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Gagliardi C, Adinolfi A, Belloli L, Romano ME, Ughi N, Epis OM. Sclerodermic hand: a retrospective study on the role of ultrasonography in the detection of subclinical joint involvement. Clin Rheumatol 2023; 42:2873-2879. [PMID: 37341932 DOI: 10.1007/s10067-023-06668-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION The inflammatory involvement of joints and tendons is common in Systemic Sclerosis (SSc). Ultrasonography (US) is a non-invasive tool commonly applied for the assessment of the main inflammatory arthropathies and could be also used in identifying pathological features in SSc patients, even without clinical evidence of joint complaint. So, the aim of this study was to assess the prevalence of US pathological features in a cohort of SSc patients and assessed the role of US in the detection of subclinical joint involvement. METHODS In this retrospective study, we collected data about the prevalence of US pathological features at the level of hands and wrists in a cohort of patients with a definite diagnosis of SSc, submitted to an ultrasound examination of hands and wrists according to the clinician's opinion, with or without joint involvement symptoms, in order to assess the US ability in detecting subclinical inflammatory signs in SSc patients. RESULTS In total, 47.5% of patients reported at least one US pathological feature. The most common was synovial hypertrophy (62.1%). Other assessed lesions were effusion (48%), tenosynovitis (37.9%), power Doppler (PD) signal (31.0%), and erosions (0.7%). Effusion and PD signal appeared significantly higher in symptomatic patients, with a p<0.01 and p=0.045, respectively. CONCLUSIONS In this cohort of SSc subjects, almost the half of the US-positive patients were clinically asymptomatic. Therefore, the application of US could be useful to detect the musculoskeletal involvement of SSc patients, a potential markers of disease severity. Further studies are required to assess the role of US in monitoring SSc patients. Key Points • The inflammatory involvement of joints and/or tendons is common in systemic sclerosis (SSc) but could be partially covered by other disease features. • Among the diagnostic methods able to increase the sensitivity of the musculoskeletal evaluation, Ultrasonography (US) is one of the most promising to reveal subclinical inflammation and predict the joint damage progression. • We retrospectively investigated the prevalence of US pathological features in a cohort of SSc patients, with or without symptoms of joint involvement, assessing the role of US in the detection of subclinical joint involvement. • We found that joint and tendon involvement, a potential marker of disease severity, is common in SSc.
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Affiliation(s)
- Clizia Gagliardi
- SC Reumatologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonella Adinolfi
- SC Reumatologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Laura Belloli
- SC Reumatologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Eva Romano
- UOC Reumatologia, ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Nicola Ughi
- SC Reumatologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Badiee F, Fatemi A, Zahedpasha R, Gharib MH, Jokar M, Livani S, Aghaie M, Abdolahi N. Hands and feet radiologic involvements in systemic sclerosis. BMC Rheumatol 2023; 7:9. [PMID: 37208734 DOI: 10.1186/s41927-023-00336-9] [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: 12/10/2021] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
AIM Systemic sclerosis (SSc) is a rare autoimmune disorder characterized by vascular and fibrosing involvement of the skin and internal organs. In this study, we determined the prevalence and characteristics of radiological hands and feet involvements in Iranian SSc patients to identify the associations between clinical features and radiologic findings. METHODS 43 SSc patients (41 women and 2 men), with a median age of 44.8 years (ranges 26-70 years) and a mean disease duration of 11.8 years (ranges 2-28 years) were studied in this cross-sectional study. RESULTS 42 patients had radiological changes both in their hands and feet. Only one patient had alteration just in hand. The most frequent changes that we found in hand were Juxta-articular Osteoporosis (93%), Acro-osteolysis (58.2%), and Joint Space Narrowing (55.8%). The prevalence of joint space narrowing or acro-osteolysis was higher in subjects with active skin involvement [modified Rodnan skin score (mRSS) > 14] [16/21 vs. 4/16 for patients with inactive skin involvement (mRSS < 14); p = 0.002]. The most frequent changes that we found in the foot were Juxta-articular Osteoporosis (93%), Acro-osteolysis (46.5%), Joint Space Narrowing (58.1%), and subluxation (44.2%). The presence of anti-ccp antibody was detected in 4 (9.3%), while positive rheumatoid factor was found in 13 (30.2%) of SSc patients. CONCLUSION This study corroborates that arthropathy is common in SSc patients. The introduction of the specific radiological involvements of SSc needs to be confirmed by further studies, in order to define the appropriate prognosis and treatment of patients.
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Affiliation(s)
- Fatemeh Badiee
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Fatemi
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Zahedpasha
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Hadi Gharib
- Department of Radiology, School of Medicine, 5Th Azar Hospital, Gorgan, Golestan, Iran
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran, Islamic Republic of
| | - Mohammadhassan Jokar
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Somayeh Livani
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran, Islamic Republic of
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Gorgan, Iran, Islamic Republic of
| | - Mehrdad Aghaie
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Nafiseh Abdolahi
- Golestan Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
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Ha JW, Hong YJ, Cha HJ, Moon JD, Pyo JY, Lee SW, Park YB, Park CH, Song JJ. A retrospective analysis of the relationship between anti-cyclic citrullinated peptide antibody and interstitial lung disease in systemic sclerosis. Sci Rep 2022; 12:19253. [PMID: 36357514 PMCID: PMC9649731 DOI: 10.1038/s41598-022-23180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
Anti-cyclic citrullinated peptide antibody testing is used to diagnose rheumatoid arthritis and associated with interstitial lung disease in RA. Herein, we investigate the relationship between anti-CCP antibody and ILD in SSc. We performed a retrospective analysis at a tertiary medical center between 2005 and 2019. Patients with SSc, systemic lupus erythematosus, and polymyositis/dermatomyositis (PM/DM) were evaluated for anti-CCP antibody and ILD. Additionally, medical records of SSc patients with ILD were reviewed. SSc patients had the highest anti-CCP antibody positivity rate compared to those with SLE and PM/DM. The incidence of ILD was higher in SSc patients with anti-CCP antibody than in those without. The usual interstitial pneumonia (UIP) incidence was higher in the anti-CCP antibody-positive group than in the anti-CCP antibody-negative group. The DLCO was lower in the anti-CCP antibody-positive group than in the anti-CCP antibody-negative group. On multivariable analysis, factors associated with SSc-ILD were anti-CCP antibody or rheumatoid factor (β coefficient, 2.652 [95% CI 1.472 to 4.776]) and anti-Scl70 antibody (β coefficient, 4.011 [95% CI 2.142 to 7.508]). Anti-CCP antibody may be associated with a higher incidence of ILD in SSc. SSc patients with anti-CCP antibody may have more UIP pattern and lower DLCO.Trial Registration Retrospectively registered.
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Affiliation(s)
- Jang Woo Ha
- grid.15444.300000 0004 0470 5454Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722 South Korea
| | - Yoo Jin Hong
- grid.15444.300000 0004 0470 5454Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jin Cha
- grid.15444.300000 0004 0470 5454Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722 South Korea ,grid.15444.300000 0004 0470 5454Synapse Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonghun Daniel Moon
- grid.417231.20000 0000 9880 7822Division of Rheumatology, Valley Medical Center, University of Washington Medicine, Renton, WA 98055 USA
| | - Jung Yoon Pyo
- grid.15444.300000 0004 0470 5454Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722 South Korea
| | - Sang-Won Lee
- grid.15444.300000 0004 0470 5454Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722 South Korea
| | - Yong-Beom Park
- grid.15444.300000 0004 0470 5454Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722 South Korea
| | - Chul Hwan Park
- grid.15444.300000 0004 0470 5454Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273 South Korea
| | - Jason Jungsik Song
- grid.15444.300000 0004 0470 5454Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, Seoul, 03722 South Korea ,grid.15444.300000 0004 0470 5454Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
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Chudek A, Kotyla P, Mossakowska M, Grodzicki T, Zdrojewski T, Olszanecka-Glinianowicz M, Chudek J, Owczarek AJ. The Prevalence of Anticitrullinated Protein Antibodies in Older Poles-Results from a Population-Based PolSenior Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14216. [PMID: 36361095 PMCID: PMC9655192 DOI: 10.3390/ijerph192114216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Little is known about the occurrence of antibodies in older subjects. We analyzed the prevalence of anticitrullinated protein antibodies (anti-CCP) in a representative cohort of Polish older adults, participants of PolSenior substudy. Randomly selected 1537 serum samples of community-dwelling participants aged 65 and over. Questionnaires were completed by qualified interviewers and laboratory assessments served as a database for this analysis. The frequency of anti-CCP seropositivity (N = 50) was estimated at 3.25% (95% CI: 2.45-4.30%), being higher among women-4.05% (2.83-5.73%) than men-2.41% (1.48-3.86%). The frequency of anti-CCP seropositivity was decreasing with age from 4.29% in aged 65-74 years and 4.07% in 70-84 years to 1.50% in aged 85 years or above (p < 0.05). Hypoalbuminemia, inflammatory status (C-reactive protein >10 mg/dL or interleukin-6 ≥10 pg/mL), and female gender were associated with increased, while age ≥85 years with decreased risk of seropositivity. Multivariable logistic regression revealed that hypoalbuminemia, inflammatory status, and age ≥85 years were independently associated factors of anti-CCP seropositivity. The decreased frequency of anti-CCP seropositivity in the oldest old suggests shorter survival of the seropositive individuals who developed rheumatoid arthritis. It seems that low symptomatic RA remains frequently undiagnosed in older subjects.
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Affiliation(s)
- Anna Chudek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Przemysław Kotyla
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-635 Katowice, Poland
| | - Małgorzata Mossakowska
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-531 Krakow, Poland
| | - Tomasz Zdrojewski
- Division of Preventive Medicine and Education, Medical University of Gdansk, 80-211 Gdansk, Poland
| | - Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, 40-029 Katowice, Poland
| | - Aleksander J. Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
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Sanges S, Guerrier T, Duhamel A, Guilbert L, Hauspie C, Largy A, Balden M, Podevin C, Lefèvre G, Jendoubi M, Speca S, Hachulla É, Sobanski V, Dubucquoi S, Launay D. Soluble markers of B cell activation suggest a role of B cells in the pathogenesis of systemic sclerosis-associated pulmonary arterial hypertension. Front Immunol 2022; 13:954007. [PMID: 35967377 PMCID: PMC9374103 DOI: 10.3389/fimmu.2022.954007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Soluble markers of B cell activation are interesting diagnostic and prognostic tools in autoimmune diseases. Data in systemic sclerosis (SSc) are scarce and few studies focused on their association with disease characteristics. Methods 1. Serum levels of 14 B cell biomarkers (β2-microglobulin, rheumatoid factor (RF), immunoglobulins (Ig) G, IgA, IgM, BAFF, APRIL, soluble (s)TACI, sBCMA sCD21, sCD23, sCD25, sCD27, CXCL13) were measured in SSc patients and healthy controls (HC). 2. Associations between these biomarkers and SSc characteristics were assessed. 3. The pathophysiological relevance of identified associations was explored by studying protein production in B cell culture supernatant. Results In a discovery panel of 80 SSc patients encompassing the broad spectrum of disease manifestations, we observed a higher frequency of RF positivity, and increased levels of β2-microglobulin, IgG and CXCL13 compared with HC. We found significant associations between several biomarkers and SSc characteristics related to disease phenotype, activity and severity. Especially, serum IgG levels were associated with pulmonary hypertension (PH); β2-microglobulin with Nt-pro-BNP and DLCO; and BAFF with peak tricuspid regurgitation velocity (TRV). In a validation cohort of limited cutaneous SSc patients without extensive ILD, we observed lower serum IgG levels, and higher β2-microglobulin, sBCMA, sCD23 and sCD27 levels in patients with pulmonary arterial hypertension (PAH). BAFF levels strongly correlated with Nt-pro-BNP levels, FVC/DLCO ratio and peak TRV in SSc-PAH patients. Cultured SSc B cells showed increased production of various angiogenic factors (angiogenin, angiopoietin-1, VEGFR-1, PDGF-AA, MMP-8, TIMP-1, L-selectin) and decreased production of angiopoietin-2 compared to HC. Conclusion Soluble markers of B cell activation could be relevant tools to assess organ involvements, activity and severity in SSc. Their associations with PAH could plead for a role of B cell activation in the pathogenesis of pulmonary microangiopathy. B cells may contribute to SSc vasculopathy through production of angiogenic mediators.
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Affiliation(s)
- Sébastien Sanges
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Thomas Guerrier
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Lucile Guilbert
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Carine Hauspie
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Alexis Largy
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
| | - Maïté Balden
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Céline Podevin
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Guillaume Lefèvre
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Manel Jendoubi
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
| | - Silvia Speca
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
| | - Éric Hachulla
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - David Launay
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
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Riccardi A, Martinroche G, Contin-Bordes C, Avouac J, Gobeaux C, Cauvet A, Guerini H, Truchetet ME, Allanore Y. Erosive arthritis autoantibodies in systemic sclerosis. Semin Arthritis Rheum 2021; 52:151947. [PMID: 35000789 DOI: 10.1016/j.semarthrit.2021.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE We aimed to evaluate in two large SSc French cohorts the prevalence and associated factors with the autoantibodies linked to erosive arthritis. METHODS 448 SSc patients were recruited from May 2015 to January 2019. Standardized clinical and laboratory variables were collected in accordance with the EUSTAR database. ELISAs for IgM rheumatoid factor (RF), IgG anti-citrullinated proteins (ACPA) and IgG anti-carbamylated proteins antibodies (anti-CarP) were all determined in a central laboratory. The prevalence and clinical associations of the different antibodies were investigated. RESULTS RF positivity was observed in 113 patients (25%) compared to 39 (9%) for ACPA and 63 (14%) for anti-CarP antibodies. Through multivariate regression analysis, both RF and ACPA positivity resulted to be associated with RA overlap disease (OR 5.7, 95% CI 2.3-13.8 and OR 44.1, 95% CI 15.4-126.3, respectively). Additionally, ACPA was found to be significantly related to synovitis/ tenosynovitis (OR 1.7, 95% CI 1.0-2.6). RF positivity was associated to a "vascular subset" (i.e. any major vascular complication) (OR 2.1, 95% CI 1.3-3.4). Moreover, anti-CarP antibodies were associated with a fibrotic subset and with digital ulcers (OR 2.0, 95% CI 1.1-3.6 and OR 1.9, 95% CI 1.1-3.4). CONCLUSION We corroborated that ACPA could be useful in identifying patients with a more prominent joint disease and RA overlap disease. Of the most interest we found that anti-CarP antibodies could be a relevant biomarker related to fibrotic skin and lung disease.
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Affiliation(s)
- Antonella Riccardi
- Department of Precision Medicine, Rheumatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Cécile Contin-Bordes
- Immunology Department, CHU Bordeaux Hospital, Bordeaux, France; ImmunoConcEpt, CNRS, UMR 5164, University of Bordeaux, France
| | - Jérôme Avouac
- Department of Rheumatology, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Camille Gobeaux
- Department of Biochemistry, Université de Paris, Cochin Hospital, Paris, France
| | - Anne Cauvet
- INSERM U1016, Institut Cochin, Université de Paris, France
| | - Henri Guerini
- Radiology B department, Cochin Hospital, Université de Paris, France
| | - Marie-Elise Truchetet
- ImmunoConcEpt, CNRS, UMR 5164, University of Bordeaux, France; Department of Rheumatology, Descartes University, APHP, Cochin Hospital, Paris, France; Department of Biochemistry, Université de Paris, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, Université de Paris, France; Radiology B department, Cochin Hospital, Université de Paris, France; Rheumatology Department, CHU Bordeaux Hospital, Bordeaux, France
| | - Yannick Allanore
- Department of Rheumatology, Descartes University, APHP, Cochin Hospital, Paris, France; Department of Biochemistry, Université de Paris, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, Université de Paris, France; Radiology B department, Cochin Hospital, Université de Paris, France; Rheumatology Department, CHU Bordeaux Hospital, Bordeaux, France.
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Azarbani N, Javadzadeh A, Mohseni I, Jalali A, Andalib E, Poormoghim H. Association of Musculoskeletal and Radiological Features with Clinical and Serological Findings in Systemic Sclerosis: A Single-Centre Registry Study. Mediterr J Rheumatol 2020; 31:341-349. [PMID: 33163868 PMCID: PMC7641026 DOI: 10.31138/mjr.31.3.341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/29/2020] [Accepted: 09/15/2020] [Indexed: 11/06/2022] Open
Abstract
AIM Systemic sclerosis (SSc) is a chronic connective tissue disease with the clinical hallmark of skin thickening and tethering. Correlation of musculoskeletal features with other parameters should be considered in SSc patients. METHODS We reviewed the records of all patients who had more than one visit and standard anteroposterior radiography of hand. We used univariate analysis, and factors with p<0.05 were included in logistic regression to find out dependent factors. RESULTS Overall, 180 SSc patients were enrolled in our study, 161 (89.4%) of whom were women. Median age (IQR) was 47.0 years (16), and 52% had diffuse subtype of the disease. In multivariate analysis, tendon friction rubs (TFRs) was associated with the presence of calcinosis, muscle tenderness, and flexion contracture (FC) on physical examination (p<0.05). Arthritis showed no differences in the two subtypes of the disease (p=0.98), and in multivariate analysis, there were no correlations between radiographic arthritis and serological and clinical features. The radiographic results indicated that disease duration correlated with joint erosion, acro-osteolysis, resorption of distal ulna, calcinosis and radiologic FC (p< 0.05). Acro-osteolysis was more frequent in the dcSSc subtype, TFRs, and anti-TOPO I antibody. Radiologic FC showed association with skin score, calcinosis and haematocrit <30% (p<0.05). Joint flexion on radiography was associated with disease duration, modified Rodnan skin score, calcinosis, and low haematocrit (P<0.01). CONCLUSION Disease duration was a main dependent factor for developing joint erosion, acro-osteolysis, bone resorption, calcinosis, and flexion contracture on hand radiography. Acro-osteolysis presented in the severe form of the disease. Acro-osteolysis was the only dependent variable associated with bone demineralization.
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Affiliation(s)
| | | | - Iman Mohseni
- Iran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran University of Medical Sciences, Tehran, Iran
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Sandler RD, Matucci-Cerinic M, Hughes M. Musculoskeletal hand involvement in systemic sclerosis. Semin Arthritis Rheum 2019; 50:329-334. [PMID: 31812353 DOI: 10.1016/j.semarthrit.2019.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/07/2019] [Accepted: 11/01/2019] [Indexed: 11/19/2022]
Abstract
Musculoskeletal (MSK) involvement of the hands is a significant source of morbidity, impacting on quality of life in patients with systemic sclerosis (SSc). MSK complications are common in SSc and can affect the whole of the MSK system. MSK hand involvement can occur early in the course of the disease. A wide range of articular involvement is recognised including from arthralgia to inflammatory joint and tendon disease. Mechanistic insights have been made into enthesitis, hand contractures and tendon friction rubs and could inform the development inform novel treatment approaches to MSK involvement in SSc. Bony involvement can include osteomyelitis from digital ulceration. Other important manifestations include (but are not limited to) calcinosis, acro-osteolysis and carpal tunnel syndrome. MSK imaging is an important tool that allows insight into both disease pathogenesis and to inform the clinical management of MSK complications. The purpose of this review is to provide an overview of the MSK hand complications in patients with SSc, highlighting the breadth and burden of pathology relevant to clinical practice.
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Affiliation(s)
- Robert David Sandler
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Divisions of Internal Medicine and Rheumatology, University of Florence, Florence, Italy
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
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9
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Thietart S, Louati K, Gatfosse M, Sornay-Rendu E, Gaigneux E, Lemeunier L, Delmaire P, Riviere S, Mahevas T, Sellam J, Berenbaum F, Fain O, Roland C, Mekinian A. Overview of osteo-articular involvement in systemic sclerosis: Specific risk factors, clinico-sonographic evaluation, and comparison with healthy women from the French OFELY cohort. Best Pract Res Clin Rheumatol 2018; 32:591-604. [PMID: 31174827 DOI: 10.1016/j.berh.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Osteoarticular involvement in systemic sclerosis (SSc) is frequent and varied. Data are scarce on the prevalence and risk factors of osteoporosis (OP). We aimed to assess clinical parameters, radiological parameters, US articular involvements, and the frequency of OP and evaluate SSc-specific risk factors. In a prospective cohort of 54 patients with SSc, data of OP risk factors, SSc organ involvements, tender and swollen joint counts, DAS28-CRP, hand US sonographies, X-ray hand views, and bone mineral density (BMD) were assessed. BMD values were compared to those from a healthy female population (OFELY cohort). Nineteen patients (40%) had OP. SSc was a risk factor of lower BMD in the patient group than in the control group. OP was associated with SSc-related risk factors and not with conventional OP risk factors. Nine patients had clinical synovitis (16%), and 23 (68%) patients had at least one US synovitis. No correlation was found with articular destruction, disease severity, autoantibody profile, or other organ impairment.
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Affiliation(s)
- Sara Thietart
- Service de Medecine Interne, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France; Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | - Karine Louati
- Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Service de Rhumatologie, Hopital Saint Antoine, AP-HP, DHU i2B, Inserm UMRS_938, Univ Paris 06, 75012 Paris, France.
| | - Marc Gatfosse
- Service de Medecine Interne, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France; Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | - Elisabeth Sornay-Rendu
- Unite Inserm UMR 1033, Universite de Lyon, Service de Rhumatologie et Pathologie Osseuse, Hopital E Herriot, Lyon, France.
| | - Emeline Gaigneux
- Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Service de Rhumatologie, Hopital Saint Antoine, AP-HP, DHU i2B, Inserm UMRS_938, Univ Paris 06, 75012 Paris, France.
| | - Lucie Lemeunier
- Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Service de Rhumatologie, Hopital Saint Antoine, AP-HP, DHU i2B, Inserm UMRS_938, Univ Paris 06, 75012 Paris, France.
| | - Philippe Delmaire
- Service de Medecine Nucleaire et Biophysique, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France.
| | - Sébastien Riviere
- Service de Medecine Interne, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France; Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | - Thibault Mahevas
- Service de Medecine Interne, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France; Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | - Jérémie Sellam
- Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Service de Rhumatologie, Hopital Saint Antoine, AP-HP, DHU i2B, Inserm UMRS_938, Univ Paris 06, 75012 Paris, France.
| | - Francis Berenbaum
- Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Service de Rhumatologie, Hopital Saint Antoine, AP-HP, DHU i2B, Inserm UMRS_938, Univ Paris 06, 75012 Paris, France.
| | - Olivier Fain
- Service de Medecine Interne, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France; Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
| | - Chapurlat Roland
- Unite Inserm UMR 1033, Universite de Lyon, Service de Rhumatologie et Pathologie Osseuse, Hopital E Herriot, Lyon, France.
| | - Arsène Mekinian
- Service de Medecine Interne, Hopital Saint Antoine, AP-HP, Universite Paris 6, 75012 Paris, France; Sorbonne Universites, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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10
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Kamalaksha S, White DHN, Solanki KK. Significance of combined anti-CCP antibodies and rheumatoid factor in a New Zealand cohort of patients with systemic sclerosis. Int J Rheum Dis 2018; 21:1430-1435. [DOI: 10.1111/1756-185x.13330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Douglas H. N. White
- Rheumatology Department; Waikato Hospital; Hamilton New Zealand
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - Kamal K. Solanki
- Rheumatology Department; Waikato Hospital; Hamilton New Zealand
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
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11
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Laustriat G, Ruyssen-Witrand A, Constantin A, Barnetche T, Adoue D, Cantagrel A, Degboé Y. Anti-citrullinated peptides antibodies in systemic sclerosis: Meta-analysis of frequency and meaning. Joint Bone Spine 2017; 85:147-153. [PMID: 29183860 DOI: 10.1016/j.jbspin.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/05/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Diagnosis of systemic sclerosis (SSc) is partially determined by the presence of specific autoantibodies often associated with specific clinical features. Recent studies report the presence of ACPA in SSc. We aimed to evaluate the prevalence of ACPA in SSc and to assess their influence on clinical presentation of SSc. METHODS A systematic literature search was performed using PubMed and Cochrane databases' publications between 1999 and March 2017. Search terms were: "systemic sclerosis [MeSH] AND (ACPA OR anti-CCP OR rheumatoid factor OR cohort OR value diagnostic)". In a first step, we selected cohorts with >50 SSc patients with ACPA identification, for ACPA frequency determination. In a second step, we included studies that analysed clinical profiles according to ACPA status. Meta-analyses were performed when at least two studies were available. RESULTS First, we identified 13 observational studies with a total of 1231 SSc patients. The mean prevalence of ACPA in SSc was 9.2%. Secondly, we identified nine studies reporting clinical aspects according to ACPA status. Our meta-analyses showed a significant association between ACPA positivity and the presence of arthritis (odds ratio (OR)=22.48 [10.71-47.21]), joint erosions seen on X-rays (OR=14.79 [6.38-34.28]), pulmonary fibrosis (OR=2.75 [1.21-6.24]), oesophagus involvement (OR=2.72 [1.05-7.07]), and diffuse skin involvement (OR=2.21 [1.21-4.03]). CONCLUSIONS The prevalence of ACPA in scleroderma is 9.2%. Our meta-analysis shows an increased risk for erosive arthritis, pulmonary fibrosis, oesophagus involvement and diffuse skin involvement, in patients with ACPA-positive SSc. ACPA should be systematically included in SSc assessment.
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Affiliation(s)
- Guillaume Laustriat
- Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Adeline Ruyssen-Witrand
- Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France; Pharmaco-épidémiologie, évaluation de l'utilisation et du risque médicamenteux, Inserm UMR 1027, faculté de médecine, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - Arnaud Constantin
- Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France; CPTP, Inserm UMR 1043, CHU Purpan, BP 3028, 31024 Toulouse cedex 3, France
| | - Thomas Barnetche
- Service de rhumatologie, FHU Acronim, CHU Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Daniel Adoue
- Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France; Service d'immunologie clinique, IUCT, oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Alain Cantagrel
- Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France; CPTP, Inserm UMR 1043, CHU Purpan, BP 3028, 31024 Toulouse cedex 3, France
| | - Yannick Degboé
- Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France; CPTP, Inserm UMR 1043, CHU Purpan, BP 3028, 31024 Toulouse cedex 3, France.
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12
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Yamakawa H, Hagiwara E, Yamanaka Y, Ikeda S, Sekine A, Kitamura H, Baba T, Okudela K, Iwasawa T, Takemura T, Ogura T. A 16-year Follow-up Case of Interstitial Pneumonia with Systemic Sclerosis-rheumatoid Arthritis Overlap Syndrome. Intern Med 2017. [PMID: 28626184 PMCID: PMC5505914 DOI: 10.2169/internalmedicine.56.7202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Interstitial pneumonia is a common and major comorbidity affecting the prognosis of patients with systemic sclerosis (SSc). However, there are few reported cases of SSc-rheumatoid arthritis (RA) overlap-associated interstitial pneumonia. We herein report a case in which the clinical behavior and histopathology of interstitial pneumonia with SSc-RA overlap syndrome was followed over a long clinical course. When clinicians are deciding on the treatment strategy for patients with SSc-RA overlap syndrome-associated interstitial pneumonia, a pathological examination of a surgical lung biopsy may be useful.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Japan
| | - Eri Hagiwara
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Yumie Yamanaka
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Japan
| | - Satoshi Ikeda
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Hideya Kitamura
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Koji Okudela
- Department of Pathobiology, Yokohama City University Graduate School of Medicine, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Japan
| | - Takashi Ogura
- Department of Internal Medicine, Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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13
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Musculoskeletal Involvement in Systemic Sclerosis: An Unexplored Aspect of the Disease. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2016. [DOI: 10.5301/jsrd.5000228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Musculoskeletal (MSK) symptoms in patients with systemic sclerosis (SSc) include articular involvement (arthralgia, synovitis, contractures), which is often an early phenomenon and significantly contributes to the disability. Predominantly the hands are affected. Consensus in outcome measures of articular involvement is missing. Health Assessment Questionnaire Disability Index (HAQ-DI), Cochin Hand Function Scale (CHFS), Hand Mobility Index in Scleroderma (HAMIS), and Disease Activity Score of 28 Joints (DAS28) may be used for the assessment of different aspects of joint involvement. There is an unmet need for therapies confirmed by randomized controlled clinical trials (RCTs) to treat both synovitis and non-inflammatory joint involvement. The few rehabilitation studies that have been conducted have shown some promising efficacy. Muscle involvement may be an early symptom. The presence of clinically meaningful muscle involvement often heralds an unfavourable prognosis. The histology of muscle biopsy shows a variable picture including inflammation and necrosis. Besides, signs of acute neurogenic atrophy have been recently described as a previously underestimated contributor to muscle weakness. Similar to articular involvement, the lack of classification criteria on inflammatory and non-inflammatory SSc-associated myopathies, and the lack of validated core set of outcome measures makes it difficult to perform RCTs. The SSc-specific fibrinous tenosynovitis (tendon-friction rubs /TFRs/) is a frequent finding in SSc. Patients with TFR are at increased risk of developing renal, vascular, cardiac and gastrointestinal involvement and have reduced survival rates. Changes of fibrinous tenosynovitis can be objectively detected by ultrasound and may be used as an outcome measure in the treatment of MSK involvement.
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14
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Factors Associated with Erosive Arthritis in Rheumatoid Arthritis and Other Connective Tissue Diseases: A Retrospective Study From a Southern Chinese Population. J Clin Rheumatol 2016; 22:22-9. [PMID: 26693623 DOI: 10.1097/rhu.0000000000000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the clinical predictors of erosive arthritis (EA) in patients with rheumatoid arthritis (RA) and other connective tissue diseases. METHODS Four hundred and one consecutive patients with newly diagnosed RA between January 2010 and January 2013 were enrolled in the study. During the study period, 729 consecutive patients with non-RA connective tissue diseases were also included, and a cross-sectional study was performed. Medical records were reviewed. Only those patients with data for 2 years were considered in the analysis (338). RESULTS Erosive arthritis was noted in 60.4% (204 /338) of patients with RA and occurred early in RA. The multivariate logistic regression analysis indicated that rheumatoid nodules, anemia, and positive anticyclic citrullinated peptide antibody (ACPA) were strongly associated factors for the occurrence of EA in RA patients. Erosive arthritis was also noted in 1.5% of patients with SLE, 5.8% of patients with primary Sjögren syndrome, and 9.1% (3/33) of patients with systemic sclerosis. When compared with patients without EA, high level and prominently higher positive rate of ACPA was found in these patients with EA. On receiver operating characteristic curve analysis, ACPA exhibited a maximum sensitivity with a cutoff value of 1.6 U/mL and 0.6 U/mL for RA and SLE patients, respectively. CONCLUSION Erosive arthritis had a high prevalence in Chinese RA patients and occurred early. Anemia, rheumatoid nodules, and ACPA were associated with EA in RA. Erosive arthritis also could be detected in SLE, primary Sjögren syndrome, and systemic sclerosis. Anticyclic citrullinated peptide antibodies were also associated with EA in these diseases. Intensive monitoring for erosions was recommended for RA patients with a cutoff of ACPA greater than 1.6 U/mL and greater than 0.6 U/mL for SLE patients.
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15
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Affiliation(s)
- Sanchit Sharma
- Department of Rheumatology; All India Institute of Medical Sciences; New Delhi India
| | - Uma Kumar
- Department of Rheumatology; All India Institute of Medical Sciences; New Delhi India
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16
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Lóránd V, Bálint Z, Komjáti D, Németh B, Minier T, Kumánovics G, Farkas N, Czirják L, Varjú C. Validation of disease activity indices using the 28 joint counts in systemic sclerosis. Rheumatology (Oxford) 2016; 55:1849-58. [DOI: 10.1093/rheumatology/kew246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Indexed: 01/23/2023] Open
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17
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Jangala MS, Lomati VP, Purma AR. Scleroderma overlap syndrome with interstitial lung disease and pulmonary artery hypertension. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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18
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Cavagna L, Nuño L, Scirè CA, Govoni M, Longo FJL, Franceschini F, Neri R, Castañeda S, Giraldo WAS, Caporali R, Iannone F, Fusaro E, Paolazzi G, Pellerito R, Schwarting A, Saketkoo LA, Ortego-Centeno N, Quartuccio L, Bartoloni E, Specker C, Murcia TP, La Corte R, Furini F, Foschi V, Corral JB, Airò P, Cavazzana I, Martínez-Barrio J, Hinojosa M, Giannini M, Barsotti S, Menke J, Triantafyllias K, Vitetta R, Russo A, Bajocchi G, Bravi E, Barausse G, Bortolotti R, Selmi C, Parisi S, Montecucco C, González-Gay MA. Clinical Spectrum Time Course in Anti Jo-1 Positive Antisynthetase Syndrome: Results From an International Retrospective Multicenter Study. Medicine (Baltimore) 2015; 94:e1144. [PMID: 26266346 PMCID: PMC4616698 DOI: 10.1097/md.0000000000001144] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Anti Jo-1 antibodies are the main markers of the antisynthetase syndrome (ASSD), an autoimmune disease clinically characterized by the occurrence of arthritis, myositis, and interstitial lung disease (ILD). These manifestations usually co-occur (for practical purpose complete forms) in the same patient, but cases with only 1 or 2 of these findings (for practical purpose incomplete forms) have been described. In incomplete forms, the ex novo occurrence of further manifestations is possible, although with frequencies and timing not still defined. The aim of this international, multicenter, retrospective study was to characterize the clinical time course of anti Jo-1 positive ASSD in a large cohort of patients. Included patients should be anti Jo-1 positive and with at least 1 feature between arthritis, myositis, and ILD. We evaluated the differences between complete and incomplete forms, timing of clinical picture appearance and analyzed factors predicting the appearance of further manifestations in incomplete ASSD. Finally, we collected 225 patients (58 males and 167 females) with a median follow-up of 80 months. At the onset, complete ASSD were 44 and incomplete 181. Patients with incomplete ASSD had frequently only 1 of the classic triad findings (110 cases), in particular, isolated arthritis in 54 cases, isolated myositis in 28 cases, and isolated ILD in 28 cases. At the end of follow-up, complete ASSD were 113, incomplete 112. Only 5 patients had an isolated arthritis, only 5 an isolated myositis, and 15 an isolated ILD. During the follow-up, 108 patients with incomplete forms developed further manifestations. Single main feature onset was the main risk factor for the ex novo appearance of further manifestation. ILD was the prevalent ex novo manifestation (74 cases). In conclusion, ASSD is a condition that should be carefully considered in all patients presenting with arthritis, myositis, and ILD, even when isolated. The ex novo appearance of further manifestations in patients with incomplete forms is common, thus indicating the need for an adequate clinical and instrumental follow-up. Furthermore, the study clearly suggested that in ASSD multidisciplinary approach involving Rheumatology, Neurology, Pneumology, and Internal Medicine specialists is mandatory.
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Affiliation(s)
- Lorenzo Cavagna
- From the Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foudation, Pavia, Italy (LC, RC, CM); Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain (LN); Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy (CAS); UOC Reumatologia, Azienda Ospedaliero Universitaria S. Anna, University of Ferrara, Ferrara, Italy (M Govoni, RLC, F Furini, VF); Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain (FJLL, JM-B, MH); Rheumatology Unit, University and AO Spedali Civili, Brescia, Italy (F Franceschini, PA, IC); Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (RN, SB); Department of Rheumatology, Hospital Universitario de la Princesa, IIS Princesa, Madrid, Spain (SC); Department of Rheumatology, University Hospital Ramón y Cajal, Madrid, Spain (WASG, JBC); Interdisciplinary Department of Medicine (DIM), Rheumatology Unit, University of Bari, Bari, Italy (FI, M Giannini); Department of Rheumatology, Città Della Salute e della Scienza, Torino, Italy (EF, SP); Rheumatology Unit, Santa Chiara Hospital, Trento, Italy (GP, G Barausse, RB); Division of Rheumatology, Mauriziano Hospital, Turin, Italy (RP, RV, AR); Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Johannes-Gutenberg, Mainz, Germany (AS, JM); Tulane University Lung Center Tulane/UMC Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA (LAS); Systemic Autoimmune Diseases Unit, Hospital Clínico San Cecilio, Granada, Spain (NO-C); Clinic of Rheumatology, Department of Medical and Biological Sciences (DSMB), Santa Maria della Misericordia Hospital, Udine, Italy (LQ); Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy (E Bartoloni); Department for Rheumatology and Clinical Immunology, St. Josef Krankenhaus, University Clinic, Essen, Germany (C Specker); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain (TPM, MAG-G); ACURA Rheumatology Center, Bad Kreuznach, Germany (KT); Rheumatology Unit, Department of Internal Medicine, S. Maria Hospital-IRCCS, Reggio Emilia, Italy (G Bajocchi); Rheumatology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy (E Bravi); and Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milano, Italy (C Selmi)
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19
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Lóránd V, Czirják L, Minier T. Musculoskeletal involvement in systemic sclerosis. Presse Med 2014; 43:e315-28. [PMID: 25179276 DOI: 10.1016/j.lpm.2014.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/18/2014] [Indexed: 12/26/2022] Open
Abstract
Musculoskeletal (MSK) involvement is a very frequent manifestation of patients with systemic sclerosis (SSc). There are several reports about clinical trials assessing musculoskeletal involvement in SSc. However, only few controlled studies have been conducted. The prevalence of musculoskeletal symptoms, clinical and radiographic findings has been assessed. The most important articular (arthralgia, synovitis, contractures), tendon (tendon friction rubs, tenosynovitis) and muscular manifestations (myalgia, muscle weakness, myositis) should be carefully evaluated during the assessment of SSc patients, because these are not only common, but substantially influence the quality of life and some of them also have predictive value concerning disease activity and severity.
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Affiliation(s)
- Veronika Lóránd
- University of Pécs, Faculty of Medicine, Department of Rheumatology and Immunology, 7632 Pécs, Hungary
| | - László Czirják
- University of Pécs, Faculty of Medicine, Department of Rheumatology and Immunology, 7632 Pécs, Hungary
| | - Tünde Minier
- University of Pécs, Faculty of Medicine, Department of Rheumatology and Immunology, 7632 Pécs, Hungary.
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20
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Stojan G, Illei PB, Yung RC, Gelber AC. Raynaud's phenomenon, inflammatory arthritis, and weight loss: pay attention to the man behind the curtain. Arthritis Care Res (Hoboken) 2014; 66:1263-8. [PMID: 24664962 DOI: 10.1002/acr.22331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/18/2014] [Indexed: 12/19/2022]
Affiliation(s)
- George Stojan
- Harvard Medical School, Boston, Massachusetts, and Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Tasliyurt T, Kisacik B, Kaya SU, Yildirim B, Pehlivan Y, Kutluturk F, Ozyurt H, Sahin S, Onat AM. The frequency of antibodies against cyclic citrullinated peptides and rheumatoid factor in healthy population: a field study of rheumatoid arthritis from northern Turkey. Rheumatol Int 2012; 33:939-42. [PMID: 22829412 DOI: 10.1007/s00296-012-2458-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 07/07/2012] [Indexed: 11/30/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic and an autoimmune disease characterized by inflammation of the synovial membrane that affects approximately 1 % of the total world population. Rheumatoid factor (RF) is a widely used auto antibody in diagnosis of the RA and found positive in 50-80 % of the patients but with a lower specificity. On the other hand, anti-cyclic citrullinated peptide (anti-CCP) is the latest serological marker with a specificity around 98 %. This field survey was conducted in different regions to investigate the frequency of RF and anti-CCP and also frequency of RA in a northern province of Turkey. This study was conducted in 70 local areas (12 urban and 58 rural) in the province of Tokat, which is located in northern Turkey. The population of Tokat was reported to be 828,000 at the last census and about 530,000 individuals aged > 18 years old. The study population of 941 subjects (462 male and 479 female; urban 501 and rural 440) was selected by random sampling method among 530,000 individuals. Of the 941 healthy controls assigned to the study, 479 of them were female (51 %) and 462 of them were males (49 %), and median age of all participants was 41 ± 17. Twenty-six subjects were RF positive (2.8 %), and 9 patients were anti-CCP positive (1 %). The presence of both RF and anti-CCP antibodies has also been shown in two patients (0.2 %). In conclusion, we demonstrated that the frequency of RA was 0.53 %, RF presence was 2.8 %, and anti-CCP presence was 1 % in total 941 healthy subjects enrolled into study.
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Affiliation(s)
- Turker Tasliyurt
- Department of Internal Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Avouac J, Clements PJ, Khanna D, Furst DE, Allanore Y. Articular involvement in systemic sclerosis. Rheumatology (Oxford) 2012; 51:1347-56. [DOI: 10.1093/rheumatology/kes041] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Anti-cyclic citrullinated peptide antibodies in scleroderma patients. Clin Rheumatol 2012; 31:877-80. [DOI: 10.1007/s10067-011-1930-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 10/18/2011] [Accepted: 12/22/2011] [Indexed: 02/02/2023]
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Demoruelle MK, Deane K. Antibodies to citrullinated protein antigens (ACPAs): clinical and pathophysiologic significance. Curr Rheumatol Rep 2012; 13:421-30. [PMID: 21713412 DOI: 10.1007/s11926-011-0193-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Antibodies to citrullinated protein antigens (ACPAs) are highly specific for rheumatoid arthritis (RA) and are useful in the diagnosis of RA as well as the prediction of the course and outcomes of disease. Multiple methodologies exist for measuring ACPAs, including the widely available tests for anticyclic citrullinated peptide antibodies and for antibodies to mutated/modified citrullinated vimentin. These methodologies overall have similar diagnostic accuracies for RA, although there is some variability. The discovery of ACPAs and the biology of citrullination have also led to important advances in the understanding of the pathophysiology and development of RA, especially regarding the relationship between potential genetic and environmental risk factors for RA. Going forward, research into autoimmunity to citrullinated proteins may help identify the specific etiology of RA and provide approaches for the prediction of future risk of disease, and ultimately prevention of RA.
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Affiliation(s)
- M Kristen Demoruelle
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Schmeiser T, Pons-Kühnemann J, Özden F, Müller-Ladner U, Dinser R. Arthritis in patients with systemic sclerosis. Eur J Intern Med 2012; 23:e25-9. [PMID: 22153544 DOI: 10.1016/j.ejim.2011.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 08/14/2011] [Accepted: 09/14/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a connective tissue diseases characterised by excessive thickening of the dermis in addition to affection of internal organs. Many patients experience musculoskeletal symptoms, but arthritis is still considered to be a rare manifestation. Therefore, we analysed a cohort of SSc patients in our department and related the findings to published data. METHODS Clinical data on inpatients with SSc between February 2007 and February 2008 were analysed retrospectively for the presence of clinically overt and documented arthritis. In addition, X-rays of these patients were reassessed. A systematic literature search using PubMed was performed to find studies on arthritis in SSc patients; suitable studies were included in a meta-analysis based on the random-effect-model. The search terms were scleroderma, systemic sclerosis, arthritis, inflammatory joint disease, hand involvement, foot involvement and musculoskeletal findings in various combinations. Original articles not written in English and articles which were not dealing with arthritis in SSc patients were excluded from the study. We included articles in which the examined cohorts corresponds to the ACR- or LeRoy criteria for SSc and arthritis was diagnosed based on clinical and/or radiological data. All manuscripts were read and reviewed by two independent investigators. RESULTS In our cohort of 58 patients, 31% had signs of arthritis, 19% clinically and 26% radiologically. In a meta-analysis of 7 studies, a prevalence of 26% (95% CI [16.7, 36.1]) for radiologically detectable arthritis in SSc patients was observed. For clinical arthritis, the prevalence was calculated to be 23% (95% CI [14.9, 30.9]). Of interest, no difference in the occurrence of arthritis in diffuse and limited SSc was observed radiologically (OR=1.1, 95% CI [0.47, 2.57]) or clinically (OR=1.11, 95% CI [0.6, 2.05]). CONCLUSION Arthritis is frequent manifestation of SSc. Its role in joint dysfunction has to be established in further studies.
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Affiliation(s)
- Tim Schmeiser
- Department of Internal Medicine and Rheumatology, Kerckhoff-Klinik, Justus-Liebig University Gießen, Germany.
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Cartilage Oligomeric Matrix Protein (COMP) in systemic sclerosis (SSc): Role in disease severity and subclinical rheumatoid arthritis overlap. Joint Bone Spine 2012; 79:51-6. [DOI: 10.1016/j.jbspin.2011.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 02/23/2011] [Indexed: 11/20/2022]
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Clements PJ, Allanore Y, Khanna D, Singh M, Furst DE. Arthritis in systemic sclerosis: systematic review of the literature and suggestions for the performance of future clinical trials in systemic sclerosis arthritis. Semin Arthritis Rheum 2011; 41:801-14. [PMID: 22177105 DOI: 10.1016/j.semarthrit.2011.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/22/2011] [Accepted: 10/04/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Musculoskeletal (MSK) pain is a frequent (between 40-80%) complaint of patients with systemic sclerosis (SSc). Unfortunately, there are virtually no systematic studies of the causes or the management of MSK involvement in SSc and with few exceptions there have been no controlled trials to determine what are and should be the best strategies for managing MSK pain and synovitis in patients with SSc. METHODS A literature search was conducted for published reports that have addressed the clinical assessment of "arthritis" and "musculoskeletal" involvement in SSc. The literature search was a prelude to developing recommendations/suggestions for performing clinical trials (preferably randomized) in the future in SSc-related arthritis. RESULTS The search netted a number of articles that reported clinical assessments of arthritis in SSc, but very few reported results of controlled clinical trials. Nevertheless, a prevalence of clinical arthritis and tools used to assess the involvement (clinical examination, functional assessments and assessments of quality of life, and radiographic imaging) was found. CONCLUSIONS Most of the tools used to assess arthritis in SSc patients have not been validated and additional work is needed to develop a "core set" of variables for assessment of arthritis in SSc and its response to treatment. This report furnishes the background information that can help provide the building blocks for the development of a "core set" that can be used to chart the efficacy of new treatments for SSc-related arthritis in the future.
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Affiliation(s)
- Philip J Clements
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1670, USA.
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Abstract
Articular symptoms are common in SSc and joint pain is a frequent presenting feature of this disease. Hand involvement is often the first clinical manifestation of SSc and could be resulted from fibrosis or synovitis or an overlap syndrome with rheumatoid arthritis (RA); though, the latter is a controversy in practice. To define the clues when identifying the nature of the hand arthropathy in SSc. In order to determine the hand arthropathy, serological tests, hand radiography, finger-to-palm (FTP) distance and other clinical features, disease activity and functional scoring parameters were assessed. Twenty-eight consecutive SSc patients and 43 controls (21 rheumatoid arthritis and 22 healthy controls) were included. Radiographic findings in SSc patients were: Erosions 25%, joint space narrowing 17.9%, arthritis 10.7%, radiological demineralisation 42.9%, acro-osteolysis 25%, flexion contracture 28.6% and calcinosis 17.9%. Anti-CCP antibody and RF positivity were as follows: In SSc group: 3 (11%) and 7 patients (25%); In RA group: 13 (62%) and 19 patients (90.5%); In healthy control group: 1 (4%) and 3 persons (13.6%), respectively. Two patients (7.14%) were regarded as RA overlap, whom both had positive RF and positive anti-CCP results and their radiographs revealed arthritis. Seventeen patients (61%) were regarded as SSc arthropathy; all were negative for RF and anti-CCP but revealed nonarthritic radiological findings. (Among them, only one patient had positive anti-CCP result). The remainder (9 patients) had no radiological or serological finding positive for arthropathy. Arthritis was found to have correlation with heart involvement and FTP was correlated with lung involvement. Hand involvement in SSc is a challenge in rheumatology practice; Radiographic testing when evaluated with RF and anti-CCP will be a helpful tool to discriminate SSc arthropathy from RA-SSc overlap. Hand arthropathy should increase the interest in the serious internal organ involvements of SSc.
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CAVAGNA LORENZO, FUSETTI CHIARA, MONTECUCCO CARLOMAURIZIO, CAPORALI ROBERTO. Anticyclic Citrullinated Peptide Antibodies as Markers of Erosive Arthritis in Antisynthetase Syndrome: Table 1. J Rheumatol 2010; 37:1967; author reply 1968. [DOI: 10.3899/jrheum.091402] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Inflammatory arthritis presents in a variety of diseases, from rheumatoid arthritis to hepatitis. Antibodies to autoantigens or to microbial constituents are commonly associated with these conditions. In some cases, the antibodies have diagnostic and prognostic relevance. It cannot as yet be determined definitively that any of them mediate joint damage, although the evidence from animal models indicates that this mechanism is likely. The purpose of this article is to give an overview of the spectrum of antibodies found in a variety of inflammatory arthritides. The relevant animal models are also discussed.
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Affiliation(s)
- Ann Duskin
- Department of Medicine, Pennsylvania Hospital, Philadelphia, PA, USA
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The diagnostic utility of the anti-CCP antibody test is no better than rheumatoid factor in South Africans with early rheumatoid arthritis. Clin Rheumatol 2010; 29:615-8. [PMID: 20127131 DOI: 10.1007/s10067-010-1374-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 11/29/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
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Aggarwal R, Liao K, Nair R, Ringold S, Costenbader KH. Anti-citrullinated peptide antibody assays and their role in the diagnosis of rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2009; 61:1472-83. [PMID: 19877103 PMCID: PMC2859449 DOI: 10.1002/art.24827] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Increasingly, assays for the detection of anti-citrullinated peptide antibodies (ACPA) are used in RA diagnosis. This review summarizes the biologic basis and development of ACPA assays, available ACPA assays and their performance characteristics, and diagnostic properties of ACPA alone and compared to rheumatoid factor (RF) in early RA. We also review correlations, precision, costs and cost-effectiveness, availability, stability and reproducibility of the available assays. Taken together, data indicate that ACPA has a higher specificity than RF for early RA, good predictive validity, high sensitivity, apparent cost-effectiveness and good stability and reproducibility. Given its superior performance characteristics and increasing availability, ACPA is emerging as the most useful single assay for the diagnosis of RA.
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Affiliation(s)
- Rohit Aggarwal
- Rush University Medical Center, Division of Rheumatology, Chicago, IL 60612, USA.
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Alessandri C, Priori R, Modesti M, Mancini R, Valesini G. The role of anti-cyclic cytrullinate antibodies testing in rheumatoid arthritis. Clin Rev Allergy Immunol 2009; 34:45-9. [PMID: 18270857 DOI: 10.1007/s12016-007-8023-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disease, which leads to joint destruction and deformity and is often accompanied by systemic complications. It is generally considered an autoimmune disease characterized by several autoantibodies. The impressive advances made in understanding the biological mechanisms of RA have led to more focused, directed therapies that have joined, and in many cases overcome, more traditional treatments. Along the last decade, the so-called biological anti-TNF-alpha agents have been shown to reduce disease activity, to slow disease progression and to improve patients' quality of life. The clear evidence that an early therapeutic intervention improves the overall outcome of the disease supports the importance of an early diagnosis. In the last years, several studies showed that anti-cyclic citrullinated peptide antibodies (anti-CCP) represent a sensitive and specific serologic marker for RA. Moreover, a large body of evidence has shown that anti-CCP may also serve as an early diagnostic and prognostic marker in RA. The aim of this article is to provide an overview of the current state of knowledge regarding anti-CCP focusing in particular on their clinical specificity and prognostic value in RA.
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Affiliation(s)
- Cristiano Alessandri
- Dipartimento di Clinica e Terapia Medica, Sapienza Università di Roma, Policlinico Umberto I, V.le del Policlinico 155, 00161, Roma, Italy
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Fabien N, Olsson NO, Goetz J, Johanet C, Escande A, Bardin N, Sanmarco M, Andre C, Chevailler A, Humbel RL, Chretien P, Monier JC, Fortenfant F, Oksman F, Taillefer MF, Sibilia J. Prevalence of autoantibodies to cyclic citrullinated peptide in patients with rheumatic diseases other than rheumatoid arthritis: a French multicenter study. Clin Rev Allergy Immunol 2009; 34:40-4. [PMID: 18247159 DOI: 10.1007/s12016-008-8073-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our objective was to evaluate the prevalence of autoantibodies to cyclic citrullinated peptides (anti-CCP aAbs) in a cohort of patients with a variety of inflammatory or non-inflammatory rheumatic diseases other than rheumatoid arthritis (RA). Six hundred and nine serum samples were tested for anti-CCP aAbs and for rheumatoid factor (RF) using enzyme-linked immunosorbent assays and immunonephelometry. The prevalence of anti-CCP aAbs and RF reached 10% and 25%, respectively, using the positive cutoff value suggested by the manufacturers. Using a higher cutoff value (50 U/ml) for both aAbs, the prevalence was lower with 6% and 16%, respectively. The specificity of both markers for RA thus reached 94% and 84%, respectively. Anti-CCP aAbs were found to be elevated in inflammatory and also in non-inflammatory rheumatic diseases in the same proportion. Clinical data obtained for 36 positive patients showed that 17% developed RA within 5 years. In conclusion, anti-CCP aAbs are clearly more specific than RF for RA. Follow-up of anti-CCP aAbs-positive patients with inflammatory or non-inflammatory rheumatic diseases other than RA could be important considering the predictive value of these aAbs for the development of RA.
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Affiliation(s)
- Nicole Fabien
- Department of Immunology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Inserm U851, 69495, Pierre-Benite Cedex, France.
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Cuomo G, Zappia M, Abignano G, Iudici M, Rotondo A, Valentini G. Ultrasonographic features of the hand and wrist in systemic sclerosis. Rheumatology (Oxford) 2009; 48:1414-7. [PMID: 19729497 DOI: 10.1093/rheumatology/kep250] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate ultrasonographic hand and wrist features in patients with SSc and their correlation with clinical and X-ray examinations. METHODS All the patients and controls underwent clinical examination, X-ray and ultrasonography (US) evaluations of the hands and wrists. Forty-five SSc patients all of whom satisfied the ACR criteria and 45 controls-15 patients with RA, 15 patients with FM syndrome and 15 healthy subjects were assessed. US was performed by a General Electric Logiq-5 PRO using a 7-12 MHz linear array transducer. RESULTS Joint effusion was found in 22 (49%) SSc patients; synovial proliferation in 19 (42%), which was associated with a power Doppler signal in 11 of them; marginal bone erosions in 5 (11%); joint space narrowing in 8 (18%); periarticular calcinosis in 12 (27%); and osteophytosis in 26 (59%). In SSc patients, the prevalence of synovitis as detected by US (i.e. effusion and/or synovial proliferation) was found to be significantly higher than that found by clinical examination (i.e. tenderness and/or swelling) (26 vs 15 out of 45 cases; P = 0.03). US indicated a significantly higher number of joints with osteophytes than X-rays (59 vs 27%; P < 0.005). CONCLUSIONS Our study depicts the main sonographic abnormalities of the SSc hand. Using US, we found an unexpectedly high prevalence of joint pathology in SSc without clinically involved hands. The clinical usefulness of US in the assessment of SSc articular involvement either in clinical practice or in therapeutic trials is yet to be defined.
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Affiliation(s)
- Giovanna Cuomo
- Department of Internal Medicine, Second University of Naples, Naples, Italy.
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Mohammed K, Pope J, Le Riche N, Brintnell W, Cairns E, Coles R, Bell DA. Association of severe inflammatory polyarthritis in primary Sjögren's syndrome: clinical, serologic, and HLA analysis. J Rheumatol 2009; 36:1937-42. [PMID: 19487261 DOI: 10.3899/jrheum.080234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the clinical, serologic, and MHC class II antigen characteristics of a group of patients with primary Sjögren's syndrome (SS) and severe arthritis. METHODS A case-control study comparing 35 patients with primary SS: 17 with inflammatory arthritis, 18 without arthritis. RESULTS All patients fulfilled criteria for primary SS. There were no demographic or clinical features other than inflammatory arthritis, often erosive, that distinguished patients with arthritis from those without. All patients had anti-Ro/SSA autoantibodies, most had anti-La/SSB autoantibodies, and a high percentage of these patients had anti-citrullinated peptide antibodies absent in those without inflammatory arthritis. HLA typing revealed that most patients with anti-citrulline antibodies expressed MHC class II molecules with the shared epitope (SE). The presence of DRB1*0301 linked to the expression of anti-Ro/SSA autoantibodies did not influence the level or frequency of anti-citrulline antibodies in these patients. CONCLUSION Severe arthritis with features resembling rheumatoid arthritis including erosive disease can occur in primary SS, particularly among those with anti-citrulline antibodies and the SE.
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Affiliation(s)
- Khulood Mohammed
- Department of Medicine, Division of Rheumatology, St Joseph's Health Care London and University of Western Ontario, London, Ontario, Canada
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Generini S, Steiner G, Miniati I, Conforti ML, Guiducci S, Skriner K, Kaloudi O, Giacomelli R, Smolen J, Matucci-Cerinic M. Anti-hnRNP and other autoantibodies in systemic sclerosis with joint involvement. Rheumatology (Oxford) 2009; 48:920-5. [PMID: 19483090 DOI: 10.1093/rheumatology/kep138] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate joint involvement in SSc and its relationship with autoantibody to the hnRNP and to anti-cyclic citrullinated peptide (anti-CCP). METHODS Sera from 55 SSc patients were investigated. Joint involvement was determined by clinical, radiological and ultrasonographical evaluation. Anti-hnRNP proteins A1 and A2 (anti-hnRNP-A1/A2) antibodies were determined by immunoblotting. Anti-CCP, ACA, anti-topo I (ATA), Sm, U1-RNP, ribosomal RNP, Ro/SSA, La/SSB autoantibody and RF were determined. RESULTS Six patients were positive for anti-hnRNP-A2 autoantibody and two were anti-A1 positive. Eight patients had joint erosions: seven of the eight patients positive for anti-hnRNP-A2 or A1 presented articular involvement (P < 0.04) and five of the eight erosive patients were positive for either of the two autoantibodies (P < 0.02). Of the four patients positive for anti-CCP, none had anti-hnRNP but three had erosive aspects. ATAs were found in 10 patients, six of which were also positive for anti-hnRNP (P < 0.05). RF was positive in 16 patients and in seven among those with articular involvement (P < 0.04). RF was significantly associated with anti-hnRNP in patients with erosive arthritis (P < 0.02), but not with the presence of anti-hnRNP alone. Epitope mapping of the three strongest anti-hnRNP-A2-positive sera recognized the same major epitope as patients with RA. SSc patients have higher incidence of erosions and anti-hnRNP-A2/A1 positivity. RF test and anti-hnRNP had a statistically significant diagnostic value for articular involvement. CONCLUSIONS These parameters might suggest that autoantibody to both hnRNP antigens might become a non-specific but useful marker for joint involvement in SSc patients and identify SSc patients prone to develop joint damage.
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Affiliation(s)
- Sergio Generini
- Department of Biomedicine, Division of Rheumatology AOUC, Denothe Center, University of Florence, Florence, Italy
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LOW ANDREAH, LAX MATTHEW, JOHNSON SINDHUR, LEE PETER. Magnetic Resonance Imaging of the Hand in Systemic Sclerosis. J Rheumatol 2009; 36:961-4. [DOI: 10.3899/jrheum.080795] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the utility of magnetic resonance imaging (MRI) in systemic sclerosis (SSc)-associated arthropathy.Methods.MRI of the hand was performed in patients presenting with joint pain/swelling in order (1) to determine the frequency of inflammation on MRI, and (2) to compare MRI with radiography.Results.Of 17 patients with SSc, 10 (59%) had inflammatory MRI findings with synovitis (n = 8), erosions (n = 7), joint effusion (n = 7), or tenosynovitis (n = 8). Bone edema was present in 9 patients. Of 7 patients with MRI erosions, only 2 had radiographic erosions.Conclusion.Our study illustrates the usefulness of MRI in the accurate diagnosis and characterization of SSc-associated arthropathy.
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The "sclerodermic hand": a radiological and clinical study. Joint Bone Spine 2008; 75:426-31. [PMID: 18455947 DOI: 10.1016/j.jbspin.2007.07.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 07/18/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the clinical and radiographic features of hand involvement in patients with systemic sclerosis (SSc). METHODS Forty-one unselected Sardinian SSc patients (32 women, 9 men; mean age 58.9, range 31-81 years; mean disease duration 11.8 years, range 1-36 years) were evaluated in this observational cross-sectional study. Twenty-six patients had diffuse scleroderma (dSSc) and 15 limited scleroderma (lSSc). Radiological examination of the hands was performed and the films were read by two independent rheumatologists blinded to the diagnosis using a classification system of four predefined radiological patterns (normal/minimal changes, articular degenerative, articular inflammatory and periarticular pattern). Correlations between radiological pattern, clinical and serological features were assessed. RESULTS The skeletal and articular involvement of the hand was frequent in SSc, being clinically evident in 30/41 (73%) and radiologically in 33/41 (80%) of patients. The periarticular pattern (defined as the occurrence of bone resorption of ungueal tufts, soft tissue calcifications and/or flexion deformities) was the most frequent pattern detected (14/41, 34.1%) and finger flexion contractures and bone resorptions were significantly associated with interstitial lung disease, reduced FVC, oesophagus involvement and prostacycline therapy. Calcinosis (29.2%) was found to be associated with erosions, suggesting a pathogenic link. An inflammatory pattern was also radiologically frequent (8/41, 19.5%), but erosions, with the exception of those localized at distal interphalangeal joints, were demonstrated mainly in patients with clinical picture of rheumatoid arthritis overlapped with SSc. We found no significant differences in terms of radiographic findings between lSSc and dSSc with the exception of calcinosis, which was more frequent in patients with lSSc. CONCLUSION This cross-sectional study confirms that the skeletal and articular involvement of the hand is frequent in SSc.
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Allali F, Tahiri L, Senjari A, Abouqal R, Hajjaj-Hassouni N. Erosive arthropathy in systemic sclerosis. BMC Public Health 2007; 7:260. [PMID: 17888166 PMCID: PMC2040159 DOI: 10.1186/1471-2458-7-260] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Accepted: 09/22/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To determine radiological features of arthropathy in systemic sclerosis patients with polyarthritis. RESULTS Forty one women and 5 men were included in this study. The mean age was 41 + 14,2 years, the mean duration of disease was 10,5+ 6,5 years. Thirty seven patients (80%) had radiological abnormalities including joint space narrowing (37%) and erosions (43%). At presentation, the prevalence of radiological foot abnormalities was lower than that of hands (26% vs 79%, p < 0,001). There was no significant difference between patients with (n = 24) and without erosive arthropathy (Joint space narrowing and/or erosion) (n = 22) in terms of cutaneous subtype, organ involvement, calcinosis presence of rheumatoid factor, ANA, Anti-topoisomerase antibodies. CONCLUSION This study showed an high frequency of erosive arthropathy in our Morroccan SSc patients with clinical synovitis.
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Affiliation(s)
- Fadoua Allali
- Rheumatology department, El Ayachi University-Hospital, Sale, Morocco
- Laboratory of Biostatistic, Clinical Research and Epidemiology. LBRCE. Faculty of Medecine and pharmacy, Rabat, Morocco
| | - Latifa Tahiri
- Rheumatology department, El Ayachi University-Hospital, Sale, Morocco
| | - Adil Senjari
- Rheumatology department, El Ayachi University-Hospital, Sale, Morocco
| | - Redouane Abouqal
- Laboratory of Biostatistic, Clinical Research and Epidemiology. LBRCE. Faculty of Medecine and pharmacy, Rabat, Morocco
| | - Najia Hajjaj-Hassouni
- Rheumatology department, El Ayachi University-Hospital, Sale, Morocco
- Laboratory of Biostatistic, Clinical Research and Epidemiology. LBRCE. Faculty of Medecine and pharmacy, Rabat, Morocco
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Santiago M, Baron M, Miyachi K, Fritzler MJ, Abu-Hakima M, Leclercq S, Bell M, Hudson M, Mathieu JP, Taillefer S, Jones N, Docherty P, Khraishi M, Markland J, Pope J, Robinson D, Smith D, Sutton E. A comparison of the frequency of antibodies to cyclic citrullinated peptides using a third generation anti-CCP assay (CCP3) in systemic sclerosis, primary biliary cirrhosis and rheumatoid arthritis. Clin Rheumatol 2007; 27:77-83. [PMID: 17570008 DOI: 10.1007/s10067-007-0656-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 05/16/2007] [Accepted: 05/18/2007] [Indexed: 12/12/2022]
Abstract
The objective was to investigate the frequency of anti-cyclic citrullinated peptides (CCP) antibodies in systemic sclerosis (SSc) and primary biliary cirrhosis (PBC), utilizing a new "third generation" anti-CCP ELISA (anti-CCP3) kit and a conventional anti-CCP2 assay. Patients with PBC, SSc, RA, and normal controls were included in the study. Serum samples were screened for autoantibodies by indirect immunofluorescence (IIF), antibodies to CCP by a second- and third-generation ELISA, antibodies to "scleroderma" antigens (CENP B, Scl-70, PM/Scl and fibrillarin-Scl-34) by a line immunoassay (LIA), and IgM RF by ELISA. The frequency of anti-CCP2 antibodies in SSc and PBC samples was 14.8% (11/74) and 6.2% (5/80), respectively, and the frequency of anti-CCP3 antibodies in SSc was 13.5% (10/74) and in PBC was 3.7% (3/80). By comparison, in the RA group the frequency of anti-CCP3 and anti-CCP2 antibodies was 79.1% (38/48) and 77% (37/48), respectively. Anti-CCP3 ELISA had a sensitivity, specificity, and positive and negative likelihood ratios (LR) of 79% (95% confidence interval [CI] = 64-89%), 93% (95% CI = 88-96%), 11.8 (95% CI = 6.8-20.3), and 0.22 (95% CI = 0.12-0.38), respectively. By comparison, the anti-CCP2 assay had a sensitivity, specificity, and positive and negative LRs of 77% (95% CI = 62-87), 90% (95% CI = 85-94), 8.3 (95% CI = 5.2-13.2), and 0.25 (95% CI = 0.15-0.42), respectively. In patients with SSc, there was an association of anti-CCP2 antibodies with the presence of arthritis, but there was no association of anti-CCP2 or anti-CCP3 with anti-CENP B, anti-Scl 70, or RF. This study confirmed the high specificity and sensitivity of both anti-CCP assays for the diagnosis of RA. The presence of anti-CCP antibodies in SSc was only correlated with the presence of arthritis.
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Affiliation(s)
- Mittermayer Santiago
- Servico de Reumatologia do Hospital do Santa Izabel, Escola Bahiana de Medicina e Saude Publica, Salvador, Brazil
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Vannini A, Cheung K, Fusconi M, Stammen-Vogelzangs J, Drenth JPH, Dall'Aglio AC, Bianchi FB, Bakker-Jonges LE, van Venrooij WJ, Pruijn GJM, Zendman AJW. Anti-cyclic citrullinated peptide positivity in non-rheumatoid arthritis disease samples: citrulline-dependent or not? Ann Rheum Dis 2006; 66:511-6. [PMID: 16984940 PMCID: PMC1856034 DOI: 10.1136/ard.2006.058933] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antibodies directed against citrullinated proteins (eg anti-cyclic citrullinated peptide (CCP)) have excellent diagnostic and good prognostic potential for rheumatoid arthritis. Type 1 autoimmune hepatitis (AIH-1) is a chronic liver disease characterised by a variety of serum autoantibodies. Recently, in a large group of patients with AIH-1 without clear rheumatoid arthritis overlap, a relatively high percentage (9%) of anti-CCP2 positivity was scored. OBJECTIVES To characterise the citrulline-dependence of the observed anti-CCP2 positivity in AIH-1 sera as well as in other groups of patients without rheumatoid arthritis (mainly rheumatic diseases). METHODS Serum samples of 57 patients with AIH-1 and 66 patients without rheumatoid arthritis, most of them reported as anti-CCP positive, were tested for citrulline-specific reactivity with a second generation anti-CCP kit, with the citrullinated and the corresponding non-citrullinated (arginine-containing) antigen. A subset of AIH-1 sera was also tested with a CCP1 ELISA (and arginine control). RESULTS The anti-CCP2 reactivity of most non-rheumatoid arthritis rheumatic diseases samples (87-93%) was citrulline-specific, whereas a relatively high percentage of AIH-1 samples (42-50%) turned out to be reactive in a citrulline-independent manner. The use of citrullinated and non-citrullinated CCP1 peptides confirmed a high occurrence of citrulline-independent reactivity in AIH-1 samples. CONCLUSIONS In rheumatoid arthritis and most non-rheumatoid arthritis rheumatologic disease sera, anti-CCP positivity is citrulline-dependent. However in some patients, particularly patients with AIH-1, citrulline-independent reactivity in the anti-CCP2 test can occur. A positive CCP test in a non-rheumatic disease (eg liver disease) should therefore be interpreted with care, and preferably followed by a control ELISA with a non-citrullinated antigen.
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Affiliation(s)
- A Vannini
- Department of Internal Medicine, Cardioangiology, Hepatology, University of Bologna, and Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy.
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