Chapters authored
Rheumatoid Arthritis and Periodontal Disease: A Complex Interplay
Recent advances in understanding the dynamic pathways involved in the pathogenesis of rheumatoid arthritis have emphasized the pivotal role of pro-inflammatory cytokines, inflammatory cells, endothelial cell activation and matrix degradation, acting in a genetically predisposed environment. On the other hand, there are significant amounts of data highlighting the potential role of bacteria (leading periodonthopatic pathogen Porfiromonas gingivalis) in promoting different types of arthritis, as well as the influence of periodontis (an infectious-inflammatory condition) as etiological or modulating factor in different pathologies, including cardio-vascular disorders, diabetes, respiratory disease and inflammatory rheumatic disorders (such as rheumatoid arthritis, ankylosing spondylitis and lupus). The present chapter deals with the possible association between rheumatoid arthritis and periodontitis as entities with common pathological events.
Part of the book: New Developments in the Pathogenesis of Rheumatoid Arthritis
BAFF System in Rheumatoid Arthritis: from Pathobiology to Therapeutic Targets
Recent advances in understanding the multifaceted pathobiology of rheumatoid arthritis have highlighted the pivotal role and continuing crosstalk between activated immune cells, pro-inflammatory cytokines, and matrix-degrading mediators, promoting chronic inflammation as well as irreversible tissue damage within an autoimmune background. B cells are widely recognized as leading players in immune-mediated pathology based on their ability to produce not only different patterns of autoantibodies and driving cytokine synthesis but also as independent antigen-presenting cells and by modulating the specific activation of T cells. Overwhelming evidence emphasized the role of BAFF, a B-cell-activating factor, and BAFF receptors (TACI, BCMA, BAFF-R) in promoting B-cell homeostasis, proliferation, and survival under normal and autoimmune systemic disorders. We systematically reviewed data from literature focusing on BAFF, its homolog molecule APRIL, and BAFF-binding receptors biology, dysregulation of BAFF/BAFF receptor signaling in autoimmune settings, and current status of targeting BAFF/BAFF receptor pathway for rheumatoid arthritis.
Part of the book: New Developments in the Pathogenesis of Rheumatoid Arthritis
Challenges in the Delivery Room: Integrated Analysis of Biomarkers Predicting Complications in Lupus Pregnancy
Pregnancy in autoimmune rheumatic diseases remains a real challenge in clinical practice due to complex interplay between disease activity, pregnancy and drugs, and account for potential influence of pregnancy on rheumatic condition and the impact of disease on pregnancy outcomes. Indeed, innovative and successful therapies have dramatically improved the quality of life in immune-mediated rheumatic conditions and, subsequently, allowed more patients of reproductive age to plan a pregnancy/to conceive. The purpose of this chapter is to discuss emerging data about the interaction of pregnancy and systemic erythematosus lupus (SLE) focusing on modulation of the immune system by pregnancy, pregnancy outcomes in women with active lupus, biomarkers of adverse pregnancy outcomes (APO) including predictors of pre-eclampsia, predictors of obstetric complications in SLE, the influence of autoantibodies on fetal health, and, finally, evidence about rheumatologic and obstetric follow-up. There are still unmet needs in this new field of reproductive rheumatology and it becomes crucial that researchers, physicians (rheumatologists, specialists in maternofetal medicine, obstetricians) and midwifes share their knowledge and expertise in counseling women with SLE wishing to conceive, assisting pregnancy and managing different issues related to APO as well as drug optimization in preconception, during pregnancy and postpartum period.
Part of the book: Empowering Midwives and Obstetric Nurses