ObjectivesTo evaluate prospectively the effect of weight loss on the achievement of minimal disease activity (MDA) in overweight/obese patients with psoriatic arthritis (PsA) starting treatment with tumour necrosis factor α (TNFα) blockers.MethodsAmong subjects with PsA starting treatment with TNFα blockers, 138 overweight/obese patients received a concomitant dietary intervention (69 a hypocaloric diet (HD) and 69 a free-managed diet (FD)). Changes in metabolic variables were measured and a complete clinical rheumatological evaluation was made in all patients at baseline and after a 6-month follow-up to define the achievement of MDA.Results126 subjects completed the study. MDA was more often achieved by HD than by FD subjects (HR=1.85, 95% CI 1.019 to 3.345, p=0.043). A diet was successful (≥5% weight loss) in 74 (58.7%) patients. Regardless of the type of diet, after 6 months of treatment with TNFα blockers, ≥5% of weight loss was a predictor of the achievement of MDA (OR=4.20, 95% CI 1.82 to 9.66, p<0.001). For increasing weight-loss categories (<5%, 5–10%, >10%), MDA was achieved by 23.1%, 44.8% and 59.5%, respectively. A higher rate of MDA achievement was found in subjects with 5–10% (OR=3.75, 95% CI 1.36 to 10.36, p=0.011) and in those with >10% (OR=6.67, 95% CI 2.41 to 18.41, p<0.001) weight loss in comparison with those with <5% weight loss.ConclusionsRegardless of the type of diet, a successful weight loss (≥5% from baseline values) is associated with a higher rate of achievement of MDA in overweight/obese patients with PsA who start treatment with TNFα blockers.

Objective. We prospectively evaluated whether obesity impacts achievement of minimal disease activity (MDA) in subjects with psoriatic arthritis (PsA). Methods. Among PsA subjects with an active disease and who were starting a treatment with tumor necrosis factor ␣ blockers, 135 obese (body mass index [BMI] >30 kg/m 2 ) patients and 135 patients of normal weight (controls) were followed up for 24 months. At baseline and at the 12-and 24-month followup, all subjects underwent a clinical, rheumatologic, and laboratory assessment. Results. With the exception of the prevalence of hypercholesterolemia and hypertriglyceridemia, case and control subjects were similar for all the clinical and demographic characteristics analyzed. At the 12-month followup, in both cases and controls, no significant changes in body weight were found (P > 0.05 for all). MDA was achieved by 98 (36.3%) of the 270 PsA individuals. The prevalence of obesity was higher in those that did not achieve MDA than in those that did (64.0% versus 25.5%; P < 0.001). After adjusting for all the other variables, obesity was associated with a higher risk of not achieving MDA (hazard ratio [HR] 4.90, 95% confidence interval [95% CI] 3.04 -7.87; P < 0.001). The HR of not achieving MDA was 3.98 (95% CI 1.96 -8.06, P < 0.001) and 5.40 (95% CI 3.09 -9.43, P < 0.001) in subjects with first-degree (BMI <30 kg/m 2 ) and second-degree (BMI 30 -35 kg/m 2 ) obesity, respectively. Among the 98 subjects who had achieved MDA at the 12-month followup, the presence of obesity was associated with a poor probability of sustained MDA at the 24-month followup (HR 2.04, 95% CI 1.015-3.61; P ‫؍‬ 0.014). Conclusion. Obesity is a negative predictor of achieving and maintaining MDA.

We performed a systematic review with meta-analysis and meta-regression of literature studies evaluating the impact of rheumatoid arthritis (RA) on common carotid artery intima-media thickness (CCA-IMT) and on the prevalence of carotid plaques. Studies evaluating the relationship between RA and markers of cardiovascular (CV) risk (CCA-IMT and prevalence of carotid plaques) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. A total of 59 studies (4,317 RA patients and 3,606 controls) were included in the final analysis, 51 studies with data on CCA-IMT (52 data-sets on 3,600 RA patients and 3,020 controls) and 35 studies reporting on the prevalence of carotid plaques (2,859 RA patients and 2,303 controls). As compared to controls, RA patients showed a higher CCA-IMT (mean difference [MD]: 0.10 mm; 95 % confidence interval [CI]: 0.07, 0.12; p < 0.00001), and an increased prevalence of carotid plaques (odds ratio [OR]: 3.61; 95 %CI: 2.65, 4.93; p< 0.00001). Interestingly, when analysing studies on early RA, the difference in CCA-IMT among RA patients and controls was even higher (MD: 0.21 mm; 95 %CI: 0.06, 0.35; p=0.006), and difference in the prevalence of carotid plaques was entirely confirmed (OR: 3.57; 95 %CI: 1.69, 7.51; p=0.0008). Meta-regression models showed that male gender and a more severe inflammatory status [as expressed by disease activity score in 28 joints (DAS28), C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR)] significantly impacted on CCA-IMT. In conclusion, RA appears significantly associated with subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.

PGA assessed by means of VAS is a reliable tool related to joint and skin disease activity. Because joint and skin disease often diverge it is suggested that in some circumstances both PJA and PSA are also assessed.

Two paroxysmal explosions occurred at Stromboli volcano in the Summer 2019, the first of which, on July 3, caused one fatality and some injuries. Within the 56 days between the two paroxysmal explosions, effusive activity from vents located in the summit area of the volcano occurred. No significant changes in routinely monitored parameters were detected before the paroxysmal explosions. However, we have calculated the polarization and the fractal dimension time series of the seismic signals from November 15, 2018 to September 15, 2019 and we have recognized variations that preceded the paroxysmal activity. In addition, we have defined a new parameter, based on RSAM estimation, related to the Very Long Period events, called VLP size, by means of which we have noticed significant variations through the whole month preceding the paroxysm of July 3. In the short term, we have analyzed the signals of a borehole strainmeter installed on the island, obtaining automatic triggers 10 minutes and 7.5 minutes before the July 3 and the August 28 paroxysms, respectively. The results of this study highlight mid-term seismic precursors of paroxysmal activity and provide valuable evidence for the development of an early warning system for paroxysmal explosions based on strainmeter measurements. Stromboli (Aeolian Archipelago, Italy) is an open conduit volcano with persistent explosive activity. It is located in the Mediterranean Sea, not far from the coasts of Sicily and Calabria (Fig. 1). The persistent explosive Strombolian activity consists of several hundred of moderate-intensity events per day. Typical Strombolian explosions eject pyroclastic fragments at the height of some tens of meters, which fall a short distance from the eruptive vent. Explosions occur in numerous eruptive vents located in the summit area of the volcano that can change over time both in number and position. However, the eruptive vents can be grouped into three areas (Fig. 1), northeast (NE), central (C) and southwest (SW), and are distributed along the dominant structural direction (NE-SW) of a graben-like collapsed area at the top of the volcanic edifice 1-3. Major explosions 4,5 eject pyroclastic material over a hundred meters high, which can fall outside the crater terrace in the area visited by tourists. The frequency of these phenomena varies in time, with an average of 2 events per year 5-7. Paroxysms, violent explosions that produce eruptive columns more than 3 km high and are often accompanied by pyroclastic flows, can also occur at Stromboli 8-13. Ballistic blocks associated with these explosions can reach up to 2 m in diameter. Strombolian paroxysms are rare and their occurrence frequency varies over time.

PsA is an axial and/or peripheral inflammatory arthritis associated with psoriasis, included in the group of spondylarthritides. It has been suggested that PsA could be a systemic disease, involving even coronary arteries and the heart. An increased prevalence of vascular risk factors has been found in PsA subjects as compared with the general population and psoriatic subjects. Moreover, PsA patients exhibit an increased prevalence of liver steatosis, a marker of metabolic syndrome, and of obesity. Interestingly, many reports demonstrate that adipose tissue is metabolically active, representing a source of inflammatory mediators, known as adipokines. The latter include TNF-α, macrophage chemoattractant protein-1, plasminogen activator inhibitor-1 (PAI-1), IL-6, leptin and adiponectin, leading to a pro-inflammatory status in obese subjects. This evidence supports the idea of obesity as a low-grade inflammatory disease. Accordingly, obesity might be associated with some rheumatic diseases. In particular, it seems to affect several features of PsA, such as its development, cardiovascular risk and clinical outcome. Recent data suggest that increased BMI in early adulthood increases the risk of PsA development in psoriatic patients, supporting a link between fat-mediated inflammation and joint involvement. Obesity may represent an additive cardio-metabolic risk factor in PsA subjects. Abdominal obesity may also determine an increased risk of not achieving minimal disease activity in PsA patients, highlighting the role of abdominal fat accumulation as a negative predictor of good clinical response to biologic agents. This review assesses the relationship between obesity and PsA according to the available literature.

Enteropathic arthritis (EA) is a spondyloarthritis (SpA) which occurs in patients with inflammatory bowel diseases (IBDs) and other gastrointestinal diseases. Diagnosis is generally established on the medical history and physical examination. It was, generally, made according to the European Spondyloarthropathy Study Group (ESSG) criteria. Rheumatic manifestations are the most frequent extraintestinal findings of IBD with a prevalence between 17% and 39%, and IBD is associated, less frequently, with other rheumatic disease such as rheumatoid arthritis, Sjogren syndrome, Takayasu arteritis, and fibromyalgia. Although the pathogenesis of EA has not been plainly clarified, the most popular theory supposes that joint inflammation occurs in genetically predisposed subjects with bacterial gut infections, provided an important evidence for a possible relationship between inflammation of the gut mucosa and arthritis. The management of patients with EA requires an active cooperation between the gastroenterologist and rheumatologist.

Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy. Therapy with anti-tumor necrosis factor (TNF)-α agents represents the first therapeutic choice for moderate and severe forms; however, PsA patients can experience anti-TNFα failure, lack of efficacy, or adverse events. Several evidences exist on the effectiveness of switching among different TNFα inhibitors, and we reviewed the published data on the effectiveness of anti-TNFα first-, second- and third-line. Most of the studies report that the main reason for switching to a second anti-TNFα agent is represented by lack of efficacy (primary or secondary) and, more rarely, adverse events. Switchers receiving their second anti-TNFα agent have considerably poorer responses compared with non-switchers. Survival of anti-TNFα treatment appears to be superior in PsA patients when compared with rheumatoid arthritis patients. Switching from anti-TNF agents to ustekinumab or secukinumab or apremilast can represent a valid alternative therapeutic strategy.