Explore the vast range of titles available.

BackgroundDeposition of calcium pyrophosphate dihydrate crystals occurs in crystalline arthropathies, such as gout and chondrocalcinosis. Occasionally, crystal deposits may affect the temporomandibular joint (TMJ), especially involving the articular cartilage and fibrocartilage, causing pain and jaw claudication, mimicking giant cell arteritis (GCA). Ultrasound (US) images reveal spotted hyperechoic signals in the articular disk and sometimes a marked destruction of the condyle with erosive changes.ObjectivesTo highlight and discuss the potential role of TMJ US in guiding differential diagnosis of orofacial pain syndrome (frontal headache and jaw claudication), arousing the suspicion of GCA.MethodsCase-report describing an old patient presenting with severe headache and jaw claudication with particular reference to the role of TMJ US in differential diagnosis of an initially suspected GCA.ResultsAn 85-year-old woman presented to the Emergency Department with a 2-days history of progressively worsening frontal headache and jaw claudication. She reported no visual loss or polymyalgia rheumatica symptoms. Right temporal artery tenderness was appreciated on clinical examination, without reduced temporal artery pulse. No axillary, brachial, or carotid bruits were appreciated. Neurologic examination was normal; brain computed tomography (CT) revealed no intracerebral hemorrhage or intraparenchymal lesions. Her erythrocyte sedimentation rate was 67 mm per hour, and C-reactive protein level 3.30 mg per deciliter. Temporal artery US revealed no abnormalities (absence of halo sign or arterial stenosis). Since patient complained of chewing pain and given that temporomandibular disorders may be misdiagnosed as GCA, TMJ US was performed revealing the presence of extensive calcifications around the right temporomandibular head and in the meniscus (Figure 1, Panel A). Brain CT images were then carefully reviewed: in the right TMJ massive calcifications surrounding the right temporomandibular head were appreciable (Figure 1, Panel B). Moreover, coronal CT scan of the atlantoaxial region showed calcifications of the alar ligaments, particularly evident on the superior-left side (Figure 1, Panel C). High dose glucocorticoid regimen was then started (Methylprednisolone 40 mg once daily). The patient’s pain rapidly improved, steroid was rapidly tapered until withdrawal, with a complete resolution of symptoms within few weeks.ConclusionCrowned dens syndrome is characterized by recurrent neck pain related to radiodense deposits of hydroxyapatite or calcium pyrophosphate dihydrate in ligaments around the odontoid process, which create the appearance of a crown or halo surrounding the odontoid process on radiographic imaging. Evidence of inflammation (e.g., fever or elevated levels of C-reactive protein) is usually observed. A short course of steroids, followed by administration of nonsteroidal anti-inflammatory medication, usually completely alleviates symptoms.Rarely, temporal arteritis headache may mimic TMJ irradiation pain, or present as jaw claudication. In this case, temporal arteries and TMJ US can enable to discern a halo sign, as a hallmark of giant cell arteritis, from suspicious signs of TMJ disorder. Rapid diagnosis can prevent misdiagnosis, invasive and unnecessary investigations (temporal artery biopsy) and inappropriate treatment (long term steroid regimen, leading to cardiovascular risk and increased bone loss).References[1]Matsumura Y, Nomura J, Nakanishi K, Yanase S, Kato H, Tagawa T. Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (Pseudogout). Dentomaxillofac Radiol. (2012) 41:703–7. doi: 10.1259/dmfr/24183821[2]Austin D, O’Donnell F, Attanasio R. Temporal arteritis mimics TMJ/myofascial pain syndrome. Ohio Dent J. 1992;66(1):44-7.Figure 1.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background:Lupus nephritis (LN), a major involvement of systemic lupus erythematosus (SLE), impacts up to 60% of SLE patients throughout their lives, with a progression rate to end-stage kidney disease ranging from 4.3% to 10.1%.Objectives:This study aims to 1) assess the attainment of lupus low disease activity state (LLDAS) and remission in SLE patients with LN at a single center and 2) analyze predictors of LLDAS, remission, and stage ≥3 chronic kidney disease (CKD).Methods:This retrospective, observational study included SLE patients diagnosed since 1977 with documented renal involvement via kidney biopsy. Demographic, clinical, and laboratory data were collected from the onset of renal disease to the last outpatient visit. CKD was defined as eGFR (calculated using CDK-EPI formula) ≤60 mL/min/m2, while LLDAS and REM definitions were based on criteria by Franklyn K. et al (Ann. Rheum. Dis., 2016) and van Vollenhoven RF (Lupus Sci. Med., 2021).Results:The study comprised 87 patients, with 42 having proliferative glomerulonephritis (see Table 1). During the follow-up, clinical remission was achieved in 63 out of 83 (75.9%) patients, and LLDAS in 73 out of 85 (85.9%) patients, with an average time of 8.46 (±8.67) and 8.33 (±8.96) months between biopsy diagnosis and achieving remission and LLDAS, respectively. Univariate analysis indicated a statistically significant association between higher SLEDAI-2K and failure to achieve LLDAS (OR 0.88, p 0.049). The occurrence of at least one LN flare during follow-up was associated with a lower probability of achieving LLDAS (OR 0.17, p 0.01) but not remission (OR 0.29, p 0.05). Predictors of stage ≥3 CKD included a longer time between LN diagnosis and LLDAS/REM achievement (OR 1.08, p 0.02/OR 1.09, p 0.01), a higher SDI score (OR 1.82, p 0.02), and the protective effect of hydroxychloroquine use (OR 0.26, p 0.02).Conclusion:In our cohort, higher SLEDAI-2K scores and the occurrence of LN flares were associated with a lower probability of response to therapy. A higher SDI score and a prolonged time to achieve REM/LLDAS serve as potential indicators of kidney function deterioration.REFERENCES:[1] Gasparrotto M et al (Rheumatology Oxford, 2020), Franklyn K. et al (Ann. Rheum. Dis., 2016), van Vollenhoven RF (Lupus Sci.Med.,2021).Table 1.Baseline characteristics (at histological diagnosis)Totaln= 87Proliferativen = 42Membranousn= 20Female, n (%)82 (94)38 (90)20 (100)Age, (mean ± DS)33 (13)30 (11)30 (11)Disease duration (years),(mean ± DS)4.6 (8.0)3.6 (6.7)3.1 (6.8)EthnicityCaucasian, n (%)82 (94)38 (90)19 (95)Afroamerican, n (%)3 (3.4)2 (4.8)1 (5)Other, n (%)2 (2.3)2 (4.8)0Weight (kg), (mean ± DS)67 (16)70 (18)67 (14)Height (cm), (mean ± DS)164 (7)164 (8)164 (7)Smoker, n (%)39 (46)17 (41)9 (45)Creatinine (mg/dl) (mean ± DS)1.08 (1.07)1.10 (1.09)0.74 (0.19)Nephrosic range proteinuria, n (%)10 (16)6 (21)1 (5)Anti-dsDNA positivity, n (%)69 (80)38 (90)13 (65)SLEDAI-2K score, (mean ± DS)9 (4)10 (5)8 (2)SLICC-SDI score (mean ± DS)1(1)0 (1)0 (1Figure 1.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Tocilizumab (TCZ), a monoclonal antibody against Interleukin-6 receptor (IL-6r), is approved for rheumatoid arthritis (RA) management, and for COVID-19 in patients on corticosteroids who need supplemental oxygen treatment or mechanic ventilation. TCZ is available both intravenously (IV) and subcutaneously (SC); the two formulations proved similar efficacy in registration trials, therefore switching from the former route to the latter can be an available strategy for those who prefer self-administration. During COVID-19 pandemics, given the high demand for patients admitted to the ICU, many RA patients were forced to switch, due to unavailability of IV-TCZ. Several real-world studies reported worsening symptoms in RA patients undergoing this switch.Objectives:The aim of this study was to describe the retention rate of SC-TCZ and to find predictors of successful IV-to-SC switch in RA patients, alongside collecting existing literature evidence about this topic.Methods:We conducted a retrospective, single-centre observational study collecting socio-demographic, clinical and laboratory data from 31 RA patients who started IV-TCZ infusions (01/09/2005-30/12/2021) at the Rheumatology Unit of the St. Anna Hospital in Ferrara and subsequently switched to SC-TCZ. Unsuccessful switchers were defined at first follow up visit after switch as the need to revert to IV-TCZ (“back IV” group, BI) while successful switchers as “go on SC” group (GoS); follow-up timing was influenced by COVID-19-related access restrictions, being 3.5 months for BI and 5.5 months for GoS group. Then, patients were followed for a mean 37.09±17.95 months, until 21/12/2023. Concurrently, we conducted a systematic literature review (SLR) in Medline, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, to explore the outcome of IV-to-SC TCZ switch in RA patients. We included articles in Italian or English. Fisher’s exact test, Pearson’s Chi-squared test and Wilcoxon sum rank test were applied.Results:After a mean follow up of 4.57±2.42 months, 17/30 patients were classified as BI and 13/30 as GoS; one patient was lost to follow up after the switch. The SC-TCZ retention rate was 43.33%. Baseline demographic characteristics, disease- (seropositivity for ACPA/FR, presence of bone erosions, failure of previous bDMARDs) and therapy-related items (dose and previous duration of IV-TCZ, concomitant use of glucocorticoids or csDMARDs) did not differ between the groups. However, the BI group had a higher baseline DAS28-ESR (2.3±1.1 versus 1.6±1.4, p=0.034) (Figure 1A), mainly conditioned by patient-reported Global Health score (GH, 0-100) (44.1±19.1 versus 25.4±23.3, p=0.017). 94.1% of BI had tried SC route due to COVID-conditioned public health directives, versus 69.2% of GoS.BI patients returned to IV-TCZ after a mean 4.2±2.7 months, mainly due to subjective arthralgias (23.5%) rather than clinically confirmed flare (70.6%) (Table 1). DAS28-ESR at first follow up visit was significantly higher in this group compared to the GoS (2.8±1.1 versus 1.3±0.9 respectively, p<0.001), as well as mean GH and tender joint count (55.9±13.7 vs 23.8±24.7, p=0.001, and 3.1±3.2 vs 0.3±0.9, p=0.001, respectively). The probability to revert to IV infusions increased for each 1 mm increment of baseline GH scale (odds ratio (OR) 1.05 [95% CI 1.01-1.10], p=0.034) and it decreased as patients made the switch willingly (OR 0.03 [95% CI 0.00-0.21], p=0.003). Ten articles were included in the SLR. The mean retention rate at 3 or 6 months (5 studies) was 75.63% (Figure 1B).Conclusion:Switching from IV-to-SC TCZ was not associated with arthritic flare; however, clinimetric tools highlighted an early increased disease activity during follow up, mainly due to the relative weight of subjective items. Therefore, a non-desired switch may influence patients’ perception of their disease. Compared with data from literature, our drug retention rate was overall lower, despite similar to other experiences during COVID pandemics.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Many drugs currently used in chemotherapy work by hindering the process of ribosome biogenesis. In tumors with functional p53, the inhibition of ribosome biogenesis may contribute to the efficacy of this treatment by inducing p53 stabilization. As the level of stabilized p53 is critical for the induction of cytotoxic effects, it seems useful to highlight those cancer cell characteristics that can predict the degree of p53 stabilization following the treatment with inhibitors of ribosome biogenesis. In the present study we exposed a series of p53 wild-type human cancer cell lines to drugs such as actinomycin D (ActD), doxorubicin, 5-fluorouracil and CX-5461, which hinder ribosomal RNA (rRNA) synthesis. We found that the amount of stabilized p53 was directly related to the level of ribosome biogenesis in cells before the drug treatment. This was due to different levels of inactivation of the ribosomal proteins–MDM2 pathway of p53 digestion. Inhibition of rRNA synthesis always caused cell cycle arrest, independent of the ribosome biogenesis rate of the cells, whereas apoptosis occurred only in cells with a high rDNA transcription rate. The level of p53 stabilization induced by drugs acting in different ways from the inhibition of ribosome biogenesis, such as hydroxyurea (HU) and nutlin-3, was independent of the level of ribosome biogenesis in cells and always lower than that occurring after the inhibition of rRNA synthesis. Interestingly, in cells with a low ribosome biogenesis rate, the combined treatment with ActD and HU exerted an additive effect on p53 stabilization. These results indicated that (i) drugs inhibiting ribosome biogenesis may be highly effective in p53 wild-type cancers with a high ribosome biogenesis rate, as they induce apoptotic cell death, and (ii) the combination of drugs capable of stabilizing p53 through different mechanisms may be useful for treating cancers with a low ribosome biogenesis rate.

Brillouin–Raman microspectroscopy is presented as an innovative label-free all-optical investigation approachable to characterize the chemical composition and the mechanical properties of human tissues at micrometric resolution. Brillouin maps unveil mechanical heterogeneities in a human femoral diaphysis, showing a ubiquitous co-existence of hard and soft components, even in the most compact sections. The novel correlative analysis of Brillouin and Raman maps shows that the relative intensity of Brillouin peaks is a good proxy for the fraction of mineralized fibers and that the stiffness (longitudinal elastic modulus) of the hard component is linearly dependent on the hydroxyapatite concentration. For the soft component, a gradient of composition is found, ranging from an abundance of proteins in the more compact, external, bone to abundance of lipids, carotenoids, and heme groups approaching the trabecular, inner, part of the diaphysis. This work unveils the strong potential of correlative mechano-chemical characterization of human tissues at a micrometric resolution for both fundamental and translational research.

Rheumatoid arthritis (RA) has a negative impact on patients' quality of life, with both physical and psychosocial impact. Treatment recommendations advocate a treat-to-target (T2T) approach with the ideal goal of remission. Composite clinimetric scores are available to assess and monitor disease activity; however, although now widely recognized as an important aspect, the patients' perceived burden of disease still remains not regularly checked during medical consultation in daily practice. Pictorial Representation of Illness and Self Measure (PRISM) was developed to measure this global suffering but, to our knowledge, not yet used in RA patients. To understand the relationships and correspondences between common clinimetric indexes and patients' perception of RA impact on daily life measured by PRISM. The present single-center explorative study included 86 RA patients, consecutively evaluated between July and December 2022 at our Rheumatoid Arthritis Clinic. During routinely scheduled follow up visits, disease activity, organ damage, treatment changes, and a number of clinimetric indices were regularly recorded. Patients were also asked to complete the basic PRISM. The physician showed patients a blank sheet with a yellow circle in a corner and they were asked to imagine the sheet as their “life” at the moment, while the yellow circle as “themselves”. Next, patients were asked to imagine another smaller as RA and were asked the question: “Where would you place the RA-red circle in your life now?”. The distance between both circles (SIS) reflects the patient's burden of suffering. A higher SIS indicates a lower burden. A blue circle has been used as an example before testing. Statistical tests produced regression R2 values and Pearson correlation coefficients. PRISM proved to correlate very well particularly with the Rheumatoid Arthritis Impact of Disease (RAID) score (p = -0,6), patient's global assessment (PtGA) (p = -0,59), patient's pain (p = -0,52) and global health (p = -0,52) but no correlation was observed with swollen joint count or tender joint count. PRISM also correlates to composite clinimetric indexes exploring disease activity but to a lesser extent, while it revealed no correlation with inflammatory indexes such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Our investigation showed significant correlation with subjective patient reported outcome (PRO) tool, not counting inflammatory indexes nor joint count. To a lesser extent, it correlates also with physician's global assessment (PhGA). PRISM strongly correlates with RAID questionnaire, which is one of the most valid tool to measure the impact of RA in different domains (pain, function, fatigue, sleep disturbance, emotional well-being, physical well-being and coping). PRISM may therefore represent a reliable new, easy, more intuitive and friendly approach to quantify each individual perceived burden of disease. It may serve as complementary to common disease activity measures in setting agreed personalized therapeutic targets. Patients who were asked for a degree of approval with the test showed satisfaction with the possibility of visually showing the degree of suffering caused by their disease. To the best of our knowledge, this is the larger cohort of RA patients described in literature tested with PRISM. A prospective validation study in RA is now ongoing. [1] Peter N, Kleinjung T, Horat L, Schmidt-Weitmann S, Meyer M, Büchi S, Weidt S. Validation of PRISM (Pictorial Representation of Illness and Self Measure) as a novel visual assessment tool for the burden of suffering in tinnitus patients. Health Qual Life Outcomes. 2016 Mar 22;14:47. doi: 10.1186/s12955-016-0454-2. NIL. None Declared. [Display omitted]

BackgroundThe European Alliance of Associations for Rheumatology (EULAR) advocates a “treat-to-target” (T2T) strategy for rheumatoid arthritis (RA) management, consisting in adjusting therapy if target is not achieved at 6 months. However, patients with moderate disease activity (MDA) currently constitute the most common RA patient subset in clinical practice, possibly leading to refractory RA, defined as resistance to multiple drugs with different mechanisms of action and persistence of physical symptoms and/or high disease activity (HDA). Real-life studies examining the impact of switching/swapping versus not switching/swapping therapies in RA active patients are still limited.ObjectivesTo evaluate predictors of therapy switch/swap in a population of patients with refractory RA who already failed ≥ 1 biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD), not reaching predefined target at 6-months after starting subsequent lines of DMARDs.MethodsThis single-center study retrospectively included 117 patients evaluated at our Clinic from 2019 to 2022. During subsequent 3- and 6-months T2T visits, disease activity through 28-joint disease activity score (DAS28), organ damage, treatment changes and composite disease activity indices were recorded. Chi square and Fisher’s exact test was used for comparison of dichotomous variables and oneway analysis of variance (ANOVA) for continuous variables. Threshold of statistical significance was defined as a p-value < 0.05.Results66 patients (56.4%) did not achieve remission or low-disease activity target 6 months after starting b/tsDMARD; among them, 47/66 (71.2%) were in MDA, 11/66 (16.6%) in HDA and 8/66 (12.1%) were lost at follow up. 24/66 patients (36.4%) switched/swapped therapy at 6-months follow up. Longer disease duration correlated with treatment continuation (p=0.04). HDA at 6-months was a strong predictor of treatment change (p=0.009), as well as drug suspension for all reasons (e.g., safety issues, lack of therapeutic efficacy reported in medical records; p < 0.001). Major results from ANOVA are summarized in Figure 1: Evaluator’s Global Assessment (EGA) at 6-months significantly correlated with treatment switch (p=0.007), while patients taking drugs from more time tend to be switched less frequently (p=0.01). Remarkably, we did not find any correlation between the variations of DAS28, Global Health (GH), swollen joint count (SJC), tender joint count (TJC), Health Assessment Questionnaire (HAQ), Visual Analogue Scale (VAS) for Pain, steroid dependence. Similarly, baseline erosions, seropositivity, or number of prior DMARDs did not influence the outcome.ConclusionIn our retrospective cohort study, drug switching seems not linked to a more severe disease. Examining disease activity indexes, neither baseline data nor PROs, but only 6-months EGA, appears statistically significant. While a number of explanations might be offered, including limitations of the current RA measurement tools, such as DAS28, and the limited sample size, our findings are concerning, suggesting that probably, in real-practice, a sort of physician “general impression” rather than objective findings of disease activity still guide therapeutic switching.Reference[1] van Vollenhoven R. Treat-to-target in rheumatoid arthritis - are we there yet? Nat Rev Rheumatol. 2019 Mar;15(3):180-186. doi: 10.1038/s41584-019-0170-5. PMID: 30700865.Figure 1.Boxplots proportional to class variability and averages (blue dots) between RA patients not at target at 6-months who switched/swapped therapy, and those not switching/swapping. In the x-axis, 0 means no therapy switch/swap, and 1 stands for therapy switch/swap.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background:Neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) is challenging and its diagnosis requires a comprehensive, multidisciplinary approach to rule out mimicking conditions. Although conventional magnetic resonance imaging (MRI) of the brain does not show specific changes and may even be negative in 40% of NPSLE cases, it is still considered the reference method for evaluating patients with NP complications.Objectives:To examine the role of conventional brain MRI (bMRI) in evaluating patients with NPSLE. We assessed the diagnostic role of lesions detected on conventional bMRI at the time of the first NP event, in manifestations attributed to SLE by both clinical judgment (CJ) and an attribution algorithm (AA) (1). Additionally, we investigated administered treatments and the 12-month outcome of these manifestations.Methods:Multicenter retrospective cohort study of SLE patients followed between 1999 and 2018 in Brazil, Cagliari (Italy), Greece, and Ferrara (Italy). Patients were evaluated according to ACR criteria and underwent bMRI during their first NPSLE event. NP manifestations were attributed to SLE using both CJ and AA. Detected lesions in bMRI were classified into the following types: large infarcts, parenchymal hemorrhages, subarachnoid hemorrhages, inflammatory lesions, myelopathy, hyperintense lesions, sequelae, cerebral atrophy. Outcome of NPSLE at 12 months was assessed using a 7-point Likert scale (improvement if score >4). Statistical analysis was performed using χ2 tests and Fisher’s test.Results:Of 154 patients, 88 had NP events attributed to the underlying pathology according to CJ, and 85 according to AA. The characteristics of included patients are presented in Table 1. Notably, 54 cases had normal bMRI results. Hyperintense lesions in T2/FLAIR were the most prevalent (71/130) finding. A higher incidence of cerebral atrophy was observed in patients with NP events not attributed to SLE according to CJ, while inflammatory lesions and myelopathy were more frequent in those attributed according to AA. Treatment choices were aligned with lesion types, with immunosuppressive drugs frequently used for inflammatory lesions and myelopathy, and antiplatelet/anticoagulant drugs for patients with parenchymal infarcts. After 12 months, myelopathy and parenchymal infarcts demonstrated a more favorable clinical outcome, as indicated by the Likert scale.Conclusion:Cerebral atrophy was negatively associated with attribution to SLE according to CJ, while inflammatory lesions and myelopathy were positively associated with attribution according to AA. These findings support the role of bMRI in supporting attribution in NPSLE patientsREFERENCES:[1] Bortoluzzi A, Scirè CA, Bombardieri S, Caniatti L, Conti F, De Vita S, Doria A, Ferraccioli G, Gremese E, Mansutti E, Mathieu A, Mosca M, Padovan M, Piga M, Tincani A, Tola MR, Tomietto P, Valesini G, Zen M, Govoni M; Study Group on Neuropsychiatric Systemic Lupus Erythematosus of the Italian Society of Rheumatology. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatology (Oxford). 2015 May;54(5):891-8. doi: 10.1093/rheumatology/keu384. Epub 2014 Oct 21. PMID: 25339643.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Systemic Lupus Erythematosus (SLE) is a heterogeneous, inflammatory, chronic autoimmune disease presenting various complexities in both diagnostic procedures and therapeutic interventions. By integrating shared decision-making into the SLE management approach, healthcare providers can empower patients to actively participate in their care, fostering improved adherence to treatment plans and overall outcomes.Objectives:This study aims to enhance shared-decision making by investigating patient preferences alongside physicians’ preferences regarding SLE treatment features. It involves integrating and comparing clinical priorities with patient perspectives.Methods:A board consisting of 11 clinicians experts in SLE, 2 patient representatives and a statistician specializing in DCE, reached a consensus on conducting complementary DCEs. The goal is to investigate whether physician and patient preferences align while maintaining consistent attributes and levels. This approach provides a direct assessment of relative preferences and hypothetical treatment approaches in SLE. The DCE methodological approach is commonly used to measure the relative importance assigned to treatment attributes, offering valuable insights into the perceptions of treatment decision-making for both clinicians and patients. The parameter estimates from the model were interpreted as relative preference weights (PWs), indicating the average relative preference for one attribute level over other levels (i.e., the relative strength of utility for each attribute level). The mean PWs were used to calculate the relative importance (RI) of each attribute. A separate sample size calculation for the DCEs was conducted, following the Orme’s rule-of-thumb, and simulations were performed using Sawtooth Software Lighthouse Studio (9.14.2).Results:95 clinicians (57% females, 71% rheumatologists) involved in the care of patients with SLE, with a median age of 45 years (range 31-71), participated in the physician-based DCE, and 410 patients with SLE (95% females) with a median age 50 years (range 18-80) participated in the patient-based DCE.In both group of respondents, the most important attribute were related to the “probability of worsening after 12 months of treatment” (RI=22%) and, in the physician-based DCE, this was synonymous with the “progression of organ damage after 12 months” (RI=41%) (Figure 1). For patients, the second most important attribute was the reduction of glucocorticoid dose after 6 months. Patients (RI=19%) and physicians (RI=11%) both prioritized the short-term goal of tapering prednisone to ≤5mg/day. However, physicians place greater preference (RI=19%) to the “reduction in disease activity levels after 6 months” while, surprisingly, “time to achieve a satisfactory clinical response to treatment” held the least importance for patients (RI=9%) (Figure 2). Significant differences between the two respondents groups were observed regarding the route of drug administration, with patients assigning greater priority (15%) compared to physicians (RI=7%). Notably, patients were willing to accept intravenous administration as long as it resulted in a reduction in the glucocorticoid dosage.Conclusion:This is the first DCE study involving patients and physicians to inform shared-decision making. The results will play a crucial role in aligning clinician priorities with patient’s values and preferences, considering their individual circumstances.REFERENCES:NIL.Figure 1.Relative importance of treatment attributes.Figure 2.Utilities by levels of treatment attributes.Acknowledgements:This work was supported with an unconditional grant by AstraZeneca Italy.Disclosure of Interests:None declared.

Since the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) pandemic outbreak, vaccines gained a growing role. Possible vaccine-related side effects range from minor local events to more prominent systemic manifestations up to anaphylactic reactions. A heterogeneous spectrum of cutaneous reactions has been reported, ranging from local injection site reactions to urticarial and morbilliform eruptions, pernio/chilblains and zoster flares. Here, we describe a case of varicella zoster virus reactivation following mRNA coronavirus 2019 vaccine and discuss the available literature upon the topic published so far.