https://doi.org/10.4081/reumatismo.2024.1769
Sex and gender differences in comorbidities in spondyloarthritis: a focus on psoriatic arthritis
Published: 11 September 2024
Abstract Views: 798
PDF: 237
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. Spondyloarthritis is a family of inflammatory diseases subdivided into those affecting the spine, called axial spondyloarthritis, and those involving peripheral joints, such as psoriatic arthritis (PsA). Several studies have reported differences in clinical manifestations, outcomes, and treatment responses between male and female PsA patients. The aim of our review was to evaluate if differences may also be identified in the context of cardiovascular (CV) risk factors and diseases.
Methods. Patients with PsA have a higher CV risk than the general population. The increased CV risk associated with PsA is likely caused by the complex interplay of traditional CV risk factors, chronic systemic inflammation, and side effects related to the use of certain anti-rheumatic drugs.
Results. Sex differences in CV risk factors in PsA patients, according to several studies, are controversial. However, the few studies that reported sex-stratified estimates did not find differences in the risk of stroke and myocardial infarction between sexes. The same also holds true for CV mortality. These mixed results may be related to the different study designs and case definitions, as well as genetic and geographical variability across the investigated populations.
Conclusions. In conclusion, our review suggests that the evaluation of sex-gender aspects of CV comorbidities in PsA should be a central step in the context of personalized medicine in order to prevent and treat properly associated comorbidities.
Ritchlin CT, Colbert RA, Gladman DD. Psoriatic Arthritis. N Engl J Med 2017; 376: 957-70.
DOI: https://doi.org/10.1056/NEJMra1505557
Tillett W, Charlton R, Nightingale A, Snowball J, Green A, Smith C, et al. Interval between onset of psoriasis and psoriatic arthritis comparing the UK clinical practice research Datalink with a hospital-based cohort. Rheumatology 2017; 56: 2109-13.
DOI: https://doi.org/10.1093/rheumatology/kex323
Alinaghi F, Calov M, Kristensen LE, Gladman DD, Coates LC, Jullien D, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2019; 80: 251-65.e19.
DOI: https://doi.org/10.1016/j.jaad.2018.06.027
Scotti L, Franchi M, Marchesoni A, Corrao G. Prevalence and incidence of psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48: 28-34.
DOI: https://doi.org/10.1016/j.semarthrit.2018.01.003
Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum 1973; 3: 55-78.
DOI: https://doi.org/10.1016/0049-0172(73)90035-8
Gottlieb AB, Merola JF. Axial psoriatic arthritis: an update for dermatologists. J Am Acad Dermatol 2021; 84: 92-101.
DOI: https://doi.org/10.1016/j.jaad.2020.05.089
Coates LC, van der Horst-Bruinsma IE, Lubrano E, Beaver S, Drane E, Ufuktepe B, et al. Sex-specific differences in patients with psoriatic arthritis: a systematic review. J Rheumatol 2023; 50: 488-96.
DOI: https://doi.org/10.3899/jrheum.220386
Menis J, Doussiere M, Touboul E, Barbier V, Sobhy-Danial JM, Fardellone P, et al. Current characteristics of a population of psoriatic arthritis and gender disparities. J Clin Transl Res 2023; 9: 84-92.
Van Kuijk AWR, Nurmohamed MT, Siebert S, Bergmans P, de Vlam K, Gremese E, et al.
Gender-specific differences in patients with psoriatic arthritis receiving ustekinumab or tumour necrosis factor inhibitor: real-world data. Rheumatology 2023; 62: 3382-90.
DOI: https://doi.org/10.1093/rheumatology/kead089
Eder L, Thavaneswaran A, Chandran V, Gladman DD. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Ann Rheum Dis 2013; 72: 578-82.
DOI: https://doi.org/10.1136/annrheumdis-2012-201357
Eder L, Chandran V, Gladman D. Gender-related differences in patients with psoriatic arthritis. Int J Clin Rheumtol 2012; 7: 641-9.
DOI: https://doi.org/10.2217/ijr.12.63
Mease PJ, Palmer JB, Liu M, Kavanaugh A, Pandurengan R, Ritchlin CT, et al. Influence of axial involvement on clinical characteristics of psoriatic arthritis: analysis from the corrona psoriatic arthritis/spondyloarthritis Registry. J Rheumatol 2018; 45: 1389-96.
DOI: https://doi.org/10.3899/jrheum.171094
Tarannum S, Leung YY, Johnson SR, Widdifield J, Strand V, Rochon P, et al. Sex- and gender-related differences in psoriatic arthritis. Nat Rev Rheumatol 2022; 18: 513-26.
DOI: https://doi.org/10.1038/s41584-022-00810-7
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 2013; 111: 52-8.
DOI: https://doi.org/10.1093/bja/aet127
Lenert ME, Avona A, Garner KM, Barron LR, Burton MD. Sensory neurons, neuroimmunity, and pain modulation by sex hormones. Endocrinology 2021; 162: bqab109.
DOI: https://doi.org/10.1210/endocr/bqab109
Gossec L, Walsh JA, Michaud K, Peterson S, Holdsworth EA, Karyekar CS, et al. Women with psoriatic arthritis experience higher disease burden than men: findings from a real-world survey in the United States and Europe. J Rheumatol 2023; 50: 192-6.
DOI: https://doi.org/10.3899/jrheum.220154
Wright GC, Kaine J, Deodhar A. Understanding differences between men and women with axial spondyloarthritis. Semin Arthritis Rheum 2020; 50: 687-94.
DOI: https://doi.org/10.1016/j.semarthrit.2020.05.005
Glintborg B, Ostergaard M, Krogh NS, Andersen MD, Tarp U, Loft AG, et al. Clinical response, drug survival, and predictors thereof among 548 patients with psoriatic arthritis who switched tumor necrosis factor alpha inhibitor therapy: results from the Danish nationwide DANBIO registry. Arthritis Rheum 2013; 65: 1213-23.
DOI: https://doi.org/10.1002/art.37876
Saad AA, Ashcroft DM, Watson KD, Hyrich KL, Noyce PR, Symmons DPM. Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register. Arthritis Res Ther 2009; 11: R52.
DOI: https://doi.org/10.1186/ar2670
Generali E, Sciré CA, Cantarini L, Selmi C. Sex differences in the treatment of psoriatic arthritis: a systematic literature review. Isr Med Assoc J 2016; 18: 203-8.
Mease PJ, Karki C, Liu M, Kavanaugh A, Ritchlin CT, Huynh DH, et al. Baseline patient characteristics associated with response to biologic therapy in patients with psoriatic arthritis enrolled in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. RMD Open 2018; 4: e000638.
DOI: https://doi.org/10.1136/rmdopen-2017-000638
Ogdie A, Palmer JL, Greenberg J, Curtis JR, Harrold LR, Solomon DH, et al. Predictors of achieving remission among patients with psoriatic arthritis initiating a tumor necrosis factor inhibitor. J Rheumatol 2019; 46: 475-82.
DOI: https://doi.org/10.3899/jrheum.171034
Albrecht K, Regierer AC, Strangfeld A, Marschall U, Callhoff J. High burden of polypharmacy and comorbidity in persons with psoriatic arthritis: an analysis of claims data, stratified by age and sex. RMD Open 2023; 9: e002960.
DOI: https://doi.org/10.1136/rmdopen-2022-002960
Kamiya K, Ohtsuki M. Epidemiological survey of patients with psoriatic arthritis in the Japanese Society for Psoriasis Research from 2017 to 2020. J Dermatol 2023; 50: 12-25.
DOI: https://doi.org/10.1111/1346-8138.16603
Haque N, Lories RJ, de Vlam K. Comorbidities associated with psoriatic arthritis compared with non-psoriatic spondyloarthritis: a cross-sectional study. J Rheumatol 2016; 43: 376-82.
DOI: https://doi.org/10.3899/jrheum.141359
Dreiher J, Freud T, Cohen AD. Psoriatic arthritis and diabetes: a population-based cross-sectional study. Dermatol Res Pract 2013; 2013: 580404.
DOI: https://doi.org/10.1155/2013/580404
Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev 2016; 37: 278-316.
DOI: https://doi.org/10.1210/er.2015-1137
Rubin R. Postmenopausal women with a “normal” BMI might be overweight or even obese. JAMA 2018; 319: 1185-7.
DOI: https://doi.org/10.1001/jama.2018.0423
Karlsson, T, Rask-Andersen M, Pan G, Höglund J, Wadelius C, Ek WE, et al. Contribution of genetics to visceral adiposity and its relation to cardiovascular and metabolic disease. Nat Med 2019; 25: 1390-5.
DOI: https://doi.org/10.1038/s41591-019-0563-7
Kautzky-Willer A, Leutner M, Harreiter J. Sex differences in type 2 diabetes. Diabetologia 2023; 66: 986-1002.
DOI: https://doi.org/10.1007/s00125-023-05891-x
Husted JA, Thavaneswaran A, Chandran V, Eder L, Rosen CF, Cook RJ, et al. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res 2011; 63: 1729-35.
DOI: https://doi.org/10.1002/acr.20627
Jafri K, Bartels CM, Shin D, Gelfand JM, Ogdie A. Incidence and management of cardiovascular risk factors in psoriatic arthritis and rheumatoid arthritis: A population-based study. Arthritis Care Res 2017; 69: 51-7.
DOI: https://doi.org/10.1002/acr.23094
Jamnitski A, Symmons D, Peters MJ, Sattar N, McInnes I, Nurmohamed MT. Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Ann Rheum Dis 2013; 72: 211-6.
DOI: https://doi.org/10.1136/annrheumdis-2011-201194
Eder L, Thavaneswaran A, Chandran V, Cook RJ, Gladman DD. Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis 2015; 74: 813-7.
DOI: https://doi.org/10.1136/annrheumdis-2013-204448
Mok CC, Ko GT, Ho LY, Yu KL, Chan PT, To CH. Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis. Arthritis Care Res 2011; 63: 195-202.
DOI: https://doi.org/10.1002/acr.20363
Bhole VM, Choi HK, Burns LC, Vera Kellet C, Lacaille DV, Gladman DD, et al. Differences in body mass index among individuals with PsA, psoriasis, RA and the general population. Rheumatology 2012; 51: 552-6.
DOI: https://doi.org/10.1093/rheumatology/ker349
di Minno MN, Peluso R, Iervolino S, Lupoli R, Russolillo A, Scarpa R, et al. Obesity and the prediction of minimal disease activity: a prospective study in psoriatic arthritis. Arthritis Care Res 2013; 65: 141-7.
DOI: https://doi.org/10.1002/acr.21711
Klingberg E, Bilberg A, Bjorkman S, Hedberg M, Jacobsson L, Forsblad-d’Elia H, et al.
Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther 2019; 21: 17.
DOI: https://doi.org/10.1186/s13075-019-1810-5
Landgren AJ, Jonsson CA, Bilberg A, Eliasson B, Torres L, Dehlin M, et al. Serum IL-23 significantly decreased in obese patients with psoriatic arthritis six months after a structured weight loss intervention. Arthritis Res Ther 2023; 25: 131.
DOI: https://doi.org/10.1186/s13075-023-03105-8
Ferguson LD, Siebert S, McInnes IB, Sattar N. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol 2019; 15: 461-74.
DOI: https://doi.org/10.1038/s41584-019-0256-0
Polachek A, Touma Z, Anderson M, Eder L. Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies. Arthritis Care Res 2017; 69: 67-74.
DOI: https://doi.org/10.1002/acr.22926
Eder L, Wu Y, Chandran V, Cook R, Gladman DD. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis 2016; 75: 1680-6.
DOI: https://doi.org/10.1136/annrheumdis-2015-207980
Maas AHEM, Appelman YEA. Gender differences in coronary heart disease. Neth Heart J 2010; 18: 598-602.
DOI: https://doi.org/10.1007/s12471-010-0841-y
Charlton R, Green A, Shaddick G, Snowball J, Nightingale A, Tillett W, et al. Risk of type 2 diabetes and cardiovascular disease in an incident cohort of people with psoriatic arthritis: a population-based cohort study. Rheumatology 2019; 58: 144-8.
DOI: https://doi.org/10.1093/rheumatology/key286
Liu W, Ma W, Liu H, Li C, Zhang Y, Liu J, et al. Stroke risk in arthritis: a systematic review and meta-analysis of cohort studies. PLoS One 2021; 16: e0248564.
DOI: https://doi.org/10.1371/journal.pone.0248564
Schieir O, Tosevski C, Glazier RH, Hogg-Johnson S, Badley EM. Incident myocardial infarction associated with major types of arthritis in the general population: a systematic review and meta-analysis. Ann Rheum Dis 2017; 76: 1396-404.
DOI: https://doi.org/10.1136/annrheumdis-2016-210275
Karmacharya P, Crowson CS, Bekele D, Achenbach SJ, Davis JM, Ogdie A, et al. The epidemiology of psoriatic arthritis over five decades: a population-based study. Arthritis Rheumatol 2021; 73: 1878-85.
DOI: https://doi.org/10.1002/art.41741
Haddad A, Saliba W, Lavi I, Batheesh A, Kasem S, Gazitt T, et al. The association of psoriatic arthritis with all-cause mortality and leading causes of death in psoriatic arthritis. J Rheumatol 2022; 49: 165-70.
DOI: https://doi.org/10.3899/jrheum.210159
Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study. J Rheumatol 2009; 36: 361-7.
DOI: https://doi.org/10.3899/jrheum.080691
Ogdie A, Haynes K, Troxel AB, Love TJ, Hennessy S, Choi H, et al. Risk of mortality in patients with psoriatic arthritis, rheumatoid arthritis and psoriasis: A longitudinal cohort study. Ann Rheum Dis 2014; 73: 149-53.
DOI: https://doi.org/10.1136/annrheumdis-2012-202424
Colaco K, Widdifield J, Luo J, Rosen CF, Alhusayen R, Paterson JM, et al. Trends in mortality and cause specific mortality among patients with psoriasis and psoriatic arthritis in Ontario, Canada. J Am Acad Dermatol 2021; 84: 1302-9.
DOI: https://doi.org/10.1016/j.jaad.2020.10.031
Wong K, Gladman DD, Husted J, Long JA, Farewell VT. Mortality studies in psoriatic arthritis: Results from a single outpatient clinic. I. Causes and risk of death. Arthritis Rheum 1997; 40: 1868-72.
DOI: https://doi.org/10.1002/art.1780401021
Ali Y, Tom BD, Schentag CT, Farewell VT, Gladman DD. Improved survival in psoriatic arthritis with calendar time. Arthritis Rheum 2007; 56: 2708-14.
DOI: https://doi.org/10.1002/art.22800
Mok CC, Kwok CL, Ho LY, Chan PT, Yip SF. Life expectancy, standardized mortality ratios, and causes of death in six rheumatic diseases in Hong Kong, China. Arthritis Rheum 2011; 63: 1182-9.
DOI: https://doi.org/10.1002/art.30277
Fagerli KM, Kearsley-Fleet L, Mercer LK, Watson K, Packham J, Symmons DPM, et al. Malignancy and mortality rates in patients with severe psoriatic arthritis requiring tumour necrosis factor alpha inhibition: results from the British Society for Rheumatology Biologics Register. Rheumatology 2019; 58: 80-5.
DOI: https://doi.org/10.1093/rheumatology/key241
Chaudhary H, Bohra N, Syed K, Donato A, Murad MH, Karmacharya P. All-cause and cause-specific mortality in psoriatic arthritis and ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res 2023; 75: 1052-65.
DOI: https://doi.org/10.1002/acr.24820
Kerola AM, Kazemi A, Rollefstad S, Lillegraven S, Sexton J, Wibetoe G, et al. All-cause and cause-specific mortality in rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis: a nationwide registry study. Rheumatology 2022; 61: 4656-66.
DOI: https://doi.org/10.1093/rheumatology/keac210
Shufelt CL, Pacheco C, Tweet MS, Miller VM. Sex-specific physiology and cardiovascular disease. Adv Exp Med Biol 2018; 1065: 433-54.
DOI: https://doi.org/10.1007/978-3-319-77932-4_27
Chen Z, Xu Y, Chen M, Cui R, Wang YH, Dai SM, et al. Gout augments the risk of cardiovascular disease in patients with psoriasis: a population-based cohort study. Front Immunol 2021; 12: 703119.
DOI: https://doi.org/10.3389/fimmu.2021.703119
Cai W, Duan XM, Liu Y, Yu J, Tang YL, Liu ZL, et al. Uric acid induces endothelial dysfunction by activating the HMGB1/RAGE signaling pathway. BioMed Res Int 2017; 2017: 4391920.
DOI: https://doi.org/10.1155/2017/4391920
Kim YH, Kim SI, Park B, Lee ES. Clinical characteristics of psoriasis for initiation of biologic therapy: a cluster analysis. Ann Dermatol 2023; 35: 132-9.
DOI: https://doi.org/10.5021/ad.22.148
Kimball AB, Gladman D, Gelfand JM, Gordon K, Horn EJ, Korman NJ, et al. National psoriasis foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol 2008; 58: 1031-42.
DOI: https://doi.org/10.1016/j.jaad.2008.01.006
Raadsen R, Hansildaar R, Pouw LC, Hooijberg F, Boekel L, Wolbink GJ, et al. Cardiovascular disease risk in patients with inflammatory arthritis nowadays still substantially elevated. RMD Open 2023; 9: e003485.
DOI: https://doi.org/10.1136/rmdopen-2023-003485
Skov L, Thomsen SF, Kristensen LE, Dodge R, Hedegaard MS; Kjellber J. Cause-specific mortality in patients with psoriasis and psoriatic arthritis. Br J Dermatol 2019; 180: 100-7.
DOI: https://doi.org/10.1111/bjd.16919
Akhlaq A, Ali HF, Sheikh AB, Muhammad H, Ijaz SH, Sattar MH, et al. Cardiovascular diseases in the patients with psoriatic arthritis. Curr Probl Cardiol 2023; 48: 101131.
DOI: https://doi.org/10.1016/j.cpcardiol.2022.101131
Zusman EZ, Howren AM, Park JYE, Dutz J, De Vera MA. Epidemiology of depression and anxiety in patients with psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2020; 50: 1481-8.
DOI: https://doi.org/10.1016/j.semarthrit.2020.02.001
Li GH, Cheung CL, Chung AK, Cheung BM, Wong IC, Fok MLY, et al. Evaluation of bi-directional causal association between depression and cardiovascular diseases: a Mendelian randomization study. Psychol Med 2022; 52: 1765-76.
DOI: https://doi.org/10.1017/S0033291720003566
Bucciarelli V, Caterino AL, Bianco F, Caputi CG, Salerni S, Sciomer S, et al. Depression and cardiovascular disease: the deep blue sea of women’s heart. Trends Cardiovasc Med 2020; 30: 170-6.
DOI: https://doi.org/10.1016/j.tcm.2019.05.001
Agca R, Heslinga SC, Rollefstad S, Heslinga M, Mclinnes IB, Peters MJL, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2017; 76: 17-28.
DOI: https://doi.org/10.1136/annrheumdis-2016-209775
Arts EE, Popa C, den Broeder AA, Semb AG, Toms T, Kitas GD, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 2015; 74: 668-74.
DOI: https://doi.org/10.1136/annrheumdis-2013-204024
Ernste FC, Sánchez-Menéndez M, Wilton KM, Crowson CS, Matteson EL, Maradit Kremers H. Cardiovascular risk profile at the onset of psoriatic arthritis: a population-based cohort study. Arthritis Care Res 2015; 67: 1015-21.
DOI: https://doi.org/10.1002/acr.22536
Anand SS, Islam S, Rosengren A, Franzosi MG, Steyn K, Yusufali AH, et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J 2008, 29: 932-40.
DOI: https://doi.org/10.1093/eurheartj/ehn018
Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroidson cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis 2015; 74: 480-9.
DOI: https://doi.org/10.1136/annrheumdis-2014-206624
Pujades-Rodriguez M, Morgan AW, Cubbon RM, Wu J. Dose-dependent oral glucocorticoid cardiovascular risks in people with immune-mediated inflammatory diseases: a population-based cohort study. PLoS Med 2020; 17: e1003432.
DOI: https://doi.org/10.1371/journal.pmed.1003432
How to Cite
Atzeni, F., Siragusano, C., Tropea, A., & Alciati, A. (2024). Sex and gender differences in comorbidities in spondyloarthritis: a focus on psoriatic arthritis. Reumatismo, 76(3). https://doi.org/10.4081/reumatismo.2024.1769
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- A.R. Carone, S. D'Amore, L. Albanese, F. Craig, P. Scagliusi, M. D'Amore, Hospital anxiety and depression , Reumatismo: Vol. 59 No. 4 (2007)
- A. Volpe, A. Angheben, A. Marchetta, P. Caramaschi, D. Biasi, A. Carletto, S. Marocco, G. Monteiro, L.M. Bambara, G. Arcaro, Z. Bisoffi, Chikungunya arthritis: report of 6 cases , Reumatismo: Vol. 60 No. 2 (2008)
- M. Rampudda, P. Marson, G. Pasero, The main stages in the history of systemic lupus erythematosus , Reumatismo: Vol. 61 No. 2 (2009)
- S. Maddali Bongi, A. Del Rosso, How to prescribe physical exercise in rheumatology , Reumatismo: Vol. 62 No. 1 (2010)
You may also start an advanced similarity search for this article.
