Name. Prof. Nicolino Ruperto, MD, MPH (date of birth March 26, 1965)
Position title. Prof. of paediatrics at the University of Milan Bicocca, Director of the Paediatric Rheumatology Research Unit at the Fondazione IRCCS San Gerardo dei Tintori in Monza Italy, Genova and Senior Scientist of the Paediatric Rheumatology International Trials Organisation (PRINTO)
Institution and Location. Università Milano Bicocca and IRCCS Fondazione San Gerardo Monza, Italy
EDUCATION
1990: Degree in Medicine Magna Cum Laudae (University of Pavia, Italy) as student of the “Almo Collegio Borromeo”.
1994: Fellowship in Pediatrics (University of Pavia, Italy)
1995-1997: Specialisation in Pediatric Rheumatology (Children’s Hospital Medical Center, Cincinnati, OH, USA)
1996-1997: Master of Public Health (Harvard School of Public Health, Boston, MA, USA)
2013-2015: The Executive Master in Management of Health and Social Care Organizations (EMMAS) Bocconi University School of Management (Scuola di Direzione Aziendale – SDA, Milan, Italy)
RESEARCH, TEACHING, or OTHER INTERESTS
Pediatrics, Perinatology and Child Health, Rheumatology
Predictors of inactive disease and remission in children and young adults with juvenile idiopathic arthritis treated with etanercept Vyacheslav Chasnyk, Tamas Constantin, Irina Nikishina, Brigitte Bader-Meunier, Luciana Breda, et al. Rheumatology Oxford England, 2026 Objectives To identify predictors of clinically inactive disease (CID) and clinical remission (CR) in patients with juvenile idiopathic arthritis receiving etanercept during the 2-year, phase 3b, open-label CLIPPER study (NCT00962741) and the 8-year extension study, CLIPPER2 (NCT01421069). Methods Patients with extended oligoarthritis (2–17 years), enthesitis-related arthritis or psoriatic arthritis (each 12–17 years) were enrolled in CLIPPER/CLIPPER2. Predictors of CID (according to Juvenile Arthritis Disease Activity Score [JADAS] and JIA-ACR response criteria) and CR (≥6 months of CID) were identified using a multivariate stepwise logistic regression model. Results Two-thirds of patients met the criteria for CID at any point and 34–43% achieved CR. Height Z-score ≥0.74, age at onset ≤12 years, normal CRP levels, HLA-B27+ status, JADAS low disease activity (LDA) at 3 months and ≤4 swollen joints were predictive of JADAS CID. BMI Z-score >0.80, age at onset ≤12 years, normal CRP levels and JADAS LDA at 3 months were predictors of JIA-ACR CID. JADAS LDA at 3 months was a predictor of JADAS CR, and height Z-score >1.23, JADAS LDA at 3 months and >12 swollen joints were identified as predictors of JIA-ACR CR. Conclusion In patients with JIA treated with etanercept, early responses to treatment in line with treat-to-target recommendations, younger age, HLA-B27+ status and lower disease activity at baseline were associated with clinically inactive disease and clinical remission. Trial registration ClinicalTrials.gov IDs: CLIPPER (NCT00962741); CLIPPER2 (NCT01421069)
Decision Tree Analysis as a Preliminary Evidence-Based Tool for Identifying the Syndrome of Undifferentiated Recurrent Fever in Children Compared With Hereditary Recurrent Fevers and Periodic Fever, Aphthosis, Pharyngitis, and Adenitis Syndrome Riccardo Papa, Francesca Bovis, Silvia Federici, Serena Palmeri, Marta Bustaffa, et al. Arthritis and Rheumatology, 2026 Objective To develop evidence‐based criteria to classify patients with syndrome of undifferentiated recurrent fevers (SURF). Methods One hundred twelve patients with SURF observed in a single tertiary referral center were analyzed. Patients with genetically confirmed hereditary recurrent fever (HRF) or with periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) syndrome already analyzed for the Eurofever classification criteria were used as disease controls. A decision tree approach was tested by randomly splitting the available data in a training set and in an internal test set. An alternative model using a classical regression model was also analyzed. An external validation for both approaches was performed on 123 patients recruited from four other centers. Results The decision tree model integrating clinical and genetic data identified 91% of patients with SURF. A decision tree model based solely on clinical variables identified up to 88% of patients with SURF. The logistic regression model including genetic tests exhibited an overall accuracy of 89.2% (95% confidence interval [CI] 81.1–94.7). In contrast, the logistic regression model exclusively based on clinical manifestations displayed an overall accuracy of 66.7% (95% CI 56.1–76.1). When the classification criteria including genetic tests were applied to the external validation cohort, the model demonstrated a strong discriminative power, with areas under the receiver operating characteristic curve of 96.3% using the decision tree model and 88.0% with the logistic regression model. Conclusion The study shows the possibility of achieving evidence‐based criteria that can classify SURF at least with respect to the main HRF and PFAPA syndrome and may be considered as a preliminary tool for the enrollment of more homogeneous cohorts of patients in future studies.
Tofacitinib for the Treatment of Juvenile Idiopathic Arthritis: Patient-Reported Outcomes in a Phase 3, Randomized, Double-Blind, Placebo-Controlled Withdrawal Trial Hermine I. Brunner, Ekaterina Alexeeva, Marcia Bandeira, Ruy Carrasco, Jeffrey Chaitow, et al. Arthritis and Rheumatology, 2026 Objective Juvenile idiopathic arthritis (JIA) is associated with impaired overall health‐related quality of life (HRQoL). We evaluated the impact of tofacitinib on patient‐reported outcomes (PROs) in patients with JIA. Methods This was a post hoc analysis of a phase 3, randomized, double‐blind, placebo‐controlled withdrawal trial (NCT02592434) in patients with JIA. In the open‐label phase (part 1; weeks 0–18), patients received body weight–based doses of tofacitinib. During the double‐blind phase (part 2; weeks 18–44), responders (per JIA‐American College of Rheumatology 30 response criteria) were randomized 1:1 to continue tofacitinib or switch to placebo for up to 26 weeks. Assessed PROs included the validated parent and/or legal guardian versions of the Childhood Health Assessment Questionnaire for evaluation of disability, arthritis pain, overall well‐being, and the Child Health Questionnaire (CHQ). Results Overall, 225 patients were enrolled and received open‐label tofacitinib in part 1, and 173 patients were randomized in part 2. During part 1, least‐squares (LS) mean (SE) disability, arthritis pain, and overall well‐being scores numerically improved from mean 1.04 (SE 0.05), mean 5.53 (SE 0.20), and mean 5.07 (SE 0.20) at baseline to mean 0.57 (SE 0.05), mean 2.46 (SE 0.18), and mean 2.47 (SE 0.18) at week 18, respectively. LS mean (SE) CHQ physical summary and psychological summary scores numerically improved from mean 29.51 (SE 1.15) and mean 47.24 (SE 0.85) at baseline to mean 42.70 (SE 0.98) and mean 51.53 (SE 0.80) at week 18, respectively. Improvements were generally maintained to week 44 in part 2. Conclusion Tofacitinib improved a range of PROs in patients with JIA, suggesting potential HRQoL benefits.
Sex differences in clinical and imaging characteristics of axial juvenile spondyloarthritis Adam S Mayer, Rui Xiao, Timothy G Brandon, Pamela F Weiss, Amita Aggarwal, et al. Rheumatology, 2026 Objectives The impact of biologic sex in axial juvenile spondyloarthritis (axJSpA) is unknown. We assessed whether biologic sex is associated with disease manifestations, patient-reported outcomes, or characteristic sacroiliac joint (SIJ) MRI lesions in a large cohort of youths with classified axJSpA. Methods This international multicentre cross-sectional study included youths aged <18 years with physician-diagnosed juvenile spondyloarthritis and fulfilling the classification criteria for axJSpA. Clinical and SIJ MRI data were available from the time axial disease was first diagnosed and were compared between males and females using Pearson’s chi-squared and Wilcoxon rank-sum tests, as appropriate. Multivariable logistic regression evaluated the association of sex with inflammatory and structural MRI lesions typical of axial disease. Results Among the 143 patients included, 67.1% were male. Males had significantly greater HLA-B27 positivity, hip/groin stiffness and inflammatory marker elevation. There were no differences in peripheral arthritis, enthesitis or patient-reported outcomes. On SIJ MRI, males had significantly higher odds of unequivocal inflammatory lesions (OR 4.86, 95% CI 1.37–17.32), bone marrow oedema (OR 4.13, 95% CI 1.17–14.62) and pelvic enthesitis (OR 5.23, 95% CI 1.39–19.61) compared with females, but no differences in structural lesions were found. Conclusion In a large multicentre axJSpA cohort, males were significantly more likely to have clinical and MRI features of inflammatory sacroiliitis at the time axial disease was first diagnosed. Future trials in axJSpA should strongly consider stratification by sex in their design.
Juvenile Spondyloarthritis Disease Activity Index Validation in Enthesitis-Related Arthritis and Juvenile Psoriatic Arthritis in a Prospective Clinical Trial Setting Pamela F. Weiss, Nicolino Ruperto, Erhard Quebe-Fehling, Alexis Shew, Luminita Pricop, et al. Journal of Rheumatology, 2026 Objective To investigate the validity of the Juvenile Spondyloarthritis Disease Activity Index (JSpADA) in children with enthesitis-related arthritis (ERA) or juvenile psoriatic arthritis (jPsA) in a prospective clinical trial setting. Methods JUNIPERA ( ClinicalTrials.gov : NCT03031782 ) is a phase III, placebo-controlled withdrawal study investigating the safety and efficacy of secukinumab in children with ERA and jPsA. After 12 weeks of open-label treatment with secukinumab, patients were randomized 1:1 to secukinumab or placebo until disease flare or week 52. JSpADA validity was assessed using 3 criteria: convergent validity (Spearman correlation) at week 12 with the Juvenile Arthritis Disease Activity Score in 10 joints (JADAS10), clinical JADAS10 (cJADAS10), and physician global assessment of disease activity (PGA); discriminatory validity at week 12 among patients with active or inactive disease and juvenile idiopathic arthritis American College of Rheumatology response criteria; and responsiveness to change in clinical disease activity from weeks 12 to 52. Results At week 12, mean (SD) JSpADA scores showed moderate to good correlation with JADAS10, cJADAS10, and PGA scores (all Spearman ρ > 0.4) and were higher among patients with active vs inactive disease (1.8 [1.3] vs 0.5 [0.8], P < 0.001). Patients with improved disease activity from weeks 12 to 52 had greater improvements in JSpADA than patients with worsening disease (−0.8 [1.1] vs 0.4 [1.0], P < 0.001); patients with stable disease had minimal change in JSpADA (−0.1 [0.5]). Validity results were similar for ERA and jPsA. Conclusion These results validate JSpADA as a disease activity measure for children with ERA and jPsA in a prospective clinical trial setting.
Juvenile idiopathic arthritis Alberto Martini, Daniel J. Lovell, Salvatore Albani, Hermine I. Brunner, Kimme L. Hyrich, et al. Nature Reviews Disease Primers, 2022
Reply Nicolino Ruperto, Alberto Martini, Angela Pistorio, for the Paediatric Rheumatology International Trials Organisation Arthritis and Rheumatology, 2022
Disease activity, overweight, physical activity and screen time in a cohort of patients with juvenile idiopathic arthritis Clinical and Experimental Rheumatology, 2018
Update on outcome assessment in myositis Lisa G. Rider, Rohit Aggarwal, Pedro M. Machado, Jean-Yves Hogrel, Ann M. Reed, et al. Nature Reviews Rheumatology, 2018
Preface For the Epidemiology, treatment and Outcome of Childhood Arthritis (EPOCA) Project, Angelo Ravelli, For the Paediatric Rheumatology International Trials Organisation (PRINTO), Alessandro Consolaro, Alberto Martini, et al. Rheumatology International, 2018
Performance of the birmingham vasculitis activity score and disease extent index in childhood vasculitides Clinical and Experimental Rheumatology, 2012
Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis Clinical and Experimental Rheumatology, 2011
Agreement between multi-dimensional and renal-specific response criteria in patients with juvenile systemic lupus erythematosus and renal disease Clinical and Experimental Rheumatology, 2010
Impact of involvement of individual joint groups on subdimensions of functional ability scales in juvenile idiopathic arthritis Clinical and Experimental Rheumatology, 2009
Reply Nicolino Ruperto, Angela Pistorio, Angelo Ravelli, Alberto Martini, Paediatric Rheumatology International Trials Organisation (PRINTO) Arthritis Care and Research, 2008
Is minimal clinically important difference relevant for the interpretation of clinical trials in pediatric rheumatic diseases? Journal of Rheumatology, 2007
Cyclosporine A in juvenile idiopathic arthritis. Results of the PRCSG/PRINTO phase IV post marketing surveillance study Clinical and Experimental Rheumatology, 2006
Consensus in pediatric rheumatology: Part II - Definition of clinical improvement in systemic lupus erythematosus and juvenile dermatomyositis Revista Brasileira De Reumatologia, 2005
Consensus in pediatric rheumatology: Part I - Criteria definition of inactive disease and remission in juvenile idiopathic arthritis/juvenile rheumatoid arthritis Revista Brasileira De Reumatologia, 2005
The Child Health Questionnaire (CHQ-PF50) studies: Sincere congratulations and a sincere plea for terminological accurary (multiple letters) [6] Clinical and Experimental Rheumatology, 2002
The Hungarian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Croatian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Danish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The European Spanish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Korean version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Finnish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Swiss German and Swiss French versions of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Belgian-Flemish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Norwegian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Bulgarian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Slovak version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Hebrew version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
Cross-cultural adaptation and psychometric evaluation of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) in 32 countries. Review of the general methodology Clinical and Experimental Rheumatology, 2001
The Argentinian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Latvian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Dutch version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The German version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Austrian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis Journal of Rheumatology, 2001
The Portuguese version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Chilean version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Greek version of the Childhood Health Assessment Questionnaire(CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The Brazilian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The French version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) Clinical and Experimental Rheumatology, 2001
The importance of clinical trials for the paediatric rheumatic diseases: Organisation, methodological and ethical problems Gaslini, 2000
Efficacy of folinic acid in reducing methotrexate toxicity in juvenile idiopathic arthritis Clinical and Experimental Rheumatology, 1999
Responsiveness of clinical measures in children with oligoarticular juvenile chronic arthritis Journal of Rheumatology, 1999
Long-term cost-effectiveness of low molecular weight heparin versus unfractionated heparin for the prophylaxis of venous thromboembolism in elective hip replacement Haematologica, 1999
Specially training and distribution of work effort among US American College of rheumatology members caring for children with rheumatic disease Arthritis and Rheumatism, 1997
Longterm health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. I. Outcome status Journal of Rheumatology, 1997
Longterm health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. II. Early predictors of outcome Journal of Rheumatology, 1997
Clinically important change in treatment trials for juvenile rheumatoid arthritis [1] Journal of Rheumatology, 1997
Intravenous immunoglobulin in the treatment of polyarticular juvenile rheumatoid arthritis: A phase I/II study Journal of Rheumatology, 1996
Frequency of relapse after discontinuation of methotrexate therapy for clinical remission in juvenile rheumatoid arthritis Journal of Rheumatology, 1995