The benefits of RFID technology in the healthcare sector are widely acknowledged. Nevertheless, the adoption of RFID as a means for pure item identification prevents adequate support to most knowledge-intensive medical tasks. Here an innovative Decision Support System for healthcare applications is presented, based on a semantic enhancement of RFID standard protocols. Semantically annotated descriptions of both medications and patient's case history are stored in RFID tags and used to help doctors in providing the correct therapy. The proposed system allows to discover possible incompatibilities in a therapy suggesting alternative treatments. © 2010 IEEE.

Objectives: There is evidence that fat tissue may influence the response to therapy in patients with arthritis. The aim of this study was to assess whether the body mass index (BMI) affects rates of clinical remission in patients with psoriatic arthritis (PsA) treated with anti-tumour necrosis factor (TNF)-α biological drugs. Method: We retrospectively studied 135 patients with active peripheral PsA (45 obese, 47 overweight, and 43 normal-weight). Baseline BMI was correlated with the clinical response to adalimumab, etanercept, or infliximab. After 36 months (median, range 6-79) of treatment, disease remission rates were assessed using the Disease Activity Score in 28 joints (DAS28) or the Simplified Disease Activity Index (SDAI). Possible predictors of clinical outcomes were assessed by multivariate analysis. Results: At baseline, BMI was significantly correlated only with the Health Assessment Questionnaire (HAQ) score (r = 0.21, p = 0.02) and not with disease activity. BMI did not predict disease remission or changes in HAQ score following anti-TNF-α therapy. Obese patients showed a significantly higher HAQ score and took significantly lower doses of prednisone than normal-weight or overweight patients, but their disease remission rates on the DAS28 (37%) or the SDAI (21%) were not significantly different from those of the other two groups (44% and 21%, respectively), regardless of the TNF-α inhibitor prescribed. Conclusions: In our retrospective analysis, disease activity and clinical response to anti-TNF-α therapy in PsA do not seem to be affected by BMI. Further prospective studies are needed to confirm these preliminary results. © 2013 Informa Healthcare on license from Scandinavian Rheumatology Research Foundation.

This study aims to evaluate the drug survival and effectiveness of ustekinumab in psoriatic arthritis (PsA) patients naïve to biologics or inadequate responders to tumor necrosis factor (TNF-IR) inhibitors in real life. PsA patients starting ustekinumab were enrolled from 2014 to 2016. Joint involvement, peripheral or axial, Psoriatic Area Severity Index, Disease Activity Psoriatic Arthritis (DAPSA), Lee Enthesitis Index, Health Assessment Questionnaire, body mass index, comorbidities, co-therapies, mechanism of action, and causes of discontinuation of prior TNFi were collected at baseline, and 6 and 12 months. Twelve-month drug survival was evaluated by Kaplan-Meier curves. Hazard ratios (HRs) of drug discontinuation adjusted for baseline factors were estimated by multiple Cox regression analysis. Percentages of DAPSA-based remission, as crude value and adjusted for drug retention (LUNDEX index), were compared by χ2 test. Mean differences of DAPSA from baseline to 6 and 12 months were compared between naïve and TNF-IR patients by ANOVA. Of 160 PsA patients starting ustekinumab, 54 were naïve and 106 were TNF-IR. Twelve-month drug survival was significantly higher in naïve (87%) than in TNF-IR (68%, p = 0.01). Baseline co-therapy with methotrexate did not increase the persistence on ustekinumab. Naïve patients had the lowest risk of ustekinumab discontinuation (HR 0.27, p = 0.01), and the highest DAPSA-based remission (34%, LUNDEX 26%). Mean differences from baseline of DAPSA was significantly greater in naïve than in TNF-IR patients at 12 months (- 14.4 ± 10 vs. - 4.1 ± 17, p = 0.01). Our data showed that ustekinumab has a good effectiveness in real life and the best outcomes are achieved in biologic-naïve PsA patients.

tObjectives: The aim of this study was to assess whether body mass index (BMI) affects clinical outcomesin rheumatoid arthritis (RA) patients starting a second line biological drug after failure of a first TNF-blocker.Methods: From a longitudinal cohort, we analyzed 292 RA patients (66 obese, 109 overweight, and117 normal-weight) treated with a first ever anti-TNF- drug. Patients discontinuing the therapy werefollowed-up if began a second biological drug. Drug survival, by Kaplan-Meier life analysis, and 12 monthsdisease remission based on the 28-joint Disease Activity Score (DAS28) were assessed for either courseof biologics. The baseline predictors of clinical outcomes were assessed by Cox regression analysis.Results: Survival of the first anti-TNF- drug was lower in obese (39.4%) than in normal-weight (49.1%)patients, but the difference was not statistically significant. Obese patients had the highest hazard todiscontinue the first anti-TNF- drug (HR 1.64, 1.02–2.62 95% IC, P = 0.04), and the lowest percent-age of DAS28-based disease remission at 12 months (P = 0.04). In 97 (37 normal-weight, 36 overweight,24 obese) patients who started a second non-anti-TNF- biological drug, persistence on therapy wassignificantly lower in obese (43.5%) than in normal-weight (80%, P = 0.04) group, and again obesity sig-nificantly predicted drug discontinuation (HR 2.9, 1.08–8.45 95% IC, P = 0.04). Significantly, less obesepatients attained a disease remission (12%, P = 0.004) at 12 months.Conclusion: Our study provides evidence that obese RA patients poorly respond to second line non-anti-TNF- drugs after failure of a first TNF- inhibitor.

Objective. The objective of this study was to draw up a set of recommendations for the format and content of the musculoskeletal ultrasonography (MSUS) report in rheumatology.Methods. A panel of rheumatologists, members of the MSUS Study Group of the Italian Society of Rheumatology, met in order to identify the main discrepancies in the MSUS report. A set of 15 recommendations was then defined, aimed at resolving the main discrepancies. They consisted of information about the motivations for the MSUS examination, the equipment, the US modalities and scanning technique, a list of the examined structures and findings, the scoring/grading systems, the number of images and main findings to include and conclusions. Subsequently a Delphi-based procedure was started in order to obtain agreement on a core set of recommendations. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%.Results. Three complete rounds were performed. The response rate was 85.2% for the first round, 78.3% for the second and 88.9% for the third. Finally, consensus was obtained for 14 of 15 statements. These 14 statements represent the recommendations of the group for the format and content of the report and documentation in MSUS in rheumatology.Conclusion. To the best of our knowledge, our group has produced the first recommendations for the format and content of the report and documentation in MSUS in rheumatology. The report is an integral part of the MSUS examination and its use in a homogeneous form can help in the correct interpretation of the findings. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings. © 2013 European Federation of Internal Medicine.