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There is a wide evidence that Psoriatic Arthritis (PsA) as well as Psoriasis (Ps) lead to significant health problems and interfere with the patient quality of life (QoL). Even though a validated questionnaire for Ps is available, no questionnaire for PsA is currently present in literature. The aim of our work has been to confirm the efficacy of our original questionnaire as well as to validate it, through the comparison with other existing recognised and accepted questionnaires, such as MOF-SF36, HAQ, McGill Pain Questionnaire, and Zeung Self-Rating Depression and Anxiety Scales.We have realized a questionnaire for PsA (Psoriatic Arthritis Impact Questionnaire, PAIP), in terms of psychological and rheumatological evaluation, QoL, social and economic assets.The statistical comparisons between PAIP and the accepted questionnaires (see above) confirm that PAIP is widely validated and represents a useful tool suitable for clinical evaluation and management of patients with PsA.The indexes of the correlation among the different parts of PAIP and the other questionnaires have shown positive correlations. Moreover, PAIP presents a dedicated unit for the economical and therapeutic parameters, The short time for compilation (15 minutes), the easy of comprehension of the questions, and - above all - the validation of PAIP, make our questionnaire a useful tool, suitable for the clinical management of the patients with PsA.

Ketoprofen (KP), a nonsteroidal anti-inflammatory drug (NSAID), possesses analgesic, antipyretic and anti-inflammatory properties. Oral KP is widely used in musculoskeletal pain and inflammation in muscles and joints, including arthritis pain, osteoarthritis, stiffness of the joints, soft tissue rheumatism, and sports injuries. In common with all NSAIDs, oral KP has been associated with systemic adverse events and in particular gastrointestinal disorders. Topical application of the active ingredient is locally effective and at the same time minimises the risk of systemic adverse events. Pharmacokinetic studies show that serum levels of the active ingredient following topical KP 2.5% gel are less than 1% of those reported after oral dosing, thereby providing good levels of pain relief without the systemic adverse events normally associated with oral NSAIDs. In comparative studies, topical KP 2.5% gel twice daily showed clinical benefits in patients with a range of musculoskeletal conditions. KP 2.5% gel is generally well tolerated but the treated skin area should not be exposed to direct sunlight, including solarium (sunbeds), during the treatment and for 2 weeks afterwards as topical photosensitization has been reported. To our knowledge, this is the first overview on the use of topical KP (tKP) 2.5% gel which includes data from both clinical trials and from 'real-life' clinical practice.

The systemic vasculitis are characterised by an inflammatory process of the blood vessel walls. These may affect any of the vessels and organs, resulting in a diverse range of signs and symptoms. These polymorphic clinical manifestations, combined with the non-specific aetiology of the histological lesions, render the diagnosis for any single form of vasculitis more complicated. The problem lies in the various forms of vasculitis with analogous clinical presentations, requiring very different prognosis and treatment. This review has been realised in order to examine the modern approach to achieve and to maintain the clinical remission and to treat the relapse.

In 1999, the Italian Society of Rheumatology started a project to determine the prevalence and clinical characteristics of aggressive rheumatoid arthritis (ARA).For 1 year, all patients with RA for5 years and referred to participating centers were entered in a registry and classified as having ARA if they fulfilled the following criteria: 10 swollen joints for at least 6 weeks, positive rheumatoid factor (RF), and at least one bone erosion (if disease duration of 2 years); (a) RF-positive and having 10 swollen joints or at least one newly eroded joint, or (b) if RF-negative, having 10 swollen joints and at least one newly eroded joint (if disease duration2 to5 years).The 94 participating centers enrolled 1218 patients with RA, 1130 of whom had enough data to be classified as ARA (29.0%) or non-ARA (71.0%). The frequency of ARA was 15% in the 2-year group and 63% in the2 to5-year group, but 35% of the patients in the 2-year group had erosions. Bone erosions were associated with disease duration, a Health Assessment Questionnaire value1.5, female sex, and RF positivity. Conditions other than RA were recorded in about 50% of the patients, and only 30% 40% were taking disease modifying antirheumatic drugs.In an Italian RA population, the GIARA (Gruppo Italiano Artrite Reumatoide Aggressiva) criteria for ARA were met by 15% of the patients with disease duration of 2 years, but erosions were seen in 35%. Upon referral, most of the RA patients were inadequately treated and had other conditions.

Rheumatoid arthritis is characterized by an impaired immune response and a defective cutaneous cell-mediated immunity has been reported. This study was realised in order to determine the characteristics of cutaneous cell-mediated immunity in patients affected by recent-onset and untreated rheumatoid arthritis.Forty-eight patients affected by newly diagnosed rheumatoid arthritis were studied by skin testing with seven common recall antigens. The skin tests were performed before the administration of disease modifying anti-rheumatic drugs (methotrexate, cyclosporine-A, hydroxychloroquine) and were repeated after four months of therapy.43.75% of the RA patients (21 out of 48) were defined as anergic compared with 2% of the normal control subjects and the rate of depression of cutaneous cell-mediated immunity was not related either with the markers of disease activity or with the clinical assessment. The impaired cutaneous cell-mediated immunity shows a slight improvement after methotrexate therapy, while cyclosporine-A and hydroxychloroquine were not able to achieve the same result.Rheumatoid arthritis shows a defective cutaneous cell-mediated immunity when the patients are studied in the early phase of the disease and before a second-line of therapy with disease modifying anti-rheumatic drugs. The anergy does not correlate either with the disease activity or with the short-term response to treatment. The prognostic significance of these data remains uncertain.

We describe a patient affected by rheumatoid arthritis (RA) that developed myasthenia gravis (MG) after 20 years of illness. The peculiarity of this case concerns both the rare association between these diseases and the fact that the patients had never assumed disease modifying antirheumatic drugs. These treatments have been associated in some clinical reports with the onset of MG during the clinical course of RA. To our knowledge this is the first case described in medical literature up to now.

We evaluated the clinical efficacy and the tolerance of Nabumetone (N), in comparison with a pool of non-steroidal anti-inflammatory drugs (NSAIDs), in a cohort of patients affected by rheumatoid arthritis, osteoarthritis, non-articular rheumatisms and primary fibromyalgic syndrome.One hundred and seventy patients were observed in an open-non randomized study. The patients have been recruited alternatively and subdivided into two groups: 84 patients that received N and 86 patients that received one of the other NSAIDs. All the patients affected by rheumatoid arthritis received a disease-modifying anti-rheumatic drug (OH-chloroquine, d-penicillamine, auranofin, cyclosporine-A); while benzodiazepines are administered in the patients suffering from primary fibromyalgic syndrome. A follow-up not inferior to 12 consecutive weeks was realized and the following clinical parameters were studied: spontaneous pain, provoked pain, pain on active movement, pain on passive movement, pain at rising, pain at bed time, morning stiffness, limited joint mobility, number of tender points, number of affected joints and number of swollen joints. All the patients were monitored for hematological, biochemical, urinary and clotting tests.The results revealed an excellent tolerability of nabumetone with a clinical efficacy not inferior to the NSAIDs' pool. Moreover, the number of drop-outs in the N-group were significantly inferior in comparison to the NSAIDs'-pool group.We conclude that N can be considered as effective as other NSAIDs. Moreover it seems to be better tolerated that the other NSAIDs utilized in our study.