Immunology, Rheumatology, Allergy and Rare Diseases

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Rheumatology
  • Clinical Immunology
  • Allergy
  • Rare Immune-mediated conditions
  • Infusion Centre
  • Day Hospital

PROCEDURES PERFORMED PER YEAR:

  • 22,000 outpatient evaluations each year

The Immunology, Rheumatology, Allergy and Rare Diseases Unit is dedicated to the care of adult patients with systemic rheumatic and autoimmune diseases, in all their manifestations, from the most frequent to the rarest ones. It is one of the largest references centres operating in the Lombardy region for the diagnosis, therapy, and research of diseases of rheumatological and immunopathological interest, as well as, rare diseases with immuno-mediated pathogenesis. The Unit actively participates in several clinical trials, thus offering potential novel therapeutic opportunities to patients with complicated diseases unable to achieve remission with conventional treatments.

In order to provide the best standard of care possible, the Unit is organized by disease-specific clinics that allow for the development of considerable and targeted experience on specific rheumatic and immunological conditions. This organization optimizes efforts to provide the best possible assistance and allows important synergies for clinical research, encouraging the acquisition of new information on the various conditions and accelerating the implementation of new therapies. The Unit also has a dedicated clinic for women with a rheumatic or immunologic disease, who are pregnant or are want to plan a pregnancy, in order to help them in face and treat the unique challenges that they encounter during pregnancy.

 

treatmentS

The Arthritis Clinic

The Clinic takes care of adult patients with inflammatory arthropathies. The Unit is specialized in the treatment of patients with arthritis who require a step-up in the management of their disease and are eligible to start with biologics and/or targeted-synthetic drugs. Patients with recent-onset arthritis (Early Arthritis) can be directly referred to this Clinic to undergo a full clinical, radiological, ultrasound and biochemical evaluation in a short period of time. Three specialized outpatient facilities and an infusion centre work daily to offer integrated and comprehensive care to these patients. The Clinic also offers musculoskeletal ultrasound and intra-articular injections to manage not only patients with inflammatory arthritis but also patients with gout, crystal arthropathies and osteoarthritis. The Arthritis Clinic has a strong collaboration with other specialists (cardiologists, gastroenterologists, radiologists, dermatologists and ophthalmologists) involved in the care of different comorbidities suffered by patients with inflammatory arthropathies. The Clinic is involved in several projects and works closely with National and International Societies such the Italian Society of Rheumatology (SIR) and the European League Against Rheumatism (EULAR) and is currently involved in several clinical trials and National and International Registries.

 

Main Pathologies Treated:

 

  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Gout and other Crystal Arthropathies
  • Acute Rheumatic Fever
  • Reactive arthritis
  • NonRadiological Spondylitis
  • Axial Spondylitis (Ankylosing Spondylitis)
  • Osteoarthritis

Lupus and Connective Tissue Diseases Clinic

The Clinic constitutes the core of a network of specialists coordinating their efforts, in order to offer a state-of-the-art multidisciplinary and individualized care for adult patients with connective tissue diseases. Dedicated and comprehensive rheumatologic, ophthalmologic, cardiologic, neurologic, and dermatologic evaluations are thus offered to patients. Multidisciplinary reviews of the most complicated cases take place regularly. Special care is also given to pregnant women with connective tissue diseases, thanks to an established collaboration with a long-experienced clinic for pregnancy in patients with autoimmune diseases. The Unit also has a strong commitment to expand current knowledge on the pathogenic, clinical and therapeutic aspects in connective tissue diseases. The Unit is part of the Lupus Italian Registry (LIRE) and has growing connections with other national and international institutions focused on research in connective tissue disorders.

Main Pathologies Treated:

  • Systemic Lupus Erythematosus
  • Mixed/Undifferentiated Connective Disease
  • Sjögren's Syndrome
  • Dermatomyositis/Polymyositis
  • Immunopathology of pregnancy

Scleroderma and Cardiac Immunopathology Clinic

The Clinic is recognized as a European (EUSTAR member) and National (GILS member) referral Centre for Scleroderma and Scleroderma-related diseases. The Clinic includes immuno-rheumatologists with international experience in the management of these diseases and takes care of patients with both limited and diffused subsets of systemic sclerosis. The Unit works closely with other specialists involved in the care of these patients such as cardiologists, arrhythmologists, respiratory specialists, gastroenterologists, wound care specialists, radiologists, and nuclear physicians. The Unit includes a Day-Hospital service for prostaglandin infusions for patients with refractory Raynaud’s phenomenon and digital ulcers, capillaroscopy service and skin biopsy service. Thanks to the strong collaboration within our Hospital with these specialists the Clinic has also gained an International expertise, especially in the management of patients affected by heart inflammation (myocarditis). The Unit is involved in several projects within the Italian Society of Rheumatology (SIR), the European League Against Rheumatism (EULAR) and the European Scleroderma Trials and Research Group (EUSTAR).

Main Pathologies Treated:

  • Systemic Sclerosis,
  • Raynaud’s Phenomenon
  • Mixed connective tissue diseases
  • Autoimmune interstitial lung diseases
  • Antisynthetase antibodies syndrome
  • Localized scleroderma (morphea)
  • Scleroderma diabeticorum
  • Scleromyxedema
  • Myocarditis

Vasculitis Clinic

The Clinic is a National and International referral Centre for systemic vasculitis (EUVAS member). Patients are managed in a specialized and multidisciplinary setting thanks to strong and corroborated collaborations with other specialists involved in the care of vasculitis (such as radiologists, vascular surgeons, nuclear physicians, cardiologists and wound care specialists). The Clinic includes an infusion Unit for intravenous biological therapies administration and a Day-Hospital service for cyclophosphamide and intravenous steroid administration. The Clinic is involved in several projects within the main National and International societies: Italian Society of Rheumatology (SIR), Italian Society of Allergy and Clinical Immunology (SIAAIC), European League Against Rheumatism (EULAR), American College of Rheumatology (ACR) and European Vasculitis Study Group (EUVAS). The Clinic has multiple research lines aiming to dissect the pathogenic drivers and new potential therapeutic targets for these diseasesand is currently involved in several clinical trials and National and International Registries.

Main Pathologies Treated:

  • Takayasu's arteritis
  • Giantcell (temporal) Arteritis
  • Polymyalgia Rheumatica (PMR)
  • Granulomatosis with polyangiitis (Wegener’s disease)
  • Eosinophilic granulomatosis with polyangiitis (ChurgStrauss Syndrome)
  • Cryoglobulinemia
  • IgA vasculitis (HenochSchönlein Purpura)
  • Polyarteritis nodosa (PAN)
  • Microscopic polyangiitis (MPA)

Autoinflammatory disease/miscellaneous and Rare Conditions Clinic

The Clinic provides specialized care to adult patients with rare disorders ranging from auto-inflammatory conditions (such as Adult Onset Still's disease and periodic fever syndromes), to Behçet's disease, sarcoidosis, erythema nodosum, and retroperitoneal fibrosis. The Clinic also actively follows the largest European single-centre cohorts of patients with IgG4-Related Disease and with Erdheim-Chester disease, and maintains international collaborations with prime research institutions, which led to major discoveries and development of innovative treatment strategies in these fields. The Clinic offers patients with these rare conditions, a highly professional health-care assistance, constant support, and personalized therapeutic approaches.

Main Pathologies Treated:

  • Adult onset Still's disease and other Autoinflammatory conditions
  • Behçet's disease
  • Sarcoidosis
  • Erythema nodosum (EN)
  • ErdheimChester disease
  • IgG4related disease
  • Retroperitoneal fibrosis

Primary Adult Immunodeficiency Clinic

The Clinic offers several services for patient with immunodeficiency, including investigation on its cause, lifelong management of patients (either with genetically determined immunodeficiencies or immunodeficiencies which are secondary to treatments for other conditions), intravenous immunoglobulin replacement therapy and subcutaneous home therapy training. We offer a specific service for helping the transition of young adults moving from paediatric to adult care and for the treatment and management of complications.

Main Pathologies Treated:

 

  • Agammaglobulinemia
  • Specific antibody deficiency
  • Common variable immunodeficiency disorders
  • Isolated IgG subclass deficiency
  • Selective IgM deficiency
  • Selective IgA deficiency
  • Severe combined immunodeficiency
  • Thymoma with immunodeficiency
  • Autoimmune lymphoproliferative syndrome
  • Chronic granulomatous disease
  • DiGeorge syndrome
  • Wiskott-Aldrich syndrome
  • Hyper IgE syndrome
  • Combined immunodeficiency
  • Latrogenic immunodeficiency

Fibromyalgia Clinic

The Clinic provides specialized care to patients with fibromyalgia and chronic fatigue syndrome in a tertiary referral centre setting. The Clinic currently follows a large cohort of patients, and works tightly with patient organizations to understand unmet clinical needs and to develop evermore patient-tailored approaches. In addition, the Unit is actively invested in research efforts aimed at understanding the pathogenesis of this condition: prime institutional as well as international collaborations in the fields of cellular neurophysiology, neuropsychology, immunology, and inflammation led to highly promising pre-clinical discoveries, whose therapeutic potential is being explored.

 

Main Pathologies Treated:

 

  • Fibromyalgia
  • Chronic fatigue syndrome

Allergy

The Unit takes care of adult patients with all allergic conditions and performs the in-vivo and in-vitro exams to precisely diagnose and categorize them.

 

The Unit is specialized in the treatment of allergic rhinitis and rhino-conjunctivitis and allergic asthma, allergy and intolerance to food and food additives, contact and atopic dermatitis, and hypersensitivity reactions to insects and insect bites.

 

The Unit is well known for the diagnosis and treatment of allergy and hypersensitivity to drugs, contrast media, biological drugs and anti-cancer agents. The Unit has set up several desensitization protocols, that allow affected patients to safely receive those therapies.

 

Main Pathologies Treated:

  • Allergic Rhinitis
  • Rhinoconjunctivitis
  • Allergic Asthma
  • Food Allergy and/or Intolerance
  • Hypersensitivity and/or allergic reaction
    • Insects and insect bites
    • Drugs (including biologic drugs)
    • Anti-cancer agents

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Video capillaroscopy
  • Articular Ultrasound with Power-Doppler
  • Fully equipped state-of-the-art infusion room for the administration of biologic drugs and advanced treatments