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Essouma M, Noubiap JJ. Lupus and other autoimmune diseases: Epidemiology in the population of African ancestry and diagnostic and management challenges in Africa. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100288. [PMID: 39282618 PMCID: PMC11399606 DOI: 10.1016/j.jacig.2024.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/15/2024] [Accepted: 02/23/2024] [Indexed: 09/19/2024]
Abstract
Autoimmune diseases are prevalent among people of African ancestry living outside Africa. However, the burden of autoimmune diseases in Africa is not well understood. This article provides a global overview of the current burden of autoimmune diseases in individuals of African descent. It also discusses the major factors contributing to autoimmune diseases in this population group, as well as the challenges involved in diagnosing and managing autoimmune diseases in Africa.
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Affiliation(s)
- Mickael Essouma
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Cameroon
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, Calif
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2
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Sherif AA, Gilvaz VJ, Abraham S, Saji AM, Mathew D, Isath A, Rajendran A, Contreras J, Lanier GM, Reginato AM. Systemic sclerosis is associated with increased in-patient mortality in patients hospitalized for heart failure. ESC Heart Fail 2024; 11:1900-1910. [PMID: 38472730 PMCID: PMC11287334 DOI: 10.1002/ehf2.14457] [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: 12/22/2022] [Revised: 05/08/2023] [Accepted: 06/21/2023] [Indexed: 03/14/2024] Open
Abstract
AIMS We aimed to analyse the characteristics and in-hospital outcomes of patients hospitalized for heart failure (HF) with co-morbid systemic sclerosis (SSc) and compare them to those without SSc, using data from the National Inpatient Sample from years 2016 to 2019. METHODS AND RESULTS International Classification of Diseases, Tenth Revision diagnosis codes were used to identify hospitalized patients with a primary diagnosis of HF and secondary diagnoses of SSc from the National Inpatient Sample database from 2016 to 2019. Patients were divided into two groups: those with and without a secondary diagnosis of SSc. Baseline characteristics including demographics and co-morbidities, outcomes of mortality, length of stay (LOS), and costs were compared between the two groups. Multivariable logistic regression analysis was performed to adjust for confounders and assess the impact of SSc on in-hospital mortality, cost, and LOS. A total of 4 709 724 hospitalizations for HF were identified, with 8150 (0.17%) having a secondary diagnosis of SSc. These patients were predominantly female (82.3% vs. 47.8%; P = 0.01), younger (mean age of 67.4 vs. 71.4; P < 0.01), and had significantly lower rates of traditional cardiovascular risk factors such as coronary artery disease (35.8% vs. 50.6%; P < 0.01), hyperlipidaemia (39.1% vs. 52.9%; P < 0.01), diabetes (22.5% vs. 49.1%; P < 0.01), obesity (13.2% vs. 25.0%; P < 0.01), and hypertension (20.2% vs. 23.8%; P < 0.01). Higher rates of co-morbid pulmonary disease in the form of interstitial lung disease (23.1% vs. 2.0%; P < 0.01) and pulmonary hypertension (36.6% vs. 12.7%; P < 0.01) were noted in the SSc cohort. Unadjusted in-hospital mortality was significantly higher in the HF with SSc group [5.1% vs. 2.6%; odds ratio: 1.99; 95% confidence interval (CI): 1.60-2.48; P < 0.001]. Unadjusted mortality was also higher among female (86.7% vs. 47.0%; P < 0.01), Black (15.7% vs. 13.0%; P < 0.01), and Hispanic (13.3% vs. 6.9%; P < 0.01) patients in the SSc cohort. After adjusting for potential confounders, SSc remained independently associated with higher in-hospital mortality (adjusted odds ratio: 1.81; 95% CI: 1.44-2.28; P < 0.001). Patients with HF and SSc also had longer LOS (6.4 vs. 5.4; adjusted mean difference [AMD]: 0.37, 95% CI: 0.05-0.68; P = 0.02) and higher hospitalization costs ($67 363 vs. $57 128; AMD: 198.9; 95% CI: -4780 to 5178; P = 0.93). CONCLUSIONS In patients hospitalized for HF, those with SSc were noted to have higher odds of in-hospital mortality than those without SSc. Patients with HF and SSc were more likely to be younger, female, and have higher rates of co-morbid interstitial lung disease and pulmonary hypertension at baseline with fewer traditional cardiovascular risk factors.
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Affiliation(s)
- Akil A. Sherif
- Division of Cardiovascular DiseasesSt Vincent HospitalWorcesterMAUSA
| | - Vinit J. Gilvaz
- Department of Rheumatology, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Sonu Abraham
- Divison of Cardiovascular diseasesLahey Hospital & Medical CenterBurlingtonMAUSA
| | | | - Don Mathew
- Department of Internal MedicineUniversity of Pittsburgh Medical CenterMcKeesportPAUSA
| | - Ameesh Isath
- Division of CardiologyWestchester Medical Center and New York Medical CollegeValhallaNYUSA
| | - Aiswarya Rajendran
- School of Public Health and Health SciencesUniversity of MassachusettsAmherstMAUSA
| | - Johanna Contreras
- Department of Cardiology, Division of Advanced Heart Failure and TransplantMount Sinai Morningside and WestNew YorkNYUSA
| | - Gregg M. Lanier
- Division of CardiologyWestchester Medical Center and New York Medical CollegeValhallaNYUSA
| | - Anthony M. Reginato
- Department of Rheumatology, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceRIUSA
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Renaud L, Waldrep KM, da Silveira WA, Pilewski JM, Feghali-Bostwick CA. First Characterization of the Transcriptome of Lung Fibroblasts of SSc Patients and Healthy Donors of African Ancestry. Int J Mol Sci 2023; 24:3645. [PMID: 36835058 PMCID: PMC9966000 DOI: 10.3390/ijms24043645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disorder that results in fibrosis of the skin and visceral organs. SSc-associated pulmonary fibrosis (SSc-PF) is the leading cause of death amongst SSc patients. Racial disparity is noted in SSc as African Americans (AA) have a higher frequency and severity of disease than European Americans (EA). Using RNAseq, we determined differentially expressed genes (DEGs; q < 0.1, log2FC > |0.6|) in primary pulmonary fibroblasts from SSc lungs (SScL) and normal lungs (NL) of AA and EA patients to characterize the unique transcriptomic signatures of AA-NL and AA-SScL fibroblasts using systems-level analysis. We identified 69 DEGs in "AA-NL vs. EA-NL" and 384 DEGs in "AA-SScL vs. EA-SScL" analyses, and a comparison of disease mechanisms revealed that only 7.5% of DEGs were commonly deregulated in AA and EA patients. Surprisingly, we also identified an SSc-like signature in AA-NL fibroblasts. Our data highlight differences in disease mechanisms between AA and EA SScL fibroblasts and suggest that AA-NL fibroblasts are in a "pre-fibrosis" state, poised to respond to potential fibrotic triggers. The DEGs and pathways identified in our study provide a wealth of novel targets to better understand disease mechanisms leading to racial disparity in SSc-PF and develop more effective and personalized therapies.
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Affiliation(s)
- Ludivine Renaud
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kristy M. Waldrep
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Willian A. da Silveira
- Department of Biological Sciences, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Joseph M. Pilewski
- Department of Medicine, Pulmonary, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Carol A. Feghali-Bostwick
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
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Zhang X, Zhang H, Zhao J, Li Y, Wang H, Li C. Diagnostic accuracy and predictive value of autoantibody profiles in patients with systemic sclerosis: a single-center study. Clin Rheumatol 2023; 42:1297-1306. [PMID: 36604358 DOI: 10.1007/s10067-022-06487-3] [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: 07/26/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine diagnostic accuracy and evaluate the predictive value of autoantibody profiles in patients with systemic sclerosis (SSc). METHODS A total of 140 patients with SSc (125 female, mean age 54.2 ± 14.2 years) were analyzed by a multiplex line immunoassay (Euroimmun) for autoantibodies against 12 SSc-related antigens. Associations between the presence of the autoantibodies and demographic clinical manifestations of patients with SSc were investigated. RESULTS The sensitivity and specificity of this assay were as follows: 32.9% and 99.4% for anti-Scl-70, 29.3% and 88.9% for anti-CENP A, 28.6% and 87.8% for anti-CENP B, 7.1% and 97.8% for anti-RP11, 5.7% and 100% for anti-RP155, 2.9% and 99.4% for anti-NOR 90, 2.9% and 98.9% for anti-Th/To, 1.4% and 96.7% for anti-PM-Scl-100, 5.0% and 98.3% for anti-PM-Scl-75, and 2.9% and 97.2% for anti-Ku, respectively. Anti-Scl-70 was significantly associated with sine scleroderma (P = 0.003), digital ulcers (P = 0.047), and Raynaud's phenomenon as the first clinical manifestation of onset (P = 0.017). SSc-ILD was more common in patients with anti-Scl-70 (P = 0.029) and less frequent in patients with anti-CENP A (P < 0.001) and anti-CENP B (P < 0.001). There was a significant association between PAH with anti-CENP A (P = 0.008) and anti-CENP B (P = 0.025). Renal involvement was significantly related to anti-NOR90 (P = 0.026) and anti-Th/To (P = 0.026). CONCLUSIONS This study confirmed the important role of autoantibodies in accurately diagnosing SSc. The autoimmune profile of patients with SSc was related to specific disease manifestations. Key Points • Autoantibody profiles were useful for diagnosing SSc and predicting clinical features of patients.
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Affiliation(s)
- Xiaoying Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Huijuan Zhang
- Department of Rheumatology, She Xian Hospital, Handan, Hebei Province, China
| | - Jing Zhao
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Yun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Hongyan Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China.
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Tukpah AMC, Rose JA, Seger DL, Dellaripa PF, Hunninghake GM, Bates DW. Development and validation of algorithms to build an electronic health record based cohort of patients with systemic sclerosis. PLoS One 2023; 18:e0283775. [PMID: 37053291 PMCID: PMC10101630 DOI: 10.1371/journal.pone.0283775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/16/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES To evaluate methods of identifying patients with systemic sclerosis (SSc) using International Classification of Diseases, Tenth Revision (ICD-10) codes (M34*), electronic health record (EHR) databases and organ involvement keywords, that result in a validated cohort comprised of true cases with high disease burden. METHODS We retrospectively studied patients in a healthcare system likely to have SSc. Using structured EHR data from January 2016 to June 2021, we identified 955 adult patients with M34* documented 2 or more times during the study period. A random subset of 100 patients was selected to validate the ICD-10 code for its positive predictive value (PPV). The dataset was then divided into a training and validation sets for unstructured text processing (UTP) search algorithms, two of which were created using keywords for Raynaud's syndrome, and esophageal involvement/symptoms. RESULTS Among 955 patients, the average age was 60. Most patients (84%) were female; 75% of patients were White, and 5.2% were Black. There were approximately 175 patients per year with the code newly documented, overall 24% had an ICD-10 code for esophageal disease, and 13.4% for pulmonary hypertension. The baseline PPV was 78%, which improved to 84% with UTP, identifying 788 patients likely to have SSc. After the ICD-10 code was placed, 63% of patients had a rheumatology office visit. Patients identified by the UTP search algorithm were more likely to have increased healthcare utilization (ICD-10 codes 4 or more times 84.1% vs 61.7%, p < .001), organ involvement (pulmonary hypertension 12.7% vs 6% p = .011) and medication use (mycophenolate use 28.7% vs 11.4%, p < .001) than those identified by the ICD codes alone. CONCLUSION EHRs can be used to identify patients with SSc. Using unstructured text processing keyword searches for SSc clinical manifestations improved the PPV of ICD-10 codes alone and identified a group of patients most likely to have SSc and increased healthcare needs.
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Affiliation(s)
- Ann-Marcia C Tukpah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Jonathan A Rose
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Diane L Seger
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Paul F Dellaripa
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Gary M Hunninghake
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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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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Ng SA, Low AHL. Systemic sclerosis in Asians: Are there racial differences? JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:98-109. [PMID: 35585950 PMCID: PMC9109507 DOI: 10.1177/23971983221074749] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 10/08/2023]
Abstract
Systemic sclerosis is a multisystemic autoimmune disease characterized by vasculopathy and fibrosis. Racial factors exert a significant influence on the epidemiology, clinical manifestations, antibody profile, mortality and genetic factors in systemic sclerosis. In this review, we examined Asian systemic sclerosis cohorts reported in Asia and multi-racial cohort studies to evaluate the disease characteristics and outcomes of systemic sclerosis in Asians. Asian patients have distinct genetic susceptibility to systemic sclerosis, younger age of systemic sclerosis onset, higher frequency of diffuse skin involvement, different autoantibody profiles such as higher frequency of anti-Scl70 and anti-U1-RNP antibodies, and more severe clinical phenotype. There was a suggestion of poorer survival among Asians that may be contributed by more severe disease, socioeconomic factors and differences in healthcare systems. Recognizing the influence of racial differences in systemic sclerosis disease course is important as it has implications for appropriate treatment, monitoring and prognostication.
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Affiliation(s)
- Sue-Ann Ng
- Department of Rheumatology and
Immunology, Singapore General Hospital, Singapore
- Duke-National University of Singapore,
Singapore
| | - Andrea Hsiu Ling Low
- Department of Rheumatology and
Immunology, Singapore General Hospital, Singapore
- Duke-National University of Singapore,
Singapore
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8
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Nunez SE, Ariza-Hutchinson A, Fields RA, Vondenberg JA, Patel RA, Emil NS, Muruganandam M, Gibb JI, Poole JL, Sibbitt WL. Systemic sclerosis manifestations and clinical outcomes in Hispanics/Latinos of the American Southwest. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:135-143. [DOI: 10.1177/23971983221086214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Objective: Certain Hispanic/Latino (Hispanic) populations have been reported to have higher rates and severity of systemic sclerosis; however, little is known of systemic sclerosis in the American Southwest. This study compared manifestations of systemic sclerosis in Hispanics with non-Hispanics of New Mexico. Methods: This cross-sectional longitudinal study included 109 systemic sclerosis patients followed over a mean of 12.6 ± 8.9 years. Subjects were repetitively evaluated including physical examination, echocardiography, chest imaging, and serologic testing and observed for complications. Disease characteristics and long-term outcomes were statistically compared between self-identified Hispanic and non-Hispanic subjects. Results: A total of 73 (67%) systemic sclerosis subjects were Hispanic and 36 (33%) were non-Hispanic. The cohorts were similar in mean age, age of systemic sclerosis onset, limited versus diffuse cutaneous systemic sclerosis, telangiectases, gastroesophageal reflux disease, Raynaud’s phenomenon, autoantibody profile, interstitial lung disease, pulmonary hypertension, scleroderma renal crisis, mortality, and comorbid malignancy (all p > 0.05). However, the standardized mortality ratio was increased in both cohorts relative to age-adjusted mortality: Hispanic: 2.08, confidence interval (1.94–2.24); non-Hispanic: 1.56, confidence interval (1.46–1.68). Furthermore, the standardized incidence ratio for malignancy was increased in both cohorts: Hispanic: 1.45, confidence interval (1.35–1.56); non-Hispanic: 1.24, confidence interval (1.16–1.34). The mean age of cancer diagnosis occurred at a significantly younger age in Hispanics (Hispanics: 53.1 ± 9.7 years; non-Hispanics 63.7 ± 7.9 years; 95% confidence interval: −19 ⩽ 10.6 ⩽ 2.2; p = 0.016). Conclusion: Systemic sclerosis phenotype, autoantibodies, complications, outcomes, malignancy rates, and mortality are generally similar between Hispanics and non-Hispanics with systemic sclerosis in the American Southwest. However, age-adjusted comorbid malignancy and mortality rates are significantly increased in both groups.
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Affiliation(s)
- Sharon E Nunez
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Angie Ariza-Hutchinson
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Roderick A Fields
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jaime A Vondenberg
- Department of Medicine, Rheumatology/Immunology, Cleveland Clinic, Cleveland, OH, USA
| | - Rosemina A Patel
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - N Suzanne Emil
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Maheswari Muruganandam
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - James I Gibb
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Janet L Poole
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Wilmer L Sibbitt
- Department of Internal Medicine, Division of Rheumatology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Jaime-Pérez JC, González-Treviño M, Meléndez-Flores JD, Ramos-Dávila EM, Cantú-Rodriguez OG, Gutiérrez-Aguirre CH, Galarza-Delgado DA, Gómez-Almaguer D. Autologous ATG-free hematopoietic stem cell transplantation for refractory autoimmune rheumatic diseases: a Latin American cohort. Clin Rheumatol 2021; 41:869-876. [PMID: 34585327 DOI: 10.1007/s10067-021-05931-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/12/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
Autologous hematopoietic stem cell transplantation (HSCT) has been recognized as treatment alternative for patients with severe, refractory autoimmune rheumatic diseases (ARDs). Usually, anti-thymocyte globulin (ATG)-containing conditioning regimens are employed; however, ATG is unavailable in some developing nations. We report our 15-year clinical experience autografting patients with ARDs with an ATG-free conditioning regimen and a brief assessment of patient-reported outcomes post-HSCT. All patients had active disease and were resistant to multiple lines of treatment. Event-free survival (EFS) was assessed using the Kaplan-Meier method. Eight patients underwent autologous HSCT. Diagnoses included juvenile idiopathic arthritis (n = 3), systemic lupus erythematosus (n = 2), systemic sclerosis (n = 2), and rheumatoid arthritis (n = 1). Median time from diagnosis to HSCT was 3 years (0.75-19). Hematological recovery was documented in all recipients, and 4 patients (50%) completed the procedure in a completely ambulatory setting. Five (62.5%) patients achieved complete response and 3 (37.5%) partial response. The median EFS was 7 months (95% CI, 4.97-9.02), and the 1-year EFS rate was 21.9% (95% CI, 18.25-25.76). Transplant-related mortality was 0%, and 1 recipient died 8 years post-HSCT due to chronic kidney disease. Six (75%) patients presented steroid dosage reduction post-HSCT, and 2 (25%) perceived improvement in functionality despite having relapsed. HSCT is a viable treatment alternative for selected patients with severe therapy-resistant ARDs, as an improvement in disease management and quality of life was documented. The need remains to elucidate the characteristics of the optimal HSCT candidate, as well as the adequate conditioning regimen when ATG is not available. Key Points • Despite advances in the treatment of autoimmune rheumatic diseases, some patients remain refractory. In this context, autologous hematopoietic stem cell transplantation (HSCT) rises as a viable alternative. • Of 8 HSCT recipients with autoimmune rheumatic diseases, 5 (62.5%) patients achieved complete response and 3 (37.5%) partial response, with a 1-year event-free survival of 21.9%. • Transplant-related mortality was 0%, with 4 (50%) patients autografted in a completely outpatient setting. • Even when relapse presented, patients reported an improvement in functionality and quality of life; also, a better response to DMARDs and a reduction in steroid dependency post-HSCT were documented.
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Affiliation(s)
- José Carlos Jaime-Pérez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Mariana González-Treviño
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jesús D Meléndez-Flores
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Eugenia M Ramos-Dávila
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Olga G Cantú-Rodriguez
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - César H Gutiérrez-Aguirre
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Dionicio A Galarza-Delgado
- Rheumatology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Gómez-Almaguer
- Hematology Department, Internal Medicine Division, Dr. José Eleuterio González University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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10
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Bayram YE, Eskan MA. A fixed reconstruction of partially edentulous patient with systemic scleroderma: A 4.8-year follow-up case report. Clin Adv Periodontics 2021; 12:159-162. [PMID: 34212516 DOI: 10.1002/cap.10174] [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: 02/28/2021] [Accepted: 06/19/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Systemic scleroderma (SSc) is a progressive autoimmune multisystem disease affecting several organs. In the oral cavity, its manifestations include enlarged periodontal ligament, xerostomia, microsomia, alveolar bone loss, and premature teeth loss. A removable prosthesis would not be a treatment option due to loss of hand dexterity, reduced chewing capacity, microsomia, and xerostomia in these patients. Alternatively, implant-supported fixed restorations are a plausible treatment for these patients. However, there is very limited literature showing implant survival rate in patients with SSc for a long follow-up. CASE PRESENTATION A 57-year-old female patient with SSc presented to our clinic. She was diagnosed with SSc 25 years ago. Initial clinical and radiological examination revealed that she showed slight to moderate chronic periodontitis, tooth cavities, remaining tooth tips, and a partial edentulism in the posterior areas. A total of seven implants were placed at different time points. The remaining upper teeth were crowned. At 4.8 years follow-up, the placed implants showed no sign of peri-implant disease. CONCLUSION This case report indicated that 4.8 years of follow-up revealed good oral hygiene and clinically or radiologically no sign of peri-implant disease around the implants in a patient with SSc. Implant-supported fixed restoration could be a viable treatment approach in these patients.
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Affiliation(s)
- Yeter Eylul Bayram
- Hamidiye Sisli Etfal Education and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Mehmet Akif Eskan
- Clinic Eska, Istanbul, Turkey.,NOVA Southeastern University College of Dental Medicine, Department of Periodontics, Fort Lauderdale, Florida, USA
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Jaeger VK, Tikly M, Xu D, Siegert E, Hachulla E, Airò P, Valentini G, Matucci Cerinic M, Distler O, Cozzi F, Carreira P, Allanore Y, Müller-Ladner U, Ananieva LP, Balbir-Gurman A, Distler JHW, Czirják L, Li M, Henes J, Jimenez SA, Smith V, Damjanov N, Denton CP, DelGaldo F, Saketkoo LA, Walker UA. Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study. Rheumatology (Oxford) 2020; 59:1684-1694. [PMID: 31680161 DOI: 10.1093/rheumatology/kez486] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/19/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations. METHODS SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses. RESULTS The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP. AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001]. CONCLUSION Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality.
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Affiliation(s)
- Veronika K Jaeger
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Mohammed Tikly
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Elise Siegert
- Department of Rheumatology and Immunology, University Hospital Charité, Berlin, Germany
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Paolo Airò
- UO Reumatologia ed Immunologia Clinica, Spedali Civili, Brescia, Italy
| | | | - Marco Matucci Cerinic
- Department of Experimental and Clinical Rheumatology, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Patricia Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Yannick Allanore
- Department of Rheumatology A, Paris Descartes University, Cochin Hospital, Paris, France
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Germany, Bad Nauheim
| | - Lidia P Ananieva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Laszlo Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Jörg Henes
- Department of Internal Medicine II, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Sergio A Jimenez
- Scleroderma Centre, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa Smith
- Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Christopher P Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Francesco DelGaldo
- Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds, Leeds, UK
| | - Lesley Ann Saketkoo
- Tulane University Lung Centre, University Medical Centre Scleroderma and Sarcoidosis Patient Care and Research Centre, New Orleans, LA, USA
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
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Chung MP, Dontsi M, Postlethwaite D, Kesh S, Simard JF, Fiorentino D, Zaba LC, Chung L. Increased Mortality in Asians With Systemic Sclerosis in Northern California. ACR Open Rheumatol 2020; 2:197-206. [PMID: 32198914 PMCID: PMC7164633 DOI: 10.1002/acr2.11126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/18/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients. Methods A retrospective cohort study was conducted among Kaiser Permanente Northern California adults with an incident SSc diagnosis by a rheumatologist from 2007 to 2016, confirmed by a chart review to fulfill 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. Self‐reported race/ethnicity was categorized as non‐Hispanic white, Asian, Hispanic, and black. Disease manifestations and survival were compared, using white patients as the reference. Results A total of 609 patients with incident SSc were identified: 89% were women, and 81% had limited cutaneous SSc, with a mean age at diagnosis of 55.4 ± 14.8 years. The racial/ethnic distribution was 51% non‐Hispanic white (n = 310), 25% Hispanic (n = 154), 16% Asian (n = 96), and 8% black (n = 49). Compared with white patients, black patients had a greater prevalence of diffuse disease (14.5% vs. 44.9%; P < 0.001), and Asians had higher rates of anti‐U1‐RNP antibodies (32.1% vs. 11.9%; P = 0.005). Nine‐year overall survival rates following SSc diagnosis were lower in Asian (52.3%), black (52.2%), and Hispanic patients (68.2%) compared with white patients (75.8%). Pulmonary hypertension and infections were the leading causes of death in Asian patients. Asian race was associated with higher mortality on univariable (hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.08‐2.99]; P = 0.020) and multivariable analyses (HR 1.80 [95% CI 0.99‐3.16]; P = 0.047) when adjusting for age, sex, body mass index, cutaneous subtype, smoking status, interstitial lung disease, pulmonary hypertension, renal crisis, and malabsorption syndrome. Conclusion Asian patients with SSc in this US cohort had increased mortality compared with white patients. These patients warrant close monitoring for disease progression.
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Affiliation(s)
- Melody P Chung
- Kaiser Permanente Santa Clara, Santa Clara, California, and Stanford University School of Medicine, Palo Alto, California
| | | | | | - Sumana Kesh
- Kaiser Permanente Santa Clara, Santa Clara, California
| | - Julia F Simard
- Stanford University School of Medicine, Palo Alto, California
| | | | - Lisa C Zaba
- Stanford University School of Medicine, Palo Alto, California
| | - Lorinda Chung
- Stanford University School of Medicine and Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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13
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Zhong L, Pope M, Shen Y, Hernandez JJ, Wu L. Prevalence and incidence of systemic sclerosis: A systematic review and meta‐analysis. Int J Rheum Dis 2019; 22:2096-2107. [DOI: 10.1111/1756-185x.13716] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/12/2019] [Accepted: 09/09/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Lixian Zhong
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Melinda Pope
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Ye Shen
- College of Public Health University of Georgia Athens Georgia
| | - Jose J. Hernandez
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Lin Wu
- Research & Learning Services Health Sciences Library University of Tennessee Health Science Center Memphis TN USA
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Koubar SH, Kort J, Kawtharani S, Chaaya M, Makki M, Uthman I. Characteristics of lupus and lupus nephritis at a tertiary care center in Lebanon. Lupus 2019; 28:1598-1603. [PMID: 31554458 DOI: 10.1177/0961203319877459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Systemic lupus erythematosus affects 4.8-78.5 people per 100,000 worldwide, 90% of whom are females. Geography and ethnicity have been shown to significantly affect the prevalence and natural history of the disease. Lupus nephritis affects around half of patients with systemic lupus erythematosus. Data about systemic lupus erythematosus and lupus nephritis in the Middle East are still scarce. In this study, we aimed to describe the characteristics of systemic lupus erythematosus and lupus nephritis at a tertiary care center in Lebanon. METHODS This is a retrospective chart review of all biopsy-proven lupus nephritis patients admitted to the American University of Beirut medical center between January 2000 and December 2018. Patients above 12 years of age who had any International Society of Nephrology/Renal Pathology Society (ISN/RPS) class of lupus nephritis on their renal biopsy were included in the study. RESULTS The study included 55 patients with lupus nephritis. Upon presentation of systemic lupus erythematosus, the most common clinical feature was arthritis, seen in 83% of patients, followed by anemia (82%) and malar rash (48%). In total 93% had positive ANA, 89% had positive anti-dsDNA and 98% of patients had proteinuria. The most common ISN/RPS class of lupus nephritis in our series was IV (49%). At the time of the biopsy 15% of patients underwent dialysis. At 6 months, 11/27 had complete remission, 6/27 had partial remission and 10/27 had no remission. At 1 year, 8/23 had complete remission, 4/23 had partial remission and 11/23 had no remission. During the study period, 15 out of 35 patients available for analysis had chronic kidney disease (CKD) and six out of 34 patients developed end-stage kidney disease requiring renal replacement therapy. In comparison to other series in the region, our series had more males affected, higher creatinine at the time of biopsy and greater degree of proteinuria. CONCLUSION Our study provided insight on the demographics, characteristics, and outcomes of lupus nephritis in Lebanon. Interestingly, male gender was present in a quarter of patients. This warrants further investigation and confirmation. We are hoping to expand this experience into a national prospective registry to further characterize this entity in our region.
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Affiliation(s)
- S H Koubar
- Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
| | - J Kort
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Kawtharani
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - M Makki
- Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - I Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Allanore Y, Gharibdoost F, Jamshidi AR, Javinani A, Avouac J, Rastkar E, Hooshmandi S, Kavosi H. Comparison of the clinical phenotype of systemic sclerosis patients in Iran and France in two university centers. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:149-159. [PMID: 35382390 PMCID: PMC8922647 DOI: 10.1177/2397198318809224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/30/2018] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Systemic sclerosis is a severe and rare chronic auto-immune multisystem disorder characterized by vasculopathy and skin stiffness. Ethnic and geographical origin can influence the outcomes. In this study, we compared the phenotypic characteristics of Iranian and French patients. METHODS This cross-sectional study was performed on 200 Iranian and 268 French systemic sclerosis patients. Iranian patients collected from the Iranian systemic sclerosis cohort of the Rheumatology Research Center, Shariati hospital, Tehran University of Medical Sciences. The French population was monocentric, and it was constituted by the patients included locally in the EUSTAR database in December 2016. RESULTS The mean age at onset was significantly lower in Iranian patients (35.58 ± 11.68 vs 47.06 ± 13.54, p-value < 0.001). The female-to-male ratio was approximately 5.2:1 and was not different in the two populations. The prevalence of diffuse cutaneous systemic sclerosis was significantly higher in Iranian patients (60.2% vs 42.85%, p-value < 0.001). Calcinosis cutis and joint synovitis were more prevalent in French patients (p-value = 0.013, <0.001). The positivity of anti-topoisomerase antibody was higher in Iranian patients, whereas the anti-centromere antibody predominated in French cases (p-value < 0.001). Restrictive pattern of pulmonary function test was more common in Iranian patients (p-value < 0.001), while estimated pulmonary arterial pressure by echocardiography was higher in French patients (p-value < 0.001). CONCLUSION It seems that systemic sclerosis occurred in younger ages among Iranian female with the predominance of diffuse cutaneous subtype. In addition, lung interstitial disease appeared to be more prevalent and severe in Iranians than French patients.
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Affiliation(s)
- Yannick Allanore
- Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Farhad Gharibdoost
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Javinani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jérôme Avouac
- Department of Rheumatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Elnaz Rastkar
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadid Hooshmandi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Kavosi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Chung A, English J, Volkmann ER. Interstitial Lung Disease in Systemic Sclerosis: Lessons Learned from Idiopathic Pulmonary Fibrosis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Johnson ZI, Jones JD, Mukherjee A, Ren D, Feghali-Bostwick C, Conley YP, Yates CC. Novel classification for global gene signature model for predicting severity of systemic sclerosis. PLoS One 2018; 13:e0199314. [PMID: 29924864 PMCID: PMC6010260 DOI: 10.1371/journal.pone.0199314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022] Open
Abstract
Progression of systemic scleroderma (SSc), a chronic connective tissue disease that causes a fibrotic phenotype, is highly heterogeneous amongst patients and difficult to accurately diagnose. To meet this clinical need, we developed a novel three-layer classification model, which analyses gene expression profiles from SSc skin biopsies to diagnose SSc severity. Two SSc skin biopsy microarray datasets were obtained from Gene Expression Omnibus. The skin scores obtained from the original papers were used to further categorize the data into subgroups of low (<18) and high (≥18) severity. Data was pre-processed for normalization, background correction, centering and scaling. A two-layered cross-validation scheme was employed to objectively evaluate the performance of classification models of unobserved data. Three classification models were used: support vector machine, random forest, and naive Bayes in combination with feature selection methods to improve performance accuracy. For both input datasets, random forest classifier combined with correlation-based feature selection (CFS) method and naive Bayes combined with CFS or support vector machine based recursive feature elimination method yielded the best results. Additionally, we performed a principal component analysis to show that low and high severity groups are readily separable by gene expression signatures. Ultimately, we found that our novel classification prediction model produced global gene signatures that significantly correlated with skin scores. This study represents the first report comparing the performance of various classification prediction models for gene signatures from SSc patients, using current clinical diagnostic factors. In summary, our three-classification model system is a powerful tool for elucidating gene signatures from SSc skin biopsies and can also be used to develop a prognostic gene signature for SSc and other fibrotic disorders.
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Affiliation(s)
- Zariel I. Johnson
- Department of Health Promotions and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
| | - Jacqueline D. Jones
- Department of Biological & Environmental Sciences, Troy University, Troy, AL, United States of America
| | - Angana Mukherjee
- Department of Biological & Environmental Sciences, Troy University, Troy, AL, United States of America
| | - Dianxu Ren
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
| | - Carol Feghali-Bostwick
- Department of Rheumatology & Immunology, University of South Carolina, Charleston, SC, United States of America
| | - Yvette P. Conley
- Department of Health Promotions and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Cecelia C. Yates
- Department of Health Promotions and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- * E-mail:
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Mejia Otero C, Assassi S, Hudson M, Mayes MD, Estrada-Y-Martin R, Pedroza C, Mills TW, Walker J, Baron M, Stevens W, Proudman SM, Nikpour M, Mehra S, Wang M, Fritzler MJ. Antifibrillarin Antibodies Are Associated with Native North American Ethnicity and Poorer Survival in Systemic Sclerosis. J Rheumatol 2017; 44:799-805. [PMID: 28365584 DOI: 10.3899/jrheum.160574] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the clinical correlates and survival in patients with antifibrillarin antibodies (AFA) in a large international study population consisting of well-characterized systemic sclerosis (SSc) cohorts from Canada, Australia, and the United States. METHODS Baseline clinical data from the prospective cohorts (Canadian Scleroderma Research Group, the Australian Scleroderma Cohort Study, and the American Genetics versus Environment in Scleroderma Outcome Study) were investigated. Clinical variables were harmonized and sera were tested for AFA using a commercially available SSc profile line immunoassay, regardless of the immunofluorescence staining pattern. Association of demographic and clinical features with AFA was investigated by logistic or linear regression. Further, a survival analysis was performed by Cox regression analysis. RESULTS A total of 1506 patients with SSc with complete serological profiles were included in the study. Fifty-two patients (3.5%) had antibodies detected against fibrillarin. Patients of African descent and Native North American ethnicity were more likely to be AFA-positive compared with other ethnicities. After adjustment for demographic factors, diffuse involvement, and intestinal bacterial overgrowth requiring antibiotics, gastrointestinal reflux disease showed a trend for association with AFA. Further, AFA positivity was associated with shorter survival independently of demographic factors and disease type (HR 1.76, 95% CI 1.11-2.79, p = 0.016). CONCLUSION In this large multinational SSc cohort, AFA was associated with Native American ethnicity and was an independent predictor of mortality.
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Takekoshi D, Arami S, Sheppard TJ, Cole-Saffold P, Michel JC, Kondos GT, Schraufnagel DE. Computed Tomography of the Esophagus in Scleroderma and Lung Disease. TOHOKU J EXP MED 2016; 237:345-52. [PMID: 26639310 DOI: 10.1620/tjem.237.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Systemic sclerosis, or scleroderma, is a collagen vascular disease characterized by hardening of the skin and involvement of internal organs, most commonly the esophagus. The most frequent cause of death in these patients is lung disease. Esophageal dysfunction has been implicated in the pathogenesis of interstitial lung disease. We previously developed a standard for the esophageal diameter on chest computed tomography (CT) and hypothesized that patients with esophageal dilation would be more likely to have interstitial lung disease than those without. In this study, we test this in 121 systemic sclerosis patients with interstitial lung disease and 48 of those without interstitial lung disease. For controls, we evaluated 121 patients followed at a general pulmonary clinic and the previously studied normal healthy standards. This study demonstrated that esophageal dilation is common in systemic sclerosis patients (66.3% for the maximal esophageal diameter more than or equal to 15 mm), that systemic sclerosis patients with interstitial lung disease have more dilated esophagi than those without interstitial lung disease (median 19.4 mm vs. 14.1 mm), and that esophageal parameters are negatively correlated with pulmonary function. We also found that patients from general pulmonary clinic were more likely to have dilated esophagi than normal controls (median 12.1 mm vs. 9.7 mm). The CT measurement of esophageal diameter may be a useful marker of patients at risk for developing lung disease.
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Affiliation(s)
- Daisuke Takekoshi
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago
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Santosa A, Tan CS, Teng GG, Fong W, Lim A, Law WG, Chan G, Ng SC, Low AHL. Lung and gastrointestinal complications are leading causes of death in SCORE, a multi-ethnic Singapore systemic sclerosis cohort. Scand J Rheumatol 2016; 45:499-506. [DOI: 10.3109/03009742.2016.1153141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - CS Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - GG Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - A Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WG Law
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - G Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - SC Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore, Singapore
| | - AHL Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore, Graduate Medical School, Singapore, Singapore
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Abstract
Significant advances have been made in understanding the genetic basis of systemic sclerosis (SSc) in recent years. Genomewide association and other large-scale genetic studies have identified 30 largely immunity-related genes which are significantly associated with SSc. We review these studies, along with genomewide expression studies, proteomic studies, genetic mouse models, and insights from rare sclerodermatous diseases. Collectively, these studies have begun to identify pathways that are relevant to SSc pathogenesis. The findings presented in this review illustrate how both genetic and genomic aberrations play important roles in the development of SSc. However, despite these recent discoveries, there remain major gaps between current knowledge of SSc, a unified understanding of pathogenesis, and effective treatment. To this aim, we address the important issue of SSc heterogeneity and discuss how future research needs to address this in order to develop a clearer understanding of this devastating and complex disease.
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Bossini-Castillo L, López-Isac E, Martín J. Immunogenetics of systemic sclerosis: Defining heritability, functional variants and shared-autoimmunity pathways. J Autoimmun 2015. [PMID: 26212856 DOI: 10.1016/j.jaut.2015.07.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Systemic sclerosis (SSc) is a clinically heterogeneous connective tissue disorder of complex etiology. The development of large-scale genetic studies, such as genome-wide association studies (GWASs) or the Immunochip platform, has achieved remarkable progress in the knowledge of the genetic background of SSc. Herein, we provide an updated picture SSc genetic factors, offering an insight into their role in pathogenic mechanisms that characterize the disease. We review the most recent findings in the HLA region and the well-established non-HLA loci. Up to 18 non-HLA risk factors fulfilled the selected criteria and they were classified according to their role in the innate or adaptive immune response, in apoptosis, autophagy or fibrosis. Additionally, SSc heritability has remained as a controversial question since twin studies provided low SSc heritability estimates. However, we have recalculated the lower bond of narrow sense SSc heritability using GWAS data. Remarkably, our results suggest a greater influence of genetics on SSc than previously reported. Furthermore, we also offer a functional classification of SSc-associated SNPs and their proxies, based on annotated data, to provide clues for the identification of causal variants in these loci. Finally, we explore the genetic overlap between SSc and other autoimmune diseases (ADs). The vast majority of SSc risk loci are shared with at least one additional AD, being the overlap between SSc and systemic lupus erythematous the largest. Nevertheless, we found that an important portion of SSc risk factors are also common to rheumatoid arthritis or primary biliary cirrhosis. Considering all these evidences, we are confident that future research will be successful in understanding the relevant altered pathways in SSc and in identifying new biomarkers and therapeutic targets for the disease.
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Affiliation(s)
- Lara Bossini-Castillo
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Parque Tecnológico de La Salud (PTS), Granada, Spain.
| | - Elena López-Isac
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Parque Tecnológico de La Salud (PTS), Granada, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN-CSIC), Parque Tecnológico de La Salud (PTS), Granada, Spain.
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Alam A, Mukhopadhyay ND, Ning Y, Reshko LB, Cardnell RJG, Alam O, Rabender CS, Yakovlev VA, Walker L, Anscher MS, Mikkelsen RB. A Preliminary Study on Racial Differences in HMOX1, NFE2L2, and TGFβ1 Gene Polymorphisms and Radiation-Induced Late Normal Tissue Toxicity. Int J Radiat Oncol Biol Phys 2015; 93:436-43. [PMID: 26238954 DOI: 10.1016/j.ijrobp.2015.05.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 05/14/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE This study tested whether racial differences in genetic polymorphisms of 4 genes involved in wound repair and response to radiation can be used to predict the occurrence of normal tissue late effects of radiation therapy and indicate potential therapeutic targets. METHODS AND MATERIALS This prospective study examined genetic polymorphisms that modulate the expression of 4 genes involved in inflammation and fibrosis and response to radiation (HMOX1, NFE2L2, NOS3, and TGFβ1). DNA from blood samples of 179 patients (∼ 80% breast and head and neck) collected at the time of diagnosis by their radiation oncologist as exhibiting late normal tissue toxicity was used for the analysis. Patient demographics were as follows: 56% white, 43% African American, 1% other. Allelic frequencies of the different polymorphisms of the participants were compared with those of the general American population stratified by race. Twenty-six additional patients treated with radiation, but without toxicity at 3 months or later after therapy, were also analyzed. RESULTS Increased frequency of a long GT repeat in the HMOX1 promoter was associated with late effects in both African American and white populations. The single nucleotide polymorphisms (SNP) rs1800469 in the TGFβ1 promoter and the rs6721961 SNP in the NFE2L2 promoter were also found to significantly associate with late effects in African Americans but not whites. A combined analysis of these polymorphisms revealed that >90% of African American patients with late effects had at least 1 of these minor alleles, and 58% had 2 or more. No statistical significance was found relating the studied NOS3 polymorphisms and normal tissue toxicity. CONCLUSIONS These results support a strong association between wound repair and late toxicities of radiation. The presence of these genetic risk factors can vary significantly among different ethnic groups, as demonstrated for some of the SNPs. Future studies should account for the possibility of such ethnic heterogeneity in the late toxicities of radiation.
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Affiliation(s)
- Asim Alam
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Nitai D Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Yi Ning
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Leonid B Reshko
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Robert J G Cardnell
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Omair Alam
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Vasily A Yakovlev
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Linda Walker
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Mitchell S Anscher
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Ross B Mikkelsen
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
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24
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Mills SD, Fox RS, Merz EL, Clements PJ, Kafaja S, Malcarne VL, Furst DE, Khanna D. Evaluation of the Satisfaction with Appearance Scale and Its Short Form in Systemic Sclerosis: Analysis from the UCLA Scleroderma Quality of Life Study. J Rheumatol 2015; 42:1624-30. [PMID: 26034157 DOI: 10.3899/jrheum.141482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Changes in appearance are common in patients with systemic sclerosis (SSc) and can significantly affect well-being. The Satisfaction with Appearance Scale (SWAP) measures body image dissatisfaction in persons with visible disfigurement; the Brief-Satisfaction with Appearance Scale (Brief-SWAP) is its short form. The present study evaluated the reliability and validity of SWAP and Brief-SWAP scores in SSc. METHODS A sample of 207 patients with SSc participating in the University of California, Los Angeles Scleroderma Quality of Life Study completed the SWAP. Brief-SWAP scores were derived from the SWAP. The structural validity of both measures was investigated using confirmatory factor analysis. Internal consistency reliability of total and subscale scores was assessed with Cronbach's alpha coefficients. Convergent and divergent validity was evaluated using the Center for Epidemiological Studies Depression Scale, the Health Assessment Questionnaire-Disability Index, and the Medical Outcomes Study Short Form-36 questionnaire. RESULTS SWAP and Brief-SWAP total scores were highly correlated (r = 0.97). The 4-factor structure of the SWAP fit well descriptively; the 2-factor structure of the Brief-SWAP fit well descriptively and statistically. Internal consistencies for total and subscale scores were good, and results supported convergent and divergent validity. CONCLUSION Both versions are suitable for use in patients with SSc. The Brief-SWAP is most efficient; the full SWAP yields additional subscales that may be informative in understanding body image issues in patients with SSc.
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Affiliation(s)
- Sarah D Mills
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Rina S Fox
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Erin L Merz
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Philip J Clements
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Suzanne Kafaja
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Vanessa L Malcarne
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan.
| | - Daniel E Furst
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
| | - Dinesh Khanna
- From the San Diego State University (SDSU)/University of California, San Diego (UC San Diego) Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU, San Diego; Department of Psychology, California State University, Dominguez Hills, Carson; Department of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.S.D. Mills, MS, MPH, Doctoral Student; R.S. Fox, MS, MPH, Doctoral Student, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology; E.L. Merz, PhD, MPH, Assistant Professor, Department of Psychology, California State University, Dominguez Hills; P.J. Clements, MD, MPH, Professor Emeritus; S. Kafaja, MD, Clinical Instructor, Department of Medicine, University of California, Los Angeles; V.L. Malcarne, PhD, Professor, Department of Psychology, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, and Department of Psychology, SDSU; D.E. Furst, MD, Professor, Department of Medicine, University of California, Los Angeles; D. Khanna, MD, MSc, Associate Professor, Department of Medicine, University of Michigan
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Osthoff M, Ngian GS, Dean MM, Nikpour M, Stevens W, Proudman S, Eisen DP, Sahhar J. Potential role of the lectin pathway of complement in the pathogenesis and disease manifestations of systemic sclerosis: a case-control and cohort study. Arthritis Res Ther 2014; 16:480. [PMID: 25403109 PMCID: PMC4264552 DOI: 10.1186/s13075-014-0480-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 10/28/2014] [Indexed: 12/28/2022] Open
Abstract
Introduction Repetitive episodes of ischemia and reperfusion (I/R) are a cardinal feature of the pathogenesis of systemic sclerosis (SSc), which precedes tissue fibrosis. The complement system is a key mediator of tissue damage after I/R, primarily by activation of the lectin pathway. This study investigated whether serum levels and polymorphisms of mannose-binding lectin (MBL) and ficolin-2 (FCN2), two pattern recognition receptors of the lectin pathway, are associated with the predisposition to and clinical features of SSc. Methods A case-control study was undertaken involving 90 patients with SSc from a single SSc outpatient clinic and 90 age- and sex-matched blood donors. MBL and FCN2 levels and polymorphisms were measured in both groups, and in cases correlated with clinical data. Results MBL levels and genotypes were equally distributed in cases and controls while there were some significant differences in FCN2 polymorphisms. Median MBL levels were higher in SSc cases with diffuse disease compared with controls (2.6 versus 1.0 μg/ml, P <0.001). In cases, higher MBL levels were associated with the presence of clinical findings associated with vascular dysfunction and local tissue damage (digital ulcers, calcinosis and pitting). Moreover, MBL levels were associated with fibrotic disease manifestations as evidenced by the presence of diffuse disease (median 2.6 versus 0.8 μg/ml, P = 0.002), the modified Rodnan skin score (r = 0.39, P <0.001), and interstitial lung disease as measured by forced vital capacity (r = −0.33, P = 0.001). Importantly, MBL levels also correlated with the Scleroderma Health Assessment Questionnaire scores (r = 0.33, P = 0.002). The results for FCN2 levels were less striking. Phenotypic MBL results were largely confirmed by analysis of MBL polymorphisms. MBL levels were not associated with the presence of autoantibodies or hypocomplementaemia. Conclusions Overall, predisposition to SSc was not influenced by the lectin pathway of complement in our matched case-control study. However, our preliminary data suggest that MBL, and to a lesser extent FCN2, may modulate disease manifestations of SSc, particularly in diffuse cutaneous disease. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0480-6) contains supplementary material, which is available to authorized users.
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26
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Wells AU. Interstitial lung disease in systemic sclerosis. Presse Med 2014; 43:e329-43. [PMID: 25217474 DOI: 10.1016/j.lpm.2014.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 12/12/2022] Open
Abstract
Based on international collaborative data, interstitial lung disease is now the most frequent cause of death in systemic sclerosis (SSc), having supplanted renal crisis in that regard. Despite detailed explorations of candidate mediators, no primary pathway in the pathogenesis of interstitial lung disease associated with SSc (SSc-ILD) has been definitively identified and, therefore, treatment with current agents is only partially successful. However, as immunomodulatory agents do, on average, retard progression of lung disease, early identification of SSc-ILD, using thoracic high resolution computed tomography (HRCT), is highly desirable. The decision whether to introduce therapy immediately is often difficult as the balance of risk and benefit favours a strategy of careful observation when lung disease is very limited, especially in long-standing SSc. The threshold for initiating treatment is substantially reduced when lung disease is severe, systemic disease is short in duration or ongoing progression is evident, based on pulmonary function tests and symptoms. This review summarises epidemiology, pathogenesis, difficult clinical problems and management issues in SSc-ILD.
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Affiliation(s)
- Athol U Wells
- Royal Brompton hospital, interstitial lung disease unit, Sydney street, Chelsea, London SW3 6HP, United Kingdom.
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27
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Leduc C, Young ID, Joneja MG, Parker CM. Unexpected post-mortem diagnosis of systemic sclerosis presenting as pneumatosis intestinalis: revised diagnostic criteria and medicolegal implications. Leg Med (Tokyo) 2014; 17:29-33. [PMID: 25212670 DOI: 10.1016/j.legalmed.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/20/2014] [Accepted: 08/20/2014] [Indexed: 12/20/2022]
Abstract
Systemic sclerosis is a challenging diagnosis for clinicians and pathologists alike due to its protean manifestations and often insidious onset, particularly in cases without significant titres of auto-antibodies. Herein we present a case of a female in her sixties who died rapidly following a clinical diagnosis of pneumatosis intestinalis and respiratory failure of unclear etiology. Recently revised clinical diagnostic criteria were applied to the clinical history and postmortem findings to reach an unexpected diagnosis of systemic sclerosis. The diagnosis of systemic sclerosis at autopsy has important medicolegal implications largely related to premature death due to delayed treatment or poor post-operative outcome. Moreover, familial clustering of this disease underscores the importance of maintaining a high index of suspicion in the postmortem setting.
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Affiliation(s)
- Charles Leduc
- Regional Forensic Pathology Unit, Department of Pathology and Molecular Medicine, Queen's University and Kingston General Hospital, 88 Stuart Street, Kingston, Ontario K7L 3N6, Canada.
| | - Iain D Young
- Regional Forensic Pathology Unit, Department of Pathology and Molecular Medicine, Queen's University and Kingston General Hospital, 88 Stuart Street, Kingston, Ontario K7L 3N6, Canada
| | - Mala G Joneja
- Division of Rheumatology, Department of Medicine, Queen's University and Kingston General Hospital, 94 Stuart Street, Kingston, Ontario K7L 3N6, Canada
| | - Christopher M Parker
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University and Kingston General Hospital, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada
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Molecular and cellular basis of scleroderma. J Mol Med (Berl) 2014; 92:913-24. [DOI: 10.1007/s00109-014-1190-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 01/11/2023]
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Blanco I, Mathai S, Shafiq M, Boyce D, M Kolb T, Chami H, K Hummers L, Housten T, Chaisson N, L Zaiman A, M Wigley F, J Tedford R, A Kass D, Damico R, E Girgis R, M Hassoun P. Severity of systemic sclerosis-associated pulmonary arterial hypertension in African Americans. Medicine (Baltimore) 2014; 93:177-185. [PMID: 25181310 PMCID: PMC4602454 DOI: 10.1097/md.0000000000000032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
African Americans (AA) with systemic sclerosis (SSc) have a worse prognosis compared to Americans of European descent (EA). We conducted the current study to test the hypothesis that AA patients with SSc have more severe disease and poorer outcomes compared to EA patients when afflicted with pulmonary arterial hypertension (PAH). We studied 160 consecutive SSc patients with PAH diagnosed by right heart catheterization, comparing demographics, hemodynamics, and outcomes between AA and EA patients. The cohort included 29 AA and 131 EA patients with similar baseline characteristics except for increased prevalence of diffuse SSc in AA. AA patients had worse functional class (FC) (80% FC III-IV vs 53%; p = 0.02), higher brain natriuretic peptide (NT-pro-BNP) (5729 ± 9730 pg/mL vs 1892 ± 2417 pg/mL; p = 0.02), more depressed right ventricular function, a trend toward lower 6-minute walk distance (263 ± 111 m vs 333 ± 110 m; p = 0.07), and worse hemodynamics (cardiac index 1.95 ± 0.58 L/min/m vs 2.62 ± 0.80 L/min/m; pulmonary vascular resistance 10.3 ± 6.2 WU vs 7.6 ± 5.0 WU; p < 0.05) compared with EA patients. Kaplan-Meier survival estimates for AA and EA patients, respectively, were 62% vs 73% at 2 years and 26% vs 44% at 5 years (p > 0.05). In conclusion, AA patients with SSc-PAH are more likely to have diffuse SSc and to present with significantly more severe PAH compared with EA patients. AA patients also appear to have poorer survival, though larger studies are needed to investigate this association definitively.
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MESH Headings
- Adult
- Black or African American
- Autoantibodies/blood
- Cardiac Catheterization/methods
- Echocardiography/methods
- Exercise Test/methods
- Familial Primary Pulmonary Hypertension
- Female
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/ethnology
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Natriuretic Peptide, Brain/blood
- Outcome Assessment, Health Care
- Peptide Fragments/blood
- Prevalence
- Prognosis
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/ethnology
- Scleroderma, Systemic/physiopathology
- Severity of Illness Index
- United States/epidemiology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- White People
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Affiliation(s)
- Isabel Blanco
- Divisions of Pulmonary and Critical Care Medicine (IB, SCM, DB, TMK, HC, TH, NC, ALZ, RD, REG, PMH), General Internal Medicine (MS, FMW), Rheumatology (LKH), and Cardiology (RJT, DAK), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (IB), Barcelona, Spain; and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (IB), Spain
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Liberal R, Grant CR, Sakkas L, Bizzaro N, Bogdanos DP. Diagnostic and clinical significance of anti-centromere antibodies in primary biliary cirrhosis. Clin Res Hepatol Gastroenterol 2013; 37:572-85. [PMID: 23876351 DOI: 10.1016/j.clinre.2013.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 02/04/2023]
Abstract
Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver characterised by biochemical evidence of cholestasis, elevated alkaline phosphatase levels and the presence of the highly disease specific anti-mitochondrial autoantibodies. Extra-hepatic autoimmune manifestations are common, including rheumatic disorders, such as systemic sclerosis (SSc). Notably, PBC is the most frequent autoimmune liver disease in SSc patients. Based on skin lesion extension, two major SSc disease subgroups are recognised: limited cutaneous SSc (lSSc) and diffuse cutaneous SSc. Anti-centromere antibody (ACA) positivity is highly characteristic of SSc, with up to 90% prevalence in lSSc patients. ACA has also been found in up to 30% of PBC patients and 80% of patients with a PBC/SSc overlap syndrome. The diagnostic and clinical significance of ACA positivity in patients with PBC without SSc has recently been under investigation, with several studies highlighting links to severe bile duct injury and portal hypertension. This review discusses the diagnostic and clinical relevance of ACA in patients with PBC, with or without SSc.
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Affiliation(s)
- Rodrigo Liberal
- Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill Campus, London SE5 9RS, UK; Faculty of Medicine, University of Porto, Porto, Portugal.
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Peschken C. The value of studying clinical and serologic phenotypes in north american native populations with autoimmune disease. J Rheumatol Suppl 2013; 40:1031-3. [PMID: 23818720 DOI: 10.3899/jrheum.130561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kahloon RA, Xue J, Bhargava A, Csizmadia E, Otterbein L, Kass DJ, Bon J, Soejima M, Levesque MC, Lindell KO, Gibson KF, Kaminski N, Banga G, Oddis CV, Pilewski JM, Sciurba FC, Donahoe M, Zhang Y, Duncan SR. Patients with idiopathic pulmonary fibrosis with antibodies to heat shock protein 70 have poor prognoses. Am J Respir Crit Care Med 2013; 187:768-75. [PMID: 23262513 DOI: 10.1164/rccm.201203-0506oc] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Diverse autoantibodies are present in most patients with idiopathic pulmonary fibrosis (IPF). We hypothesized that specific autoantibodies may associate with IPF manifestations. OBJECTIVES To identify clinically relevant, antigen-specific immune responses in patients with IPF. METHODS Autoantibodies were detected by immunoblots and ELISA. Intrapulmonary immune processes were evaluated by immunohistochemistry. Anti-heat shock protein 70 (HSP70) IgG was isolated from plasma by immunoaffinity. Flow cytometry was used for leukocyte functional studies. MEASUREMENTS AND MAIN RESULTS HSP70 was identified as a potential IPF autoantigen in discovery assays. Anti-HSP70 IgG autoantibodies were detected by immunoblots in 3% of 60 control subjects versus 25% of a cross-sectional IPF cohort (n = 122) (P = 0.0004), one-half the patients with IPF who died (P = 0.008), and 70% of those with acute exacerbations (P = 0.0005). Anti-HSP70 autoantibodies in patients with IPF were significantly associated with HLA allele biases, greater subsequent FVC reductions (P = 0.0004), and lesser 1-year survival (40 ± 10% vs. 80 ± 5%; hazard ratio = 4.2; 95% confidence interval, 2.0-8.6; P < 0.0001). HSP70 protein, antigen-antibody complexes, and complement were prevalent in IPF lungs. HSP70 protein was an autoantigen for IPF CD4 T cells, inducing lymphocyte proliferation (P = 0.004) and IL-4 production (P = 0.01). IPF anti-HSP70 autoantibodies activated monocytes (P = 0.009) and increased monocyte IL-8 production (P = 0.049). ELISA confirmed the association between anti-HSP70 autoreactivity and IPF outcome. Anti-HSP70 autoantibodies were also found in patients with other interstitial lung diseases but were not associated with their clinical progression. CONCLUSIONS Patients with IPF with anti-HSP70 autoantibodies have more near-term lung function deterioration and mortality. These findings suggest antigen-specific immunoassays could provide useful clinical information in individual patients with IPF and may have implications for understanding IPF progression.
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Affiliation(s)
- Rehan A Kahloon
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Ling ALH, Gee TG, Giap LW, Cheng NS, Santosa A, Chan G, Lim A, Ee PM, Qing TH, Ting LP, Thumboo J. Disease Characteristics of the Singapore Systemic Sclerosis Cohort. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea Low Hsiu Ling
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore
| | - Teng Gim Gee
- Division of Rheumatology, Department of Medicine, National University Health System, Singapore
| | - Law Weng Giap
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Ng Swee Cheng
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Health System, Singapore
| | - Grace Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Anita Lim
- Division of Rheumatology, Department of Medicine, National University Health System, Singapore
| | - Png May Ee
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Teo Huan Qing
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Lee Ping Ting
- Division of Rheumatology, Department of Medicine, National University Health System, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore
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FURST DANIELE, FERNANDES ANCILLAW, IORGA SERBANR, GRETH WARREN, BANCROFT TIM. Annual Medical Costs and Healthcare Resource Use in Patients with Systemic Sclerosis in an Insured Population. J Rheumatol 2012; 39:2303-9. [DOI: 10.3899/jrheum.120600] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Systemic sclerosis (SSc) is a chronic autoimmune disease. The objective of our study was to estimate the medical costs and healthcare resource use of subjects with SSc in a large US managed care plan.Methods.Subjects at least 18 years of age and with claims-based evidence of SSc (ICD-9-CM code 710.1x) were identified from a health plan database from 2003 through 2008. Subjects were matched to unaffected controls, based on index date, age, sex, geographic region, time on insurance, and comorbidity score. Costs and resource use were identified during the 12-month postindex period. A generalized linear model (GLM) was used to estimate costs, controlling for demographic and clinical characteristics.Results.In this study, 1648 subjects with SSc were matched to 4944 controls. Mean overall annual medical costs were higher among SSc subjects than controls ($17,365 vs $5,508; p < 0.001). A GLM model supported these results. Evidence of lung disease, gastrointestinal bleeding, or renal disease increased costs (all p < 0.001). Compared to controls, significantly higher proportions of SSc subjects had postindex ambulatory visits, emergency department visits, and inpatient hospital stays (all p < 0.001).Conclusion.Our findings suggest that the medical costs and resource use associated with treating SSc are high (compared to matched controls), and as expected, subjects with serious disease complications experience the highest costs.
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Gaddy JR, Vista ES, Robertson JM, Dedeke AB, Roberts VC, Klein WS, Levin JH, Mota FH, Cooper TM, Grim GA, Khan S, James JA. Rheumatic disease among Oklahoma tribal populations: a cross-sectional study. J Rheumatol 2012; 39:1934-41. [PMID: 22896022 DOI: 10.3899/jrheum.110984] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Rheumatic diseases cause significant morbidity within American Indian populations. Clinical disease presentations, as well as historically associated autoantibodies, are not always useful in making a rapid diagnosis or assessing prognosis. The purpose of our study was to identify autoantibody associations among Oklahoma tribal populations with rheumatic disease. METHODS Oklahoma tribal members (110 patients with rheumatic disease and 110 controls) were enrolled at tribal-based clinics. Patients with rheumatic disease (suspected or confirmed diagnosis) were assessed by a rheumatologist for clinical features, disease criteria, and activity measures. Blood samples were collected and tested for common rheumatic disease autoantibodies [antinuclear antibody (ANA), anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), anti-Ro, anti-La, anti-Sm, anti-nRNP, anti-ribosomal P, anti-dsDNA, and anticardiolipins]. RESULTS In patients with suspected systemic rheumatic diseases, 72% satisfied American College of Rheumatology classification criteria: 40 (36%) had rheumatoid arthritis (RA), 16 (15%) systemic lupus erythematosus, 8 (7%) scleroderma, 8 (7%) osteoarthritis, 4 (4%) fibromyalgia, 2 (2%) seronegative spondyloarthropathy, 1 Sjögren's syndrome, and 1 sarcoidosis. Compared to controls, RA patient sera were more likely to contain anti-CCP (55% vs 2%; p < 0.001) or RF IgM antibodies (57% vs 10%; p < 0.001); however, the difference was greater for anti-CCP. Anti-CCP positivity conferred higher disease activity scores (DAS28 5.6 vs 4.45; p = 0.021) while RF positivity did not (DAS28 5.36 vs 4.64; p = 0.15). Anticardiolipin antibodies (25% of rheumatic disease patients vs 10% of controls; p = 0.0022) and ANA (63% vs 21%; p < 0.0001) were more common in rheumatic disease patients. CONCLUSION Anti-CCP may serve as a more specific RA biomarker in American Indian patients, while the clinical significance of increased frequency of anticardiolipin antibodies needs further evaluation.
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Affiliation(s)
- Jasmine R Gaddy
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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PENG WENJIA, WANG BINGXIANG, PAN HAIFENG, WANG JING. Association of Interleukin 1α Promoter Polymorphism (–889C/T) with Susceptibility to Systemic Sclerosis. J Rheumatol 2012; 39:1755; author reply 1755. [DOI: 10.3899/jrheum.120027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Martín JE, Bossini-Castillo L, Martín J. Unraveling the genetic component of systemic sclerosis. Hum Genet 2012; 131:1023-37. [PMID: 22218928 DOI: 10.1007/s00439-011-1137-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
Abstract
Systemic sclerosis (SSc) is a severe connective tissue disorder characterized by extensive fibrosis, vascular damage, and autoimmune events. During the last years, the number of genetic markers convincingly associated with SSc has exponentially increased. In this report, we aim to offer an updated review of the classical and novel genetic associations with SSc, analyzing the firmest and replicated signals within HLA and non-HLA genes, identified by both candidate gene and genome-wide association (GWA) studies. We will also provide an insight into the future perspectives and approaches that might shed more light into the complex genetic background underlying SSc. In spite of the remarkable advance in the field of SSc genetics during the last decade, the use of the new genetic technologies such as next generation sequencing (NGS), as well as the deep phenotyping of the study cohorts, to fully characterize the genetic component of this disease is imperative.
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Affiliation(s)
- José Ezequiel Martín
- Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Consejo Superior de Investigaciones Científicas, Parque Tecnológico Ciencias de la Salud, Avenida del Conocimiento, 18100-Armilla, Granada, Spain
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Conrad K, Roggenbuck D, Reinhold D, Sack U. Autoantibody diagnostics in clinical practice. Autoimmun Rev 2011; 11:207-11. [PMID: 21621008 DOI: 10.1016/j.autrev.2011.05.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disease associated autoantibodies (AAB) are important biomarkers not only to confirm the diagnosis of the respective systemic autoimmune disease but also to diagnose the disease at very early stages (mono- or oligosymptomatic manifestations) or to diagnose the respective disease without the typical clinical manifestations (atypical forms). A confirmation of the diagnosis in early stages is required, if patients should benefit from early therapeutic intervention. Furthermore, AAB determinations are used for prognostic purposes and for monitoring of disease activity or response to therapy. For the advancement of autoantibody diagnostics in clinical practice the following aspects have to be considered: (i) The search for novel clinically relevant AAB and the identification of autoantigenic targets of AAB broadened the spectrum of autoimmune diagnostics and permit the diagnosis of former idiopathic diseases. (ii) To obtain steady diagnostic variables of clinically relevant AAB, the evaluation studies have to be standardized. (iii) Several special features and novel developments of autoantibody diagnostics make correct interpretation of antibody test results increasingly difficult. (iv) Beside standardization of AAB detection methods and quality management efforts the improvement of autoantibody diagnostics depends on further development of diagnostic algorithms including cost-effective multiparametric analyses.
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Affiliation(s)
- Karsten Conrad
- Institute of Immunology, Technical University Dresden, Germany.
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Sharif R, Fritzler MJ, Mayes MD, Gonzalez EB, McNearney TA, Draeger H, Baron M, Furst DE, Khanna DK, del Junco DJ, Molitor JA, Schiopu E, Phillips K, Seibold JR, Silver RM, Simms RW, Perry M, Rojo C, Charles J, Zhou X, Agarwal SK, Reveille JD, Assassi S, Arnett FC. Anti-fibrillarin antibody in African American patients with systemic sclerosis: immunogenetics, clinical features, and survival analysis. J Rheumatol 2011; 38:1622-30. [PMID: 21572159 DOI: 10.3899/jrheum.110071] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Anti-U3-RNP, or anti-fibrillarin antibodies (AFA), are detected more frequently among African American (AA) patients with systemic sclerosis (SSc) compared to other ethnic groups and are associated with distinct clinical features. We examined the immunogenetic, clinical, and survival correlates of AFA in a large group of AA patients with SSc. METHODS Overall, 278 AA patients with SSc and 328 unaffected AA controls were enrolled from 3 North American cohorts. Clinical features, autoantibody profile, and HLA class II genotyping were determined. To compare clinical manifestations, relevant clinical features were adjusted for disease duration. Cox proportional hazards regression was used to determine the effect of AFA on survival. RESULTS Fifty (18.5%) AA patients had AFA. After Bonferroni correction, HLA-DRB1*08:04 was associated with AFA, compared to unaffected AA controls (OR 11.5, p < 0.0001) and AFA-negative SSc patients (OR 5.2, p = 0.0002). AFA-positive AA patients had younger age of disease onset, higher frequency of digital ulcers, diarrhea, pericarditis, higher Medsger perivascular and lower Medsger lung severity indices (p = 0.004, p = 0.014, p = 0.019, p = 0.092, p = 0.006, and p = 0.016, respectively). After adjustment for age at enrollment, AFA-positive patients did not have different survival compared to patients without AFA (p = 0.493). CONCLUSION Our findings demonstrate strong association between AFA and HLA-DRB1*08:04 allele in AA patients with SSc. AA SSc patients with AFA had younger age of onset, higher frequency of digital ulcers, pericarditis and severe lower gastrointestinal involvement, but less severe lung involvement compared to AA patients without AFA. Presence of AFA did not change survival.
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Affiliation(s)
- Roozbeh Sharif
- Division of Rheumatology and Immunogenetics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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Affiliation(s)
- Armando Gabrielli
- Department of Medical Science and Surgery, Section of Clinical Medicine, Università Politecnica delle Marche, and Ospedali Riuniti, Ancona, Italy.
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LOW ANDREAH, JOHNSON SINDHUR, LEE PETER. Ethnic Influence on Disease Manifestations and Autoantibodies in Chinese-Descent Patients with Systemic Sclerosis. J Rheumatol 2009; 36:787-93. [DOI: 10.3899/jrheum.080915] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective.To investigate ethnic influence on disease manifestations and autoantibody profile in patients of Chinese descent with systemic sclerosis (SSc).Methods.In a retrospective study of a multiethnic SSc cohort followed over a 17-year period, disease manifestations and autoantibody profile of patients of European and Chinese descent were compared.Results.There were 300 patients of European descent and 36 of Chinese descent, with similar proportions of women (81% and 72%, respectively) and patients with diffuse SSc (50% and 56%). Patients of Chinese descent [mean age ± standard deviation (SD) 52 ± 16 yrs; p = 0.05] were diagnosed at an older age compared to patients of European descent (mean ± SD 46 ± 12 yrs). Patients of Chinese descent compared to those of European descent had less frequent joint (69% vs 86%; p = 0.01) and gastrointestinal involvement (78% vs 94%; p = 0.004), but increased prevalence of myositis (17% vs 5%; p = 0.01). Patients of Chinese descent had less frequent digital ulceration (36% vs 55%; p = 0.04), and an absence of renal crisis. The frequency of cardiac and pulmonary involvement was similar in both groups. More patients of Chinese than of European descent were positive for anti-topoisomerase-I (47% vs 27%; p = 0.02), anti-Ro (36% vs 10%; p = 0.001), and anti-U1RNP (17% vs 5%; p = 0.03) antibodies. The observed differences for anti-topoisomerase-I, anti-Ro, and joint and gastrointestinal manifestations persisted in the subgroup analysis of patients matched for sex, disease subtype, and age at diagnosis.Conclusion.Patients of Chinese descent have milder SSc disease with less frequent joint and gastrointestinal manifestations, less severe vasculopathy, but increased prevalence of myositis and certain autoantibodies. Research is needed to identify determinants (genetic, environmental, and cultural factors) of the relationship between ethnicity and disease.
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Affiliation(s)
- Mary J Roman
- Division of Cardiology, Weill Medical College of Cornell University and the Hospital for Special Surgery, New York, NY 10021, USA.
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Bogatkevich GS, Ludwicka-Bradley A, Highland KB, Hant F, Nietert PJ, Singleton CB, Feghali-Bostwick CA, Silver RM. Impairment of the antifibrotic effect of hepatocyte growth factor in lung fibroblasts from African Americans: possible role in systemic sclerosis. ARTHRITIS AND RHEUMATISM 2007; 56:2432-42. [PMID: 17599773 DOI: 10.1002/art.22713] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the composition of cytokines in African American and Caucasian patients with systemic sclerosis (SSc; scleroderma) and in healthy individuals, particularly the expression and function of hepatocyte growth factor (HGF). METHODS Bronchoalveolar lavage (BAL) fluid samples were analyzed using cytokine array techniques. HGF in plasma and cell culture medium samples was measured by enzyme-linked immunosorbent assay. Connective tissue growth factor (CTGF), type I collagen expression, and c-Met receptor phosphorylation were studied by immunoblotting. RESULTS Overall greater expression of cytokines in BAL fluid from African American patients as compared with Caucasian patients was observed. Significant increases in HGF concentrations were detected in BAL fluid, plasma, and fibroblast culture medium from Caucasian SSc patients. In contrast, African American SSc patients did not demonstrate an increase in HGF. Recombinant HGF readily abolished CTGF expression and collagen accumulation in lung fibroblasts isolated from Caucasian SSc patients. Pretreatment of lung fibroblasts with neutralizing anti-c-Met antibody abolished the effects of HGF on CTGF expression and collagen accumulation, suggesting that the antifibrotic activity of HGF is mediated via c-Met receptor tyrosine kinase. Whereas recombinant HGF rapidly induced c-Met receptor phosphorylation in lung fibroblasts from Caucasian patients, c-Met receptor phosphorylation was significantly reduced in lung fibroblasts from African American subjects. Moreover, recombinant HGF failed to prevent CTGF expression and collagen accumulation in lung fibroblasts derived from African American subjects. CONCLUSION Ethnic differences exist in terms of antifibrotic HGF expression in lung fibroblasts derived from Caucasian and African American subjects. Reduced levels of HGF as well as a deficiency in c-Met receptor function appear to be present in African American patients with SSc. These findings may explain in part the greater disease severity and worse prognosis observed in African Americans with SSc.
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Smith MW, O'Brien SJ. Mapping by admixture linkage disequilibrium: advances, limitations and guidelines. Nat Rev Genet 2005; 6:623-32. [PMID: 16012528 DOI: 10.1038/nrg1657] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mapping by admixture linkage disequilibrium (MALD) is a theoretically powerful, although unproven, approach to mapping genetic variants that are involved in human disease. MALD takes advantage of long-range haplotypes that are generated by gene flow among recently admixed ethnic groups, such as African-Americans and Latinos. Under ideal circumstances, MALD will have more power to detect some genetic variants than other types of genome-wide association study that are carried out among more ethnically homogeneous populations. It will also require 200-500 times fewer markers, providing a significant economic advantage. The MALD approach is now being applied, with results expected in the near future.
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Affiliation(s)
- Michael W Smith
- Laboratory of Genomic Diversity, National Cancer Institute, Frederick, Maryland 21702, USA.
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Abstract
The pathogenesis of systemic sclerosis (SSc; scleroderma) is still enigmatic. Genetic, familial, and twin studies suggest that SSc occurs in genetically susceptible individuals. Recent high-throughput technologies, including gene expression profiling and proteomics, have accelerated the rate of information acquired on possible mechanisms involved in SSc pathogenesis. The potential of the data obtained lies in their use for identifying new disease markers, monitoring disease activity, and developing tailored therapies. The result is an era of unprecedented advance that will benefit SSc and many other diseases.
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Affiliation(s)
- Carol A Feghali-Bostwick
- Division of Pulmonary, Allergy, and Critical Care Medicine, Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Department of Medicine, 628 NW MUH, 3459 Fifth Ave, Pittsburgh, PA 15213, USA.
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Zurauskas J, Beroukas D, Walker JG, Smith MD, Ahern MJ, Roberts-Thomson PJ. Scleroderma in Australian Aborigines. Intern Med J 2005; 35:60-2. [PMID: 15667472 DOI: 10.1111/j.1445-5994.2004.00729.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Scleroderma (systemic sclerosis) has not been reported before in Australian Aborigines. We describe in detail a community middle-aged Aboriginal woman whose diffuse scleroderma terminated fatally with a renal crisis. Moreover, we have identified a further five Aboriginal patients on the South Australian Scleroderma Register (two with diffuse, two with limited and one with overlap scleroderma), a number consistent with that expected from the 2001 census data for our state. However, an analysis of all antinuclear antibody (ANA) requests from the Top End of Australia over a 6-year period revealed only two Aborigines with low titre anticentromere antibody (despite frequent occurrence of ANA with other specificities). Neither of these Aborigines had features of scleroderma. In conclusion, scleroderma does occur in indigenous Australians but further studies are needed to confirm the apparent infrequency of centromere-associated limited scleroderma (which is the commonest form of scleroderma in our Caucasian population).
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Affiliation(s)
- J Zurauskas
- Department of Medicine, Allergy and Arthritis, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Krishnan E, Furst DE. Systemic sclerosis mortality in the United States: 1979-1998. Eur J Epidemiol 2005; 20:855-61. [PMID: 16283476 DOI: 10.1007/s10654-005-2210-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2005] [Indexed: 10/25/2022]
Abstract
The US national mortality rates from systemic sclerosis (SSc) have not been reported since 1979. We studied age, gender and race specific time trends in US national mortality rates of SSc during the period 1979-1998 using poisson regression models. Over the 4.93 billion person-years of observation during the study period, there were 18,126 deaths from SSc, representing a mortality rate of 3.9 per million. The age adjusted mortality rates for men and women were 1.9 and 5.4 per million respectively. There were relatively few deaths in the extremes of age. SSc mortality rates increased with age in both genders and in all racial groups (p<0.001). In multivariable models adjusted for two-way statistical interactions, being African-American, female and of older age were associated with higher death rates. Over the 20 years of observation, overall (age-adjusted) SSc mortality rates showed a 36% increase (p<0.001) and subgroup analyses revealed that the increases were confined to women of both races. This rise occurred during a period in which post-diagnosis survival of SSc is known to have increased, suggesting an increasing incidence of this disease.
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Affiliation(s)
- Eswar Krishnan
- Department of Medicine, Division of Rheumatology and Clinical Immmunology, University of Pittsburgh, Pittsburgh, PA, USA.
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