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Aronson KI, Rajan M, Varadarajan J, Paul TK, Swigris JJ, Krishnan JK, Kaner RJ, Martinez FJ, Safford MM, Pinheiro LC. Development and initial validation of a disease-specific instrument to measure health-related quality of life in hypersensitivity pneumonitis. ERJ Open Res 2024; 10:00155-2024. [PMID: 39104956 PMCID: PMC11299010 DOI: 10.1183/23120541.00155-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/10/2024] [Indexed: 08/07/2024] Open
Abstract
Rationale and objective Disease-specific health-related quality of life (HRQOL) instruments enable us to capture domains that are most relevant to specific patient populations and are useful when a more individualised approach to patient assessment is desired. In this study, we assessed the validity and reliability of the first instrument specifically developed to measure HRQOL in hypersensitivity pneumonitis (HP). Methods A 39-item HP-HRQOL instrument and several anchors were collected from a cohort of patients with HP. Exploratory factor analysis and item reduction were utilised to construct a shortened version of the instrument. Several validity and reliability analyses were conducted on this version of the HP-HRQOL. Measurements and main results 59 patients with HP completed the study. The revised HP-HRQOL instrument comprises 15 items composing two factors (domains): 1) impacts on daily life; and 2) mental wellbeing. Internal consistency reliability was strong for Factor 1 (Cronbach's α=0.94, 95% CI 0.92-0.96) and Factor 2 (Cronbach's α=0.89, 95% CI 0.85-0.94). Test-retest reliability was strong (ICC 0.94, 95% CI 0.89-0.97). The HP-HRQOL strongly correlated with other validated patient-reported outcome measures and moderately correlated with % predicted forced vital capacity. The HP-HRQOL distinguished between those with different severities of HP as determined by lung function and supplemental oxygen use. Conclusions The HP-HRQOL, the first patient-reported outcome instrument specific to adults with HP, possesses strong validity and reliability characteristics for measuring disease-specific HRQOL and distinguishes among patients with different severities of disease.
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Affiliation(s)
- Kerri I. Aronson
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Janani Varadarajan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Tessy K. Paul
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Jeffrey J. Swigris
- Center for Interstitial Lung Disease, National Jewish Health, Denver, CO, USA
| | - Jamuna K. Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
- Department of Genetic Medicine, Weill Cornell Medicine New York, NY, USA
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, NY, USA
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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De Angelis R, Cipolletta E, Francioso F, Carotti M, Farah S, Giovagnoni A, Salaffi F. Low-Carbon Monoxide Diffusing Capacity, Patient-Reported Measures and Reduced Nailfold Capillary Density Are Associated with Interstitial Lung Disease in Systemic Sclerosis. J Pers Med 2024; 14:635. [PMID: 38929856 PMCID: PMC11205232 DOI: 10.3390/jpm14060635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of this paper is to identify factors associated with interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) and build an algorithm to better define this association for a personalised application in clinical practice. METHODS A total of 78 SSc patients underwent HRCT to assess ILD. Demographic, clinical and laboratory variables were collected, focusing on those associated either directly or indirectly with lung involvement. The discriminant value of each variable was determined using the operating characteristic curves (ROC) and included in a model to estimate the strength of ILD association in SSc. RESULTS Thirty-three (42.31%) patients showed ILD on HRCT. DLco, M-Borg, GERD-Q and capillary density were significantly associated with the presence of ILD-SSc. A model including these variables had a coefficient of determination (R2) of 0.697. DLco had an AUC of 0.861 (p < 0.001) with a cut-off of ≤72.3% (sensitivity 78.8%, specificity 91.1%, +LR 8.86). The m-Borg Scale showed an AUC of 0.883 (p < 0.001) with a cut-off >2 (sensitivity 84.8%, specificity 82.2%, +LR 4.77), GERD-Q had an AUC of 0.815 (p < 0.001) with a cut-off >7 (sensitivity 72.7%, specificity 86.7%, +LR 5.45). The capillary density showed an AUC of 0.815 (p < 0.001) with a cut-off of ≤4.78 (sensitivity 87.9%, specificity 68.9%, +LR 2.82). Based on the pre-test probability values, these four variables were applied to Fagan's nomogram to calculate the post-test probability of this association. CONCLUSIONS Our study identified four associated clinical factors of ILD in SSc patients. Moreover, their inclusion in an algorithm for the post-test probability, tailored to the specific patients' characteristics, significantly increases the ability to find out the presence of SSc-ILD.
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Affiliation(s)
- Rossella De Angelis
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Jesi, 60035 Ancona, Italy; (E.C.); (F.F.); (S.F.); (F.S.)
- IRCCS INRCA, 60121 Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Jesi, 60035 Ancona, Italy; (E.C.); (F.F.); (S.F.); (F.S.)
- Academic Rheumatology, University of Nottingham, Nottingham NG7 2RD, UK
| | - Francesca Francioso
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Jesi, 60035 Ancona, Italy; (E.C.); (F.F.); (S.F.); (F.S.)
| | - Marina Carotti
- Department of Radiology, “Ospedali Riuniti”, Polytechnic University of Marche, 60121 Ancona, Italy; (M.C.); (A.G.)
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Jesi, 60035 Ancona, Italy; (E.C.); (F.F.); (S.F.); (F.S.)
| | - Andrea Giovagnoni
- Department of Radiology, “Ospedali Riuniti”, Polytechnic University of Marche, 60121 Ancona, Italy; (M.C.); (A.G.)
| | - Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, “Carlo Urbani” Hospital, Jesi, 60035 Ancona, Italy; (E.C.); (F.F.); (S.F.); (F.S.)
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Petelytska L, Bonomi F, Cannistrà C, Fiorentini E, Peretti S, Torracchi S, Bernardini P, Coccia C, De Luca R, Economou A, Levani J, Matucci-Cerinic M, Distler O, Bruni C. Heterogeneity of determining disease severity, clinical course and outcomes in systemic sclerosis-associated interstitial lung disease: a systematic literature review. RMD Open 2023; 9:e003426. [PMID: 37940340 PMCID: PMC10632935 DOI: 10.1136/rmdopen-2023-003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/02/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The course of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is highly variable and different from continuously progressive idiopathic pulmonary fibrosis (IPF). Most proposed definitions of progressive pulmonary fibrosis or SSc-ILD severity are based on the research data from patients with IPF and are not validated for patients with SSc-ILD. Our study aimed to gather the current evidence for severity, progression and outcomes of SSc-ILD.Methods A systematic literature review to search for definitions of severity, progression and outcomes recorded for SSc-ILD was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in Medline, Embase, Web of Science and Cochrane Library up to 1 August 2023.Results A total of 9054 papers were reviewed and 342 were finally included. The most frequent tools used for the definition of SSc-ILD progression and severity were combined changes of carbon monoxide diffusing capacity (DLCO) and forced vital capacity (FVC), isolated FVC or DLCO changes, high-resolution CT (HRCT) extension and composite algorithms including pulmonary function test, clinical signs and HRCT data. Mortality was the most frequently reported long-term event, both from all causes or ILD related.Conclusions The studies presenting definitions of SSc-ILD 'progression', 'severity' and 'outcome' show a large heterogeneity. These results emphasise the need for developing a standardised, consensus definition of severe SSc-ILD, to link a disease specific definition of progression as a surrogate outcome for clinical trials and clinical practice.PROSPERO registration number CRD42022379254.Cite Now.
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Affiliation(s)
- Liubov Petelytska
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department Internal Medicine #3, Bogomolets National Medical University, Kiiv, Ukraine
| | - Francesco Bonomi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Carlo Cannistrà
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Elisa Fiorentini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Silvia Peretti
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Sara Torracchi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Pamela Bernardini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Carmela Coccia
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Riccardo De Luca
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Alessio Economou
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Juela Levani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan, Italy
| | - Oliver Distler
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosimo Bruni
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
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Liem SIE, Bergstra SA, Ciaffi J, van der Meulen C, Ueckert DA, Schriemer MR, Huizinga TWJ, Vliet Vlieland TPM, de Vries-Bouwstra JK. The long-term course of the Health Assessment Questionnaire in patients with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:192-202. [PMID: 37744048 PMCID: PMC10515995 DOI: 10.1177/23971983231181719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/27/2023] [Indexed: 09/26/2023]
Abstract
Objective The Health Assessment Questionnaire-Disability Index is an important outcome measure reflecting functional disability, but knowledge on its course over time in patients with systemic sclerosis is scarce. Therefore, we investigated the long-term course of the Health Assessment Questionnaire-Disability Index and its association with baseline characteristics in systemic sclerosis patients. Methods Systemic sclerosis patients, fulfilling the European League Against Rheumatism and the American College of Rheumatology 2013 criteria, were included from the Leiden Combined Care in Systemic Sclerosis cohort with annual assessments including the Scleroderma Health Assessment Questionnaire-Disability Index (range = 0-3). The course of the Health Assessment Questionnaire-Disability Index was evaluated over the total follow-up (baseline to last available Health Assessment Questionnaire-Disability Index) and between yearly visits. Based on a minimal clinical important difference of 0.22, courses were categorized into worsening, stable or improvement. The course of the Health Assessment Questionnaire-Disability Index over time was evaluated with linear mixed models. Baseline characteristics were compared between patients with a worsening or improvement of the Health Assessment Questionnaire-Disability Index over the total follow-up period with logistic regression analyses. Results A total of 517 systemic sclerosis patients were included, with a median follow-up of 7 years (interquartile range = 4-9; 2649 visits) and a baseline Health Assessment Questionnaire-Disability Index of 0.625 (interquartile range = 0.125-1.25). On group level, the Health Assessment Questionnaire-Disability Index is stable with an annual increase of 0.019 (95% confidence interval = 0.011 to 0.027). Looking at subgroups, patients >65 years or who died/were physically unable to come during follow-up had a worse mean Health Assessment Questionnaire-Disability Index. In individual courses from baseline to the last follow-up, the proportions of patients with a clinically meaningful worsening, stable or improved Health Assessment Questionnaire-Disability Index were 35%, 42% and 23%, respectively. Patients with immunosuppressants (odds ratio = 0.5, 95% confidence interval = 0.3 to 0.9) or gastrointestinal involvement (odds ratio = 0.6, 95% confidence interval = 0.4 to 0.9) at baseline showed a reduced chance of worsening of the Health Assessment Questionnaire-Disability Index over the total follow-up period. Conclusion Over time, the average course of the Health Assessment Questionnaire-Disability Index was stable in systemic sclerosis patients. However, individual courses vary, with worsening occurring in one-third. Worsening occurred less often in individuals using immunosuppressants or with gastrointestinal involvement at baseline.
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Affiliation(s)
- Sophie IE Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Coen van der Meulen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - David A Ueckert
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marisca R Schriemer
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Tom WJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theodora PM Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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Kreuter M, Hoffmann-Vold AM, Matucci-Cerinic M, Saketkoo LA, Highland KB, Wilson H, Alves M, Erhardt E, Schoof N, Maher TM. Impact of lung function and baseline clinical characteristics on patient-reported outcome measures in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2022; 62:SI43-SI53. [PMID: 35640959 PMCID: PMC9910566 DOI: 10.1093/rheumatology/keac325] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The SENSCIS® trial demonstrated a significant reduction of lung function decline in patients with SSc-associated interstitial lung disease (SSc-ILD) treated with nintedanib, but no significant effect on health-related quality of life (HRQoL). To assess whether SSc/SSc-ILD severity and large changes in lung function correlate with HRQoL, a post-hoc analysis of SENSCIS®, aggregating treatment arms, was undertaken. METHODS Patient-reported outcome (PRO) measures [St. George's Respiratory Questionnaire (SGRQ), Functional Assessment of Chronic Illness Therapy (FACIT)-Dyspnoea, and HAQ-Disability Index (HAQ-DI), incorporating the Scleroderma HAQ visual analogue scale (SHAQ VAS)] at baseline and week 52 were assessed for associations to SSc-ILD severity. RESULTS At baseline and at week 52, forced vital capacity (FVC) <70% predicted was associated with worse PRO measure scores compared with FVC ≥70% predicted [week 52: SGRQ 45.1 vs 34.0 (P < 0.0001); FACIT-Dyspnoea 48.9 vs 44.5 (P < 0.0001); HAQ-DI 0.7 vs 0.6 (P < 0.0228); SHAQ VAS breathing problems 3.6 vs 2.6 (P < 0.0001)]. Patients with diffuse cutaneous SSc and other characteristics associated with SSc-ILD severity had worse PRO measure scores. Patients requiring oxygen or with >30% fibrosis on high-resolution computed tomography at baseline demonstrated worse PRO measure scores at week 52. After 1 year, patients with a major (>10%) improvement/worsening in FVC demonstrated corresponding improvement/worsening in SGRQ and other PRO measures, significant for the SGRQ symptom domain (P < 0.001). CONCLUSION Severe SSc-ILD and major deteriorations in lung function have important impacts on HRQoL. Treatments that slow lung function decline and prevent severe SSc-ILD are important to preserve HRQoL. TRIAL REGISTRATION clinicaltrials.gov, www.clinicaltrials.gov, NCT02597933.
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Affiliation(s)
- Michael Kreuter
- Correspondence to: Michael Kreuter, Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Röntgenstrasse 1, 69126 Heidelberg, Germany. E-mail:
| | | | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine and Division of Rheumatology, University of Florence, Florence,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, UMC Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, Louisiana State University and Tulane University Schools of Medicine, New Orleans, LA
| | | | - Hilary Wilson
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein
| | | | | | - Nils Schoof
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London,National Institute for Health Research Clinical Research Facility, Royal Brompton Hospital, London, UK,Hastings Center for Pulmonary Research and Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
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Chen L, Zhu M, Lu H, Yang T, Li W, Zhang Y, Xie Q, Li Z, Wan H, Luo F. Quantitative evaluation of disease severity in connective tissue disease-associated interstitial lung disease by dual-energy computed tomography. Respir Res 2022; 23:47. [PMID: 35248040 PMCID: PMC8897904 DOI: 10.1186/s12931-022-01972-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background High-resolution computed tomography (HRCT) is recommended diagnosing and monitoring connective tissue disease-associated interstitial lung disease (CTD-ILD). Quantitative computed tomography has the potential to precisely assess the radiological severity of CTD-ILD, but has still been under study. Objective To investigate whether dual-energy computed tomography (DECT), a novel quantitative technique, can be used for quantitative severity assessment in CTD-ILD. Methods This cross sectional study recruited adult CTD-ILD patients who underwent DECT scans from the ICE study between October 2019 and November 2021. DECT parameters, including effective atomic number (Zeff), lung (lobe) volume, and monochromatic CT number (MCTN) of each lung lobe, were evaluated. CTD-ILD was classified into extensive CTD-ILD and limited CTD-ILD by staging algorithm using combined forced vital capacity (FVC)%predicted and total extent of ILD (TEI) on CT. Dyspnea, cough, and life quality were scored by Borg dyspnea score, Leicester cough questionnaire (LCQ), and short-form 36 health survey questionnaire (SF-36), respectively. Results There was a total of 147 patients with DECT scans enrolled. Higher Zeff value (3.104 vs 2.256, p < 0.001), higher MCTN (− 722.87 HU vs − 802.20 HU, p < 0.001), and lower lung volume (2309.51cm3 vs 3475.21cm3, p < 0.001) were found in extensive CTD-ILD compared with limited CTD-ILD. DECT parameters had significant moderate correlations with FVC%predicted (|r|= 0.542–0.667, p < 0.01), DLCO%predicted (|r|= 0.371–0.427, p < 0.01), and TEI (|r|= 0.485–0.742, p < 0.01). Receiver operating characteristic (ROC) analysis indicated MCTN averaged over the whole lung had the best performance for extensive CTD-ILD discrimination (AUC = 0.901, cut-off: − 762.30 HU, p < 0.001), with a sensitivity of 82.1% and a specificity of 85.4%. The Zeff value was the independent risk factor for dyspnea (OR = 3.644, 95% CI: 1.846–7.192, p < 0.001) and cough (OR = 3.101, 95% CI: 1.528–6.294, p = 0.002), and lung volume significantly contributed to the mental component summary (MCS) in SF-36 (standardized β = 0.198, p < 0.05). Conclusions DECT can be applied to evaluate the severity of CTD-ILD. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01972-4.
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Volkmann ER, Kreuter M, Hoffmann-Vold AM, Wijsenbeek M, Smith V, Khanna D, Denton CP, Wuyts WA, Miede C, Alves M, Sambevski S, Allanore Y. Dyspnoea and cough in patients with systemic sclerosis-associated interstitial lung disease in the SENSCIS trial. Rheumatology (Oxford) 2022; 61:4397-4408. [PMID: 35150246 PMCID: PMC9629379 DOI: 10.1093/rheumatology/keac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of these analyses was to investigate the rate of decline in forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (SSc-ILD) with and without cough or dyspnoea in the SENSCIS trial. Methods Patients in the SENSCIS trial were randomized to receive nintedanib or placebo. Subgroups with and without cough or dyspnoea at baseline were defined by responses to the St George’s Respiratory Questionnaire. Results At baseline, 114/575 patients (19.8%) did not have cough and 172/574 patients (30.0%) did not have dyspnoea. In the placebo group, the rate of FVC decline over 52 weeks was similar in patients with and without cough (−95.6 and −83.4 mL/year, respectively) or dyspnoea (−95.8 and −87.7 mL/year, respectively). The effect of nintedanib vs placebo on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough [difference: 74.4 (95% CI −11.1, 159.8) vs 31.5 (−11.1, 74.1)] and without than with dyspnoea [79.8 (9.8, 149.7) vs 25.7 (−19.9, 71.3)], but interaction P-values did not indicate heterogeneity in the treatment effect between these subgroups (P = 0.38 and P = 0.20, respectively). Conclusion In the placebo group of the SENSCIS trial, the rate of FVC decline was similar irrespective of the presence of cough or dyspnoea at baseline. The effect of nintedanib on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough or dyspnoea at baseline, but no statistically significant heterogeneity was observed between the subgroups. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02597933.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Vanessa Smith
- Department of Rheumatology and Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher P Denton
- University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
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Ruaro B, Baratella E, Confalonieri P, Wade B, Marrocchio C, Geri P, Busca A, Pozzan R, Andrisano AG, Cova MA, Confalonieri M, Salton F. High-Resolution Computed Tomography: Lights and Shadows in Improving Care for SSc-ILD Patients. Diagnostics (Basel) 2021; 11:1960. [PMID: 34829307 PMCID: PMC8617987 DOI: 10.3390/diagnostics11111960] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and classification of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is essential to improve the prognosis of systemic sclerosis (SSc) patients. The risk-stratification of disease severity and follow-up requires a multidisciplinary approach, integrating high-resolution computed tomography (HRTC) of the lung, pulmonary function tests (PFT), along with clinical and symptomatic evaluations. The use of HRCT in detecting SSc-ILD is not so much based on a definitive validation, but rather reflects the widespread clinician recognition of dissatisfaction with other modalities. However, due to the heterogeneity of SSc-ILD and the potential absence of symptoms in early or mild disease, it is prudent to consider as many parameters as possible in the assessment and monitoring of newly diagnosed patients. An early diagnosis meets the primary goal, i.e., the prevention of disease progression. The current first line treatment regimens are mainly centered on immunosuppressive therapy. This review assesses the role HRCT plays in optimizing care and improving clinical outcomes in SSc-ILD patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Annalisa Busca
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Alessia Giovanna Andrisano
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
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9
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Aronson KI, Suzuki A. Health Related Quality of Life in Interstitial Lung Disease: Can We Use the Same Concepts Around the World? Front Med (Lausanne) 2021; 8:745908. [PMID: 34692737 PMCID: PMC8526733 DOI: 10.3389/fmed.2021.745908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/31/2021] [Indexed: 01/17/2023] Open
Abstract
Health-Related Quality of Life (HRQOL) is increasingly viewed as an important patient-centered outcome by leading health organizations, clinicians, and patients alike. This is especially true in the interstitial lung disease community where patients often struggle with progressive and debilitating disease with few therapeutic options. In order to test the effectiveness of new pharmacologic therapies and non-pharmacologic interventions globally in ILD, this will require expansion of clinical research studies to a multinational level and HRQOL will be an important endpoint to many. In order to successfully expand trials across multiple nations and compare the results of studies between different communities we must recognize that there are differences in the concepts of HRQOL across the world and have strategies to address these differences. In this review, we will describe the different global influences on HRQOL both generally and in the context of ILD, discuss the processes of linguistic translation and cross-cultural adaptation of HRQOL Patient Reported Outcome Measures (PROMs), and highlight the gaps and opportunities for improving HRQOL measurement in ILD across the world.
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Affiliation(s)
- Kerri I. Aronson
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Atsushi Suzuki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Wilfong EM, Vowell KN, Bunn KE, Rizzi E, Annapureddy N, Dudenhofer RB, Barnado A, Bonami RH, Johnson JE, Crofford LJ, Kendall PL. CD19 + CD21 lo/neg cells are increased in systemic sclerosis-associated interstitial lung disease. Clin Exp Med 2021; 22:209-220. [PMID: 34374937 PMCID: PMC8828801 DOI: 10.1007/s10238-021-00745-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Interstitial lung disease (ILD) represents a significant cause of morbidity and mortality in systemic sclerosis (SSc). The purpose of this study was to examine recirculating lymphocytes from SSc patients for potential biomarkers of interstitial lung disease (ILD). Peripheral blood mononuclear cells (PBMCs) were isolated from patients with SSc and healthy controls enrolled in the Vanderbilt University Myositis and Scleroderma Treatment Initiative Center cohort between 9/2017–6/2019. Clinical phenotyping was performed by chart abstraction. Immunophenotyping was performed using both mass cytometry and fluorescence cytometry combined with t-distributed stochastic neighbor embedding analysis and traditional biaxial gating. This study included 34 patients with SSc-ILD, 14 patients without SSc-ILD, and 25 healthy controls. CD21lo/neg cells are significantly increased in SSc-ILD but not in SSc without ILD (15.4 ± 13.3% vs. 5.8 ± 0.9%, p = 0.002) or healthy controls (5.0 ± 0.5%, p < 0.0001). While CD21lo/neg B cells can be identified from a single biaxial gate, tSNE analysis reveals that the biaxial gate is comprised of multiple distinct subsets, all of which are increased in SSc-ILD. CD21lo/neg cells in both healthy controls and SSc-ILD are predominantly tBET positive and do not have intracellular CD21. Immunohistochemistry staining demonstrated that CD21lo/neg B cells diffusely infiltrate the lung parenchyma of an SSc-ILD patient. Additional work is needed to validate this biomarker in larger cohorts and longitudinal studies and to understand the role of these cells in SSc-ILD.
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Affiliation(s)
- Erin M Wilfong
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.,Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine N Vowell
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kaitlyn E Bunn
- Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elise Rizzi
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Narender Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rosemarie B Dudenhofer
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - April Barnado
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachel H Bonami
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN, USA
| | - Joyce E Johnson
- Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN, USA
| | - Peggy L Kendall
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA. .,Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN, USA. .,Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8122, St. Louis, MO, 63110, USA.
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11
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Aronson KI, Danoff SK, Russell AM, Ryerson CJ, Suzuki A, Wijsenbeek MS, Bajwah S, Bianchi P, Corte TJ, Lee JS, Lindell KO, Maher TM, Martinez FJ, Meek PM, Raghu G, Rouland G, Rudell R, Safford MM, Sheth JS, Swigris JJ. Patient-centered Outcomes Research in Interstitial Lung Disease: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e3-e23. [PMID: 34283696 PMCID: PMC8650796 DOI: 10.1164/rccm.202105-1193st] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: In the past two decades, many advances have been made to our understanding of interstitial lung disease (ILD) and the way we approach its treatment. Despite this, many questions remain unanswered, particularly those related to how the disease and its therapies impact outcomes that are most important to patients. There is currently a lack of guidance on how to best define and incorporate these patient-centered outcomes in ILD research. Objectives: To summarize the current state of patient-centered outcomes research in ILD, identify gaps in knowledge and research, and highlight opportunities and methods for future patient-centered research agendas in ILD. Methods: An international interdisciplinary group of experts was assembled. The group identified top patient-centered outcomes in ILD, reviewed available literature for each outcome, highlighted important discoveries and knowledge gaps, and formulated research recommendations. Results: The committee identified seven themes around patient-centered outcomes as the focus of the statement. After a review of the literature and expert committee discussion, we developed 28 research recommendations. Conclusions: Patient-centered outcomes are key to ascertaining whether and how ILD and interventions used to treat it affect the way patients feel and function in their daily lives. Ample opportunities exist to conduct additional work dedicated to elevating and incorporating patient-centered outcomes in ILD research.
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12
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High-intensity interval training can improve hand grip strength, inspiratory muscle, and quality of life in systemic sclerosis subjects. Reumatologia 2021; 59:98-103. [PMID: 33976463 PMCID: PMC8103409 DOI: 10.5114/reum.2021.105454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Systemic sclerosis/scleroderma (SSc) is a chronic autoimmune disease with connective tissue, multi-organ, and multisystem involvement. The disease has three main characteristics, namely vasculopathy, fibrosis, and autoimmunity. The effect of high-intensity interval training (HIIT) in aerobic exercise on other rheumatic diseases has been studied, for example in patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). The purpose of this work is to investigate the effectiveness of HIIT of aerobics exercise on improving the inspiratory muscle, quality of life and functional ability for systemic sclerosis subjects. Material and methods The study was conducted on patients with confirmed systemic sclerosis who met the inclusion criteria. The research was carried out for 12 months in the outpatient clinic and gait laboratory of the Department of Physical Medicine and Rehabilitation. Results After HIIT in aerobic exercise, we found significant changes in inspiratory muscle (SNIP values 45.67 [30.92] vs. 54.25 [22.71]), handgrip (13.14 [4.42] vs. 15.63 [4.08]), walking speed (184.70 [26.86] vs. 246.6 [12.30]), metabolic equivalent (3.53 [0.30] vs. 4.21 [1.25]) and Scleroderma-Specific Health Assessment Questionnaire Disability Index for all visual analog scale (VAS) domains except Disability Index. Exercise approaches are characterized by repeated cycles of exercise interrupted by rest. For a range of clinical conditions, HIIT in aerobic exercise is known to remedy blood vessel function. Conclusions Our results suggest that HIIT in aerobic exercise has improved functional ability, respiratory muscle strength, and quality of life in SSc subjects. Training twice a week in a 12-week HIIT program is considered to be safe for this population. We have to consider internal and external factors that influenced the result. A larger sample and further exploration of the feasibility of combined exercise in SSc patients should be the focus for future research.
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13
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Topcu A, Mursaloglu HH, Yalcinkaya Y, Karakurt S, Yagiz B, Alaca Z, Demir M, Coskun BN, Dalkilic E, Inanc N. Evaluation of rheumatoid arthritis and connective tissue disease-related interstitial lung disease with pulmonary physiologic test, HRCT, and patient-based measures of dyspnea and functional disability. Clin Rheumatol 2021; 40:3797-3805. [PMID: 33811590 DOI: 10.1007/s10067-021-05693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We aim to investigate the relationship between pulmonary function and imaging parameters with symptom-related patient-reported outcome measures (PROs). METHOD We included 65 patients of rheumatoid arthritis (RA) and connective tissue disease (CTD) with and without interstitial lung disease (ILD) into this cross-sectional study. We evaluated the relationship between FVC, DLco, and PROs and compared to HRCT findings. PROs included visual analogue scale for breathing, modified Borg scale, medical research council dyspnea scale, St. George's respiratory questionnaire (SGRQ), Leicester cough questionnaire, and Short Form 36 quality of life (SF-36 QoL). RESULTS The mean age was 57.4 ± 9.7 and 61.9% (39/65) of patients had an established ILD. In RA-ILD group, SGRQ score was higher (p < 0.001) and SF-36 physical functioning score was lower (p = 0.02) than CTD-ILD group. In RA group, there was a significant correlation between FVC and SF-36 role functioning/physical score (r = 0.724, p = 0.012). In CTD group, SF-36 general health score was correlated with both FVC (r = 0.441, p = 0.045) and DLco (r = 0.485, p = 0.035), and also SF-36 physical functioning score was correlated with FVC (r = 0.441, p = 0.040). PROs were found to be similar between ILD and non-ILD patients. SF-36 QoL total and SGRQ outcomes were worse in non-ILD group. CONCLUSIONS We concluded that PROs could be used to evaluate health-related quality of life (HRQoL) in RA- or CTD-related ILD. The physical health determinants of HRQoL are measurably worse in RA-ILD patients than in CTD patients. But, PROs may not be very helpful in differentiating patients with cough and/or shortness of breath due to ILD or non-ILD causes in RA/CTD. KEY POINTS • HRQoL may be affected differently among specific subtypes of ILD. • PROs can be used to evaluate dyspnea and function of patients with RA- or CTD-related ILD but are not distinguished from patients with cough and/or shortness of breath due to non-ILD causes in RA/CTD.
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Affiliation(s)
- Atakan Topcu
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Yasemin Yalcinkaya
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Sait Karakurt
- Department of Chest Diseases and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Burcu Yagiz
- Division of Rheumatology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Zeynep Alaca
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Meryem Demir
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Belkis Nihan Coskun
- Division of Rheumatology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey.
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14
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Rotondo C, Urso L, Praino E, Cacciapaglia F, Corrado A, Cantatore FP, Iannone F. Thoracic lymphadenopathy as possible predictor of the onset of interstitial lung disease in systemic sclerosis patients without lung involvement at baseline visit: A retrospective analysis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:210-218. [DOI: 10.1177/2397198320923545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/08/2020] [Indexed: 12/25/2022]
Abstract
Objective: To evaluate clinical, laboratory, or radiographic predictors of the onset of interstitial lung disease in systemic sclerosis. Methods: Sixty-five out of 220 systemic sclerosis outpatients, without interstitial lung disease at baseline and with ⩾3 chest high resolution computed tomography scans during follow-up were recruited. Thoracic lymphadenopathy and interstitial lung disease were assessed by chest high resolution computed tomography. Hazard ratio (95% confidence interval) of interstitial lung disease occurrence was assessed by Cox regression models, adjusting patient’s demographics and disease characteristics. Sensitivity, specificity, and accuracy of the interstitial lung disease predictors were evaluated by receiver operating characteristic analysis. Results: The development of interstitial lung disease was observed in 44/65 (68%) patients. Thoracic lymphadenopathies was detected in 40/65 (61%) patients, of whom 36 (82%) developed interstitial lung disease, but only four patients with thoracic lymphadenopathies did not develop ILD at last visit of follow-up (19%) (p = 0.0001). Adjusted hazard ratio of systemic sclerosis-interstitial lung disease onset was 5.8 (95% confidence interval, 2.0–16.5) for thoracic lymphadenopathy, which preceded by 108 ± 98 weeks the systemic sclerosis-interstitial lung disease detection. Thoracic lymphadenopathy had 84% specificity, 81% sensitivity, and 0.82 accuracy to predict interstitial lung disease. In particular, anticentromere antibodies or limited cutaneous subset of systemic sclerosis patients with thoracic lymphadenopathy showed earlier interstitial lung disease onset than those without lymphadenopathy. In addition, patients who developed interstitial lung disease had higher frequency of anti-Scl-70 (57% vs 19%; p = 0.009) and diffuse cutaneous subset (29% vs 3%; p = 0.02) than those who did not. Conclusions: Thoracic lymphadenopathy was the strongest independent predictor of systemic sclerosis-interstitial lung disease, mostly in anticentromere antibodies and limited cutaneous subset of systemic sclerosis patients. Further prospective studies are needed to confirm our preliminary data and to understand whether thoracic lymphadenopathies may have a pathogenetic role in interstitial lung disease development.
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Affiliation(s)
- Cinzia Rotondo
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Livio Urso
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
| | - Emanuela Praino
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
| | - Fabio Cacciapaglia
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
| | - Addolorata Corrado
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantations, University of Bari Aldo Moro, Bari, Italy
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15
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Pauling JD, Caetano J, Campochiaro C, De Luca G, Gheorghiu AM, Lazzaroni MG, Khanna D. Patient-reported outcome instruments in clinical trials of systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:90-102. [PMID: 35382020 PMCID: PMC8922614 DOI: 10.1177/2397198319886496] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/04/2019] [Indexed: 09/01/2023]
Abstract
Patient-reported outcome instruments provide valuable insight into disease-related morbidity known only to the patient and complement more objective outcome tools in the clinical trial setting. They are of particular importance in systemic sclerosis owing to the challenges around defining disease activity, the episodic nature of many disease-specific manifestations and the paucity of validated objective surrogate outcome measures for use in clinical trials. Early clinical trials of systemic sclerosis often incorporated legacy patient-reported outcome instruments, but the last 20 years has witnessed the emergence of several scleroderma-specific instruments that are now being routinely used alongside other outcomes in systemic sclerosis clinical trials. More recently, the value of patient-reported outcomes has been highlighted by their prominence in the American College of Rheumatology Combined Response Index for Systemic Sclerosis that has been utilized as the primary endpoint of recent clinical trials of early diffuse systemic sclerosis. This review considers the role and performance of the various patient-reported outcome instruments utilized in systemic sclerosis clinical trials, the current positioning of patient-reported outcome instruments within clinical trial endpoint models across the range of systemic sclerosis disease manifestations and, where applicable, we shall highlight areas for future research.
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Affiliation(s)
- John D Pauling
- Royal National Hospital for Rheumatic Diseases, Bath, UK
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - Joana Caetano
- Systemic Immune-Mediated Diseases Unit, Department of Medicine IV, Fernando Fonseca Hospital, Amadora, Portugal
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ana Maria Gheorghiu
- Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Dinesh Khanna
- Scleroderma Program, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
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16
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Saketkoo LA, Scholand MB, Lammi MR, Russell AM. Patient-reported outcome measures in systemic sclerosis-related interstitial lung disease for clinical practice and clinical trials. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:48-60. [PMID: 32455167 DOI: 10.1177/2397198320904178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Systemic sclerosis (SSc) is a progressive vasculopathic, fibrosing autoimmune condition, portending significant mortality; wherein interstitial lung disease (ILD) is the leading cause of death. Although lacking a definitive cure, therapeutics for (SSc-ILD) that stave progression exist with further promising primary and adjuvant compounds in development, as well as interventions to reduce symptom burden and increase quality of life. To date, there has been a significant but varied history related to systemic sclerosis-related interstitial lung disease trial design and endpoint designation. This is especially true of endpoints measuring patient-reported perceptions of efficacy and tolerability. This article describes the underpinnings and complexity of the science, methodology, and current state of patient-reported outcome measures used in (SSc-ILD) systemic sclerosis-related interstitial lung disease in clinical practice and trials.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Interstitial Lung Disease Clinic Programs, Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, LA, USA.,Division of Pulmonary Diseases, School of Medicine, Louisiana State University, New Orleans, LA, USA.,School of Medicine, Tulane University, New Orleans, LA, USA
| | - Mary Beth Scholand
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, UT, USA
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Interstitial Lung Disease Clinic Programs, Comprehensive Pulmonary Hypertension Center, University Medical Center, New Orleans, LA, USA.,Division of Pulmonary Diseases, School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Anne-Marie Russell
- National Heart and Lung Institute, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
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17
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Hajsadeghi S, Mirshafiee S, Pazoki M, Moradians V, Mansouri P, Kianmehr N, Iranpour A. The relationship between global longitudinal strain and pulmonary function tests in patients with scleroderma and normal ejection fraction and pulmonary artery pressure: a case-control study. Int J Cardiovasc Imaging 2020; 36:883-888. [PMID: 32060775 DOI: 10.1007/s10554-020-01788-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/31/2020] [Indexed: 11/25/2022]
Abstract
This study examined the relationship between global longitudinal strain (GLS) and pulmonary function tests (PFT) in patients with systemic sclerosis (SS) and normal ejection fraction (EF) and pulmonary artery pressure (PAP) and healthy controls. Sixty patients in two groups underwent extensive screening, including echocardiography, physical examination, the modified Rodnan Skin Score, and pulmonary function tests. Pulmonary interstitial disease was diagnosed by the pulmonary function test and by CT scan in case of indication. GLS score was computed as the mean peak systolic strain for 17 segments. The mean GLS score was - 18.36 ± 2.1 in the case group and - 20.66 ± 1.6 in the control group (P value < 0.001). GLS scores had a significant inverse relationship with the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio (P value = 0.049) and both FEV and FVC in patients younger than 35 years old (P = 0.046 and 0.049, respectively). GLS scores had no significant relationship with time elapsed since the onset of skin manifestations, and Raynaud phenomenon, Rodnan score, EF, systolic PAP, or the six-minute walk test results. The patients' six-minute walk test had a significant positive relationship with FVC and right ventricular end diastolic diameter (P value = 0.018 and 0.047, respectively). According to our findings, GLS is significantly lower in patients with SS (with normal EF & PAP) than in healthy individuals. It is also related with certain pulmonary function indices including FEV1/FVC. The reduction in GLS is associated with reduced pulmonary function strength.
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MESH Headings
- Adult
- Arterial Pressure
- Case-Control Studies
- Exercise Tolerance
- Female
- Forced Expiratory Volume
- Humans
- Lung/blood supply
- Lung/physiopathology
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/physiopathology
- Male
- Middle Aged
- Myocardial Contraction
- Prognosis
- Pulmonary Arterial Hypertension/diagnosis
- Pulmonary Arterial Hypertension/etiology
- Pulmonary Arterial Hypertension/physiopathology
- Pulmonary Artery/physiopathology
- Risk Factors
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/physiopathology
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Vital Capacity
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahboubeh Pazoki
- Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Vahan Moradians
- Pulmonology Department, Hazrat-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nahid Kianmehr
- Internal Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - Aida Iranpour
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
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18
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Mugii N, Someya F, Noto S, Hamaguchi Y, Matsushita T, Takehara K. Availability of EuroQol-5-Dimensions-5-Level (EQ-5D-5L) as health-related QOL assessment for Japanese systemic sclerosis patients. Mod Rheumatol 2019; 30:681-686. [DOI: 10.1080/14397595.2019.1640409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Naoki Mugii
- Department of Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
- Division of Health Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Fujiko Someya
- School of Health Science, Kanazawa University, Kanazawa, Japan
| | - Shinichi Noto
- Department of Health Science, Niigata University of Health and Welfare, Niigata, Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takashi Matsushita
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Yates H, Adamali HI, Maskell N, Barratt S, Sharp C. Visual analogue scales for interstitial lung disease: a prospective validation study. QJM 2018; 111:531-539. [PMID: 29788503 DOI: 10.1093/qjmed/hcy102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Visual analogue scales (VAS) are simple symptom assessment tools which have not been validated in interstitial lung disease (ILD). Simple measures of ILD disease burden would be valuable for non-specialist clinicians monitoring disease away from ILD specialist centres. OBJECTIVE To validate VAS to assess change in dyspnoea, cough and fatigue in ILD, and to define the minimal clinically important difference (MCID) for change in these. METHODS Patients of 64 with ILD completed VAS for dyspnoea, cough and fatigue. Baseline King's Brief ILD questionnaire (K-BILD) scores, lung function and 6-min walk test results were collected. Tests were repeated 3-6 months later, in addition to a seven-point Likert scale. The MCID was estimated using median change in VAS in patients who reported 'small but just worthwhile change' in symptoms at follow-up. Methods were repeated in a validation cohort of 31 ILD patients to confirm findings. RESULTS VAS scores were significantly higher for patients who reported a 'small but just worthwhile change' in symptoms vs. 'no change' or 'not worthwhile change' (P < 0.01). The MCID for VAS Dyspnoea was estimated as 22.0 mm and 14.5 mm for VAS Fatigue. These results were reproducible in the validation cohort. Results were not significant for VAS Cough. Change in VAS Dyspnoea correlated with change in K-BILD (r = -0.51, P < 0.01), forced vital capacity (r = -0.32, P = 0.01) and 6-min walking distance (r = -0.37, P = 0.01). CONCLUSION The VAS is valid for assessing change in dyspnoea and fatigue in ILD. The MCID is estimated as 22.0 mm for dyspnoea and 14.5 mm for fatigue. This could be used to monitor disease in settings away from ILD specialist review. MESH DESCRIPTORS Lung Diseases, Interstitial, Dyspnoea, Fatigue, Cough.
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Affiliation(s)
- H Yates
- Respiratory and Sleep Physiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - H I Adamali
- Bristol ILD Service, North Bristol NHS Trust, Bristol, UK
| | - N Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - S Barratt
- Bristol ILD Service, North Bristol NHS Trust, Bristol, UK
| | - C Sharp
- Respiratory Department, Gloucestershire Hospitals NHS Foundation Trust, Gloucester Royal Hospital, Great Western Road, Gloucester, UK
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Asano Y, Jinnin M, Kawaguchi Y, Kuwana M, Goto D, Sato S, Takehara K, Hatano M, Fujimoto M, Mugii N, Ihn H. Diagnostic criteria, severity classification and guidelines of systemic sclerosis. J Dermatol 2018; 45:633-691. [PMID: 29687465 DOI: 10.1111/1346-8138.14162] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 01/17/2023]
Abstract
Several effective drugs have been identified for the treatment of systemic sclerosis (SSc). However, in advanced cases, not only their effectiveness is reduced but they may be also harmful due to their side-effects. Therefore, early diagnosis and early treatment is most important for the treatment of SSc. We established diagnostic criteria for SSc in 2003 and early diagnostic criteria for SSc in 2011, for the purpose of developing evaluation of each organ in SSc. Moreover, in November 2013, the American College of Rheumatology and the European Rheumatology Association jointly developed new diagnostic criteria for increasing their sensitivity and specificity, so we revised our diagnostic criteria and severity classification of SSc. Furthermore, we have revised the clinical guideline based on the newest evidence. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of SSc.
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Affiliation(s)
- Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Goto
- Department of Rheumatology, Faculty of Medicine, Univertity of Tsukuba, Ibaraki, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Masaru Hatano
- Graduate School of Medicine Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoki Mugii
- Section of Rehabilitation, Kanazawa University Hospital, Ishikawa, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Relationship between interstitial lung disease and oesophageal dilatation on chest high-resolution computed tomography in patients with systemic sclerosis: a cross-sectional study. Radiol Med 2018; 123:655-663. [PMID: 29687210 DOI: 10.1007/s11547-018-0894-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/11/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Oesophageal dilatation (OD) has been implicated in the pathogenesis of interstitial lung disease (ILD) in systemic sclerosis (SSc). The aims of this study were to explore the association of the OD and SSc-ILD on chest high-resolution computed tomography (HRCT), and to establish a cutoff point for the OD suggestive for the presence of a significant lung involvement. METHODS The widest oesophageal diameter (WOD) was obtained on axial HRCT images. The parenchymal abnormalities on HRCT were coded and scored according to Warrick method. Patient-centred measures, pulmonary function tests and the single breath carbon monoxide diffusing capacity of the lung (DLco) were also obtained. Multivariate regression analysis was performed to identify factors associated with oesophageal diameter. RESULTS 126 subjects with SSc were included. The mean (± SD) WOD was 13.5 (± 4.2) mm, and in 76 (60.3%) participants WOD was ≥ 11 mm. SSc patients with ILD had larger oesophageal diameters than those without lung disease (19.4 vs. 14.1 mm, p < 0.001). We observed a high correlation between WOD and gastro-oesophageal reflux disease questionnaire (GerdQ) (r = 0.886, p < 0.001), Borg score (r = 0.705, p < 0.001), and Warrick score (r = 0.614, p < 0.001). WOD negatively correlated with DLco (r = - 0.508, p < 0.001). Multivariate analysis demonstrated positive associations between WOD and GerdQ (p < 0.0001), Borg score (p < 0.0005), and total Warrick score (p = 0.019). CONCLUSION An increased oesophageal diameter (> 11 mm) on chest HRCT is associated with pulmonary and oesophageal symptoms, more severe ILD, and lower DLco.
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Mugii N, Hamaguchi Y, Maddali-Bongi S. Clinical significance and usefulness of rehabilitation for systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:71-80. [PMID: 35382125 PMCID: PMC8892873 DOI: 10.1177/2397198317750043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 07/30/2023]
Abstract
Systemic sclerosis is a multisystem connective tissue disorder characterized by excessive fibrosis of the skin and internal organs. Impairments in skin, the musculoskeletal system, and respiratory system require rehabilitation therapy because they may lead to disabilities and reduce the quality of life in daily activities. Rehabilitation for systemic sclerosis mainly comprises two distinct approaches that include local and global rehabilitation. Local rehabilitation is applied to maintain and/or improve hand and face functions, while global rehabilitation includes aerobic and resistance exercises. Although few high-quality randomized clinical trials have been conducted to date, previous studies indicated the effectiveness of rehabilitation therapy for decreasing local and systemic disabilities, resulting in improved quality of life. Rehabilitation for systemic sclerosis needs to be regularly and constantly performed at home as well as in hospitals. Physicians involved in the treatment of systemic sclerosis need to consider rehabilitation, and skilled physiotherapists and occupational therapists also play a crucial role in evaluating and treating systemic sclerosis patients.
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Affiliation(s)
- Naoki Mugii
- Department of Rehabilitation, Kanazawa
University Hospital, Kanazawa - Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, School of
Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa
University, Kanazawa - Japan
| | - Susanna Maddali-Bongi
- Rheumatological Rehabilitation Unit,
Division of General Rehabilitation, Department of Experimental and Clinical
Medicine, University of Florence, Florence - Italy
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Barnes H, Holland AE, Westall GP, Goh NSL, Glaspole IN. Cyclophosphamide for connective tissue disease-associated interstitial lung disease. Cochrane Database Syst Rev 2018; 1:CD010908. [PMID: 29297205 PMCID: PMC6491200 DOI: 10.1002/14651858.cd010908.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately one-third of individuals with interstitial lung disease (ILD) have associated connective tissue disease (CTD). The connective tissue disorders most commonly associated with ILD include scleroderma/systemic sclerosis (SSc), rheumatoid arthritis, polymyositis/dermatomyositis, and Sjögren's syndrome. Although many people with CTD-ILD do not develop progressive lung disease, a significant proportion do progress, leading to reduced physical function, decreased quality of life, and death. ILD is now the major cause of death amongst individuals with systemic sclerosis.Cyclophosphamide is a highly potent immunosuppressant that has demonstrated efficacy in inducing and maintaining remission in autoimmune and inflammatory illnesses. However this comes with potential toxicities, including nausea, haemorrhagic cystitis, bladder cancer, bone marrow suppression, increased risk of opportunistic infections, and haematological and solid organ malignancies.Decision-making in the treatment of individuals with CTD-ILD is difficult; the clinician needs to identify those who will develop progressive disease, and to weigh up the balance between a high level of need for therapy in a severely unwell patient population against the potential for adverse effects from highly toxic therapy, for which only relatively limited data on efficacy can be found. Similarly, it is not clear whether histological subtype, disease duration, or disease extent can be used to predict treatment responsiveness. OBJECTIVES To assess the efficacy and adverse effects of cyclophosphamide in the treatment of individuals with CTD-ILD. SEARCH METHODS We performed searches on CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science up to May 2017. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. SELECTION CRITERIA We included randomised controlled parallel-group trials that compared cyclophosphamide in any form, used individually or concomitantly with other immunomodulating therapies, versus non-cyclophosphamide-containing therapies for at least six months, with follow-up of at least 12 months from the start of treatment. DATA COLLECTION AND ANALYSIS We imported studies identified by the search into a reference manager database. We retrieved the full-text versions of relevant studies, and two review authors independently extracted data. Primary outcomes were change in lung function (change in forced vital capacity (FVC) % predicted and diffusing capacity of the lung for carbon monoxide (DLCO) % predicted), adverse events, and health-related quality of life measures. Secondary outcomes included all-cause mortality, dyspnoea, cough, and functional exercise testing. When appropriate, we performed meta-analyses and subgroup analyses by severity of lung function, connective tissue disease diagnosis, and radiological pattern of fibrosis. We assessed the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and created 'Summary of findings' tables. MAIN RESULTS We included in the analysis four trials with 495 participants (most with systemic sclerosis). We formed two separate comparisons: cyclophosphamide versus placebo (two trials, 195 participants) and cyclophosphamide versus mycophenolate (two trials, 300 participants). We found evidence to be of low quality, as dropout rates were high in the intervention groups, and as we noted a wide confidence interval around the effect with small differences, which affected the precision of results.The data demonstrates significant improvement in lung function with cyclophosphamide compared with placebo (post-treatment FVC % mean difference (MD) 2.83, 95% confidence interval (CI) 0.80 to 4.87; P = 0.006) but no significant difference in post-treatment DLCO (% MD -1.68, 95% CI -4.37 to 1.02; P = 0.22; two trials, 182 participants).Risk of adverse effects was increased in the cyclophosphamide treatment groups compared with the placebo groups, in particular, haematuria, leukopenia, and nausea, leading to a higher rate of withdrawal from cyclophosphamide treatment. The data demonstrates statistically significant improvement in one-measure of quality of life in one trial favouring cyclophosphamide over placebo and clinically and statistically significant improvement in breathlessness in one trial favouring cyclophosphamide compared with placebo, with no significant impact on mortality.Trialists reported no significant impact on lung function when cyclophosphamide was used compared with mycophenolate at 12 months (FVC % MD -0.82, 95% CI -3.95 to 2.31; P = 0.61; two trials, 149 participants; DLCO % MD -1.41, 95% CI -10.40 to 7.58; P = 0.76; two trials, 149 participants).Risk of side effects was increased with cyclophosphamide versus mycophenolate, in particular, leukopenia and thrombocytopenia.The data demonstrates no significant impact on health-related quality of life, all-cause mortality, dyspnoea, or cough severity in the cyclophosphamide group compared with the mycophenolate group. No trials reported outcomes associated with functional exercise tests.We performed subgroup analysis to determine whether severity of lung function, connective tissue disease diagnosis, or radiological pattern had any impact on outcomes. One trial reported that cyclophosphamide protected against decreased FVC in individuals with worse fibrosis scores, and also showed that cyclophosphamide may be more effective in those with worse lung function. No association could be made between connective tissue disease diagnosis and outcomes. AUTHORS' CONCLUSIONS This review, which is based on studies of varying methodological quality, demonstrates that overall, in this population, small benefit may be derived from the use of cyclophosphamide in terms of mean difference in % FVC when compared with placebo, but not of the difference in % DLCO, or when compared with mycophenolate. Modest clinical improvement in dyspnoea may be noted with the use of cyclophosphamide. Clinical practice guidelines should advise clinicians to consider individual patient characteristics and to expect only modest benefit at best in preserving FVC. Clinicians should carefully monitor for adverse effects during treatment and in the years thereafter.Further studies are required to examine the use of cyclophosphamide; they should be adequately powered to compare outcomes within different subgroups, specifically, stratified for extent of pulmonary infiltrates on high-resolution computed tomography (HRCT) and skin involvement in SSc. Studies on other forms of connective tissue disease are needed. Researchers may consider comparing cyclophosphamide (a potent immunosuppressant) versus antifibrotic agents, or comparing both versus placebo, in particular, for those with evidence of rapidly progressive fibrotic disease, who may benefit the most.
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Affiliation(s)
- Hayley Barnes
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Anne E Holland
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe UniversityDiscipline of PhysiotherapyMelbourneVictoriaAustralia3086
- The Alfred HospitalDepartment of PhysiotherapyMelbourneVictoriaAustralia3181
- Austin HealthInstitute for Breathing and SleepMelbourneAustralia
| | - Glen P Westall
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Nicole SL Goh
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Ian N Glaspole
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
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de Oliveira NC, Portes LA, Pettersson H, Alexanderson H, Boström C. Aerobic and resistance exercise in systemic sclerosis: State of the art. Musculoskeletal Care 2017; 15:316-323. [PMID: 28378937 DOI: 10.1002/msc.1185] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Patients with systemic sclerosis (SSc) experience reduced exercise capacity and muscle strength compared with healthy subjects. There are also indications of reduced levels of physical activity. OBJECTIVE To present the current knowledge of physical exercise in SSc. RESULTS Most studies presently available [three case studies, one single subject experimental design, one study comparing patients with healthy controls, one quasi experimental design (pre-post), two clinical trials and two random controlled trials] have included small samples of patients, mostly composed of patients with and without pulmonary involvement. It seems that patients with SSc without pulmonary involvement are able to perform and benefit from aerobic exercises of at least moderate intensity. Exercise tolerance, aerobic capacity, walking distance, muscle strength and muscle function as well as health-related quality of life (HRQL) have been found to be improved after participation in programmes including aerobic exercise and aerobic exercise combined with resistance exercises. Improvements seem to be only partially retained at follow up. Patients with pulmonary involvement may also experience improved muscle strength, physical and aerobic capacity, as well as HRQL following exercise. CONCLUSIONS Patients with SSc without pulmonary involvement can be recommended to be as physically active as the general population. Patients with mild pulmonary involvement can be recommended to be physically active by engaging in exercises of moderate intensity and to participate in moderate-load resistance exercises. Health professionals should inform patients with SSc about the importance of physical activity and avoidance of a sedentary lifestyle.
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Affiliation(s)
- Natália Cristina de Oliveira
- Research Group in Physical Exercise, Lifestyle and Health Promotion. Health Promotion Master Program, UNASP - Adventist University of São Paulo, São Paulo, SP, Brazil
| | - Leslie Andrews Portes
- Research Group in Physical Exercise, Lifestyle and Health Promotion. Health Promotion Master Program, UNASP - Adventist University of São Paulo, São Paulo, SP, Brazil
| | - Henrik Pettersson
- Unit of Rheumatology, Department of Medicine Solna, Karolinska Institutet, and, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, and, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, and, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, and, Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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Khanna D, Hays RD, Furst DE. Functional disability and other health-related quality-of-life domains: points to consider for clinical trials in systemic sclerosis. Rheumatology (Oxford) 2017; 56:v17-v22. [PMID: 28992164 DOI: 10.1093/rheumatology/kex193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
Patients with SSc have the highest mortality among the rheumatic diseases. In addition, SSc is associated with disfigurement, hand contractures, fatigue, poor sleep, severe RP with numbness and tingling of the fingers can lead to decrements in quality of life. This Points to Consider article provides practical considerations for design of trials for functional disability and other health-related quality-of-life issues.
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Affiliation(s)
- Dinesh Khanna
- Department of Medicine, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI
| | - Ron D Hays
- Department of General Internal Medicine and Health Services Research
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Khanna D, Seibold J, Goldin J, Tashkin DP, Furst DE, Wells A. Interstitial lung disease points to consider for clinical trials in systemic sclerosis. Rheumatology (Oxford) 2017; 56:v27-v32. [PMID: 28992174 DOI: 10.1093/rheumatology/kex203] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Indexed: 01/08/2023] Open
Abstract
Interstitial lung disease causes major morbidity and mortality in patients with systemic sclerosis (SSc-ILD). Large randomized clinical trials in SSc-ILD have provided important information regarding the feasibility, reliability and validity of outcome measures. Forced vital capacity percentage predicted should be considered as a primary outcome measure, with inclusion of appropriate radiological and patient-reported measures. We provide practical recommendations for trial design in SSc-ILD.
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Affiliation(s)
- Dinesh Khanna
- Department of Medicine, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI
| | | | | | | | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Athol Wells
- Department of Medicine, Royal Brompton Hospital, Faculty of Medicine, London, UK
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Suzuki A, Kondoh Y, Fischer A. Recent advances in connective tissue disease related interstitial lung disease. Expert Rev Respir Med 2017; 11:591-603. [PMID: 28544856 DOI: 10.1080/17476348.2017.1335600] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is a common manifestation of connective tissue disease (CTD). Although the majority of patients with CTD-ILD are stable or slowly progressive, a significant group exhibits a more severe and progressive decline. Interstitial pneumonia with autoimmune features (IPAF) describes the subset of patients with interstitial pneumonia who have features suggesting underlying autoimmunity, but whose features fall short of a clear diagnosis of CTD. Areas covered: In this focused review, we discuss recent advances in early detection, prognostic evaluation, and management of autoimmune forms of ILD. Expert commentary: Early detection of ILD and a better understanding of factors that impact prognostication may be helpful when making decisions regarding therapeutic interventions. The treatment of CTD-ILD should be comprehensive, is often fraught with challenges and can be complicated by comorbid conditions and extra-thoracic disease activities. Several large randomized studies have examined the impact of immunosuppressive therapy for CTD-ILD, however, additional studies are needed to determine the optimal treatment strategies. Future studies may provide additional information about the best treatments in patients with IPAF.
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Affiliation(s)
- Atsushi Suzuki
- a Department of Respiratory Medicine and Allergy , Tosei General Hospital , Seto , Japan
| | - Yasuhiro Kondoh
- a Department of Respiratory Medicine and Allergy , Tosei General Hospital , Seto , Japan
| | - Aryeh Fischer
- b Department of Medicine, Divisions of Rheumatology, Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , CO , USA
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Validity of the PROMIS-29 in a large Australian cohort of patients with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2017. [DOI: 10.5301/jsrd.5000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background We aimed to evaluate the construct validity of the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) in Australian systemic sclerosis (SSc) patients. Methods SSc patients, identified through the Australian Scleroderma Cohort Study database, completed two quality-of-life instruments concurrently, the PROMIS-29 and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). The construct validity of the PROMIS-29 was assessed by the correlations between the PROMIS-29 and the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). Cronbach's alpha was used to test the internal reliability of all instruments in Australian SSc patients and non-parametric correlation, including Spearman's correlation, was used to test the construct validity of PROMIS-29 against the SF-36 and HAQ-DI. Results A total of 477 completed questionnaires were returned, equating to a response rate of 59.6%. The mean (±SD) age of respondents at the time of the survey was 64.1 (±11.1) years. They were predominantly female (87.4%), with limited disease subtype (lcSSc) (77.8%) and long disease duration from onset of first non-Raynaud's phenomenon symptom at the time of survey (10.9 ± 11.1 years). For the correlation analysis between the PROMIS-29 and the legacy instruments, all Spearman correlation coefficients were in the logical direction and highly significant suggesting that the PROMIS-29 is a good alternative to other validated measures of disease burden. Conclusions Our study indicates that the PROMIS-29 questionnaire is a valid instrument for measuring health-related quality of life in Australian females with lcSSc of long duration.
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Pelrine ER, Ah-Kioon MD, Zhang M, Barrat FJ, Spiera RF, Gordon JK. Musculoskeletal Involvement in SSc Is Associated with Worse Scores on Short Form-36 and Scleroderma Health Assessment Questionnaire and Lower Tumor Necrosis Factor-α Gene Expression in Peripheral Blood Mononuclear Cells. HSS J 2016; 12:255-260. [PMID: 27703420 PMCID: PMC5026664 DOI: 10.1007/s11420-016-9515-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is characterized by a wide variety of symptoms and disease manifestations including joint pain, gastrointestinal dysfunction, interstitial lung disease, and cardiomyopathy. QUESTIONS/PURPOSES Using the Scleroderma Health Assessment Questionnaire (SHAQ) and Short Form-36 (SF-36) we explored how patient-reported physical health, mental health, and functional status related to these clinical characteristics and to cytokine levels utilizing the Hospital for Special Surgery Scleroderma Registry. METHODS In a cross-sectional study of 185 patients meeting the 2013 ACR/EULAR criteria for SSc, we compared disease features and patient-reported outcomes (PROs). Interleukin-6 (IL-6), interleukin-1β (IL1β), and tumor necrosis factor-α (TNFα) levels were assessed by luminex and ELISA assays in a subset of 32 patients. The Pearson correlation coefficient, Spearman correlation coefficient, two-sample t test or Wilcoxon rank sum test, ANOVA or Kuskal-Wallis test, and Pearson chi-squared or Fisher's exact test were performed as applicable to detect the association between disease manifestations, PROs, and blood biomarkers. RESULTS The modified Rodnan skin score (MRSS) was positively correlated with SHAQ scores. Patients who had musculoskeletal involvement scored worse on both the SHAQ and SF-36. Lower levels of TNFα expression in PBMCs were also correlated with musculoskeletal involvement. No other significant correlations were found between clinical factors, PROs, and cytokine data. CONCLUSION Musculoskeletal outcomes are a major determinant of quality of life and function in patients with SSc. These results emphasize the importance of musculoskeletal outcomes in clinical studies of SSc.
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Affiliation(s)
- Eliza R. Pelrine
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Streret, New York, NY 10021 USA
| | | | - Meng Zhang
- Department of Biostatistics, Hospital for Special Surgery, New York, NY USA
| | - Franck J. Barrat
- Department of Research, Hospital for Special Surgery, New York, NY USA
| | - Robert F. Spiera
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Streret, New York, NY 10021 USA
| | - Jessica K. Gordon
- Department of Medicine, Hospital for Special Surgery, 535 East 70th Streret, New York, NY 10021 USA
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Salaffi F, Carotti M, Di Donato E, Di Carlo M, Ceccarelli L, Giuseppetti G. Computer-Aided Tomographic Analysis of Interstitial Lung Disease (ILD) in Patients with Systemic Sclerosis (SSc). Correlation with Pulmonary Physiologic Tests and Patient-Centred Measures of Perceived Dyspnea and Functional Disability. PLoS One 2016; 11:e0149240. [PMID: 26930658 PMCID: PMC4773230 DOI: 10.1371/journal.pone.0149240] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 01/17/2023] Open
Abstract
Objectives This study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),—related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement. Methods 126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson’s correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis. Results Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods. Conclusions Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy.
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Affiliation(s)
- Fausto Salaffi
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
- * E-mail:
| | - Marina Carotti
- Department of Radiology, Polythecnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
| | - Luca Ceccarelli
- Department of Radiology, Polythecnic University of Marche, Ancona, Italy
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Ariani A, Aiello M, Silva M, Alfieri V, Bonati E, Lumetti F, Delsante G, Sverzellati N, Chetta A. Quantitative CT indexes are significantly associated with exercise oxygen desaturation in interstitial lung disease related to systemic sclerosis. CLINICAL RESPIRATORY JOURNAL 2016; 11:983-989. [DOI: 10.1111/crj.12451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 11/25/2015] [Accepted: 01/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
| | - Marina Aiello
- Department of Clinical & Experimental Medicine, Respiratory Disease and Lung Function Unit; University of Parma; Parma Italy
| | - Mario Silva
- Department of Clinical Sciences; Section of Radiology, University of Parma; Parma Italy
| | - Veronica Alfieri
- Department of Clinical & Experimental Medicine, Respiratory Disease and Lung Function Unit; University of Parma; Parma Italy
| | - Elisa Bonati
- Department of Clinical & Experimental Medicine, Respiratory Disease and Lung Function Unit; University of Parma; Parma Italy
| | - Federica Lumetti
- Department of Medicine, Internal Medicine and Rheumatology Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
| | - Giovanni Delsante
- Department of Medicine, Internal Medicine and Rheumatology Unit; Azienda Ospedaliero-Universitaria di Parma; Parma Italy
| | - Nicola Sverzellati
- Department of Clinical Sciences; Section of Radiology, University of Parma; Parma Italy
| | - Alfredo Chetta
- Department of Clinical & Experimental Medicine, Respiratory Disease and Lung Function Unit; University of Parma; Parma Italy
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Iversen LV, Ullman S, Østergaard O, Nielsen CT, Halberg P, Karlsmark T, Heegaard NHH, Jacobsen S. Cross-sectional study of soluble selectins, fractions of circulating microparticles and their relationship to lung and skin involvement in systemic sclerosis. BMC Musculoskelet Disord 2015; 16:191. [PMID: 26265409 PMCID: PMC4534013 DOI: 10.1186/s12891-015-0653-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 07/30/2015] [Indexed: 01/29/2023] Open
Abstract
Background Endothelial damage and activation may play central roles in the pathogenesis of systemic sclerosis (SSc) and are reflected by microparticles (MPs) and soluble selectins. The objective of this study was to determine if these potential biomarkers are associated with specific organ involvements or cutaneous subgroups of SSc patients. Method MPs in platelet-poor plasma from 121 patients with SSc, 79 and 42 with limited and diffuse cutaneous disease, respectively, were characterized by flow cytometry for their capacity to bind annexin V in combination with surface markers of either platelets (PMPs), leukocytes (LMPs) or endothelial cells (EMPs). Soluble E- and P-selectin levels were determined in plasma. By correlation analyses, this was held against involvement of skin, lung function, lung fibrosis, pulmonary artery hypertension, and serology. Results None of the markers were associated with cutaneous subgroups of SSc. Concentrations of annexin V non-binding EMPs and annexin V non-binding LMPs were negatively correlated to pulmonary diffusing capacity (DLCO) (r = -0.28; p = 0.003; r = -0.26; p = 0.005) and forced vital capacity (FVC) (r = -0.24; p = 0.009; r = -0.29; p = 0.002), driven by patients with limited and diffuse cutaneous disease, respectively. Soluble E-selectin levels correlated negatively to DLCO (r = -0.21, p = 0.03) and FVC (r = -0.25; p = 0.007); and soluble P-selectin correlated negatively to DLCO (r = -0.23, p = 0.01). Conclusion Negative correlations between annexin V non-binding EMP and LMP concentrations with lung function parameters (DLCO and FVC) differed between limited and diffuse cutaneous subsets of SSc, indicative of various pathogeneses of lung involvement in SSc, possibly with a differential role of MPs.
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Affiliation(s)
- Line V Iversen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, 2200, Denmark. .,Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen, 2300, Denmark.
| | - Susanne Ullman
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, 2200, Denmark.
| | - Ole Østergaard
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen, 2300, Denmark.
| | - Christoffer T Nielsen
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen, 2300, Denmark.
| | - Poul Halberg
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, 2200, Denmark.
| | - Tonny Karlsmark
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, 2200, Denmark.
| | - Niels H H Heegaard
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen, 2300, Denmark. .,Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, 5000, Denmark.
| | - Søren Jacobsen
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark.
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Wallace B, Kafaja S, Furst DE, Berrocal VJ, Merkel PA, Seibold JR, Mayes MD, Khanna D. Reliability, validity and responsiveness to change of the Saint George's Respiratory Questionnaire in early diffuse cutaneous systemic sclerosis. Rheumatology (Oxford) 2015; 54:1369-79. [PMID: 25667436 PMCID: PMC4502336 DOI: 10.1093/rheumatology/keu456] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Dyspnoea is a common, multifactorial source of functional impairment among patients with dcSSc. Our objective was to assess the reliability, construct validity and responsiveness to change of the Saint George's Respiratory Questionnaire (SGRQ) in patients with early dcSSc participating in a multicentre prospective study. METHODS At enrolment and 1 year, patients completed the SGRQ (a multi-item instrument with four scales: symptoms, activity, impact and total), a visual analogue scale (VAS) for breathing and the HAQ Disability Index (HAQ-DI) and underwent 6 min walk distance and pulmonary function tests, physician and patient global health assessments and high-resolution CT (HRCT). We assessed internal consistency reliability using Cronbach's α. For validity we examined the ability of the SGRQ to differentiate the presence vs absence of interstitial lung disease (ILD) on HRCT or restrictive lung disease and evaluated the 1 year responsiveness to change using pulmonary function tests and patient- and physician-reported anchors. Correlation coefficients of 0.24-0.36 were considered moderate and >0.37 was considered large. RESULTS A total of 177 patients were evaluated. Reliability was satisfactory for all SGRQ scales (0.70-0.93). All scales showed large correlations with the VAS for breathing and diffusing capacity of the lung for carbon monoxide in the overall cohort and in the subgroup with ILD. Three of the four scales in the overall cohort and the total scale in the ILD subgroup showed moderate to large correlation with the HAQ-DI and the predicted forced vital capacity (r = 0.33-0.44). Each scale discriminated between the presence and absence of ILD and restrictive lung disease (P ≤ 0.0001-0.03). At follow-up, all scales were responsive to change using different anchors. CONCLUSION The SGRQ has acceptable reliability, construct validity and responsiveness to change for use in a dcSSc population and differentiates between patients with and without ILD.
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Affiliation(s)
- Beth Wallace
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | | | | | - Veronica J. Berrocal
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Peter A. Merkel
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Maureen D. Mayes
- Division of Rheumatology, University of Texas Health Science Center, Houston, TX and
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan Scleroderma Program, Ann Arbor, MI, USA
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Hansell DM, Goldin JG, King TE, Lynch DA, Richeldi L, Wells AU. CT staging and monitoring of fibrotic interstitial lung diseases in clinical practice and treatment trials: a Position Paper from the Fleischner society. THE LANCET RESPIRATORY MEDICINE 2015; 3:483-96. [DOI: 10.1016/s2213-2600(15)00096-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 02/06/2023]
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Mittoo S, Frankel S, LeSage D, Strand V, Shah AA, Christopher-Stine L, Danoff S, Hummers LK, Swigris JJ, Huscher D, Christensen AM, Cenac SL, Erbil JK, Ferguson S, Garcia-Valladares I, Grewal HK, Orbai AM, Smith KC, Tran M, Bingham CO, Castelino FV, Fischer A, Saketkoo LA. Patient Perspectives in OMERACT Provide an Anchor for Future Metric Development and Improved Approaches to Healthcare Delivery in Connective Tissue Disease Related Interstitial Lung Disease (CTD-ILD). CURRENT RESPIRATORY MEDICINE REVIEWS 2015; 11:175-183. [PMID: 26568747 PMCID: PMC4643941 DOI: 10.2174/1573398x11666150619182624] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The impact and natural history of connective tissue disease related interstitial lung disease (CTD-ILD) are poorly understood; and have not been previously described from the patient's perspective. This investigation sought insight into CTD-ILD from the patients' perspective to add to our knowledge of CTD-ILD, identify disease-specific areas of unmet need and gather potentially meaningful information towards development of disease-specific patient-reported outcome measures (PROMs). METHODS A mixed methods design incorporating patient focus groups (FGs) querying disease progression and life impact followed by questionnaires with items of importance generated by >250 ILD specialists were implemented among CTD-ILD patients with rheumatoid arthritis, idiopathic inflammatory myopathies, systemic sclerosis, and other CTD subtypes. FG data were analyzed through inductive analysis with five independent analysts, including a patient research partner. Questionnaires were analyzed through Fisher's Exact tests and hierarchal cluster analysis. RESULTS Six multicenter FGs included 45 patients. Biophysiologic themes were cough and dyspnea, both pervasively impacting health related quality of life (HRQoL). Language indicating dyspnea was unexpected, unique and contextual. Psycho-social themes were Living with Uncertainty, Struggle over Self-Identity, and Self-Efficacy - with education and clinician communication strongly emphasised. All questionnaire items were rated 'moderately' to 'extremely' important with 10 items of highest importance identified by cluster analysis. CONCLUSION Patients with CTD-ILD informed our understanding of symptoms and impact on HRQoL. Cough and dyspnea are central to the CTD-ILD experience. Initial FGs have provided disease-specific content, context and language essential for reliable PROM development with questionnaires adding value in recognition of patients' concerns.
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Affiliation(s)
| | | | - Daphne LeSage
- Louisiana State Office of Public Health, Louisiana, New Orleans, USA
| | | | - Ami A. Shah
- Johns Hopkins University School of Medicine – Baltimore, USA
| | | | - Sonye Danoff
- Johns Hopkins University School of Medicine – Baltimore, USA
| | | | | | - Dörte Huscher
- German Rheumatism Research Centre and Charité University Hospital, Berlin, Germany
| | | | - Sophia L. Cenac
- Louisiana State University Health Sciences Center - New Orleans, USA
| | - Jen K. Erbil
- Louisiana State University Health Sciences Center - New Orleans, USA
| | | | | | | | - Ana-Maria Orbai
- Johns Hopkins University School of Medicine – Baltimore, USA
| | | | | | | | | | | | - Lesley Ann Saketkoo
- Tulane University School of Medicine, New Orleans, USA
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA
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Ariani A, Silva M, Bravi E, Saracco M, Parisi S, De Gennaro F, Lumetti F, Idolazzi L, Seletti V, Caramaschi P, Benini C, Bodini FC, Scirè CA, Lucchini G, Santilli D, Mozzani F, Imberti D, Arrigoni E, Delsante G, Pellerito R, Fusaro E, Sverzellati N. Operator-independent quantitative chest computed tomography versus standard assessment of interstitial lung disease related to systemic sclerosis: A multi-centric study. Mod Rheumatol 2015; 25:724-30. [DOI: 10.3109/14397595.2015.1016200] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Assessing disease activity and outcome in systemic sclerosis (scleroderma). Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fraticelli P, Gabrielli B, Pomponio G, Valentini G, Bosello S, Riboldi P, Gerosa M, Faggioli P, Giacomelli R, Del Papa N, Gerli R, Lunardi C, Bombardieri S, Malorni W, Corvetta A, Moroncini G, Gabrielli A. Low-dose oral imatinib in the treatment of systemic sclerosis interstitial lung disease unresponsive to cyclophosphamide: a phase II pilot study. Arthritis Res Ther 2014; 16:R144. [PMID: 25007944 PMCID: PMC4227120 DOI: 10.1186/ar4606] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/20/2014] [Indexed: 01/12/2023] Open
Abstract
Introduction Pulmonary involvement represents a major cause of death of systemic sclerosis (SSc) patients. Recent data suggest that tyrosine kinase inhibitors, such as imatinib, may be a therapeutic option for SSc patients. However, preliminary published clinical trials were inconclusive about imatinib efficacy and showed side effects. The purpose of this study was to verify efficacy and tolerability of low-dose imatinib on interstitial lung disease in a cohort of SSc patients unresponsive to cyclophosphamide therapy. Methods Thirty consecutive SSc patients with active pulmonary involvement, unresponsive to cyclophosphamide, were treated with imatinib 200 mg/day for 6 months followed by a 6-month follow-up. A “good response” was defined as an increase of forced vital capacity (FVC) by more of 15% and/or increase of diffusing capacity of carbon monoxide (DLCO) >15% and PaO2 > 90% of initial value and high-resolution computed tomography (HRCT)-scan pattern unchanged or improved. Results Twenty-six patients completed the study. Three patients died and one patient was lost to follow-up. Four patients (15.32%) had a good response, 7 worsened and 15 had a stabilized lung disease. Overall, 19 (73.07%) patients had an improved or stabilized lung disease. After a 6-month follow-up, 12 (54.5%) of the 22 patients showed an improved or stabilized lung disease. Conclusions Lung function was stabilized in a large proportion of patients unresponsive to cyclophosphamide therapy and a beneficial outcome emerged from the analysis of HRCT lung scans. There was no significant improvement of skin involvement, and the low dose was well tolerated. These data provide useful suggestions to design future randomized clinical trials for SSc therapeutics. Trial registration ClinicalTrials.gov NCT00573326. Registered 13 December 2007.
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Alexanderson H, Bergegård J, Björnådal L, Nordin A. Intensive aerobic and muscle endurance exercise in patients with systemic sclerosis: a pilot study. BMC Res Notes 2014; 7:86. [PMID: 24507585 PMCID: PMC3996139 DOI: 10.1186/1756-0500-7-86] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 01/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background No previous studies have examined the effect of intensive exercise in systemic sclerosis patients with pulmonary impairment. The objective of this study was to examine the effect of an eight-week intensive aerobic exercise and muscle endurance training program for patients with systemic sclerosis with 50–100% of forced vital capacity. Methods A single-subject experimental design with repeated systematic measures during a six week A-phase (non-interventional baseline period) and an eight week B-phase (exercise intervention period) was used. Three women and one man with median age 66 years and median disease duration of 3.5 years completed aerobic exercise corresponding to 15 on the Borg RPE scale (strenuous) and muscular endurance training three times/week. Physical capacity (six-minute walk test), aerobic capacity (submaximal treadmill test) and muscle endurance in shoulder and hip flexion (Functional Index 2) were assessed every other week throughout the 14-week study. Activity limitation (Health Assessment Questionnaire), quality of life (Short Form 36), Raynaud, Fatigue and Global Health during the recent week (Visual Analogue Scales) were assessed at weeks 0, 6, 14. Results Three participants improved significantly in muscular endurance, and two participants improved significantly or clinically relevant in aerobic capacity. All other variables remained unchanged, except for a trend towards reduced fatigue. Conclusions This eight week exercise program was largely successful with positive effects on aerobic capacity and muscle endurance. Trial registration Clinicaltrials.gov Identifier: NCT01813578
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Affiliation(s)
- Helene Alexanderson
- Department of Neurobiology, Care Science and Society, Division of Physical Therapy, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Pathogenic processes that underlie the development and progression of systemic sclerosis (SSc) are being defined in preclinical, clinical and genetic studies. Important evidence of interplay between the vasculature, connective tissue and specialized epithelial structures is emerging, and abnormalities of both the innate and adaptive immune systems have been identified. In this context, information regarding pivotal mediators, pathways or cell types that could be targets for therapeutic intervention, and that might offer potential for true disease modification, is accruing. Precedent for the regression of some aspects of the pathology has been set in clinical studies showing that potential exists to improve tissue structure and function as well as to prevent disease progression. This article reviews the concept of targeted therapies and considers potential pathways and processes that might be attenuated by therapeutic intervention in SSc. As well as improving outcomes, such approaches will undoubtedly provide information about pathogenesis. The concept of translational medicine is especially relevant in SSc, and we anticipate that the elusive goal of an effective antifibrotic treatment will emerge from one of the several clinical trials currently underway or planned in this disease. Therapeutic advances in SSc would have implications and potential beyond autoimmune rheumatic diseases.
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Affiliation(s)
- Christopher P Denton
- Centre for Rheumatology and Connective Tissue Disease, UCL Medical School, Royal Free Hospital, London NW3 2QG, UK.
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Chung L, Chen H, Khanna D, Steen VD. Dyspnea assessment and pulmonary hypertension in patients with systemic sclerosis: Utility of the University of California, San Diego, Shortness of Breath Questionnaire. Arthritis Care Res (Hoboken) 2013; 65:454-63. [DOI: 10.1002/acr.21827] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/01/2012] [Indexed: 01/17/2023]
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Khanna D, Tseng CH, Farmani N, Steen V, Furst DE, Clements PJ, Roth MD, Goldin J, Elashoff R, Seibold JR, Saggar R, Tashkin DP. Clinical course of lung physiology in patients with scleroderma and interstitial lung disease: analysis of the Scleroderma Lung Study Placebo Group. ACTA ACUST UNITED AC 2013; 63:3078-85. [PMID: 21618205 DOI: 10.1002/art.30467] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) are thought to have the greatest decline in lung function (forced vital capacity [FVC]% predicted) in the early years after disease onset. The aim of this study was to assess the natural history of the decline in FVC% predicted in patients receiving placebo in the Scleroderma Lung Study and to evaluate possible factors for cohort enrichment in future therapeutic trials. METHODS Patients randomized to receive placebo (n=79) were divided into 3 groups based on the duration of SSc (0-2 years, 2-4 years, and >4 years). Descriptive statistics and a mixed-effects model were used to analyze the rate of decline in the FVC% predicted over a 1-year period. Additional analyses stratified according to the severity of fibrosis on high-resolution computed tomography (HRCT) were performed, and interactions between disease severity and disease duration were explored. RESULTS The mean±SD decline in the unadjusted FVC% predicted during the 1-year period was 4.2±12.8%. At baseline, 28.5%, 43.0%, and 28.5% of patients were in the groups with disease durations of 0-2 years, 2-4 years, and >4 years, respectively. The rate of decline in the FVC% predicted was not significantly different across the 3 disease groups (P=0.85). When stratified by baseline fibrosis on HRCT, the rate of decline in the FVC% predicted was statistically significantly greater in the group with severe fibrosis (mean annualized decline in the FVC% predicted 7.2% versus 2.7% in the groups with no or moderate fibrosis; P=0.008). The decline observed in the group with severe fibrosis was most pronounced in those with a relatively short disease duration (0-2 years; annualized decline 7.0%). CONCLUSION Among patients with SSc-ILD in the Scleroderma Lung Study, the rates of progression of lung disease were similar irrespective of disease duration. The baseline HRCT fibrosis score is a predictor of a future decline in the FVC% predicted in the absence of effective treatment.
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Theodore AC, Tseng CH, Li N, Elashoff RM, Tashkin DP. Correlation of cough with disease activity and treatment with cyclophosphamide in scleroderma interstitial lung disease: findings from the Scleroderma Lung Study. Chest 2013; 142:614-621. [PMID: 22156609 DOI: 10.1378/chest.11-0801] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cough is a significant symptom in patients with scleroderma interstitial lung disease (SSc-ILD), affecting 73% of the 158 patients enrolled in the Scleroderma Lung Study (SLS), a multicenter randomized trial of oral cyclophosphamide (CYC) vs placebo (PLA) in patients with active interstitial lung disease. METHODS We examined the correlation of cough frequency and severity and phlegm production at baseline in 156 SLS participants with other baseline variables representing SSc-ILD disease activity and the cough response to 1 year of treatment with CYC vs PLA. RESULTS Patients with cough at baseline had significantly lower diffusing capacity of the lung for carbon monoxide, dyspnea, the quality-of-life physical component summary, and the maximal fibrosis score on high-resolution CT imaging compared with those without cough at baseline. Cough severity and frequency correlated with FVC % predicted. After 12 months of treatment, cough frequency decreased in the CYC group compared with the PLA group and was significantly different from the PLA group at 18 months (6 months after discontinuation of CYC). However, the decreases in cough frequency did not correlate with the changes in FVC or diffusing capacity of the lung for carbon monoxide observed in the CYC group. Treatment-related improvements in cough frequency, as well as in FVC, were no longer apparent 12 months after discontinuation of CYC. CONCLUSIONS Cough is a common symptom in SSc-ILD and correlates with the extent of fibrosis. Cough frequency decreases significantly in response to treatment with CYC but returns to baseline 1 year after withdrawal of treatment. Cough may be a symptom of ongoing fibrosis and an independent variable in assessing therapeutic response to CYC. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT000004563; URL: www.clinicaltrials.gov
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Affiliation(s)
- Arthur C Theodore
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Boston University School of Medicine, Boston, MA.
| | - Chi-Hong Tseng
- Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ning Li
- Biostatistics Core, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert M Elashoff
- Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Pope J. Measures of systemic sclerosis (scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), physician- and patient-rated global assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler's Index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud's Condition Score (RCS). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S98-111. [PMID: 22588774 DOI: 10.1002/acr.20598] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Janet Pope
- University of Western Ontario, London, Ontario, Canada.
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Sanchez O, Caumont-Prim A, Gillet-Juvin K, Callens E, Graba S, Essalhi M, Chevalier-Bidaud B, Israël-Biet D, Mahut B, Delclaux C. Activity-related dyspnea is not modified by psychological status in people with COPD, interstitial lung disease or obesity. Respir Physiol Neurobiol 2012; 182:18-25. [DOI: 10.1016/j.resp.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
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Common geriatric conditions and disabilities in older persons with chronic obstructive pulmonary disease. Curr Opin Pulm Med 2012; 17 Suppl 1:S29-34. [PMID: 22209927 DOI: 10.1097/01.mcp.0000410745.75216.99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases among older persons worldwide and the rapid increase in commonly associated COPD-disabilities requires urgent awareness among healthcare professionals. The presence of pulmonary and extrapulmonary comorbidities is highly prevalent among COPD patients and complicates treatment management, especially in advanced age. Some of the most common geriatric conditions in COPD patients lead to respiratory function decline, physical function impairment with limited physical performance, cognitive decline, and depression. Unfortunately, the activation of each component may lead to the progression of the other, which, if not corrected, will lead to critical clinical outcomes such as disability (as seen by the worsening of each condition) and death. RECENT FINDINGS Studies in older persons with COPD have shown that disability is mainly due to the severity of comorbidities that have been shown to significantly impact treatment options and the prognosis for such individuals. In addition to spirometric functional parameters, exercise performance and efficacy of specific therapeutic interventions may be useful indicators for overall health status and outcomes. The scientific literature underlines the necessity to use additional parameters other than spirometry for COPD patient monitoring. SUMMARY As disability is a growing phenomenon in COPD and substantially impacts patient perception of the disease, we will highlight the recent literature regarding the importance of common geriatric conditions leading to disability in older COPD patients. In particular, we will discuss the impact of the following conditions in older patients with COPD: respiratory function decline, physical function impairment, and mood disorders. Clinical use for measuring such parameters in COPD elderly will aid in identifying those at risk for severe clinical decline.
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Khanna D, Maranian P, Rothrock N, Cella D, Gershon R, Khanna PP, Spiegel B, Furst DE, Clements PJ, Bechtel A, Hays RD. Feasibility and construct validity of PROMIS and "legacy" instruments in an academic scleroderma clinic. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:128-134. [PMID: 22264980 PMCID: PMC3457915 DOI: 10.1016/j.jval.2011.08.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 07/17/2011] [Accepted: 08/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) roadmap initiative is a cooperative group program of research designed to develop, evaluate, and standardize item banks to measure patient-reported outcomes relevant across medical conditions. The objective of the current study was to assess feasibility and evaluation of the construct validity of PROMIS item banks versus legacy measures in an observational study in systemic sclerosis (SSc). We hypothesized that the PROMIS item banks can be administered in a clinical setting if there is adequate staff support without disrupting the flow of clinic. METHODS Patients with SSc in a single academic center completed computerized adaptive test (CAT) administered PROMIS item banks during the clinic visit and legacy measures (using paper and pencil). The construct validity of PROMIS items was evaluated by examining correlations with corresponding legacy measures using multitrait-multimethod analysis. RESULTS Participants consisted of 143 SSc patients with an average age of 51.5 years; 71% were female and 68% were white. The average number of items completed for each CAT-administered item bank ranged from 5 to 8 (69 CAT items per patient), and the average time to complete each CAT-administered item bank ranged from 48 seconds to 1.9 minutes per patient (average time = 11.9 minutes/per patient for 11 banks). All correlations between PROMIS domains and respective legacy measures were large and in the hypothesized direction (ranged from 0.61 to 0.82). CONCLUSION Our study supports the construct validity of the CAT-administered PROMIS item banks and shows that they can be administered successfully in a clinic with support staff. Future studies should assess the feasibility of PROMIS item banks in a busy clinical practice.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI 48106, USA.
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