, thus showing up its value for addressing health policy in order to guide national health planning.

Idiopathic inflammatory myopathies (IIMs) encompass a heterogeneous group of rare autoimmune diseases characterised by muscle weakness and inflammation, but in antisynthetase syndrome arthritis and interstitial lung disease are more frequent and often inaugurate the disease. Clinical practice guidelines (CPGs) have been proposed for IIMs, but they are sparse and heterogeneous. This work aimed at identifying: i) current available CPGs for IIMs, ii) patients' and clinicians' unmet needs not covered by CPGs. It has been performed in the framework of the European Reference Network on rare and complex connective tissue and musculoskeletal diseases (ReCONNET), a network of centre of expertise and patients funded by the European Union's Health Programme. Fourteen original CPGs were identified, notably recommending that: i) extra-muscular involvements should be assessed; ii) corticosteroids and methotrexate or azathioprine are first-line therapies of IIMs. iii) IVIG is a treatment of resistant-DM that may be also used in other resistant-IIMs; iv) physical therapy and sun protection (in DM patients) are part of the treatment; v) tumour screening for patients with DM include imaging of chest, abdomen, pelvis and breast (in woman) along with colonoscopy (in patients over 50 years); vi) disease activity and damages should be monitor using standardised and validated tools. Yet, only half of these CPGs were evidence-based. Crucial unmet needs were identified both by patients and clinicians. In particular, there was a lack of large multidisciplinary working group and of patients' preferences. The following fields were not or inappropriately targeted: diagnosis; management of extra-muscular involvements other than skin; co-morbidities and severe manifestations.

The prevalence of ANA and anti-ENA in the general population is not well established, especially their clinical significance in healthy subjects. We herein determined the prevalence and predictive value of serum ANA and anti-ENA for connective tissue diseases (CTD), cancer, and mortality. We took advantage of a randomly selected sample of the 1998 general population (Isola I) consisting of 2828 subjects (53% women, age 43 ± 13 years) from a well-defined Northern Italian area. Serum ANA and anti-ENA were tested on the 2690 samples available in 2012 (Isola II, 50% women, age 58 ± 13 years). Administrative databases were searched for CTD, cancer diagnosis, and death cases occurring between enrollment and December 31, 2013. The hazard ratio (HR) was calculated for incident cases. Serum ANA is positive in 18.1% for any titer and 6.1% for titers ≥ 1:160, 23% in subjects over 50 years and 13.1% and 6.1% for any titer and titers ≥ 1:160, respectively, in women. The HR for CTD development was significantly high for all ANA titers, with the highest for ANA ≥ 1:160 (HR 14.19, 95% CI 3.07-65.68). ANA positivity was not associated with cancer (HR 1.03; 95% CI 0.75-1.43), or with mortality (HR adjusted for age and sex 1.40; 95% CI 0.94-2.09). Serum anti-ENA is positive in a minority of subjects with highest figures for anti-nucleosome (1.9%), -histone (1.6%) and -PM/Scl (1.5%). In conclusion, serum ANA prevalence in the general population is highest in senior subjects and in women, while the female predominance is significantly lower compared to overt CTD. Serum ANA is associated with an increased probability of CTD development over time, but does not influence survival or cancer risk.