Ateneo - UPO

The course covers the main diseases of immunological and rheumatological interest, with particular attention to the relationship between immune system alterations, inflammation, tissue damage, and clinical manifestations.The main mechanisms of immunopathology are addressed, including immunodeficiencies, hypersensitivity, autoimmunity, autoinflammation, and systemic autoimmune diseases. The course also focuses on the most relevant inflammatory and systemic rheumatological disorders, including rheumatoid arthritis, spondyloarthritis, connective tissue diseases, vasculitis, and idiopathic inflammatory myopathies.The course further includes selected conditions commonly encountered in rheumatological practice, such as crystal-induced arthritis, osteoarthritis, osteoporosis, and other metabolic bone diseases. Topics are developed by integrating immunopathogenetic mechanisms, clinical presentation, laboratory and instrumental diagnostic elements, differential diagnosis, and the rational principles of treatment.

Teaching materials provided by the lecturer during the course, including slides, slide notes, possible clinical cases, and supplementary resources made available on the DIR online platform, constitute the primary reference for examination preparation.Texts for optional consultation and personal further study:Firestein GS, McInnes IB, Koretzky G, Mikuls TR, Neogi T, O’Dell JR. Firestein & Kelley’s Textbook of Rheumatology. 12th ed. Elsevier; 2025.Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, Holland SM, Langford CA. Harrison's Principles of Internal Medicine. 22nd ed. McGraw Hill; 2025.Rugarli C. Medicina Interna Sistematica. 8th ed. Edra; 2021.Students are not expected to study the listed textbooks in their entirety. These reference texts are intended as supporting resources to consolidate or expand, where desired, the chapters relevant to the topics covered during the course.

The course aims to provide students with the conceptual tools required to understand the main diseases of immunological and rheumatological interest, integrating immunopathogenetic mechanisms, clinical manifestations, laboratory and instrumental diagnostic elements, and the rational principles of treatment.The central objective is to promote understanding of the relationship between immune system alterations, inflammation, autoimmunity, autoinflammation, tissue damage, and the development of the characteristic clinical pictures of the main immunological and rheumatological diseases.The course also aims to develop a reasoned approach to patients presenting with musculoskeletal symptoms or systemic manifestations potentially related to immune-mediated disease, guiding students in the recognition of major clinical patterns, the appropriate interpretation of autoantibodies and other laboratory tests, and the differential diagnostic approach.Particular attention is devoted to systemic autoimmune diseases, inflammatory arthritis, connective tissue diseases, vasculitis, idiopathic inflammatory myopathies, crystal-induced arthritis, and the main degenerative and metabolic disorders of the musculoskeletal system.By the end of the course, students are expected to have acquired an integrated view of immunological and rheumatological diseases, enabling them to suspect clinically relevant conditions at an early stage, orient the initial diagnostic pathway, and understand the rationale behind the main therapeutic strategies.

Successful participation in the course requires basic knowledge of immunology, general pathology, anatomy, physiology, and biochemistry, acquired during previous courses within the Degree Program.Students are also expected to have a basic understanding of clinical methodology and medical semiology, in order to interpret the meaning of symptoms, signs, laboratory abnormalities, and instrumental findings discussed during the course.Understanding the main mechanisms of inflammation, innate and adaptive immune responses, immunological tolerance, and immune-mediated tissue damage is particularly useful for linking immunopathogenetic mechanisms to the clinical manifestations of immunological and rheumatological diseases.

The course is mainly delivered through face-to-face lectures, supported by multimedia presentations and teaching materials made available on the DIR online platform.During lectures, theoretical topics are integrated with clinical examples, guided discussion of immunological and rheumatological conditions, and interpretation of clinical, laboratory, and instrumental data of common relevance to clinical practice.Particular attention is devoted to the link between immunopathogenetic mechanisms, clinical presentation patterns, the significance of autoantibodies and laboratory tests, differential diagnosis, and the rational principles of treatment.Ongoing formative assessment is encouraged through questions addressed to students during lectures, aimed at stimulating active participation, clinical reasoning, and the ability to link disease mechanisms to clinical manifestations.

Class attendance is regulated according to the Degree Program requirements.Teaching materials made available on the DIR online platform constitute an integral part of the learning process and should be used together with class attendance and individual study.Any organizational communications, updates to teaching materials, or information concerning the course will be provided during lectures and/or through the DIR online platform.

Assessment is part of the examination of the integrated course in Medical Pathology III and, unless otherwise specified by the organization of the integrated course, includes an assessment of EBM and Statistics for EBM and an assessment of the clinical disciplines included in the integrated course.The assessment of EBM and Statistics for EBM may be administered as a preliminary test according to the procedures defined by the integrated course. Passing this component is a prerequisite for access to the assessment of the clinical disciplines and contributes to the final grade according to the weighting established by the integrated course.The assessment of the clinical disciplines includes a written examination and an oral examination. The written examination consists of multiple-choice questions covering Infectious Diseases, Hematology, and Clinical Immunology and Rheumatology. For the Clinical Immunology and Rheumatology module, unless otherwise specified, 15 multiple-choice questions are administered, with only one correct answer.The written examination is administered through the DIR/DIR Esami online platform, according to the operational procedures communicated to students before the exam session. Questions may include theoretical items and short clinical cases aimed at assessing knowledge of the main immunological and rheumatological diseases, the ability to recognize relevant clinical patterns, interpret laboratory and instrumental findings, and link immunopathogenetic mechanisms to clinical manifestations.Access to the oral examination and the definition of the final grade follow the rules established for the integrated course. Generally, unless otherwise communicated, students are admitted to the oral examination when the scores obtained in at least 2 out of the 3 clinical disciplines are equal to or higher than 18/30, and the only insufficient score is not lower than 16/30. The oral examination focuses on one of the clinical disciplines, selected by the examination board, and generally consists of the discussion of a clinical case or a relevant topic, with the aim of assessing clinical reasoning, differential diagnosis, interpretation of diagnostic tests, and understanding of the rationale for treatment.

The course covers the main diseases of immunological and rheumatological interest, integrating immunopathogenetic mechanisms, clinical presentation, laboratory and instrumental diagnostics, differential diagnosis, and the rational principles of treatment.The course initially reviews the main concepts of clinical immunology required to understand immune-mediated diseases, with particular reference to innate and adaptive immune responses, clonal selection, immunological tolerance, inflammation, autoimmunity, autoinflammation, hypersensitivity, and immunodeficiency. The main ways in which the immune system may be insufficient, dysregulated, or directed against self-antigens are discussed, together with the clinical significance of autoantibodies and immunological tests.Part of the course is devoted to the approach to patients presenting with musculoskeletal and systemic symptoms of potential rheumatological interest. Essential elements of joint anatomy and pathophysiology are reviewed, with particular reference to synovial joints, the synovial membrane, synovial fluid, and mechanisms of joint inflammation. The clinical meaning of pain, stiffness, swelling, joint distribution, extra-articular manifestations, and systemic signs is discussed, with attention to the distinction between inflammatory, degenerative, metabolic, and infectious diseases.The course addresses rheumatoid arthritis as a model of autoimmune inflammatory arthritis, including epidemiology, immunopathogenesis, synovial involvement, the role of autoantibodies, articular and extra-articular manifestations, diagnostic elements, and therapeutic principles. Spondyloarthritis is also discussed as a spectrum of seronegative inflammatory diseases with predominant axial and/or peripheral involvement, including ankylosing spondylitis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis, enthesitis, dactylitis, uveitis, and the role of HLA-B27.The main connective tissue diseases and systemic autoimmune diseases are covered, with particular attention to Sjögren’s syndrome, systemic sclerosis, mixed connective tissue disease, and idiopathic inflammatory myopathies. For each disease group, the main immunopathogenetic mechanisms, characteristic clinical patterns, organ involvement, significance of autoantibodies, elements of differential diagnosis, and rationale of the main therapeutic strategies are discussed.A specific section is devoted to vasculitis, considered as inflammatory diseases of the vessel wall that may cause organ damage through ischemia, necrosis, or structural alteration of the vessel. Classification criteria based on vessel size, the relationship between the type of vessel involved and clinical manifestations, the significance of mono- or multiorgan involvement, and laboratory and instrumental findings useful for diagnostic assessment are reviewed.The course also includes the main crystal-induced arthropathies, with particular reference to gout and calcium pyrophosphate deposition disease. Uric acid metabolism, hyperuricemia, crystal deposition, acute arthritis flares, tophi, renal involvement, chondrocalcinosis, diagnosis through synovial fluid analysis, differential diagnosis with septic arthritis, and general principles of treatment are discussed.Finally, the course covers selected degenerative and metabolic disorders of the musculoskeletal system commonly encountered in clinical practice, including osteoarthritis, osteoporosis, and Paget’s disease. The mechanisms of cartilage and whole-joint damage in osteoarthritis, the determinants of bone fragility, the role of bone mineral density, bone turnover and skeletal microarchitecture in osteoporosis, and the main pathophysiological and clinical aspects of metabolic bone diseases are addressed.Topics are developed by integrating immunological mechanisms, clinical patterns, interpretation of laboratory and instrumental data, clinical examples, and in-class formative questions, in order to promote a reasoned approach to patients with suspected immunological or rheumatological disease.

By the end of the course, students will be able to:understand the main immunopathogenetic mechanisms underlying the immunological and rheumatological diseases covered during the course;recognize the main clinical patterns of systemic autoimmune diseases, inflammatory arthritis, connective tissue diseases, vasculitis, idiopathic inflammatory myopathies, crystal-induced arthritis, and degenerative and metabolic disorders of the musculoskeletal system;link immune system alterations, inflammation, autoimmunity, autoinflammation, and tissue damage to the development of signs, symptoms, and clinical manifestations;interpret the main laboratory and instrumental findings of immunological and rheumatological relevance using a reasoned approach, with particular reference to autoantibodies, inflammatory markers, synovial fluid analysis, and major imaging investigations;distinguish, on the basis of essential clinical and laboratory findings, inflammatory, degenerative, metabolic, infectious, and systemic disorders of the musculoskeletal system;orient the initial diagnostic pathway in patients presenting with musculoskeletal symptoms or systemic manifestations potentially related to immune-mediated disease;understand the rationale behind the main therapeutic strategies used in immunological and rheumatological diseases, including symptomatic drugs, immunosuppressive agents, corticosteroids, conventional DMARDs, biologic agents, and targeted therapies;use appropriate medical terminology to describe the main immunopathological, rheumatological, and musculoskeletal processes;integrate the acquired knowledge with the other clinical courses of the Degree Program in Medicine and Surgery.