Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ... more Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors mig...
ObjectiveEarly identification of patients with rheumatoid arthritis (RA) is essential to allow th... more ObjectiveEarly identification of patients with rheumatoid arthritis (RA) is essential to allow the prompt institution of therapy. The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, which replace the 1987 classification criteria, have been developed to facilitate such identification in patients with newly presenting inflammatory arthritis. This study therefore assesses the performance of these new criteria
To identify the factors associated with discharge to an inpatient rehabilitation facility versus ... more To identify the factors associated with discharge to an inpatient rehabilitation facility versus discharge directly to home after elective total hip replacement (THR). Data were obtained from a medical record review and a cross-sectional survey of a population-based cohort of patients who received elective primary or revision THR in 1995. Postoperative functional status was measured as the ability to walk independently prior to discharge. A multivariate regression model was developed with discharge to an inpatient rehabilitation facility versus directly to home as the dependent variable. The model adjusted for demographic characteristics, socioeconomic features, and several preoperative and postoperative clinical factors. We included 1,276 patients age 65-94 years in the analysis. Of these, 58% were discharged from the acute care hospital to a rehabilitation facility. The cohort had mean age of 73 years; 96% were white; 62% were female; 32% were living alone; 38% had an annual income less than $20,000; and 78% were unable to walk independently in the hospital before discharge. For primary THR patients, multivariate analysis showed a significant association between being discharged to a rehabilitation facility and being unable to walk at discharge, older age, obesity, and living alone. For revision THR patients, multivariate analysis also showed a significant association between being discharged to a rehabilitation facility and being unable to walk at discharge. In a large population-based sample, postoperative functional status, age, obesity, and social support all influenced the discharge destination following elective THR.
Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ... more Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors mig...
No new drugs have been approved for the treat- ment of systemic lupus erythematosus (SLE) in more... more No new drugs have been approved for the treat- ment of systemic lupus erythematosus (SLE) in more than 30 years, and no drugs have been approved specif- ically for the treatment of lupus nephritis. The remark- able advances in our understanding of the pathogenetic mechanisms of SLE make it possible to target specific molecules, rather than treat the disease empirically
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. CTS is a co... more Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. CTS is a compression neuropathy caused by elevated pressure in the carpal tunnel. CTS has the potential to substantially limit performance of activities of daily living for some individuals. The goal of therapy for CTS is to improve symptoms and reduce signs of the disease, as well as prevent progression and loss of hand function. There are several treatment alternatives to relieve the pressure on the median nerve, both surgical and conservative. The most common measures employed in the initial treatment of CTS are NSAIDs, local and systemic corticosteroids, diuretics and pyridoxine. However, CTS treatment usually includes a combination of pharmacotherapy with other strategies such as splinting and activity modification. Injections of corticosteroids into the carpal tunnel are often employed for cases not responding to conservative treatment. Surgery is superior to conservative therapies for most persistently symptomatic patients. The aim of this paper is to review the pharmacological agents used for relieving the symptoms of CTS.
European Journal of Cardiovascular Prevention & Rehabilitation, 2007
Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and sm... more Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and smoking cessation on C-reactive protein (CRP) concentrations in men, but results were inconsistent for women. The aim of this study was to evaluate the dose-dependent and time-dependent association of smoking and smoking cessation with CRP concentrations in men and women using a novel comprehensive smoking index (CSI). Cross-sectional study of representative US survey data (National Health and Nutrition Examination Survey 1999-2002). The CSI simultaneously accounts for intensity, duration and time since cessation of smoking. We analyzed data of 3505 men and 3896 women using sex-specific multiple linear regression models adjusting for other determinants of CRP concentrations, including age, race/ethnicity, body mass index, alcohol intake, diabetes, physical activity, oral hormone use among women, and history of coronary heart disease, stroke, chronic obstructive pulmonary disease and arthritis. A positive association of similar strength was found between smoking and CRP concentrations in both men and women who did not use exogenous oral hormones. Among women who used exogenous oral hormones, no association with smoking was found. In older men and women it took several years after smoking cessation for CRP concentrations to return to that of individuals who never smoked. Smoking is associated with dose-dependent and time-dependent increases in CRP concentrations in both men and women. Furthermore, the effect of exogenous oral hormones on CRP concentrations in women is affected by smoking in a dose-dependent fashion.
ABSTRACT Rheumatoid arthritis (RA) is characterised by antibodies to citrullinated proteins (ACPA... more ABSTRACT Rheumatoid arthritis (RA) is characterised by antibodies to citrullinated proteins (ACPA) which may be present several years before development of clinical symptoms. Smoking is a known risk factor for the development of RA, but data is scarce on the relationship of smoking with specific subsets of ACPA in the years before disease onset. In this study we examined the immune response to citrullinated antigens and a detailed smoking history, in a nested case-control study of subjects enrolled in the European Prospective Investigation into Cancer (EPIC) project who later developed RA. The study sample included 412 participants from EPIC centres in Italy and Spain. Serum from 103 individuals who would eventually develop RA (pre-RA cases) were compared with three age-, sex- and centre-matched controls (n = 309). Antibodies to CCP, citrullinated-α-enolase peptide-1 (CEP-1; CKIHACitEIFDSCitGNPTVEC), citrullinated-fibrinogen (cFIB; CNEEGFFSACitGHRPLDKKC) and citrullinated-vimentin (cVIM; CVYATCitSSAVCitLCitSSVPC) were analysed by ELISA with positivity defined by 98(th) percentile of the controls. The median time to diagnosis in the pre-RA cases was 7 years (1.7-15.8 years). The frequency of positive antibodies (cases vs. controls) were: anti-CCP2 (20%; p < 0.001), anti-cFIB (18%; p < 0.001), anti-CEP-1 (15%; p < 0.001), and anti-cVIM (6%; p < 0.006). All of the antibodies increased in frequency closer to diagnosis and with no specificity being particularly prominent in very early presymptomatic autoimmunity. The frequency of ever smoking was higher amongst pre-RA cases compared with controls (59% vs. 47%, p = 0.02). Pre-RA cases who smoked had higher levels of ACPA by all measures, which reached statistical significance when comparing former smokers to other groups. Pre-RA former smokers were 2.5 times more likely to develop RA (OR 2.50, 95% CI: 1.28, 4.89; p = 0.007) and were four times more likely to have positive anti-CEP-1 (OR 4.06, 95% CI 1.02, 16.2) than pre-RA never smokers. This is the first study of Pre-RA from a Southern European population in which we show that smoking is a risk factor not only for RA but for the development of presymptomatic autoimmunity, with citrullinated enolase being prominent. This strengthens the hypothesis that smoking is of aetiological importance in the very early stages of generating the autoantibodies that ultimately drive the disease.
Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ... more Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors mig...
ObjectiveEarly identification of patients with rheumatoid arthritis (RA) is essential to allow th... more ObjectiveEarly identification of patients with rheumatoid arthritis (RA) is essential to allow the prompt institution of therapy. The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, which replace the 1987 classification criteria, have been developed to facilitate such identification in patients with newly presenting inflammatory arthritis. This study therefore assesses the performance of these new criteria
To identify the factors associated with discharge to an inpatient rehabilitation facility versus ... more To identify the factors associated with discharge to an inpatient rehabilitation facility versus discharge directly to home after elective total hip replacement (THR). Data were obtained from a medical record review and a cross-sectional survey of a population-based cohort of patients who received elective primary or revision THR in 1995. Postoperative functional status was measured as the ability to walk independently prior to discharge. A multivariate regression model was developed with discharge to an inpatient rehabilitation facility versus directly to home as the dependent variable. The model adjusted for demographic characteristics, socioeconomic features, and several preoperative and postoperative clinical factors. We included 1,276 patients age 65-94 years in the analysis. Of these, 58% were discharged from the acute care hospital to a rehabilitation facility. The cohort had mean age of 73 years; 96% were white; 62% were female; 32% were living alone; 38% had an annual income less than $20,000; and 78% were unable to walk independently in the hospital before discharge. For primary THR patients, multivariate analysis showed a significant association between being discharged to a rehabilitation facility and being unable to walk at discharge, older age, obesity, and living alone. For revision THR patients, multivariate analysis also showed a significant association between being discharged to a rehabilitation facility and being unable to walk at discharge. In a large population-based sample, postoperative functional status, age, obesity, and social support all influenced the discharge destination following elective THR.
Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ... more Periodontitis is a chronic inflammatory disease that is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. Results from clinical and epidemiologic studies have suggested that periodontitis and tooth loss are more prevalent in individuals with rheumatoid arthritis (RA). However, the strength and temporality of the association are uncertain. Several biologically plausible causal and noncausal mechanisms might account for this association between periodontitis and RA. There is evidence to suggest that periodontitis could indeed be a causal factor in the initiation and maintenance of the autoimmune inflammatory response that occurs in RA. If proven, chronic periodontitis might represent an important modifiable risk factor for RA. In addition, patients with RA might show an increased risk of developing periodontitis and tooth loss through various mechanisms. Moreover, exposure to common genetic, environmental or behavioral factors mig...
No new drugs have been approved for the treat- ment of systemic lupus erythematosus (SLE) in more... more No new drugs have been approved for the treat- ment of systemic lupus erythematosus (SLE) in more than 30 years, and no drugs have been approved specif- ically for the treatment of lupus nephritis. The remark- able advances in our understanding of the pathogenetic mechanisms of SLE make it possible to target specific molecules, rather than treat the disease empirically
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. CTS is a co... more Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. CTS is a compression neuropathy caused by elevated pressure in the carpal tunnel. CTS has the potential to substantially limit performance of activities of daily living for some individuals. The goal of therapy for CTS is to improve symptoms and reduce signs of the disease, as well as prevent progression and loss of hand function. There are several treatment alternatives to relieve the pressure on the median nerve, both surgical and conservative. The most common measures employed in the initial treatment of CTS are NSAIDs, local and systemic corticosteroids, diuretics and pyridoxine. However, CTS treatment usually includes a combination of pharmacotherapy with other strategies such as splinting and activity modification. Injections of corticosteroids into the carpal tunnel are often employed for cases not responding to conservative treatment. Surgery is superior to conservative therapies for most persistently symptomatic patients. The aim of this paper is to review the pharmacological agents used for relieving the symptoms of CTS.
European Journal of Cardiovascular Prevention & Rehabilitation, 2007
Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and sm... more Previous studies have shown dose-dependent and time-dependent effects of cigarette smoking and smoking cessation on C-reactive protein (CRP) concentrations in men, but results were inconsistent for women. The aim of this study was to evaluate the dose-dependent and time-dependent association of smoking and smoking cessation with CRP concentrations in men and women using a novel comprehensive smoking index (CSI). Cross-sectional study of representative US survey data (National Health and Nutrition Examination Survey 1999-2002). The CSI simultaneously accounts for intensity, duration and time since cessation of smoking. We analyzed data of 3505 men and 3896 women using sex-specific multiple linear regression models adjusting for other determinants of CRP concentrations, including age, race/ethnicity, body mass index, alcohol intake, diabetes, physical activity, oral hormone use among women, and history of coronary heart disease, stroke, chronic obstructive pulmonary disease and arthritis. A positive association of similar strength was found between smoking and CRP concentrations in both men and women who did not use exogenous oral hormones. Among women who used exogenous oral hormones, no association with smoking was found. In older men and women it took several years after smoking cessation for CRP concentrations to return to that of individuals who never smoked. Smoking is associated with dose-dependent and time-dependent increases in CRP concentrations in both men and women. Furthermore, the effect of exogenous oral hormones on CRP concentrations in women is affected by smoking in a dose-dependent fashion.
ABSTRACT Rheumatoid arthritis (RA) is characterised by antibodies to citrullinated proteins (ACPA... more ABSTRACT Rheumatoid arthritis (RA) is characterised by antibodies to citrullinated proteins (ACPA) which may be present several years before development of clinical symptoms. Smoking is a known risk factor for the development of RA, but data is scarce on the relationship of smoking with specific subsets of ACPA in the years before disease onset. In this study we examined the immune response to citrullinated antigens and a detailed smoking history, in a nested case-control study of subjects enrolled in the European Prospective Investigation into Cancer (EPIC) project who later developed RA. The study sample included 412 participants from EPIC centres in Italy and Spain. Serum from 103 individuals who would eventually develop RA (pre-RA cases) were compared with three age-, sex- and centre-matched controls (n = 309). Antibodies to CCP, citrullinated-α-enolase peptide-1 (CEP-1; CKIHACitEIFDSCitGNPTVEC), citrullinated-fibrinogen (cFIB; CNEEGFFSACitGHRPLDKKC) and citrullinated-vimentin (cVIM; CVYATCitSSAVCitLCitSSVPC) were analysed by ELISA with positivity defined by 98(th) percentile of the controls. The median time to diagnosis in the pre-RA cases was 7 years (1.7-15.8 years). The frequency of positive antibodies (cases vs. controls) were: anti-CCP2 (20%; p < 0.001), anti-cFIB (18%; p < 0.001), anti-CEP-1 (15%; p < 0.001), and anti-cVIM (6%; p < 0.006). All of the antibodies increased in frequency closer to diagnosis and with no specificity being particularly prominent in very early presymptomatic autoimmunity. The frequency of ever smoking was higher amongst pre-RA cases compared with controls (59% vs. 47%, p = 0.02). Pre-RA cases who smoked had higher levels of ACPA by all measures, which reached statistical significance when comparing former smokers to other groups. Pre-RA former smokers were 2.5 times more likely to develop RA (OR 2.50, 95% CI: 1.28, 4.89; p = 0.007) and were four times more likely to have positive anti-CEP-1 (OR 4.06, 95% CI 1.02, 16.2) than pre-RA never smokers. This is the first study of Pre-RA from a Southern European population in which we show that smoking is a risk factor not only for RA but for the development of presymptomatic autoimmunity, with citrullinated enolase being prominent. This strengthens the hypothesis that smoking is of aetiological importance in the very early stages of generating the autoantibodies that ultimately drive the disease.
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Papers by Paola Pablo