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We performed a systematic literature review to summarize the underlying pathogenic mechanisms by which adipokines influence rheumatological diseases and the resulting clinical manifestations. Increasing evidence display that numerous adipokines may significantly influence the development or clinical course of various rheumatological diseases. Despite the normal anti- or pro-inflammatory role of the cytokines, the serum level varies enormously in various rheumatological diseases. The expression of high levels of pro-inflammatory cytokines such as leptin or visfatin, respectively in systemic lupus erythematosus and in rheumatoid arthritis, represents a negative prognostic factor; other adipokines such as adiponectin, broadly known for their anti-inflammatory effects, showed a correlation with disease activity in rheumatoid arthritis. In the near future pro-inflammatory cytokines may represent a potential therapeutic target to restrain the severity of rheumatological diseases. Further studies on adipokines may provide important information on the pathogenesis of these diseases, which are not yet fully understood. The mechanisms by which adipokines induce, worsen, or suppress inflammatory and degenerative musculoskeletal pathologies and their clinical significance will be discussed in this review.

Nailfold video-capillaroscopy (NVC) is a useful diagnostic tool, used to early detect abnormalities in micro-circulation, providing a qualitative description of microvascular anomalies in Raynaud's phenomenon. NVC role in the diagnosis of Systemic Sclerosis is well known. In other rheumatic conditions such as connective tissue diseases, vasculitis, and arthritis, the NVC anomalies are often included in a scleroderma like pattern. The use of NVC in non-rheumatic diseases (NRD), with remarkable microvascular damage, as diabetes, is not standardized yet, although several research studies are carrying on. The aim of this article is to provide a resume of published results in order to lay the groundwork for the employment of NVC both in the diagnosis and follow up of microvascular complication in NRD. Furthermore, we mention NVC findings in pathologies without well recognize microvascular damages in their pathogenesis : micro-vessels abnormalities may suggest a different point of view.

Background: To date, only a few real-world-setting studies evaluated apremilast effectiveness in psoriatic arthritis (PsA). The aims of this retrospective observational study are to report long-term Disease Activity Index for Psoriatic Arthritis (DAPSA) response of apremilast in PsA patients and to analyze the predictors of clinical response. Methods: All PsA consecutive patients treated with apremilast in fifteen Italian rheumatological referral centers were enrolled. Anamnestic data, treatment history, and PsA disease activity (DAPSA) at baseline, 6 months, and 12 months were recorded. The Mann–Whitney test and chi-squared tests assessed the differences between independent groups, whereas the Wilcoxon matched pairs signed-rank test assessed the differences between dependent samples. Logistic regressions verified if there were factors associated with achievement of DAPSA low disease activity or remission at 6 and 12 months. Results: DAPSA low disease activity or remission rates at 6 and 12 months were observed, respectively, in 42.7% (n = 125) and 54.9% (n = 161) patients. Baseline DAPSA was inversely associated with the odds of achieving low disease activity or remission at 6 months (odds ratio (OR) 0.841, 95% confidence interval (CI) 0.804–0.879; p < 0.01) and at 12 months (OR 0.911, 95% CI 0.883–0.939; p < 0.01). Conclusions: Almost half of the PsA patients receiving apremilast achieved DAPSA low disease activity or remission at 6 and 12 months. The only factor associated with achievement of low disease activity or remission at both 6 and 12 months was baseline DAPSA.

BackgroundVitamin D exerts different extra-skeletal effects, including a positive effect on muscle function. Circulating levels of the 25 hydroxylated Vitamin D - 25(OH)D - reflect the body Vitamin D reserves; to reach the optimal serum 25(OH)D threshold, Vitamin D supplementation is often requested. The commonest Vitamin D supplementation is represented by cholecalciferol (D3), but the hydroxylated Vitamin D metabolite calcifediol (HyD) represents a therapeutic alternative.ObjectivesThe aim of the study was to evaluate the efficacy of the calficediol supplementation compared to various cholecalciferol administration schedules in increasing the 25(OH) vitamin D serum levels and the effects on muscular function in post-menopausal women.Methods60 post-menopausal women aged ≤ 65 years with low serum 25(OH)D levels (8-24 ng/ml) were included in the study. Recruited patients were randomly assigned to receive oral Vitamin D 1000 UI/day according to four different regimens. 1) cholecalciferol (D3) 300.000 UI, single oral dose; 2) monthly cholecalciferol 100.000 UI for three consecutive months; 3) weekly cholecalciferol 7000 UI; 4) weekly HyD 7000 UI. At baseline and every three months, for 12 months, the following parameters were evaluated: serum levels of 25(OH)D; PTH, calcium, phosphates; at baseline and every 15 days muscular function was evaluated using the Timed Up and Go (TUG) and the Sit to Stand test.ResultsWeekly administration of HyD induced a significantly faster and greater increase of 25(OH)D levels, compared to the other treatment groups (at 12 months: +384% vs +145%, + 220%, + 248% in groups 1, 2, 3, respectively); the increase appeared after 1 month from baseline. D3 300.000 UI single dose induces a slower increase of 25(OH)D compared to monthly and weekly supplementation. An increase of muscular strength was observed after 12 months in all supplementation groups, starting from 1 months from baseline, with a greater effect in subjects treated with weekly HyD compared to D3 treated subjects (TUG 6 second vs 7.3, 7.7, 7.9 in groups 1, 2, 3, respectively; Sit to Stand 16,2 vs 15.4, 15.3, 15.7 in groups 1, 2, 3 respectively). Overall, the effects on 25(OH)D levels and on muscular function were greater in subject treated with weekly D3 compared to subject treated with monthly or single dose D3. No differences in PTH, calcium and phosphate serum levels were found between supplementation groups.ConclusionSupplementation with calcifediol is more effective and faster compared to cholecalciferol in increasing 25(OH)D serum levels; further, weekly cholecalciferol is more effective and faster compared to single dose or monthly administration. Increase in circulating levels of 25(OH)D is associated to an improvement of muscular strength.References[1] Bischoff-Ferrari, et al., Oral supplementation with 25(OH)D3 versus Vitamin D3: effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity. Journal for bone and mineral Research, Vol. 27, N. 1,January2012, pp 160-169.[2] Bischoff –...