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Kayser C, de Oliveira Delgado SM, Zimmermann AF, Horimoto AMC, Del Rio APT, de Souza Müller C, Camargo CZ, Lupo CM, de Moraes DA, Do Rosário E Souza EJ, Santos FPST, Sekiyama JY, Lonzetti LS, de Oliveira Martins LV, Bezerra MC, Bredemeier M, Oliveira MC, da Fonseca Salgado MC, Miossi R, de Araújo Fontenele SM, Hax V, Dantas AT, Sampaio-Barros PD. 2023 Brazilian Society of Rheumatology guidelines for the treatment of systemic sclerosis. Adv Rheumatol 2024; 64:52. [PMID: 38987832 DOI: 10.1186/s42358-024-00392-w] [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: 09/30/2023] [Accepted: 06/25/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc. METHODS A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed. RESULTS Six recommendations were elaborated regarding the pharmacological treatment of Raynaud's phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found. CONCLUSION These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.
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Affiliation(s)
- Cristiane Kayser
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua dos Otonis 863, 2º andar, Vila Clementino, São Paulo, SP, 04025-002, Brazil.
| | - Sandra Maximiano de Oliveira Delgado
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua dos Otonis 863, 2º andar, Vila Clementino, São Paulo, SP, 04025-002, Brazil
- Rheumatology Division, Hospital Sírio Libanês, Brasília, DF, Brazil
| | - Adriana Fontes Zimmermann
- Rheumatology Division, Professor Polydoro Ernani de São Tiago University Hospital, Universidade Federal de Santa Catarina-UFSC, Florianópolis, SC, Brazil
| | - Alex Magno Coelho Horimoto
- Rheumatology Division, Hospital Regional do Mato Grosso do Sul, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul-UFMS, Campo Grande, MS, Brazil
| | | | - Carolina de Souza Müller
- Rheumatology Division, Hospital de Clínicas, Universidade Federal do Paraná-UFPR, Curitiba, PR, Brazil
| | - Cintia Zumstein Camargo
- Internal Medicine Departament, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista-UNESP, Botucatu, SP, Brazil
| | - Cristiano Michelini Lupo
- Rheumatology Division, Faculdade de Medicina de São José do Rio Preto-FAMERP, São José do Rio Preto, SP, Brazil
| | | | | | | | - Juliana Yuri Sekiyama
- Internal Medicine Departament, Universidade Estadual de Maringá-UEM, Maringá, PR, Brazil
| | - Lilian Scussel Lonzetti
- Rheumatology Division, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, RS, Brazil
| | - Lucas Victória de Oliveira Martins
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua dos Otonis 863, 2º andar, Vila Clementino, São Paulo, SP, 04025-002, Brazil
| | | | - Markus Bredemeier
- Rheumatology Division, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil
| | - Maria Carolina Oliveira
- Clinical Immunology Division, Ribeirão Preto Medical School, Universidade de São Paulo-USP, Ribeirão Preto, SP, Brazil
| | | | - Renata Miossi
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo-USP, São Paulo, SP, Brazil
| | | | - Vanessa Hax
- Rheumatology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil
| | | | - Percival Degrava Sampaio-Barros
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo-USP, São Paulo, SP, Brazil
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Hui M, Wang X, Zhou J, Zhang L, Duan X, Li M, Wang Q, Zhao J, Hou Y, Xu D, Zeng X. Systemic sclerosis patients with negative antinuclear antibodies have distinctive clinical manifestations: a multicenter CRDC cohort in China. Z Rheumatol 2024; 83:160-166. [PMID: 35852599 DOI: 10.1007/s00393-022-01242-0] [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] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of circulating antinuclear antibodies (ANAs) is a hallmark of immune dysregulation in patients with systemic sclerosis (SSc). OBJECTIVE A variety of ANAs are associated with unique sets of disease manifestations and are widely used in clinical practice in SSc. This study aimed to investigate the clinical features of SSc patients negative for ANAs in a Chinese Rheumatism Data Center (CRDC) multicenter cohort in China. METHODS Patients were prospectively recruited between April 2008 and June 2019 from 154 clinical centers nationwide, and all cases fulfilled the 2013 ACR/EULAR classification criteria for systemic sclerosis. Results for antinuclear antibodies were intensively collected. Demographic, clinical, and laboratory data were compared between ANA-positive SSc patients and those negative for ANAs. RESULTS Antinuclear antibodies were detected in 2129 of 2809 patients enrolled in the study; 4.2% of patients were negative. There were more males among ANA-negative SSc patients (29/60 vs. 294/1746, p < 0.001). The incidence of certain critical organ involvement, including gastroesophageal reflux (5.6% vs. 18.5%, p = 0.002), interstitial lung disease (65.2% vs. 77.9%, p = 0.015), and pulmonary arterial hypertension (11.5% vs. 29.0%, p = 0.006) was significantly lower in ANA-negative patients than in ANA-positive patients. The proportion of abnormal erythrocyte sedimentation rate (32.4% vs. 47.6%, p = 0.013) and IgG elevation (14.3% vs. 37.0%, p = 0.003), an indicator of disease activity, was significantly lower in ANA-negative patients than in ANA-positive patients. CONCLUSION Antinuclear antibodies are strongly associated with the clinical manifestations of systemic sclerosis, with ANA-negative SSc patients tending to exhibit relatively milder disease.
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Affiliation(s)
- Min Hui
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Xianbin Wang
- Department of Rheumatology and Immunology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, 20 Yuhuangding East Road, Zhifu District, 264000, Yantai, Shandong, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Liyun Zhang
- Department of Rheumatology, ShanXi Bethune Hospital, ShanXi Academy of Medical Sciences, 030000, Shanxi, China
| | - Xinwang Duan
- Department of Rheumatology, the Second Affiliated Hospital of Nanchang University, 330006, Jiangxi, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Yong Hou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China.
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China.
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Nihtyanova SI, Schreiber BE, Ong VH, Wells AU, Coghlan JG, Denton CP. Dynamic Prediction of Pulmonary Hypertension in Systemic Sclerosis Using Landmark Analysis. Arthritis Rheumatol 2023; 75:449-458. [PMID: 36122180 DOI: 10.1002/art.42349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/31/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pulmonary hypertension (PH) is a serious complication of systemic sclerosis (SSc). In this study, we explored the prediction of short-term risk for PH using serial pulmonary function tests (PFTs) and other disease features. METHODS SSc patients in whom disease onset occurred ≥10 years prior to data retrieval and for whom autoantibody specificity and PFT data were available were included in this study. Mixed-effects modeling was used to describe changes in PFTs over time. Landmarking was utilized to include serial assessments and stratified Cox proportional hazards regression analysis with landmarks as strata was used to develop the PH prediction models. RESULTS We analyzed data from 1,247 SSc patients, 16.3% of whom were male and 35.8% of whom had diffuse cutaneous SSc. Anticentromere, antitopoisomerase, and anti-RNA polymerase antibodies were observed in 29.8%, 22.0%, and 11.4% of patients, respectively, and PH developed in 13.6% of patients. Over time, diffusing capacity for carbon monoxide (DLco) and carbon monoxide transfer coefficient (Kco) declined in all SSc patients (up to 1.5% per year) but demonstrated much greater annual decline (up to 4.5% and 4.8%, respectively) in the 5-7 years preceding PH diagnosis. Comparisons between multivariable models including either DLco, Kco, or forced vital capacity (FVC)/DLco ratio, demonstrated that both absolute values and change over the preceding year in those measurements were strongly associated with the risk of PH (hazard ratio [HR] 0.93 and 0.76 for Kco and its change; HR 0.90 and 0.96 for DLco and its change; and HR 1.08 and 2.01 for FVC/DLco ratio and its change; P < 0.001 for all). The Kco-based model had the greatest discriminating ability (Harrell's C-statistic 0.903). CONCLUSION Our findings strongly support the importance of PFT trends over time in identifying patients at risk of developing PH.
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Affiliation(s)
- Svetlana I Nihtyanova
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK, and GSK, London, UK
| | | | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - John G Coghlan
- Pulmonary Hypertension Service, Royal Free Hospital, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
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Autoantibodies and Clinical Correlations in Polish Systemic Sclerosis Patients: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12020657. [PMID: 36675584 PMCID: PMC9863773 DOI: 10.3390/jcm12020657] [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: 12/23/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
We evaluated the prevalence of systemic sclerosis (SSc)-related autoantibodies and their clinical significance and compared the sensitivity of two line immunoblot assays on a prospective study group of 96 Polish SSc patients (ACR-EULAR 2013 criteria) whose sera were assessed by indirect immunofluorescence (HEp-2 and monkey liver) and line immunoblot assays: ANA Profile 3 and Systemic Sclerosis Profile by EUROIMMUN (Lübeck, Germany). Organ involvement was evaluated according to the EUSTAR Minimal Essential Data Set. The following autoantibodies’ prevalence was found: Scl-70 (36%), Ro-52 (28%), CENP-B (22%), CENP-A (20%), PM-Scl-75 (20%), PM-Scl-100 (14%), fibrillarin (7%), Th/To (7%), RNA polymerase III 11 kDa (5%), RNA polymerase III 155 kDa (3%), PDGFR (3%), NOR-90 (2%), and Ku (1%). Significant associations between the autoantibodies’ presence and organ involvement were found: ATA (dcSSc > lcSSc, less prevalent muscle weakness), Ro-52 (gangrene, DLCO < 60), CENP-B and A (lcSSc > dcSSc, normal CK), CENP-B (rarer digital ulcers and joint contractures), PM-Scl-100 and 75 (PM/SSc overlap, CK increase, muscle weakness, muscle atrophy), PM-Scl-100 (dcSSc unlikely), PM-Scl-75 (lung fibrosis), fibrillarin (muscle atrophy, proteinuria, conduction blocks, palpitations), Th/To (proteinuria, arthritis, muscle weakness, and rarer esophageal symptoms), RNA Polymerase III 11 kDa (arterial hypertension, renal crisis), RNA polymerase III 155 kDa (renal crisis), and PDGFR (dcSSc, tendon friction rubs). Additionally, the Systemic Sclerosis Profile was significantly more sensitive in detecting SSc-related autoantibodies than ANA Profile 3 (p = 0.002). In conclusion, individual autoantibodies associated with specific characteristics of SSc.
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Satoh M, Ceribelli A, Hasegawa T, Tanaka S. Clinical Significance of Antinucleolar Antibodies: Biomarkers for Autoimmune Diseases, Malignancies, and others. Clin Rev Allergy Immunol 2022; 63:210-239. [PMID: 35258843 DOI: 10.1007/s12016-022-08931-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 01/13/2023]
Abstract
Nucleolar staining is one of the standard patterns in immunofluorescence antinuclear antibodies (ANA), seen in 5-9% of ANA in various conditions. Antinucleolar antibodies (ANoA) are classified into 3 patterns in the International Consensus on ANA Patterns (ICAP) classification; AC-8 homogeneous pattern, AC-9 clumpy pattern, and AC-10 punctate pattern. Specificities known to show AC-8 include anti-Th/To, -PM-Scl, -nucleophosmin/B23, -nucleolin/C23, -No55, and others. AC-9 is seen by anti-fibrillarin/U3RNP and AC-10 by anti-RNA polymerase I and hUBF/NOR-90. ANoA has been classically known to be associated with scleroderma (SSc) and the characterization of nucleolar antigens identified several autoantigens recognized by SSc autoantibodies. The clinical association of anti-Th/To, PM-Scl, fibrillarin/U3RNP, and RNA polymerase I with SSc or SSc-overlap syndrome is well established, and commercial assays are developed. Anti-hUBF/NOR90, nucleophosmin/B23, and nucleolin/C23 are known for decades and reported in systemic autoimmune rheumatic diseases (SARDs), malignancies, graft versus host disease (GVHD), and others; however, their clinical significance remains to be established.
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Affiliation(s)
- Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano (Milan), 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via A. Manzoni 56, Pieve Emnuele (Milan), 20089, Italy
| | - Tomoko Hasegawa
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Shin Tanaka
- Department of Human, Information and Sciences, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
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Suresh S, Charlton D, Snell EK, Laffoon M, Medsger TA, Zhu L, Domsic RT. Development of Pulmonary Hypertension in Over One-Third of Patients With Th/To Antibody-Positive Scleroderma in Long-Term Follow-Up. Arthritis Rheumatol 2022; 74:1580-1587. [PMID: 35467794 PMCID: PMC9477491 DOI: 10.1002/art.42152] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/15/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study was undertaken to describe clinical manifestations in patients with Th/To antibody-positive systemic sclerosis (SSc) during long-term follow-up. METHODS We performed a case-control study involving anti-Th/To antibody-positive patients with SSc who were newly referred to the University of Pittsburgh Medical Center and the Pittsburgh Scleroderma Center from 1980 to 2015. For every case, 2 anti-Th/To antibody-negative SSc patients (the first 2 consecutively seen after a case) were used as controls. Long-term disease manifestations and survival were then compared between cases and controls. RESULTS A total of 204 anti-Th/To antibody-positive SSc patients and 408 controls were identified. The cohort had a mean ± SD age of 52 ± 12.9 years, and 76% of individuals were women. Anti-Th/To antibody-positive patients more often presented without skin thickening (P < 0.0001) and had a higher rate of pulmonary hypertension (PH) (P < 0.0001) and interstitial lung disease (P = 0.05) compared to anti-Th/To antibody-negative SSc controls. Anti-Th/To antibody-positive SSc patients also had less frequent muscle and joint involvement than anti-Th/To antibody-negative SSc controls (P < 0.0001). After a median clinical follow-up period of 6.1 years (interquartile range 2.4-12.7), 38% of anti-Th/To-positive patients had developed PH compared to 15% of anti-Th/To antibody-negative SSc controls (P < 0.0001). The rate of PH classified as World Health Organization (WHO) Group 1 pulmonary arterial hypertension [PAH] was 23% in anti-Th/To-positive patients compared to 9% in anti-Th/To antibody-negative SSc controls (P < 0.0001). After adjusting for age and sex, anti-Th/To antibody positivity was associated with a hazard ratio (HR) of 3.3 (95% confidence interval 2.3-4.9) for increased risk of developing PH at 10 years of follow-up from the first scleroderma center visit. CONCLUSION This is the largest cohort of patients with anti-Th/To antibody-positive SSc with long-term follow-up data. The very high rate (38%) and associated independent risk of anti-Th/To antibody-positive patients developing PH in follow-up, particularly in WHO Group 1 PAH patients, is striking. Patients presenting with limited skin involvement should be tested for Th/To antibodies, and if present, careful monitoring for PH is warranted.
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Affiliation(s)
| | - Devon Charlton
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine
| | | | - Maureen Laffoon
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine
| | - Thomas A. Medsger
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine
| | - Lei Zhu
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine
| | - Robyn T. Domsic
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine
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Siqueira VS, Helbingen MFS, Medeiros-Ribeiro AC, Carriço da Silva H, Miossi R, Luppino-Assad AP, Sampaio-Barros PD. Predictors of progression to systemic sclerosis: Analysis of Very Early Disease of Systemic Sclerosis (VEDOSS) in a large single cohort. Rheumatology (Oxford) 2022; 61:3686-3692. [PMID: 35020814 DOI: 10.1093/rheumatology/keac006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study analyzed the Very Early Disease of Systemic Sclerosis (VEDOSS) characteristics in a group of 217 patients with Raynaud phenomenon (RP) and at least one manifestation of systemic sclerosis (SSc) in search of predictors for the progression to SSc. METHODS This is a cross-sectional single-center analysis of patients presenting RP with a specific SSc clinical manifestation or SSc autoantibody or SD pattern at nailfold capillaroscopy (SD-NFC), without skin involvement, who attended a scleroderma outpatient clinic between 2010 and 2019. The performance of VEDOSS and the importance of the combination of VEDOSS characteristics to predict the progression to SSc were evaluated. RESULTS Among 217 patients, 153 (70.5%) were classified as SSc, including 65 (30%) in the first investigation; 69.3% of the SSc patients met VEDOSS criteria, compared with 6.3% of patients who did not progress to SSc. The combinations most associated with progression to SSc were RP + puffy fingers (PF) + positive antinuclear antibodies (ANA) + (SD-NFC and/or SSc specific antibody) (VEDOSS level 2), with an odds ratio (OR) of 19.52 (95%CI 4.48-85.06; p< 0.001) and RP + PF + positive ANA (VEDOSS level 1; "red flags") (OR = 15.45; p< 0.001), while combinations without non-Raynaud clinical symptoms, as RP + SD-NFC (OR = 0.03; p< 0.001) and RP + anticentromere + SD-NFC (OR = 0.06; p= 0.006) were associated with non-progression to SSc. CONCLUSION Among patients with RP with at least one manifestation of SSc, without skin involvement, combinations of VEDOSS characteristics were the strongest predictors of progression to SSc at a median follow-up of 4 years.
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Affiliation(s)
- Valdirene S Siqueira
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Mariely F S Helbingen
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Henrique Carriço da Silva
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Renata Miossi
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Paula Luppino-Assad
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Percival D Sampaio-Barros
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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Vilela VS, Vanhaecke A, da Silva BRA, da Costa CH, Lopes AJ, Rufino R, Cutolo M, Smith V. Is There a Link Between Nailfold Videocapillaroscopy and Pulmonary Function Tests in Systemic Sclerosis Patients?: A 24-Month Follow-up Monocentric Study. J Clin Rheumatol 2022; 28:26-32. [PMID: 34741001 DOI: 10.1097/rhu.0000000000001798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to explore the associations between nailfold videocapillaroscopy (NVC) and pulmonary function tests (PFTs) in systemic sclerosis (SSc) patients. METHODS This was a longitudinal study with follow-up of unselected Brazilian SSc patients. Baseline clinical examination, serological workup, high-resolution chest tomography, and NVC were performed. Pulmonary function test was performed at baseline and after 24 months. Pulmonary function test worsening over time was defined as either a ΔFVC decline ≥10% or a ΔFVC decline ≥5% and <9%, combined with a ΔDLCO decline ≥15%, at 24 months. The NVC parameters were quantitatively (capillary density number, dimension, morphology, and hemorrhages) and qualitatively (NVC pattern) evaluated according to the consented standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. RESULTS Seventy-nine patients were included. Fifty-nine were rated to have a scleroderma pattern (6 "early"/16 "active"/37 "late"). The mean FVC and DLCO were 76.8% and 67.2% at baseline and 73.8% and 64.3% at 24 months, respectively. After multivariate analysis, we found that a reduced baseline FVC was associated with reduced capillary density (odds ratio [OR], 11; 95% confidence interval [CI], 1.5-90.7; p = 0.03) and a reduced baseline DLCO associated with the late scleroderma pattern (OR, 6.75; 95% CI, 1.09-42; p = 0.03). No association between worsening of PFT over time and NVC was found. CONCLUSIONS The association between NVC and PFTs might corroborate the link between microangiopathy and interstitial lung disease in patients with SSc. This finding might strengthen the idea of incorporating NVC as a tool to predict progressive interstitial lung disease in these patients in the future.
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Affiliation(s)
- Verônica Silva Vilela
- From the Department of Rheumatology, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bruno Rangel Antunes da Silva
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique da Costa
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Chen J, Yang C, Pan J, Zhao C, Chen Z, Wen J, Dong F, Liao X, Lei L. Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single-center study of long-term survival in 470 patients. Int J Rheum Dis 2021; 25:182-191. [PMID: 34889515 DOI: 10.1111/1756-185x.14261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune disease the prevalence of which varies among populations. We analyzed SSc patients from Guangxi to improve the clinical understanding of this disease. METHODS Data of 470 SSc patients admitted to our institution from October 1,2012 to January 1,2019 were examined. The characteristics of these patients were analyzed using Kaplan-Meier survival analysis. Cox proportional-hazard regression was used to identify prognostic factors. RESULTS The average age was 50.44 ± 12.31 years, 285 patients (60.6%) were women, 2.1% had pneumoconiosis, 58.2% had pulmonary interstitial disease (ILD), 18.7% had pulmonary hypertension (PH), and 3.6% had renal crisis. These patients had diffuse cutaneous systemic sclerosis (dcSSc, 70.2%) or limited cutaneous systemic sclerosis (29.7%), and PH and renal crisis were more common in the dcSSc group. Patients 50 years old or more had greater prevalences of ILD, PH, and musculoskeletal damage, greater positivity of laboratory biomarkers, and increased mortality (all P < .05). Seventy-four patients (15.7%) died. The non-survivors were older, had longer disease duration, had higher prevalences of ILD, restrictive ventilation dysfunction, PH, and renal crisis, and had higher levels of creatine kinase myocardial band (CK-MB), C-reactive protein, and immunoglobin A (all P < .05). Renal crisis, PH, and high CK-MB were independent risk factors for death. CONCLUSIONS Pneumoconiosis was more common in SSc patients than the general population from this region. Our patients had a 10-year cumulative survival rate of 74.9%, higher than reported for patients from the US. Renal crisis, PH, and high CK-MB level were independent risk factors for death.
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Affiliation(s)
- Juan Chen
- The Department of Rheumatology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chenxi Yang
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jie Pan
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Cheng Zhao
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Zhanrui Chen
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jing Wen
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Fei Dong
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Xiaoling Liao
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Ling Lei
- The Department of Rheumatology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Vilela VS, Dias MM, Salgado ÂA, da Silva BRA, Lopes AJ, Bessa EJC, Bruno LP, da Costa CH, Levy RA, Rufino R. Pulmonary hypertension in systemic sclerosis: diagnosis by systematic screening and prognosis after three years follow-up. BMC Pulm Med 2021; 21:251. [PMID: 34325685 PMCID: PMC8323291 DOI: 10.1186/s12890-021-01618-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a rare disease, and the presence of pulmonary hypertension can be a determining factor in prognosis. The aim of this study was to evaluate the diagnosis, profile, and prognosis of systemic sclerosis pulmonary hypertension (SSc-PH) diagnosed by systematic screening in a Brazilian population.
Methods A cohort of SSc patients underwent systematic screening for SSc-PH. Patients were referred for right heart catheterization (RHC) according to transthoracic echocardiogram or a combination of diagnostic tools. The clinical, immunological, and hemodynamic features and prognosis after 3 years were evaluated.
Results Twenty patients underwent RHC. SSc pulmonary arterial hypertension (SSc-PAH) was the most common group of SSc-PH. These patients had long disease duration, high urate levels and highly elevated mean pulmonary arterial pressure (mPAP) and peripheral vascular resistance (PVR) on hemodynamics. Patients with mPAP > 20– < 25 mmHg had hemodynamic features of intermediate disease. Patients with SSc-PH associated to interstitial lung disease (SSc-ILD-PH) had signs of vasculopathy on hemodynamics. In patients with no-SSc-PH, the survival at 1, 2, and 3 years was 96%, 92% and 92%, respectively and in patients with SSc-PH it was 86.7%, 60% and 53.3%, respectively. Conclusions Patients identified with SSc-PAH and SSc-ILD-PH in our screening had severe clinical and hemodynamic features. Mortality remains high in SSc-PH but was more related to Bo-PAH and SSc-ILD-PH, while in SSc-PAH, the prognosis was better. Trial registration: Current Controlled Trials ISRCTN 72968188, July 8th, 2021. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01618-z.
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Affiliation(s)
- Verônica Silva Vilela
- Rheumatology Discipline, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Marcio Macri Dias
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Ângelo Antunes Salgado
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Bruno Rangel Antunes da Silva
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Agnaldo José Lopes
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Elizabeth Jauhar Cardoso Bessa
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Leonardo Palermo Bruno
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Cláudia Henrique da Costa
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Roger Abramino Levy
- Rheumatology Discipline, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil.,Immunology and Specialty Medicine, GSK, 1250 Collegville Rd, Collegeville, PA, 19426, USA
| | - Rogério Rufino
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil.
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Abstract
Racial and ethnic disparities in systemic sclerosis are abundant. The incidence, severity of end-organ manifestations, functional impairment, quality of life, and mortality of systemic sclerosis vary by ethnic group. This article summarizes such disparities and explores the role of socioeconomic status in their development and persistence.
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Affiliation(s)
- Duncan F Moore
- Division of Rheumatology, Department of Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, PHC 3004, Washington, DC 20007, USA.
| | - Virginia D Steen
- Division of Rheumatology, Department of Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, PHC 3004, Washington, DC 20007, USA
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12
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Aguila LA, da Silva HC, Medeiros-Ribeiro AC, Bunjes BG, Luppino-Assad AP, Sampaio-Barros PD. Is exposure to environmental factors associated with a characteristic clinical and laboratory profile in systemic sclerosis? A retrospective analysis. Rheumatol Int 2020; 41:1143-1150. [PMID: 32862308 DOI: 10.1007/s00296-020-04693-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/20/2020] [Indexed: 01/19/2023]
Abstract
To identify environmental factors (EF) in a large cohort of patients with systemic sclerosis (SSc) analyzing their clinical and laboratory presentation. A cohort of consecutive patients attended at a single Brazilian SSc outpatient clinic was analyzed regarding EF. Data were analyzed according to clinical, demographic and laboratory characteristics, as well as SSc subtype. In a cohort of 662 patients, 70 (10.6%) had known previous exposure to EF, predominantly organic solvents (51.4%), silica (20%), silicone (12.9%) and pesticides (11.4%). In the SSc cohort, patients with EF had a significantly higher frequency of male gender (p < 0.01), African-Brazilian ethnicity (p = 0.01), myopathy (p = 0.02), and pigmentary disorders (p = 0.04), with shorter disease duration (p = 0.01). When SSc subtypes were analyzed separately, there was positive association with male gender in limited (p < 0.01) and diffuse (p < 0.01) SSc, as well as African-Brazilian ethnicity (p = 0.04), severe interstitial lung disease (p < 0.01), myopathy (p = 0.02) and SD pattern at nailfold capillaroscopy (p = 0.01) in limited SSc, and negative association with esophageal hypomotility (p < 0.01) and ANA positivity (p = 0.02) in diffuse SSc. Multiple regression analyses showed that myopathy was independently associated with previous exposure to EF (OR = 2.09; 95% CI 1.15-3.82), especially silica exposure (OR = 3.09; 95% CI 1.67-5.73). This study showed that SSc patients with previous exposure to EF may have some specific clinical characteristics, mainly a higher frequency of myopathy, also showing more severe ILD, preferably in male and African-Brazilian patients, associated with a lower frequency of ANA positivity.
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Affiliation(s)
- Lisbeth A Aguila
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o. Andar, Cerqueira César, São Paulo, SP, 01246-903, Brasil
| | - Henrique Carriço da Silva
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o. Andar, Cerqueira César, São Paulo, SP, 01246-903, Brasil
| | - Ana Cristina Medeiros-Ribeiro
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o. Andar, Cerqueira César, São Paulo, SP, 01246-903, Brasil
| | - Bruna Giusto Bunjes
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o. Andar, Cerqueira César, São Paulo, SP, 01246-903, Brasil
| | - Ana Paula Luppino-Assad
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o. Andar, Cerqueira César, São Paulo, SP, 01246-903, Brasil
| | - Percival D Sampaio-Barros
- Division of Rheumatology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o. Andar, Cerqueira César, São Paulo, SP, 01246-903, Brasil.
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13
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Recent advances steer the future of systemic sclerosis toward precision medicine. Clin Rheumatol 2019; 39:1-4. [PMID: 31760537 DOI: 10.1007/s10067-019-04834-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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