Publications by authors named "Greta Carrara"

Background: Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain.

Objectives: We performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3-, 6-, or 24-months with a standard duration of DAPT for 12 months after PCI.

Methods: We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT.

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Objective: To develop and test an algorithm with the aim of optimizing the implementation of ultrasound in the diagnostic workflow in clinical practice.

Methods: Through a consensus among the Musculoskeletal Ultrasound (MSUS) Study Group of the Italian Society for Rheumatology, we identified clinical and laboratory variables to be included in 1000minds surveys to develop an algorithm driving clinical diagnostic suspicion. The algorithm would identify potential differential diagnoses where MSUS protocols targeted for specific diseases (rheumatoid arthritis, psoriatic arthritis, gout, calcium pyrophosphate deposition disease, polymyalgia rheumatica, and osteoarthritis) could be applied.

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Objectives: We aimed to investigate which elementary lesions, identified through conventional brain MRI, correlated with the attribution of neuropsychiatric (NP) manifestations of SLE as determined by clinical judgement (CJ) and a validated attribution algorithm (AA).

Methods: We conducted a multicentre, retrospective cohort study of patients with SLE (1999-2018) from four tertiary SLE centres. Patients were assessed using American College of Rheumatology nomenclature and underwent MRI at their first NP event.

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Background: Severe Acquired Brain Injury (sABI) presents significant challenges in clinical management and rehabilitation due to its diverse and complex nature. The primary objective of the Tiresia project is to identify medium and medium-to-long-term prognostic factors for patients with sABI and to develop outcome indicators to evaluate the quality of care in rehabilitation units.

Methods: This paper outlines the protocol for a prospective observational multicenter study conducted within the Tiresia Network.

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Objective: To date, there is no shared national guideline in Italy for the management of reproductive health in rheumatic diseases (RHRD). The Italian Society for Rheumatology (SIR) has committed to developing clinical practice recommendations to provide guidance on both management and treatment regarding RHRD in Italy.

Methods: Using the GRADE-ADOLOPMENT methodology, a systematic literature review was conducted to update the scientific evidence that emerged after the publication of the reference recommendations from the American College of Rheumatology.

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Objectives: To test the prognostic role of ultrasonography at diagnosis of giant cell arteritis (GCA) and the change of ultrasound abnormalities during the initial weeks of follow-up for the prediction of relapse, vascular complications, or initiation of disease-modifying antirheumatic drugs (DMARDs).

Methods: Prospective, multicentre study of patients with new onset GCA undergoing serial ultrasound assessment at fixed time points. The Outcome Measures in Rheumatology (OMERACT) GCA ultrasonography score (OGUS) was used to quantify vessel wall abnormalities.

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Background: Few data are available on polymer-free drug-eluting stents in patients undergoing percutaneous coronary intervention (PCI).

Aims: We aimed to determine the efficacy and safety of a polymer-free amphilimus-eluting stent (AES), using a reservoir-based technology for drug delivery, compared with a biodegradable-polymer everolimus-eluting stent (EES).

Methods: This was a randomised, investigator-initiated, assessor-blind, non-inferiority trial conducted at 14 hospitals in Italy (ClinicalTrials.

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Objectives: The purpose of this study was to evaluate the performance of a dermatologist-filled-in 7-item questionnaire (called HERACLES) as a screening tool for psoriatic arthritis (PsA) in patients with psoriasis.

Methods: This study was performed in Italy in seven dermatology centres cooperating with rheumatology centres. Adults with psoriasis were consecutively recruited up to a calculated number of 750.

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Background: The role of quantitative flow ratio (QFR) in the treatment of nonculprit vessels of patients with myocardial infarction (MI) is a topic of ongoing discussion.

Objectives: This study aimed to investigate the predictive capability of QFR for adverse events and its noninferiority compared to wire-based functional assessment in nonculprit vessels of MI patients.

Methods: The FIRE (Functional Assessment in Elderly MI Patients With Multivessel Disease) trial randomized 1,445 older MI patients to culprit-only (n = 725) or physiology-guided complete revascularization (n = 720).

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Article Synopsis
  • The study examined pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) enrolled in the Italian P-RHEUM.it cohort from 2018 to 2023, focusing on maternal and infant health.
  • Results showed that out of 866 pregnancies, 15.6% experienced maternal disease flares, 30.1% had obstetrical complications, and 91.7% resulted in live births, with a relatively low rate of perinatal deaths and complications.
  • The research concluded that effective preconception counseling and proper medication management during pregnancy may help reduce disease-related risks, suggesting that outcomes for women with ARD were comparable to those in the general obstetric population.
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Assessing quality of care is essential for improving the management of patients experiencing traumatic brain injury (TBI). This study aimed at devising a rigorous framework to evaluate the quality of TBI care provided by intensive care units (ICUs) and applying it to the Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe (CREACTIVE) consortium, which involved 83 ICUs from seven countries. The performance of the centers was assessed in terms of patients' outcomes, as measured by the 6-month Glasgow Outcome Scale-Extended (GOS-E).

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Objectives: The management of neuropsychiatric systemic lupus erythematosus (NPSLE) poses considerable challenges due to limited clinical trials. Therapeutic decisions are customized based on suspected pathogenic mechanisms and symptoms severity. This study aimed to investigate therapeutic strategies and disease outcome for patients with NPSLE experiencing their first neuropsychiatric (NP) manifestation.

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Objective: This post-hoc analysis was carried out on data acquired in the longitudinal Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission (STARTER) study. Our primary aim was to determine the predictive clinical and musculoskeletal ultrasonographic (MSUS) features associated with disease flare in RA patients in clinical remission, while our secondary aim was to evaluate the probability of disease flare based on clinical and MSUS features.

Methods: We analysed data for a total of 389 RA patients in DAS28-defined remission.

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Objective: Sepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes.

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Objective: To develop the optimal US scanning protocol for the diagnosis of calcium pyrophosphate crystal deposition (CPPD) disease.

Methods: In this cross-sectional study, consecutive patients with a crystal-proven diagnosis of CPPD disease, and age-, sex-matched disease controls with a negative synovial fluid analysis were prospectively enrolled in two Italian Institutions. Four rheumatologists, blinded to patients' clinical details, performed US examinations using a standardized scanning protocol including 20 joints (shoulders, elbows, wrists, metacarpophalangeal joints from second to fifth fingers, hips, knees, ankles).

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Article Synopsis
  • The study aimed to compare COVID-19 outcomes among patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and spondyloarthritis (SPA) before vaccination, given conflicting data on their prognosis.
  • Analysis of the CONTROL-19 Database revealed that SLE and RA patients had similar severe outcome rates, while SPA patients had better outcomes than those with SLE.
  • Key risk factors for severe outcomes in SLE patients included being over 65, having hypertension, and using prednisone, while hydroxychloroquine use appeared to reduce risk.
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Importance: While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.

Objective: To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.

Design, Setting, And Participants: CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years.

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Objective: Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern.

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Article Synopsis
  • The PARTHENOPE trial investigates the clinical performance of two types of drug-eluting stents (Cre8 and SYNERGY) in patients undergoing percutaneous coronary intervention (PCI), aiming to understand the best duration for dual antiplatelet therapy (DAPT).
  • The study randomizes 2,107 patients to either personalized or standard DAPT durations based on their DAPT score, which takes into account the risk of bleeding and ischemia.
  • The trial's primary goal is to show that both stents are equally effective in preventing major cardiovascular events after 12 months, while also assessing whether personalized DAPT is more beneficial than the standard 12-month approach.
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Objective: To describe demographic, clinical and laboratory features of systemic sclerosis sine scleroderma (ssSSc) in a large multicentre systemic sclerosis (SSc) cohort.

Methods: Data involving 1808 SSc patients from Italian Systemic sclerosis PRogression INvestiGation registry were collected. The ssSSc was defined by the absence of any cutaneous sclerosis and/or puffy fingers.

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Article Synopsis
  • The study aimed to evaluate the reliability of ultrasound (US) muscle echogenicity assessments in patients with rheumatic diseases, involving 42 rheumatologists and 2 radiologists analyzing images and clips from 64 patients and 8 healthy subjects.
  • Results showed that a semi-quantitative scale had moderate inter-reliability and substantial intra-reliability, while a continuous quantitative measurement ("VAS echogenicity") exhibited high reliability in both observer types.
  • Overall, the findings confirmed good inter and intra-reliability of ultrasound assessments for muscle echogenicity in this patient group, suggesting consistency in evaluation methods across different observers.
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Objective: A subanalysis of the multicentre Early Lupus inception cohort was performed to investigate the real-world Glucocorticoids (GCs) Use in newly diagnosed systemic lupus erythematosus (SLE) Patients (GULP).

Methods: Patients starting prednisone (PDN) ≥5 mg/day and concomitant hydroxychloroquine or immunosuppressant within 12 months of SLE classification were enrolled. Core set variables were recorded at baseline and every 6 months, including changes in PDN dose, European Consensus Lupus Activity Measurement (ECLAM) and Systemic Lupus International Collaborating Clinics damage index.

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Aims: Using the principles of clinical governance, a patient-centred approach intended to promote holistic quality improvement, we designed a prospective, multicentre study in patients with acute coronary syndrome (ACS). We aimed to verify and quantify consecutive inclusion and describe relative and absolute effects of indicators of quality for diagnosis and therapy.

Methods And Results: Administrative codes for invasive coronary angiography and acute myocardial infarction were used to estimate the ACS universe.

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Objective: This study is a sub-analysis from the patient cohort of the STARTER (Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission) study. The aim was to evaluate differences in ultrasound-detected joint and/or tendon involvement between patients receiving therapies based on a combination of conventional synthetic DMARDs (csDMARDs) and biologic DMARDs (bDMARDs) and those who were treated with either csDMARDs or bDMARDs in monotherapy.

Material And Methods: Four hundred and twenty-seven consecutive patients with a diagnosis of RA were recruited between October 2013 and June 2014.

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Objectives: Gout treatment is largely suboptimal in clinical practice. We aimed to assess the predictors of disease-activity at 12 months in a real-life setting.

Methods: Consecutive patients referred to Rheumatology Units for suspected acute crystal-induced arthritis were enrolled in a multicentre-cohort study.

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