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Wang F, Li C, Li X, Li S, Jia Y. Autoantibodies in systemic sclerosis overlap syndrome and their correlation with organ damage and survival. Ann Med 2024; 56:2407526. [PMID: 39348269 PMCID: PMC11443570 DOI: 10.1080/07853890.2024.2407526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) often overlaps with other autoimmune diseases. More complex autoantibody profiles may be observed in SSc overlap syndrome (SSc OS). To determine the clinical significance of autoantibodies in SSc OS and classify the patients more accurately for better disease assessments, we analysed the correlation between serological profiles, organ involvements and outcomes. METHODS A retrospective cohort study was conducted in Peking University People's Hospital. Chi-square tests and analysis of variance were used to analyse univariate comparisons of clinical symptoms, organ involvement and laboratory indicators. Survival was evaluated using Cox proportional hazards model. RESULTS Among 141 cases, anti-Ro-52 was the most common antibody, followed by anti-centromere antibody and anti-Scl-70 antibody. We analysed the correlation between autoantibodies and vital organ damage in SSc OS patients, and compared the differences across four SSc OS subgroups (SSc SLE, SSc RA, SSc PM/DM and SSc SS) to demonstrate the correlation between autoantibodies and clinical characteristics and organ damage. Cox regression analysis showed that scleroderma renal crisis (SRC) (p = .004) and pulmonary arterial hypertension (PH) (p = .010) were independent risk factors for survival. CONCLUSIONS Autoantibodies are associated with clinical features, organ involvement and prognosis in SSc OS patients. Anti-Scl-70 antibody is associated with interstitial lung disease (ILD) and SRC, while ACA is a protective factor of ILD. SRC and PH are risk factors associated with death.
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Affiliation(s)
- Fangqing Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xue Li
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Siying Li
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuan Jia
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
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Alsing P, Ladefoged Assmann M, Linddal Kristensen T, Uggerby Næser E, Søndergaard K, de Thurah A, Mechlenburg I. Feasibility of a home-based exercise intervention for patients with systemic sclerosis. Physiother Theory Pract 2024:1-10. [PMID: 39041393 DOI: 10.1080/09593985.2024.2377348] [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: 02/01/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare connective tissue disease causing pain, reduced mobility and decreased health-related quality of life (HRQoL). Studies suggest that exercise is a necessary adjunct to the medical treatment. PURPOSE To examine the feasibility of a 12-week home-based exercise program for SSc patients, and evaluate changes in physical function, HRQoL and SSc-related symptoms. METHODS Twenty patients were enrolled in the study. Feasibility was measured by adherence, adverse events, and exercise task self-efficacy. At baseline and follow-up patients completed the 6-minute walk test, 30-second sit-to-stand test, 30-second arm curl, SSc Impact of Disease (ScleroID) and 36-item short form survey (SF-36). RESULTS Median adherence to the intervention was 36 (interquartile range 27-36) out of a total of 36 exercise sessions. Fifteen patients completed the intervention, with three dropouts. Patients' exercise task self-efficacy was 98%, 93% and 78%, for one, two and three weekly exercise sessions, respectively. There were no adverse events related to the exercise sessions. Improvements were observed in all physical tests, and minor improvements in HRQoL and SSc-related symptoms. CONCLUSION This study suggests that a home-based exercise intervention is feasible for patients with SSc. The results suggest improvements in physical function, HRQoL and SSc-related symptoms.
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Affiliation(s)
- Peter Alsing
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mie Ladefoged Assmann
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Linddal Kristensen
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Klaus Søndergaard
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Santos GDS, Barros MF, da Matta DN, Tenório ADS, Gonçalves RSG, Duarte ALBP, Dantas AT. Quality of sleep in individuals with systemic sclerosis and its correlation with functional disability and quality of life: a cross-sectional study. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231254. [PMID: 38716943 PMCID: PMC11068387 DOI: 10.1590/1806-9282.20231254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/30/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study aimed to evaluate the quality of sleep in individuals with systemic sclerosis and its correlation with the quality of life and disability. METHODS This is a cross-sectional study, carried out in a tertiary service of a university hospital. Inclusion criteria were diagnosis of systemic sclerosis according to the criteria of the American College of Rheumatology/European League Against Rheumatism 2013 or the preliminary criteria of the American College of Rheumatology 1980, age ≥ 18 years; regularly monitored at the outpatient clinic of rheumatology. Clinical and demographic data of the patients were obtained through a structured interview and evaluation of the medical records. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire, daytime sleepiness using the Epworth Sleepiness Scale, quality of life using 12-item short-form health survey, and disability using the scleroderma health assessment questionnaire. RESULTS A total of 50 patients with systemic sclerosis were included, with 92% female, mean age 48.9 years, mean disease duration 8.9 years, and 60% limited cutaneous form. Most systemic sclerosis patients (84%) have poor sleep quality and 20% have excessive daytime sleepiness. There was a significant negative correlation between Pittsburgh Sleep Quality Index and the physical and mental components of the 12-item short-form health survey (r=-0.42, p=0.003 and r=-0.43, p=0.002, respectively) and a positive correlation with the scleroderma health assessment questionnaire (r=0.52, p=<0.001). CONCLUSION This study showed that poor sleep quality is a very common finding among systemic sclerosis patients, and it negatively affects both the quality of life and the degree of disability. Sleep quality is an unmet need in patients with systemic sclerosis Poor sleep quality is very common in patients with systemic sclerosis Poor sleep quality correlated with worse quality of life and greater disability.
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Affiliation(s)
| | | | - Daniel Neri da Matta
- Universidade Federal de Pernambuco, Department of Clinical Medicine – Recife (PE), Brazil
| | | | | | | | - Andréa Tavares Dantas
- Universidade Federal de Pernambuco, Department of Clinical Medicine – Recife (PE), Brazil
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Dehghan Nayeri N, Fooladzadeh Dehghan M. Exploring the Experiences of Patients with Autoimmune Skin Diseases During the COVID-19 Pandemic. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38506584 DOI: 10.1097/asw.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To explore the experiences of patients with an autoimmune disease during the COVID-19 pandemic. METHODS A total of 12 patients with autoimmune skin disease who were hospitalized in dermatology wards between 2021 and 2022 participated in this qualitative study. The researchers conducted in-depth, semi-structured interviews, which they analyzed using conventional content analysis. RESULTS Data analysis revealed three main themes: changes in mental/psychological status, social impacts and financial problems, and physical consequences. These patients reported changes in mental/psychological status as their most important experiences. CONCLUSIONS During a pandemic, it is important to manage the therapeutic course of patients who are at risk of infection, especially patients with autoimmune skin diseases, via appropriate planning.
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Affiliation(s)
- Nahid Dehghan Nayeri
- Nahid Dehghan Nayeri, PhD, is Professor, Nursing and Midwifery Care Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Fooladzadeh Dehghan, MSN, is Practical Nurse and PhD Candidate, Medical-Surgical Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Chicharro-Luna E, Gracia-Vesga MÁ, Ramos-Petersen L, Gijón-Nogueron G. Impact of foot functionality in patients with systemic sclerosis: Cross-sectional study. J Tissue Viability 2024:S0965-206X(24)00029-9. [PMID: 38514374 DOI: 10.1016/j.jtv.2024.03.004] [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: 09/04/2023] [Revised: 11/27/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Progressive systemic sclerosis or systemic scleroderma (SS) is a chronic and rare autoimmune disease that mainly affects the skin and various internal organs. Raynaud's phenomenon and digital ulcers are some of the symptoms that affect the foot, causing a decrease in the quality of life of patients. The objective of this study is to determine the functionality of the feet in patients with SS and determine the impact on their daily lives. METHODS A sample of 165 patients (154 women, 11 men) diagnosed with SS with a mean age of 46.29 ± 11.36 years and a mean body mass index (BMI) of 24.90 ± 5.77 was recruited. Each participant completed the Foot Function Index (FFI) questionnaire and the Systemic Sclerosis Questionnaire (SySQ). A multivariate analysis was performed to determine which factors were related to a higher score in both questionnaires. RESULTS 32.1% of the participants (n = 53) had claw toe deformities, 79.4% (n = 131) Raynaud's disease and 20% (n = 33) a history of foot ulcers. 51.5% of the participants (n = 85) presented symptoms in their nails, the most frequent sign being thickening, hardening and yellow coloration. The final score of the FFI questionnaire was 3.51 ± 2.41 (0-9.9), the pain subscale being the highest, with a score of 5.06 ± 2.75, followed by foot disability (3.26 ± 2.91) and difficulty performing activities (1.55 ± 2.22). The final score of the SySQ questionnaire was 0.95 ± 0.45 (0.18-2.45), and the subscales with the highest score were symptom frequency (1.30 ± 0.47), symptom intensity (1.11 ± 0.55), and general skill limitation (0.47 ± 0.51). A high correlation was observed between the final FFI score and the final SySQ score (r = 0.712; p=<0.001). Also, between foot activity limitation and general skill limitation (r = 0.658; p=<0.001). A moderate correlation was observed between foot pain score and overall symptom intensity (r = 0.482; p=<0.001). Also, between foot disability and overall symptom frequency (r = 0.556; p=<0.001). The multivariate analysis (R2 0.51) showed that the final FFI score had a significant relationship with the final SySQ score (p < 0.001). No significant correlation was found between age (p = 0.15), gender (p = 0.49), BMI (p = 0.74) or time of diagnosis (p = 0.57) and FFI. CONCLUSION SS is a disease that affects foot functionality in patients, with a greater impact on the pain scale. There is a correlation between the final FFI score and the final SySQ score, so improving foot functionality could help to improve the overall functionality of the patient with sclerosis.
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Affiliation(s)
- Esther Chicharro-Luna
- Department Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Spain.
| | | | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain.
| | - Gabriel Gijón-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, IBIMA, University of Málaga, Spain.
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You F, Nicco C, Harakawa Y, Yoshikawa T, Inufusa H. The Potential of Twendee X ® as a Safe Antioxidant Treatment for Systemic Sclerosis. Int J Mol Sci 2024; 25:3064. [PMID: 38474309 DOI: 10.3390/ijms25053064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by systemic skin hardening, which combines Raynaud's phenomenon and other vascular disorders, skin and internal organ fibrosis, immune disorders, and a variety of other abnormalities. Symptoms vary widely among individuals, and personalized treatment is sought for each patient. Since there is no fundamental cure for SSc, it is designated as an intractable disease with patients receiving government subsidies for medical expenses in Japan. Oxidative stress (OS) has been reported to play an important role in the cause and symptoms of SSc. HOCl-induced SSc mouse models are known to exhibit skin and visceral fibrosis, vascular damage, and autoimmune-like symptoms observed in human SSc. The antioxidant combination Twendee X® (TwX) is a dietary supplement consisting of vitamins, amino acids, and CoQ10. TwX has been proven to prevent dementia in humans with mild cognitive impairment and significantly improve cognitive impairment in an Alzheimer's disease mouse model by regulating OS through a strong antioxidant capacity that cannot be achieved with a single antioxidant ingredient. We evaluated the effectiveness of TwX on various symptoms of HOCl-induced SSc mice. TwX-treated HOCl-induced SSc mice showed significantly reduced lung and skin fibrosis compared to untreated HOCl-induced SSc mice. TwX also significantly reduced highly oxidized protein products (AOPP) in serum and suppressed Col-1 gene expression and activation of B cells involved in autoimmunity. These findings suggest that TwX has the potential to be a new antioxidant treatment for SSc without side effects.
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Affiliation(s)
- Fukka You
- Division of Anti-Oxidant Research, Life Science Research Center, Gifu University, Yanagito 1-1, Gifu 501-1194, Japan
- Anti-Oxidant Research Laboratory, Louis Pasteur Center for Medical Research, Tanakamonzen-cho 103-5, Sa-kyo-ku, Kyoto 606-8225, Japan
| | - Carole Nicco
- Université Paris Cité, 45 Rue des Saints-Pères, 75006 Paris, France
| | - Yoshiaki Harakawa
- Division of Anti-Oxidant Research, Life Science Research Center, Gifu University, Yanagito 1-1, Gifu 501-1194, Japan
| | - Toshikazu Yoshikawa
- Louis Pasteur Center for Medical Research, Tanakamonzen-cho 103-5, Sakyo-ku, Kyoto 606-8225, Japan
- School of Medicine, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Haruhiko Inufusa
- Division of Anti-Oxidant Research, Life Science Research Center, Gifu University, Yanagito 1-1, Gifu 501-1194, Japan
- Anti-Oxidant Research Laboratory, Louis Pasteur Center for Medical Research, Tanakamonzen-cho 103-5, Sa-kyo-ku, Kyoto 606-8225, Japan
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Bass RD, Moore DF, Steen VD. Prevalence and Characteristics of Patients With Systemic Sclerosis Fulfilling the 2019 EULAR/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2024; 76:311-317. [PMID: 37691427 DOI: 10.1002/acr.25235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE There is limited literature describing the overlap of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), and the studies have employed a range of case definitions. Our study used the new EULAR/American College of Rheumatology (ACR) SLE classification criteria to define SSc-SLE cases among our center's SSc cohort. METHODS This is a single-center, retrospective study of a previously described cohort of patients with SSc. Patient data were re-abstracted to evaluate for fulfillment of the 2019 EULAR/ACR classification criteria for SLE. Demographic, laboratory, clinical features, and mortality were compared among patients with SSc-SLE and patients with SSc alone. RESULTS Among the 402 patients with SSc that were analyzed, 40 (10%) fulfilled the 2019 EULAR/ACR SLE classification criteria. Neuropsychiatric and renal involvement were rare. An initial SLE diagnosis was purported in 43% of the patients with SSc-SLE and 7% of patients with SSc alone (P < 0.001). Patients with SSc-SLE were more likely to be female, African American, and with limited cutaneous SSc. Anti-U1-RNP antibody positivity prevalence was 30% among patients with SSc-SLE and 6.6% among patients with SSc alone (P < 0.001). Death during follow-up occurred in 12 patients (30%) with SSc-SLE and in 81 patients (22%) with SSc alone, but there was no difference in survival among the groups per log rank test (P = 0.404). CONCLUSION Ten percent of patients with SSc fulfill the 2019 EULAR/ACR classification criteria for SLE. These patients comprise a distinct demographic, serologic, and clinical phenotype but have similar severe SSc-specific end-organ damage and mortality as patients with SSc alone. Patients with SLE with Raynaud phenomenon should be evaluated for SSc-specific autoantibodies and scleroderma organ involvement.
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Affiliation(s)
- Ronald D Bass
- Georgetown University School of Medicine, Washington, DC, and University of Texas Southwestern, Dallas
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Antonacci A, Praino E, Abbinante A, Favia G, Rotondo C, Bartolomeo N, Giotta M, Iannone F, Orrù G, Agneta MT, Capodiferro S, Barile G, Corsalini M. Orofacial Manifestation of Systemic Sclerosis: A Cross-Sectional Study and Future Prospects of Oral Capillaroscopy. Diagnostics (Basel) 2024; 14:437. [PMID: 38396477 PMCID: PMC10888273 DOI: 10.3390/diagnostics14040437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES oral alterations in Systemic Sclerosis (SSc) patients are widespread and include microstomia, periodontitis, telangiectasias, mandibular resorption, bone lesions, and xerostomia. This cross-sectional study aims to evaluate the differences between SSc patients (cases) and healthy subjects (controls) regarding oral manifestations, quality of life (QoL), and microcirculation alterations. METHODS plaque index (PCR), periodontal index (PSR), DMFT, salivary flow rate, and buccal opening were measured by expert clinicians. S-HAQ test, the Self-Rating Anxiety State (SAS), the Self-Rating Depression Scale (SDS), and the WHOQOL-BREF test were administered to patients to evaluate their QoL. Microvascular alterations were assessed by oral videocapillaroscopy, performed on gingival and labial mucosa. A statistical analysis was conducted to find significant differences between healthy people and SSc patients. RESULTS 59 patients were enrolled in this study. Standard salivary flow is significantly more frequent in controls, while xerostomia, reduced flow, microstomia, lip retraction, and periodontitis are significantly more frequent in the cases. Gingival capillaroscopy showed differences concerning loop visibility, thickening of the gum, tortuosity of gingival loops, and reduced gingival density. Labial capillaroscopy demonstrates that visibility of the labial loops, the labial ectasias, and the tortuosity of the loops are significantly associated with the presence of scleroderma. Hand and facial deformities, hypomobility of the tongue, cheeks, lips, microstomia, and xerostomia significantly compromised the quality of life of SSc patients, which was significantly worse among them. Moreover, oral videocapillaroscopy could be a proper diagnostic method to detect oral microcirculation alterations. SSc patients often present ectasias, rarefaction of the reticulum, microhemorrhages, and megacapillaries, which negatively impact their oral health. CONCLUSIONS periodontitis, reduced salivary flow, and microstomia could be considered SSc oral manifestations. Joint deformities, facial appearance, and comorbidities significantly reduce the QoL of SSc patients compared to healthy subjects. Oral videocapillaroscopy could be an innovative and reliable technique to detect oral microcirculation anomalies.
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Affiliation(s)
- Anna Antonacci
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Emanuela Praino
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePReJ), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Antonia Abbinante
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Gianfranco Favia
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Cinzia Rotondo
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Nicola Bartolomeo
- School of Medical Statistics and Biometry, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.B.); (M.G.)
| | - Massimo Giotta
- School of Medical Statistics and Biometry, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (N.B.); (M.G.)
| | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePReJ), University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Germano Orrù
- Department of Surgical Science, University of Cagliari, 09124 Cagliari, Italy;
| | - Maria Teresa Agneta
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Saverio Capodiferro
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Giuseppe Barile
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
| | - Massimo Corsalini
- Complex Operative Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.A.); (A.A.); (G.F.); (M.T.A.); (S.C.); (M.C.)
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Sredojevic S, Colak D, Gaspersic R, Pavlov Dolijanovic S, Jakovljevic A, Nikolic-Jakoba N. Periodontal health status in systemic sclerosis patients: Systematic review and meta-analysis. PLoS One 2024; 19:e0291078. [PMID: 38306335 PMCID: PMC10836703 DOI: 10.1371/journal.pone.0291078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/22/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE The present systematic review and meta-analysis aimed to evaluate the periodontal health of systemic sclerosis patients compared with non-systemic sclerosis controls. MATERIALS AND METHODS Online databases were searched for eligible studies on February 24, 2023. The primary outcomes of interest in systemic sclerosis patients and controls included the clinical attachment level, periodontal probing depth, recession depth, plaque index, bleeding on probing score, gingival index, number of teeth with periodontitis, prevalence of periodontitis and gingivitis, and extent and severity of periodontitis. RESULTS Fourteen studies met inclusion criteria and were incorporated in the qualitative and quantitative analysis. In comparison with the controls, systemic sclerosis patients had a higher prevalence of periodontitis (OR = 7.63 (1.74-33.50), p = 0.04, I2 = 69%), including more severe forms of periodontitis (OR = 6.68 (3.39-13.15), p = 0.85, I2 = 0%), as well as higher periodontal probing depth ((0.88 (0.45-1.31), p = 0.02, I2 = 99%)), clinical attachment level (1.22 (0.8-1.64), p = 0.003, I2 = 98%), and plaque presence (0.83 (0.13-1.53), p = 0.03, I2 = 96%). There was no statistically significant difference in gingival inflammation (1.14 (0.07-2.21), p = 0.04, I2 = 98%). CONCLUSIONS The systematic review and the meta-analysis showed that systemic sclerosis patients suffer from worse periodontal health than non-systemic sclerosis individuals.
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Affiliation(s)
- Stefan Sredojevic
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejana Colak
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Gaspersic
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | | | - Aleksandar Jakovljevic
- Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Natasa Nikolic-Jakoba
- Department of Periodontology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Heřmánková B, Špiritović M, Oreská S, Štorkánová H, Mann H, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study. Rheumatol Ther 2023; 10:1089-1105. [PMID: 37221419 PMCID: PMC10326194 DOI: 10.1007/s40744-023-00559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) are very rare rheumatic diseases burdened by a high prevalence of sexual dysfunctions. However, no specific treatment has been proposed to date. To our knowledge, this is the first (pilot) study aiming to investigate the effect of an 8-week tailored physiotherapy program on the sexual health of women with SSc and IIM. METHODS In total, 12 women with SSc and 4 women with IIM were enrolled in the study. Based on the patients' capability to participate in the program, they were divided into an intervention group (IG) (mean ± SD age 46.8 ± 8.6 years) and a control group (CG) (mean ± SD age 46.3 ± 8.5 years). IG underwent the 8-week program (1 h of supervised physiotherapy twice weekly), whereas CG received no physiotherapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function (Female Sexual Function Index [FSFI], Brief Index of Sexual Functioning for Women [BISF-W]), sexual quality of life (Sexual Quality of Life-Female [SQoL-F]), functional ability (Health Assessment Questionnaire [HAQ]), quality of life (Medical Outcomes Short Form-36 [SF-36]), and depression (Beck's Depression Inventory-II [BDI-II]). The changes were analyzed with two-way ANOVA and Friedmann's test. RESULTS Compared to the statistically significant deterioration in CG over weeks 0-8, we found statistically significant improvements in the total scores of FSFI and BISF-W, and some of their domains, functional status, and the physical component of quality of life. CONCLUSION Our 8-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc and IIM. However, due to the lack of randomization and a relatively small sample size resulting from the strict inclusion criteria, further validation of our results is needed. TRIAL REGISTRATION NUMBER ISRCTN91200867 (prospectively registered).
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Affiliation(s)
- Barbora Heřmánková
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic.
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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11
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Frech TM, Poole JL, Murtaugh M, Matucci-Cerinic M. Expanding the Treatment Team. Rheum Dis Clin North Am 2023; 49:377-387. [PMID: 37028841 DOI: 10.1016/j.rdc.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The optimal systemic sclerosis (SSc) care plan includes an occupational therapist and physical therapist as well as wound care experts and a registered dietitian if indicated. Screening instruments for functional and work disability, hand and mouth limitations, malnutrition, and dietary intake can identify the need for ancillary support services. Telemedicine can assist in developing effective ancillary treatment plans. Reimbursement for services may limit access for patients with SSc to expand their care team but a focus on prevention rather than management of damage is recognized as an important unmet need in SSc. In this review, the role of a comprehensive care team for SSc is discussed.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Janet L Poole
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Maureen Murtaugh
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence and Department of Experimental and Clinical Medicine, University of Florence, Italy
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12
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Kong Q, Chen LM, Dai ZH, Tang YZ, Zhou YY, Tu WZ, Zhao YH, Zhang JQ. Care patterns and Traditional Chinese Medicine constitution as factors of depression and anxiety in patients with systemic sclerosis: A cross-sectional study during the COVID-19 pandemic. Front Integr Neurosci 2023; 17:1052683. [PMID: 36864895 PMCID: PMC9971602 DOI: 10.3389/fnint.2023.1052683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Objective Care patterns and Traditional Chinese Medicine (TCM) constitution affects the emotion and health of patients with systemic sclerosis (SSc) while the prevalence of COVID-19 may aggravate such patients' emotion and health. We investigated the depression and anxiety levels of patients with SSc during the pandemic to identify the correlation between care patterns, TCM constitution, and patients' emotion. Materials and methods This was a cross-sectional study. Patients with SSc and healthy individuals were surveyed using the patient health questionnaire-9, generalized anxiety disorder-7, and constitution in Chinese medicine questionnaire and a modified care pattern questionnaire. Factors correlated with depression and anxiety were screened using univariate and multivariate logistic regression analyses. Results A total of 273 patients with SSc and 111 healthy individuals were included in the analysis. The proportion of patients with SSc who were depressed was 74.36%, who had anxiety was 51.65%, and who experienced disease progression during the pandemic was 36.99%. The proportion of income reduction in the online group (56.19%) was higher than that in the hospital group (33.33%) (P = 0.001). Qi-deficiency [adjusted odds ratio (OR) = 2.250] and Qi-stagnation (adjusted OR = 3.824) constitutions were significantly associated with depression. Remote work during the outbreak (adjusted OR = 1.920), decrease in income (adjusted OR = 3.556), and disease progression (P = 0.030) were associated with the occurrence of depression. Conclusion Chinese patients with SSc have a high prevalence of depression and anxiety. The COVID-19 pandemic has changed the care patterns of Chinese patients with SSc, and work, income, disease progression, and change of medications were correlates of depression or anxiety in patients with SSc. Qi-stagnation and Qi-deficiency constitutions were associated with depression, and Qi-stagnation constitution was associated with anxiety in patients with SSc. Trial registration http://www.chictr.org.cn/showproj.aspx?proj=62301, identifier ChiCTR2000038796.
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Affiliation(s)
- Qi Kong
- Scientific Innovation Volunteer Team of Rare Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li-Ming Chen
- Scientific Innovation Volunteer Team of Rare Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zong-Hao Dai
- Scientific Innovation Volunteer Team of Rare Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Department of Vascular Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun-Zhe Tang
- Scientific Innovation Volunteer Team of Rare Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Yang Zhou
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Zhen Tu
- Department of Rheumatology, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yin-Huan Zhao
- Department of Rheumatology, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Qian Zhang
- Scientific Innovation Volunteer Team of Rare Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Department of Rheumatology, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,*Correspondence: Jia-Qian Zhang,
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13
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Mattsson M, Hesselstrand R, Gunnarsson K, Dyrsmeds E, Holmner M, Nordin A, Boström C. The validity and reliability of the Swedish version of the Satisfaction with appearance scale for individuals with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:53-63. [PMID: 36743814 PMCID: PMC9896191 DOI: 10.1177/23971983221107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
Background Systemic sclerosis (SSc) can lead to visible changes in appearance which could generate concerns among patients. Thus, valid questionnaires that capture these concerns are valuable to identify and communicate appearance concerns. Objective To determine aspects of the validity and reliability of the Swedish version of the Satisfaction with Appearance scale for individuals with SSc (SWAP-Swe in SSc). Methods Content validity was assessed by interviews. In a cross-sectional design, construct validity was evaluated by comparing the self-reported questionnaire SWAP-Swe in SSc to the Scleroderma Health Assessment Questionnaire (SSc HAQ), Patient Health Questionnaire-8 (PHQ-8), RAND-36, modified Rodnan skin score (mRSS), disease duration and age using Spearman's rank correlations (rs ). Internal consistency was evaluated by Cronbach's alpha coefficient and corrected item-to-total correlations. Test-retest reliability was investigated using the intraclass correlation coefficient (ICC). Results Eleven patients and 10 health professionals participated in the assessment of content validity. For the other aspects of validity and reliability 134 patients (median age 62 years, women 81%, limited cutaneous SSc 75%) participated. Overall, the content validity was satisfactory. The SWAP-Swe in SSc correlated with SSc HAQ (HAQ-DI rs = 0.50, visual analogue scales rs = 0.24-0.41), PHQ-8 (rs = 0.46), RAND-36 (rs = -0.21 to -0.47), mRSS (rs = 0.28), disease duration (rs = -0.01) and age (rs = -0.15). The Cronbach's alpha coefficient was 0.92, corrected item-to-total correlations ⩾ 0.45 and the ICC 0.82. Conclusion The SWAP-Swe in SSc showed satisfactory content validity, sufficient and good internal consistency and sufficient test-retest reliability. It was more strongly associated with self-reported questionnaires than with physician-assessed skin involvement and age, indicating that appearance concerns in SSc seem to be multidimensional as earlier reported. Our study contributes with a thorough investigation of validity and reliability including aspects that have not been investigated before. However, evaluation of more validity aspects of the SWAP-Swe in SSc is suggested.
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Affiliation(s)
- Malin Mattsson
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Physiotherapy, Sunderby
Hospital, Luleå, Sweden
- Malin Mattsson, Department of
Physiotherapy, Sunderby Hospital, 971 80 Luleå, Sweden.
| | - Roger Hesselstrand
- Department of Clinical Sciences, Lund
University, Lund, Sweden
- Department of Rheumatology, Skåne
University Hospital, Lund, Sweden
| | - Karin Gunnarsson
- Division of Rheumatology, Department of
Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm,
Sweden
| | - Elisabet Dyrsmeds
- Division of Rheumatology, Karolinska
University Hospital, Stockholm, Sweden
| | - Monica Holmner
- The Swedish Rheumatism Association
National Association for Systemic Sclerosis, Stockholm, Sweden
| | - Annica Nordin
- Division of Rheumatology, Department of
Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm,
Sweden
| | - Carina Boström
- Department of Neurobiology, Care
Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women’s Health and Health Professionals
Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University
Hospital, Stockholm, Sweden
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14
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Kiss F, Farkas N, Nagy G, Minier T, Kumánovics G, Faludi R, Czirják L, Varjú C. Minimal Clinically Important Differences (MCID) for the Functional Assessment of Chronic Illness Therapy Fatigue Scale in Patients with Systemic Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:771. [PMID: 36613093 PMCID: PMC9819291 DOI: 10.3390/ijerph20010771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Systemic sclerosis (SSc) is characterized by significant fatigue, causing diminished quality of life (QoL). The aim of this study was to examine fatigue levels and their associations with clinical factors and determine the minimal clinically important difference (MCID) value for the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-FS). (2) Methods: A total of 160 SSc patients and 62 individuals without SSc were followed-up over a 12-month period by measuring the FACIT-FS and the Visual Analogue Scale and the Short Form 36 Vitality Score analyzing changes in exhaustion. (3) Results: Fatigue was strongly correlated with HRQoL, level of pain, emotional disorders, physical capability and functionality. The MCID values for FACIT-FS were calculated as -3 for deterioration and +4 for improvement after a 12-month follow-up. The predictors of improvement of fatigue from baseline parameters were the significant disease activity, the patients' poorer functionality and the short disease duration. Patients with scleroderma-related interstitial lung disease at baseline had approximately tripled risks for worsening fatigue. The independent influential factors regarding the changing of FACIT-FS were improving or worsening in the same direction in reference to physical condition, gastrointestinal and emotional factors. (4) Conclusions: Fatigue is a multi-dimensional symptom, which is strongly correlated to HRQoL. MCID values of FACIT-FS can be useful tools in monitoring the changes of HRQoL in clinical trials and in daily practice among patients with SSc.
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Affiliation(s)
- Franciska Kiss
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Gabriella Nagy
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Tünde Minier
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
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15
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Thepwiwatjit S, Charoensri S, Sirithanaphol W, Mahakkanukrauh A, Suwannaroj S, Foocharoen C. Prevalence and clinical associations with primary hypogonadism in male systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:234-242. [PMID: 36211203 PMCID: PMC9537708 DOI: 10.1177/23971983221112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/18/2022] [Indexed: 10/03/2023]
Abstract
Background Systemic sclerosis may affect male and female fertility. Premature ovarian failure has been reported in female systemic sclerosis patients, but the effects on male fertility in systemic sclerosis have not been studied. Objectives We aimed to determine the prevalence and clinical associations with primary hypogonadism among male systemic sclerosis patients. Methods This was a cross-sectional pilot study, including 30 adult male systemic sclerosis patients attending the Scleroderma Clinic, Khon Kaen University. Testosterone deficiency symptoms were assessed using the Aging Males' Symptoms Rating Scale, urological examination, and blood testing (for total testosterone, free testosterone, follicle-stimulating hormone, and luteinizing hormone). We excluded patients with congenital hypogonadism and any acquired disorders of the testes and genitalia. The definition of primary hypogonadism was based on the International Society for the Study of the Aging Male 2015 diagnostic criteria for hypogonadism. Results Seven patients met the definition of primary hypogonadism-a prevalence of 23.3% (95% confidence interval: 9.9-42.3). The respective mean age and mean systemic sclerosis duration was 59.4 ± 11.9 and 5.5 ± 4.7 years. Older age at onset, high triglyceride level, and older age starting corticosteroid treatment were significantly associated with primary hypogonadism (p = 0.02, 0.02, and 0.03, respectively). Systemic sclerosis subset, disease severity, and immunosuppressant use were not associated with primary hypogonadism among Thai male systemic sclerosis patients. Conclusion Around one-quarter of male systemic sclerosis patients had primary hypogonadism. Elderly onset of systemic sclerosis, hypertriglyceridemia, and late corticosteroid treatment were risk factors for developing primary hypogonadism.
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Affiliation(s)
- Sapol Thepwiwatjit
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suranut Charoensri
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wichien Sirithanaphol
- Department of Surgery, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chingching Foocharoen
- Department of Medicine, Faculty of
Medicine, Khon Kaen University, Khon Kaen, Thailand
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16
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Trieste L, Cannizzo S, Palla I, Triulzi I, Turchetti G. State of the art and future directions in assessing the quality of life in rare and complex connective tissue and musculoskeletal diseases. Front Med (Lausanne) 2022; 9:986218. [PMID: 36213631 PMCID: PMC9537631 DOI: 10.3389/fmed.2022.986218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background As chronic conditions, rare and complex connective tissue and musculoskeletal diseases (rCTDs) significantly affect the quality of life generating an impact on the physical, psychological, social, and economic dimensions of the patients' lives, having implications on the family, changing the lifestyle and interpersonal relationships. Traditionally, generic and disease-specific measures for Quality of Life (QoL) provide valuable information to clinicians since QoL affects healthcare services utilization, predicts morbidities and mortalities, workability, etc. Moreover, the assessment of unmet clinical needs, satisfaction, the experience with the treatment and the care, the psychological dimensions, and the effects of the diseases, such as fatigue, could represent valuable dimensions to be considered in the QoL impact assessment. It is also necessary to measure the impact of rCTDs by considering the perspectives of family members/informal caregivers, for instance considering values, beliefs, experiences, life circumstances, psychological aspects, family relationships, economic issues, changes in social activities, etc. Objective The aim of this scoping review is to better understand the status of QoL metrics used in clinical and economic research for the assessment of the individual's perspective on living with rCTDs. Research question What are the main challenges in QoL measures (and/or) measurement/assessment in rCTDs? Materials and methods Scoping review of the literature referring to QoL measures in rCTDs. Database: PUBMED, ISI-Web of Science; last date: 21/09/2021. Results Anxiety and depression, body image satisfaction, daily activity, fatigue, illness perception, pain, personality, QoL, resilience, satisfaction with the relationship, self-management, sexual QoL, sleep quality, social support, stress, uncertainty, and work productivity are the observed dimensions covered by the included studies. However, "more shadows than lights" can summarize the review's outcome in terms of Patient Reported Outcome Measures (PROMs) domains covered for each of the rCTDs. Also, for those diseases characterized by a relatively high prevalence and incidence, such as Systemic Lupus Erythematosus, Sjögren's Syndrome, and Systemic Sclerosis, the analysis of patients' resilience, satisfaction with the quality of the relationship, personality, and stress are still missing dimensions. It has been observed how reducing items, increasing the number of domains, and disease-specific questionnaires characterize the "technological trajectory," such as the evolution of questionnaires' characteristics for assessing QoL and QoL-related dimensions and the burden of rCTDs. Conclusion The scoping review presents an overview of studies focused on questionnaires used to evaluate the different dimensions of quality of life in terms of general instruments and disease-specific questionnaires. Future research should include the co-design with patients, caregivers, and patient representatives to create questionnaires focused on the unmet needs of people living with rCTDs.
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17
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Affiliation(s)
- Ilaria Galetti
- Gruppo Italiano per la Lotta alla Sclerodermia (GILS), Milan, Italy
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18
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Galetti I, Nunzio SD, Brogelli L, Mirisola V, Garbagnati C. How do systemic sclerosis manifestations influence patients' lives? Results from a survey on patients and caregivers. Curr Med Res Opin 2021; 37:5-15. [PMID: 34726112 DOI: 10.1080/03007995.2021.1992371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the patient- and caregiver-reported impact of systemic sclerosis (SSc) manifestations (hand/feet/joint involvement and pulmonary complications) on the diagnostic and therapeutic journey, working productivity, and social life. METHODS Two questionnaires (one for the patients, n = 260 and one for the caregivers, n = 47) were designed in collaboration with the patients' association Gruppo Italiano per la Lotta alla Sclerodermia (GILS). Validated questionnaires were combined with specific questions relevant to the Italian scenario. RESULTS Pulmonary fibrosis and hand/feet/joint involvement have a major impact on patient's working status: (85.3% of patients with pulmonary fibrosis and 72.6% with hand/feet/joint involvement report loss of job/job change due to SSc. Productivity was affected as well: 60.6% of the patients (75% of those with fibrosis) reported that working productivity in the previous 4 weeks was restricted by physical limitations. The disease has a significant impact on patients' life, limiting the ability to conduct common activities, especially those related to movement, such as object manipulation (61.1%), doing small manual jobs (44.0%), writing (38.9%), and an increased impact in case of pulmonary fibrosis and hands/feet/joints involvement. Half of the patients also present some difficulties in eating-related activities a Patients also experience poorer social life, personal relationships, and sexual life. Caregivers are also deeply influenced by the manifestations of SSc. Pulmonary fibrosis and hand/feet/joint involvement represent an additional challenge. CONCLUSION Pulmonary fibrosis and hand/feet/joint involvement are extremely burdensome complications for both SSc patients and caregivers, decreasing work productivity, limiting relationship and social life, and impacting psychological status and everyday activities.
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Affiliation(s)
- Ilaria Galetti
- GILS, Gruppo Italiano per la Lotta alla Sclerodermia, Milan, Italy
| | | | | | | | - Carla Garbagnati
- GILS, Gruppo Italiano per la Lotta alla Sclerodermia, Milan, Italy
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Buchbender M, Lugenbühl A, Fehlhofer J, Kirschneck C, Ries J, Lutz R, Sticherling M, Kesting MR. Investigation of the Expression of Inflammatory Markers in Oral Biofilm Samples in Patients with Systemic Scleroderma and the Association with Clinical Periodontal Parameters-A Preliminary Study. Life (Basel) 2021; 11:life11111145. [PMID: 34833021 PMCID: PMC8618500 DOI: 10.3390/life11111145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Systemic scleroderma (SSc) has multiple orofacial effects. The aim of this study was to analyze the expression of inflammatory mediators in biofilm samples. It was hypothesized that different expression levels and clinical associations might be drawn. METHODS A total of 39 biofilm samples from group 1 = SSc and group 2 = healthy control were examined for the expression levels of interleukin (IL)-2,-6, and -10; matrix metalloprotease (MMP)-9; and surface antigens CD90 and CD34 by quantitative real-time PCR and clinical parameters. Relative quantitative (RQ) gene expression was determined using the ∆∆CT method. RESULTS The mean bleeding on probing values (p = 0.006), clinical attachment loss (CAL) (p = 0.009), gingival recession (p = 0.020), limited mouth opening (p = 0.001) and cervical tooth defects (p = 0.011) were significantly higher in group 1. RQ expressions of IL-2 and CD34 were significantly lower, IL-6, MMP-9, and CD90 were significantly higher. There was a significant positive correlation of IL-6/MMP-9 and negative correlation of mouth opening/CAL and IL-6/CAL. CONCLUSION Different expression levels of IL-2, IL-6, MMP-9, CD34 and CD90 were detected in biofilm samples from patients with SSc compared to control. An immunological correlation to the clinical parameters of mouth opening and CAL was shown; thus, we conclude that SSc might have an impact on periodontal tissues.
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Affiliation(s)
- Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.L.); (J.F.); (J.R.); (R.L.); (M.R.K.)
- Correspondence: ; Tel.: +49-9131-85-33614
| | - Amelie Lugenbühl
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.L.); (J.F.); (J.R.); (R.L.); (M.R.K.)
| | - Jakob Fehlhofer
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.L.); (J.F.); (J.R.); (R.L.); (M.R.K.)
| | - Christian Kirschneck
- Department of Orthodontics, University of Regensburg, 93053 Regensburg, Germany;
| | - Jutta Ries
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.L.); (J.F.); (J.R.); (R.L.); (M.R.K.)
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.L.); (J.F.); (J.R.); (R.L.); (M.R.K.)
| | - Michael Sticherling
- Department of Dermatology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.L.); (J.F.); (J.R.); (R.L.); (M.R.K.)
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20
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Santiago T, Santos E, Duarte AC, Martins P, Sousa M, Guimarães F, Azevedo S, Ferreira RM, Guerra M, Cordeiro A, Cordeiro I, Pimenta S, Pinto P, Pinto AM, Salvador MJ, Silva JAPD. Happiness, quality of life and their determinants among people with systemic sclerosis: a structural equation modelling approach. Rheumatology (Oxford) 2021; 60:4717-4727. [PMID: 33521812 DOI: 10.1093/rheumatology/keab083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients' objectives and experiences must be core to the study and management of chronic diseases, such as SSc. Although patient-reported outcomes are attracting increasing attention, evaluation of the impact of disease on the overall subjective well-being, equivalent to 'happiness', is remarkably lacking. OBJECTIVES To examine the determinants of happiness and quality of life in patients with SSc, with emphasis on disease features and personality traits. METHODS Observational, cross-sectional multicentre study, including 142 patients, with complete data regarding disease activity, disease impact, personality, health-related quality of life (HR-QoL) and happiness. Structural equation modelling was used to evaluate the association between the variables. RESULTS The results indicated an acceptable fit of the model to the data. Perceived disease impact had a significant negative direct relation with HR-QoL (β = -0.79, P < 0.001) and with happiness (β = -0.52, P < 0.001). Positive personality traits had a positive relation with happiness (β = 0.36, P = 0.002) and an important indirect association upon QoL (β = 0.43) and happiness (β = 0.23). Perceived disease impact is influenced by body image, fatigue and SSc-related disability to a higher degree (β = 0.6-0.7) than by disease activity (β = 0.28) or form (β = 0.17). Impact of disease had a much stronger relation with HR-QoL than with happiness. CONCLUSIONS The results suggest that treatment strategies targeting not only disease control but also the mitigation of relevant domains of disease impact (body image, fatigue, global disability) may be important to improve patients' experience of the disease. The reinforcement of resilience factors, such as positive psychological traits, may also play a contributory role towards better patient outcomes.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | - Eduardo Santos
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra
| | | | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, CHULN.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa
| | - Marlene Sousa
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | | | | | | | - Miguel Guerra
- Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia
| | | | - Inês Cordeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, CHULN.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa
| | | | - Patrícia Pinto
- Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia
| | - Ana Margarida Pinto
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences.,Psychological Medicine Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | - José António P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
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21
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Wojeck RK, Silva SG, Bailey DE, Knisely MR, Kwakkenbos L, Carrier ME, Nielson WR, Bartlett SJ, Pope J, Thombs BD. Pain and Self-Efficacy Among Patients With Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study. Nurs Res 2021; 70:334-343. [PMID: 34173376 PMCID: PMC8543734 DOI: 10.1097/nnr.0000000000000528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain is one of the most common symptoms affecting patients with systemic sclerosis; however, little is known about the relationship between self-efficacy and pain and changes in pain over time. OBJECTIVES The purpose of this study was to describe the relationships between self-efficacy and pain in patients with systemic sclerosis, as well as determine whether changes in self-efficacy mediate changes in pain. METHODS A prospective longitudinal study was conducted using data from the Scleroderma Patient-Centered Intervention Network Cohort. The baseline sample included 1,903 adults, with a trajectory subsample of 427 who completed 3-month assessments across 3 years. Hierarchical (sequential) forward multivariable regression, covarying for participant characteristics, was conducted to determine the association between self-efficacy and patient characteristics on pain outcomes. Trajectory models, covarying for participant characteristics, were used to examine changes in self-efficacy and pain outcomes across time and whether self-efficacy mediated the pain trajectories. RESULTS Mean time since diagnosis was 9.5 years, with 39.2% diagnosed with diffuse cutaneous systemic sclerosis. Greater self-efficacy was associated with less pain interference and intensity. Increasing age, female gender, finger ulcers, and small joint contractures were related to greater pain interference and intensity. Esophageal gastrointestinal symptoms were associated with more pain interference. Self-efficacy and pain trajectories remained stable across time, and self-efficacy did not mediate the pain trajectories. DISCUSSION This study identified self-efficacy, age, gender, finger ulcers, small joint contractures, and esophageal gastrointestinal symptoms as important correlates associated with pain in patients with systemic sclerosis. In addition, this study found that self-efficacy and pain outcomes remained stable over time, providing important insights into the longitudinal pain experiences of patients with systemic sclerosis.
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22
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Santos Cardozo Roque LC, Tenório ADS, de Aquino LT, Ferreira RDS, Duarte ALBP, Dantas AT. Joint mobilization and therapeutic exercises in the hands of patients with systemic sclerosis: A preliminary randomized controlled trial. Clin Rehabil 2021; 36:113-124. [PMID: 34414814 DOI: 10.1177/02692155211038728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effectiveness of Maitland's joint mobilization and therapeutic exercises on the functionality of the hands in patients with systemic sclerosis. DESIGN Randomized controlled trial. SETTING Tertiary university hospital. SUBJECTS Twenty-four patients diagnosed with systemic sclerosis according to ACR/EULAR 2013 criteria; age ⩾18 years and Cochin Hand Functional Scale (COCHIN) score ⩾10. They were randomized to physical therapy group (n = 12) or control group (n = 12). INTERVENTIONS The physical therapy group received joint mobilization and undertook therapeutic exercises, twice a week, for 12 weeks, and received a booklet with information about the disease. The control group only received the booklet about the disease. MAIN MEASURES The primary outcome measure was functionality of the hands (COCHIN). The secondary outcomes measures were disability (SHAQ), pain (visual analogic scale), range of motion (HAMIS and Delta finger-to-palm), grip strength (JAMAR dynamometer), and quality of life (SF12). RESULTS Twenty-two patients were female, with a mean age of 47.4 ± 11.1 years and 18 had limited cutaneous form. The physical therapy group showed a decrease of 11.33 points in the COCHIN in comparison with the control group (P = 0.09). There was a significant increase in range of motion by HAMIS (3.00 ± 1.48 vs 5.42 ± 2.64, P = 0.008), reduction in pain VAS (3.42 ± 2.78 vs 7.75 ± 2.53, P < 0.001), and increase in the physical component of SF12 (38.51 ± 9.60 vs 32.65 ± 9.10, P = 0.038). CONCLUSION Maitland's joint mobilization and therapeutic exercises improved the functionality of the hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life in patients with systemic sclerosis.
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Affiliation(s)
| | | | | | | | | | - Andréa Tavares Dantas
- Graduate Program in Physiotherapy, Universidade Federal de Pernambuco, Recife, Brazil.,Rheumatology Department of Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
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23
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Sibeoni J, Dunogué B, Dupont A, Haiddar D, Benmostefa N, Falissard B, Mouthon L, Révah-Levy A, Verneuil L. Development and validation of a Patient-Reported Outcome in systemic sclerosis: the Hand scleroDerma lived Experience Scale (HAnDE Scale). Br J Dermatol 2021; 186:96-105. [PMID: 34355380 DOI: 10.1111/bjd.20688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES to develop and validate a Patient Reported Outcome (PRO) scale-the HAnDE (Hand-ScleroDerma Disease lived Experience) scale-assessing the lived experience of hand involvement in patients with systemic sclerosis (SSc). METHODS explanatory sequential mixed-method study with two phases: 1) PRO development through an Inductive Process to analyze the Structure of lived Experience approach, involving 21 SSc patients, 2) PRO validation by assessing the psychometric properties of the scale among 105 SSc patients. RESULTS 1) Phase-1 enabled to generate the 18-item provisional scale. 2) The mean total score of the scale was 29,16 (SD 16,15). The item reduction process retained 16 items with 5 levels of answers (range 0-64). Internal consistency of the 16-item version was excellent (Cronbach-alpha coefficient=0,946). Construct validity was very good, the Principal Component Analysis being in favour of a unidimensional instrument, with one factor explaining 56% of the variance, and concurrent validity being confirmed: Cochin Hand Function Scale r=0,66; Health Assessment Questionnaire-Disability index r=0.58; Hospital Anxiety Depression, anxiety r=0,51, depression r=0,4; Mouth Handicap in Systemic Sclerosis r=0,61; SF-36, physical component r=-0,48, mental component r=-0,46; and Kapandji score r=-0,46. The correlations were statistically significant (p<0,05). CONCLUSION We propose, for future trials and clinical practice in SSc, a new PRO the HAnDE scale, that assesses all the dimensions -functional, aesthetic, relational, existential, and emotional- of the lived experience of hand involvement.
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Affiliation(s)
- J Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - B Dunogué
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - A Dupont
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - D Haiddar
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - N Benmostefa
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - B Falissard
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
| | - L Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - A Révah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, Argenteuil, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
| | - L Verneuil
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, F-75010, Paris, France
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24
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Yakut H, Özalevli S, Aktan R, Özgen Alpaydın A, Merih Birlik A, Can G. Effects of supervised exercise program and home exercise program in patients with systemic sclerosis: A randomized controlled trial. Int J Rheum Dis 2021; 24:1200-1212. [PMID: 34268887 DOI: 10.1111/1756-185x.14177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
AIM To compare the effects of supervised exercise and home exercise program in patients with systemic sclerosis (SSc). METHODS Thirty-seven SSc patients were included. Patients with SSc were allocated into 2 groups as supervised and home exercise. Breathing, aerobic and resistance exercises were performed with a physiotherapist for 12 weeks in the supervised exercise group. Breathing, posture and aerobic exercises were given to the home exercise group as a home program for 12 weeks. All patients were assessed at baseline and 12 weeks later in terms of functional capacity, pulmonary functions, respiratory-peripheral muscle strength, dyspnea severity, health-related quality of life (HRQoL) and fatigue level. RESULTS Significant improvements were observed in the functional capacity, measured by 6 minute walking test in the supervised exercise group (before = 376.21 ± 65.50, after = 518.78 ± 75.84 m) and home exercise group (before = 384.44 ± 68.14, after = 432.7 ± 70.8 m; (P < .05). Respiratory-peripheral muscle strength (with the exception of inspiratory muscle strength and upper limb strength in the home exercise group) and HRQoL were significantly increased and fatigue level was significantly decreased in the supervised exercise and home exercise groups (P < .05). However, pulmonary functions and dyspnea severity were significantly improved only in the supervised exercise group (P < .05). The supervised exercise program was found superior to the home exercise program for change in all parameters (P < .05). CONCLUSION This study suggests that exercise interventions should be applied in addition to the medical treatments of patients with SSc as supervised and home exercise programs play an important role in the functionality and health status of these patients.
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Affiliation(s)
- Hazal Yakut
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sevgi Özalevli
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Ridvan Aktan
- Department of Physiotherapy, Izmir University of Economics, Izmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Pulmonary disease, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ahmet Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Gerçek Can
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Dokuz Eylül University, Izmir, Turkey
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25
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Shi Y, Meng Y, Dong X, Liu Y, Liu Y, Lai J, Tian Z, Zhao J, Peng J, Wang Q, Li M, Zeng X. Quality of life in ambulatory pulmonary arterial hypertension in connective tissue diseases and its relationship with risk stratification. Pulm Circ 2021; 11:20458940211029899. [PMID: 34290858 PMCID: PMC8278470 DOI: 10.1177/20458940211029899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
The Pulmonary Arterial Hypertension Symptoms and Impact Questionnaire (PAH-SYMPACT) is a PAH-specific patient-reported outcome scale assessing patients’ quality of life from four aspects: cardiopulmonary symptoms, cardiovascular symptoms, physical impacts and cognitive/emotional impacts. This study aimed to validate the Chinese version of PAH-SYMPACT and explore its relationship with risk stratification in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH). In addition, 75 patients with CTD-PAH confirmed by right heart catheterization were invited to complete questionnaires including PAH-SYMPACT, the 36-item Medical Outcomes Study Short Form Survey (SF-36) and EuroQol five dimensions questionnaire (EQ-5D). The demographic, clinical, laboratory and treatment data were collected. The endpoint was treatment goal achievement status in 6–12 months after completing the questionnaires, defined as an integrated outcome. Participants’ mean age was 36.4 ± 11.9 years and the mean pulmonary arterial pressure was 38.9 ± 13.67 mmHg. The reliability of the PAH-SYMPACT domains ranged from 0.83 to 0.88. Results of factor analysis basically conformed the original PAH-SYMPACT. The treatment goal achievement (TGA) status in 6–12 months was significantly associated with physical impacts scores (odds ratio: 0.180, 95% confidence interval: 0.036–0.908, P=0.038). The Chinese version of PAH-SYMPACT is a reliable measurement to evaluate quality of life in CTD-PAH patients and is also a potential predictor of patient’s condition change in routine clinical practice.
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Affiliation(s)
- Yue Shi
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yanling Meng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingbei Dong
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yang Liu
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jinmin Peng
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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26
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Gheorghiu AM, Gyorfi H, Capotă R, Matei A, Oneaţă R, Bojincă M, Stoica V, Mihai C. Reliability, Validity, and Sensitivity to Change of the Cochin Hand Functional Disability Scale and Testing the New 6-Item Cochin Hand Functional Disability Scale in Systemic Sclerosis. J Clin Rheumatol 2021; 27:102-106. [PMID: 31703022 DOI: 10.1097/rhu.0000000000001195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune disease causing complex hand disability. A reliable tool for hand function assessment in SSc is the Cochin Hand Functional Disability Scale (CHFS). More recently, a short-form CHFS of 6 items (CHFS-6) has been developed. OBJECTIVES To validate the CHFS and the new CHFS-6 in Romanian patients with SSc. PATIENTS AND METHODS Consecutive patients with SSc who completed the CHFS were included. All patients were assessed according to the recommendations of the European Scleroderma and Research Trials and also completed the Scleroderma Health Assessment Questionnaire and the Hand Mobility in Scleroderma questionnaire. Finger range-of-motion distances were measured. RESULTS Seventy patients, 63 female and 7 male patients (age median, 53.0 years; interquartile range [IQR], 21.0 years), were included. Twenty seven had diffuse cutaneous involvement (dcSSc). Median CHFS and CHFS-6 at baseline were 25.0 (IQR, 37.0) and 8.0 (IQR, 13.0), respectively.The internal consistency (Cronbach α = 0.96, respectively, 0.90, in all 70 patients) and test-retest reliability (intraclass correlation coefficient = 0.98 for both, in 38 patients) of both CHFS and CHFS-6 were excellent. The CHFS-6 had a very high correlation with the CHFS. There were moderate to good correlations with Hand Mobility in Scleroderma, Scleroderma Health Assessment Questionnaire, and the anthropometric measurements (construct validity). In patients with early dcSSc with a second evaluation, we found good to moderate sensitivity to change (standardized response mean of 0.8 and effect size of 0.4 for CHFS, and standardized response mean of 1.1 and effect size of 0.6 for CHFS-6). CONCLUSIONS The CHFS and CHFS-6 are valid and easy-to-use tools for hand involvement in SSc, which can be used in clinical or research setting.
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Affiliation(s)
| | - Hermina Gyorfi
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
| | - Răzvan Capotă
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
| | - Alexandru Matei
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
| | - Raida Oneaţă
- From the Internal Medicine and Rheumatology Department, Cantacuzino Clinical Hospital
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27
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Wojeck RK, Bailey DE, Somers TJ, Knisely MR. Self-management interventions in systemic sclerosis: A systematic review. Res Nurs Health 2021; 44:376-392. [PMID: 33651396 PMCID: PMC7971253 DOI: 10.1002/nur.22118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/12/2020] [Accepted: 02/02/2021] [Indexed: 11/07/2022]
Abstract
Systemic sclerosis is a rare and incurable autoimmune disease in which patients are challenged with self-managing their disease. Systematic evaluation of the essential self-management intervention components and self-management outcomes is necessary to assess the state of the science of self-management for patients with systemic sclerosis. As such, the purpose of this systematic review was to identify and describe self-management interventions and their impact on self-management outcomes in adults with systemic sclerosis. Studies were included if they contained a self-management intervention, incorporated at least one self-management outcome identified as a common data element by the National Institute of Nursing Research (i.e., patient activation, self-efficacy, self-regulation, global health), and were conducted in adults with systemic sclerosis. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched from the inception of each database to March 2020, yielding a total of 215 studies. Of these reports, 16 met the inclusion criteria for this review. There was notable variability in the types of self-management interventions and their effects on key self-management outcomes. Self-management interventions focused on improving physical function through rehabilitation programs were the most common interventions (n = 7). The poor methodological quality of the studies included in this systematic review, however, limited the synthesis of and recommendations for self-management interventions in adults with systemic sclerosis. Future research in systemic sclerosis should include key self-management outcomes in larger, more rigorously designed studies to allow for comparisons across studies and to advance the science of self-management.
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Affiliation(s)
- Robyn K. Wojeck
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Tamara J. Somers
- Department of Psychiatry and Behavioral, Sciences, Duke University, Durham, North Carolina, USA
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28
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ÖZCAN M, CİFTCİ V, TÜRK İ. Skleroderma hastalarının ağız ve periodontal bulguları ile hastalık tutulumları arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.783473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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29
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Bering J, Griffing WL, Crowell M, Umar SB. Progression of gastrointestinal symptoms over time in patients with systemic sclerosis. Rheumatol Int 2021; 41:1281-1287. [PMID: 33630144 DOI: 10.1007/s00296-021-04806-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
Up to 90% of patients with systemic sclerosis (SSc) develop gastrointestinal (GI) symptoms. To evaluate whether GI symptoms and quality of life in patients with SSc demonstrate longitudinal stability. Consecutive patients with SSc (n = 100) completed the validated university of California at Los Angeles scleroderma clinical trial consortium gastrointestinal tract 2.0 (GIT) instrument and completed the same instrument approximately 5 years later. Comparison was made between patients with diffuse (dcSSc) and limited (lcSSc) subtypes and duration of disease of less than or greater than 5 years. GIT scores were calculated and analyzed for differences. 37 patients with dcSSc and 63 patients with lcSSc were included. Social functioning score significantly improved over time [0.44 (0.59)-0.31 (0.47); P = 0.003]. Total GIT scores were lower in patients with diffuse [0.51 (0.41)] compared with limited [(0.72 (0.53); P = 0.029] disease at both baseline and follow-up. Social functioning improved similarly in both dcSSc and lcSSc over time (P = 0.004). GIT Total scores increased in 27% (27/100) of patients and did not change or improved in 73% (73/100). Patients with worsening GI status had significantly increased scores on all GIT subscales. A lower body-mass index at baseline was significantly associated with worsening GIT Total score (OR 1.22; 95% CI 1.07-1.39; P < 0.001). Patients with SSc generally demonstrate longitudinal stability or improvement in their GI symptoms, but a subset of patients experience worsening of GI symptoms and negative impacts on GI-related quality of life.
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Affiliation(s)
- Jamie Bering
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - W Leroy Griffing
- Division of Rheumatology Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Michael Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sarah B Umar
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
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30
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Alhendi FJ, Werth VP, Sollecito TP, Stoopler ET. Systemic sclerosis: Update for oral health care providers. SPECIAL CARE IN DENTISTRY 2021; 40:418-430. [PMID: 33448431 DOI: 10.1111/scd.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune disease of unknown origin characterized by an uncontrolled inflammatory process resulting in fibrosis of the skin, internal organs and vasculopathy. Manifestations of SSc are heterogenous and can include pulmonary, cardiac, neural, renal, muscular, cutaneous and orofacial complications. Recent scientific advances have led to a better understanding of disease etiopathogenesis and the development of a new classification system. Therapeutic management is often multidisciplinary and targeted toward the affected organs. Oral health care providers (OHCPs) should be familiar with SSc, particularly as it relates to its impact on the orofacial region and modifications to delivery of oral health care for patients with this condition.
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Affiliation(s)
- Fatmah J Alhendi
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Philadelphia V.A. Hospital, Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center, Philadelphia, Pennsylvania
| | - Thomas P Sollecito
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Eric T Stoopler
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
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DiRenzo D, Russell J, Bingham CO, McMahan Z. The Relationship Between Autonomic Dysfunction of the Gastrointestinal Tract and Emotional Distress in Patients With Systemic Sclerosis. J Clin Rheumatol 2021; 27:11-17. [PMID: 31524844 PMCID: PMC7065966 DOI: 10.1097/rhu.0000000000001144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES We hypothesized that emotional distress in systemic sclerosis (SSc) patients with moderate to severe gastrointestinal (GI) dysfunction is associated with dysautonomia. We sought to determine (1) the clinical characteristics associated with emotional distress in SSc, (2) the odds of having dysautonomia in those with emotional distress, and (3) whether GI dysautonomia, as measured by the Survey of Autonomic Symptoms (SAS), correlates with GI dysautonomia on the Composite Autonomic Symptom Score-31 (COMPASS-31). METHODS Clinical and demographic features from our prospective cohort study were compared among SSc patients with and without GI-associated emotional distress (University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 well-being subscale >0.5 or ≤0.5) in cross-sectional analysis. Covariates/confounders independently associated with emotional distress were used to construct multivariable logistic regression models. The COMPASS-31 and SAS GI subdomains were compared with Spearman correlation. RESULTS Forty-six patients with SSc were enrolled in the study. In univariate analyses, age (odds ratio [OR], 1.06; p = 0.026), severity of GI dysautonomia (COMPASS-31: OR, 1.41; p = 0.003), anti-centromere (A/B) antibodies (OR, 3.60; p = 0.044), and anti-PM-Scl (75/100) antibodies (OR, 0.15; p = 0.035) were associated with emotional distress. In the adjusted model, those with more severe GI dysautonomia remained more likely to have emotional distress (OR, 1.85; p = 0.026); those with anti-PM-Scl (75/100) antibodies were less likely to have emotional distress (OR, 0.03; p = 0.031). The SAS and COMPASS-31 GI subdomains moderately correlated (ρ = 0.68, p < 0.001). CONCLUSIONS In SSc, increased symptom burden related to GI dysautonomia is associated with emotional distress. Multidisciplinary approaches addressing both the physical and emotional needs of the SSc patient may be warranted to optimize patient care.
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Affiliation(s)
- Dana DiRenzo
- Johns Hopkins University School of Medicine, Division of Rheumatology
| | | | | | - Zsuzsanna McMahan
- Johns Hopkins University School of Medicine, Division of Rheumatology
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Stöcker JK, Vonk MC, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Spierings J, Staal JB, Satink T, van den Ende CHM. Opening the black box of non-pharmacological care in systemic sclerosis: a cross-sectional online survey of Dutch health professionals. Rheumatol Int 2020; 41:1299-1310. [PMID: 33355711 PMCID: PMC8164617 DOI: 10.1007/s00296-020-04765-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
The objective is to describe the spectrum of the health professional (HP) treatment approach for systemic sclerosis (SSc) from the perspective of Dutch HPs, including alignment of treatment goals set by HPs with self-reported referral reasons, coverage of patient-reported unmet care needs, and quality of communication between HPs and rheumatologists. Dutch HPs were invited through their patients with SSc to complete an anonymous online survey. The survey covered referral reasons, treatment goals, and interventions of the last patient treated, as well as the perceived quality of communication between HPs and rheumatologists. Referral reasons and treatment targets were linked to the International Classification of Functioning, Disability and Health following the refined ICF Linking Rules. Seventy-nine HPs from 8 professions (including 58 physiotherapists, 73%) completed the survey. One hundred and thirty-three different referral reasons were reported, yielding 58 different ICF codes, with 41 (70.7%) being linked to the ICF domain “body structures and functions.” The reported interventions focused on body functions/structures (27.9%), training of daily activities (25.6%), education and advice (26.3%), and psychosocial interventions (20.2%). The quality of communication between HPs and rheumatologists was perceived as low. Our findings revealed numerous treatment options offered by Dutch HPs addressing the unmet care needs of patients with SSc. There is an overlap in the content of the various HP disciplines, and HP treatment goals are not sufficiently aligned with referrals of rheumatologists. HP treatment offer seemed inefficiently organized, possibly precluding rheumatologists from making targeted referrals. Communication between rheumatologists and HPs should be improved.
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Affiliation(s)
- Juliane K Stöcker
- Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands.
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ton Satink
- Research Group Neuro Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- European Masters of Science in Occupational Therapy, Amsterdam, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Gedik TE, Kucuk H, Goker B, Haznedaroglu S, Pasaoglu H, Varan O, Ozturk MA, Pasaoglu OT, Tufan A. Serum defensin levels in patients with systemic sclerosis. Adv Rheumatol 2020; 60:54. [PMID: 33353556 DOI: 10.1186/s42358-020-00156-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/08/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of skin and lung as well as involvement of kidney, gastrointestinal system and heart. Aetiology and exact mechanism of disease is poorly understood. The association between antimicrobial peptides (AMPs) and other diseases such as idiopathic pulmonary fibrosis, diffuse panbronchiolitis, pulmoner alveolar proteinosis and psoriasis have been reported. A small number of studies have examined the role of AMPs on autoimmune diseases which has not been studied in scleroderma yet. We aimed to investigate AMP serum levels and their association with disease characteristics of SSc. METHODS Forty-two patients (40 female, mean age 42 years) and 38 healthy subjects (32 female, mean age 38 years) were enrolled. For SSc patients, the following data were recorded: disease subset (limited/diffuse), autoantibodies (antinuclear, anti-centromere (ACA), and anti-SCL-70), blood tests, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), modified Rodnan skin score, presence and history of digital ulcers, kidney, gastrointestinal disease and lung involvement assessed by computed tomography and pulmonary function tests. Association between serum AMPs and disease characteristics were analysed. RESULTS Twenty-nine of the patients had diffuse (69%) and 13 of the patients had limited (31%) systemic sclerosis. Average disease duration was 5.5 years. Pulmonary involvement was detected in 20 patients (47.6%). Serum concentration of alpha defensin was higher than healthy subjects (563 ± 415 vs 377 ± 269 ng/mL, p = 0.02). However, no difference was observed for beta-1 and beta-2 defensins in SSc patients and healthy controls. In sub-group analysis patients with interstitial lung disease had higher levels of alpha defensin than those without lung involvement (684 ± 473 vs 430 ± 299 ng/ml, p = 0.04). There was also correlation between alfa defensin serum concentrations and CRP (r = 0.34). CONCLUSIONS Alpha defensin levels are increased in scleroderma patients and correlated with lung involvement indicating a role in the pathogenesis of disease. TRIAL REGISTRATION This study is not a clinical trial study.
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Affiliation(s)
- Tugce Emiroglu Gedik
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey. .,Department of Internal Medicine, Division of Geriatrics, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
| | - Hamit Kucuk
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Goker
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Seminur Haznedaroglu
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hatice Pasaoglu
- Department of Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ozkan Varan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Ozturk
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ozge Tugce Pasaoglu
- Department of Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Abdouh I, Porter S, Fedele S, Elgendy N, Ni Riordain R. Web-based information on the treatment of the mouth in systemic sclerosis. BMC Rheumatol 2020; 4:61. [PMID: 33292857 PMCID: PMC7684884 DOI: 10.1186/s41927-020-00160-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To categorise the content and assess the quality and readability of the web-based information regarding treatment of the mouth in systemic sclerosis. METHODS An online search using three different search terms regarding the treatment of the mouth in SSc was undertaken using the Google search engine. The first 100 websites from each search were selected for analysis. Data recorded included DISCERN instrument scores along with the Journal of the American Medical Association (JAMA) benchmarks and the presence of the Health on the Net seal (HON). Flesch Reading Ease Scores, Flesch-Kincaid Grade Level, the Simplified Measure of Gobbledygook Index and Coleman-Liau index were calculated to assess readability. RESULTS Fifty seven of the first websites remained for analysis after applying appropriate exclusion criteria. The mean overall DISCERN score was 2.37 (±1.01). Only 4 websites (7%) achieved all four JAMA benchmarks. Only 12 websites (21.1%) displayed the HON seal. The reading level was found to be difficult to very difficult among the majority of websites. CONCLUSION The overall quality of the available online information concerning the treatment of the mouth of systemic sclerosis is questionable and requires a high level of reading skill. Further efforts should be directed toward establishing higher quality, reliable online information sources on the treatment of oral disease relevant to patients with systemic sclerosis.
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Affiliation(s)
- Ismail Abdouh
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK. .,Oral Medicine, College of Dentistry, Taibah University, Al Munawarah, Al Madinah, Saudi Arabia.
| | - Stephen Porter
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK
| | - Stefano Fedele
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK.,Oral Theme UCLH/UCL NIHR, Biomedical Research Centre, London, UK
| | - Nadia Elgendy
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Richeal Ni Riordain
- Oral Medicine, UCL Eastman Dental Institute, University Street, London, WC1E 6DE, UK.,Cork University Dental School and Hospital, University College Cork, Cork, Ireland
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Ruan L, Yang P, Chen SP, Wu C, Zhu QX. Vitamin E attenuates the development of bleomycin-induced skin fibrosis in mice. Australas J Dermatol 2020; 62:e298-e300. [PMID: 33125707 DOI: 10.1111/ajd.13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Liang Ruan
- Institute of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, China
| | - Peng Yang
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Shuang-Ping Chen
- Department of Occupational Health and Environmental Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Changhao Wu
- Faculty of Health and Medical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Qi-Xing Zhu
- Institute of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Parat K, Radić M, Perković D, Lukenda DB, Kaliterna DM. Reduced salivary flow and caries status are correlated with disease activity and severity in patients with diffuse cutaneous systemic sclerosis. J Int Med Res 2020; 48:300060520941375. [PMID: 33081544 PMCID: PMC7588767 DOI: 10.1177/0300060520941375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To analyze the correlations of saliva production and pH value with disease activity, disease severity, and oral health-related quality of life in patients with diffuse cutaneous systemic sclerosis (dcSSc) without concomitant Sjögren’s syndrome (SS) or SS-related antibodies. Methods This cross-sectional study included 28 patients with dcSSc and matching healthy controls. Sialometric assessment and caries status were compared between the two groups. Clinical and laboratory parameters were used to evaluate disease severity, in accordance with the Medsger Severity Scale. Results In patients with dsSSc, reduced saliva production and higher pH value were associated with disease activity and severity; moreover, caries status was correlated with SSc disease characteristics, including disease duration and disease severity. Oral health-related quality of life was negatively correlated with mean salivary flow rate. Conclusions These findings contradict the existing notion that reduced saliva production in patients with SSc is linked to SS-related antibodies or caused by underlying SS. In addition, patients with dcSSc exhibit elevated risk of cardiovascular disease and invasive dental treatment has been shown to enhance the rates of stroke and heart attack in the general population; therefore, oral health is particularly important in patients with SSc.
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Affiliation(s)
- Katica Parat
- Department of Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, Split, Croatia
| | - Mislav Radić
- Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Dijana Perković
- Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Dolores Biočina Lukenda
- Department of Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, Split, Croatia
| | - Dusanka Martinović Kaliterna
- Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
- University of Split School of Medicine, Split, Croatia
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Doutre MS, Godard D, Benani M, Taieb C. Création et validation d’un outil d’évaluation du handicap lié à l’atteinte du visage de la sclérodermie systémique. Ann Dermatol Venereol 2020; 147:595-601. [DOI: 10.1016/j.annder.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
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Filippetti M, Cazzoletti L, Zamboni F, Ferrari P, Caimmi C, Smania N, Tardivo S, Ferrari M. Effect of a tailored home-based exercise program in patients with systemic sclerosis: A randomized controlled trial. Scand J Med Sci Sports 2020; 30:1675-1684. [PMID: 32350931 PMCID: PMC7496851 DOI: 10.1111/sms.13702] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim was to evaluate the effect of a home-based exercise program on functional capacity, health-related quality of life (HRQoL), and disability, in patients with systemic sclerosis (SSc). METHODS A 6-month randomized controlled trial was conducted on SSc patients by comparing a home-based minimally supervised exercise program (exercise on a stationary cycle and strengthening of upper limbs; stretching of the hands) with usual care. At baseline and after 3 and 6 months, the patients underwent: 6 minutes walking test; hand mobility in scleroderma test; maximal exercise test on an ergocycle; strength measures (handgrip, quadriceps, and biceps). HRQoL (short-form 36 [SF-36]) and disability (health assessment questionnaire disability index [HAQ-DI]) were measured at the same time. RESULTS Forty-four patients participated in the study. Twenty-two were randomly assigned to the intervention group (IG, mean age 63.60 ± 10.40 years) and 22 to the control group (CG, 61.80 ± 14.40 years). At 6 months, the distance walked in 6 minutes increased by 46 m (baseline 486, 95% CI 458-513 m; 6 months 532, 95% CI 504-561 m) in IG, whereas it decreased by 5 m (baseline 464, 95% CI 431-497 m; 6 months 459, 95% CI 427-490 m) in CG with a significantly different temporal trend at the between-groups comparison (P < .001). An improvement was also observed for strength measures (handgrip, P = .003; quadriceps, P < .001; biceps, P < .001), for the SF-36 physical component score (P < .001) and for the HAQ-DI (P = .011). CONCLUSIONS This study indicates that in SSc patients, a minimally supervised home-based exercise program improves physical performance, quality of life, and disability in comparison with usual care.
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Affiliation(s)
- Mirko Filippetti
- Unit of Respiratory Disease and Sports MedicineDepartment of MedicineUniversity of VeronaVeronaItaly
- Neuromotor and Cognitive Rehabilitation Research CenterDepartment of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Lucia Cazzoletti
- Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | - Francesco Zamboni
- Unit of Respiratory Disease and Sports MedicineDepartment of MedicineUniversity of VeronaVeronaItaly
| | - Pietro Ferrari
- Unit of Respiratory Disease and Sports MedicineDepartment of MedicineUniversity of VeronaVeronaItaly
| | - Cristian Caimmi
- Rheumatology UnitDepartment of MedicineUniversity of VeronaVeronaItaly
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research CenterDepartment of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Stefano Tardivo
- Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | - Marcello Ferrari
- Unit of Respiratory Disease and Sports MedicineDepartment of MedicineUniversity of VeronaVeronaItaly
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Li S, Wang Y, Zhang C. Network pharmacology strategy for predicting the correlation of Systemic Scleroderma with Vitamin D deficiency. Int Immunopharmacol 2020; 86:106702. [PMID: 32563782 DOI: 10.1016/j.intimp.2020.106702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 01/25/2023]
Abstract
The deficiency of Vitamin D (VD) is a common symptom of systemic scleroderma (SSc), but the correlation of VD deficiency and SSc is not completely clear. Therefore, a strategy based on network pharmacology was designed to explore the correlation of VD deficiency and SSc. After a series of network construction and analysis, 5 integrins were predicated as the kernel targets in the correlation of VD deficiency and SSc, including ITGA5, ITGA4, ITGB3, ITGB1 and ITGAV. The crucial pathways in which the kernel targets participated were mainly involved in the function of immune, vascular and internal organ. The regulation modules of crucial pathways were closely related to the biological processes in the pathological of SSc. Taken together, the analysis predicted that the deficiency of VD might affect the pathological of SSc through the mediation of these integrins. Therefore, targeted regulation of these integrins might be an effective therapy against SSc.
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Affiliation(s)
- Shizhe Li
- Institute of Chemical and Industrial Bioengineering, Jilin Engineering Normal University, Changchun 130052, PR China.
| | - Yeming Wang
- Institute of Chemical and Industrial Bioengineering, Jilin Engineering Normal University, Changchun 130052, PR China
| | - Chaoqun Zhang
- Institute of Chemical and Industrial Bioengineering, Jilin Engineering Normal University, Changchun 130052, PR China
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40
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Abdouh I, Porter S, Fedele S, Ni Riordain R. Validity and reliability of the Mouth Handicap of Systemic Sclerosis questionnaire in a UK population. J Oral Pathol Med 2020; 49:986-993. [PMID: 32531075 DOI: 10.1111/jop.13060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of this study was to explore the psychometric properties of the Mouth Handicap in Systemic Sclerosis (MHISS) specifically exploring aspects of validity and reliability of MHISS in UK SSc patients. METHODS A total of 150 questionnaires were distributed in this study at the Oral Medicine Department of UCLHT Eastman Dental Hospital, the Outpatient Rheumatology Clinic of the Royal Free Hospital and Scleroderma Family Day. Participants were asked to complete three questionnaires (SF-36, OHIP-14 and MHISS) along with a pro forma of demographic and disease-specific questions. Both convergent validity and internal consistency reliability were examined. The convergent validity was assessed by Spearman's correlation coefficient, and internal consistency reliability was assessed by Cronbach's alpha. RESULTS Of the 150 questionnaires distributed to participants, 68 respondents were included. With regard to construct validity, a low to moderate degree of convergent validity was found between MHISS total score and all SF-36 subscales. However, the total MHISS score was highly correlated to all OHIP subscales. CONCLUSION MHISS questionnaire is a self-administered patient-reported outcome measure that assesses the mouth disability in SSc patients. However, improving the global and oral health of SSc patients is important as there is no cure for the disease; thus, instruments that record the impact of the condition and indicate the effect of treatment on the lives of patients are of paramount importance. Current results demonstrate good preliminary psychometric properties (validity and reliability) in a UK population with further exploration of psychometric properties with an emphasis on interpretability required.
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Affiliation(s)
- Ismail Abdouh
- Oral Medicine, UCL Eastman Dental Institute, London, UK.,Oral Medicine, College of Dentistry, Taibah University, Al Madinah Al Munawarah, Saudi Arabia
| | | | - Stefano Fedele
- Oral Medicine, UCL Eastman Dental Institute, London, UK.,Oral Theme UCLH/UCL NIHR, Biomedical Research Centre, London, UK
| | - Richeal Ni Riordain
- Oral Medicine, UCL Eastman Dental Institute, London, UK.,UCL Eastman and University College Cork, London, UK
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Spierings J, van den Ende CHM, Schriemer RM, Bernelot Moens HJ, van der Bijl EA, Bonte-Mineur F, de Buck MPD, de Kanter MAE, Knaapen-Hans HKA, van Laar JM, Mulder UDJ, Potjewijd J, de Pundert LAJ, Schoonbrood THM, Schouffoer AA, Stel AJ, Vercoutere W, Voskuyl AE, de Vries-Bouwstra JK, Vonk MC. How do patients with systemic sclerosis experience currently provided healthcare and how should we measure its quality? Rheumatology (Oxford) 2020; 59:1226-1232. [PMID: 31539063 PMCID: PMC7244783 DOI: 10.1093/rheumatology/kez417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives To gain insight into SSc patients’ perspective on quality of care and to survey their preferred quality indicators. Methods An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals. Results Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s.d. 6.9) and was longer in women compared with men (4.8 (s.d. 7.3) vs 2.5 (s.d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s.d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators. Conclusion The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek.,Department of Rheumatology, Radboud University Medical Center, Nijmegen
| | - Rita M Schriemer
- NVLE, Dutch patient organization for systemic autoimmune diseases, Utrecht
| | | | | | | | | | | | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht
| | - Udo D J Mulder
- Department of Internal Medicine, division Vascular Medicine, University of Groningen, Groningen
| | - Judith Potjewijd
- Department of Clinical immunology, Maastricht University Medical Center+, Maastricht
| | | | | | | | - Alja J Stel
- Department of Rheumatology, University Medical Center Groningen, Groningen
| | - Ward Vercoutere
- Department of Rheumatology, Zuyderland Medical Center, Heerlen
| | - Alexandre E Voskuyl
- Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, loc. VUMC, Amsterdam
| | | | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen
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Rezus E, Burlui AM, Gafton B, Stratulat TA, Zota GR, Cardoneanu A, Rezus C. A patient-centered approach to the burden of symptoms in patients with scleroderma treated with Bosentan: A prospective single-center observational study. Exp Ther Med 2020; 19:1739-1746. [PMID: 32104228 PMCID: PMC7027142 DOI: 10.3892/etm.2019.8361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare and complex autoimmune disease associated with poor vital and functional outcomes. The functional hindrance in patients derives from various disease-specific manifestations, including Raynaud's phenomenon and digital ulcers (DUs). Bosentan is an endothelin receptor antagonist capable of preventing the appearance of new DUs in patients with scleroderma. The present study aimed to evaluate the effects of Bosentan on the severity of Raynaud's phenomenon, DU-related symptoms and functional impairment during the first year of treatment. A prospective study that included adult patients with SSc admitted to the Rheumatology Department between January 2016 and January 2017 that were candidates for Bosentan therapy, was performed. All patients were asked to evaluate the burden of symptoms secondary to Raynaud's and DUs using a visual analogue scale (VAS), whereas functional hindrance was assessed via Health Assessment Questionnaire Disability Index (HAQ-DI). The outcomes were assessed at baseline and every 3 months during 1 year of therapy. Among the 41 patients included initially, 2 participants discontinued the treatment after 1 month due to adverse events (elevation of liver enzymes). The study cohort exhibited a significant improvement in HAQ-DI, VAS-R and VAS-DU scores in response to Bosentan therapy over the 1-year follow-up period. Higher scores at baseline predicted a weaker treatment-related improvement, with the risk of a poor outcome being increased by 220% for VAS-R, 116% for VAS-DU, whereas no increase was observed for HAQ-DI. The post-treatment improvement in VAS-DU levels was associated with a better outcome for HAQ-DI (R=0.44; P=0.005). This association was not identified for VAS-R (R=0.24; P=0.137). Throughout the follow-up period, patients with dyspnea presented with significantly higher HAQ-DI scores compared with non-dyspneic patients. Bosentan therapy may indirectly influence functionality and quality of life in patients with scleroderma by reducing the burden of Raynaud's and DU-related symptoms. Nonetheless, patients with SSc with a decreased symptom burden at baseline exhibited improved outcomes.
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Affiliation(s)
- Elena Rezus
- Department of Rheumatology and Physiotherapy, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandra Maria Burlui
- Department of Rheumatology and Physiotherapy, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Bogdan Gafton
- Department of Medical Oncology-Radiotherapy, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Teodora Alexa Stratulat
- Department of Medical Oncology-Radiotherapy, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Rusu Zota
- Department of Pharmacology, Clinical Pharmacology and Algesiology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Cardoneanu
- Department of Rheumatology and Physiotherapy, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
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Gündüz İ, Batmaz İ, Bozan T, Ekinci A, Cevik R. The relationship of serum SCUBE-1, -2 and -3 levels with clinical findings and ultrasonographic skin thickness in systemic sclerosis patients. Int J Rheum Dis 2020; 23:526-531. [PMID: 31991528 DOI: 10.1111/1756-185x.13798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/14/2019] [Accepted: 01/02/2020] [Indexed: 01/15/2023]
Abstract
AIM This study aimed to investigate the relationship between the level of serum signal peptide-CUB-EGF domain-containing protein (SCUBE)-1, SCUBE-2 and SCUBE-3 and clinical findings and ultrasonographic skin thickness in systemic sclerosis (SSc). MATERIAL AND METHODS Thirty patients who met the American College of Rheumatology/European League against Rheumatism 2013 SSc classification criteria and 44 healthy volunteers who were compatible with the patient group in terms of age and gender were included in the study. Serum SCUBE levels were measured by enzyme-linked immunosorbent assay. Ultrasonographic skin thickness measurements were simultaneously performed. RESULTS No significant difference was found between the serum SCUBE levels of SSc patients and serum SCUBE levels of the control group. A negative correlation was detected between serum SCUBE-1 level and forced expiratory volume in 1 second (FEV1 ). While a positive correlation was detected between serum SCUBE-2 level and the Duruöz Hand Index and serum C4 level, a negative correlation was determined with the forced vital capacity (FVC) value. A negative correlation was determined between serum SCUBE-3 level and echocardiographic pulmonary artery pressure (PAP). A correlation could not be determined between serum SCUBE levels and ultrasonographic skin thickness. However, a positive correlation was observed between ultrasonographic skin thickness and the modified Rodnan skin score. CONCLUSION In this study, a correlation was observed between serum SCUBE levels and some clinical and laboratory parameters (FEV1 , FVC, PAP, C4, and Duruöz Hand Index) in SSc patients. New clinical studies are needed to better understand the contribution of these molecules in the progression and pathogenesis of SSc.
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Affiliation(s)
- İbrahim Gündüz
- Department of Physical Medicine and Rehabilitation, Diyarbakır Gazi Yaşargil Eğitim Araştırma Hastahanesi, Diyarbakır, Turkey
| | - İbrahim Batmaz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Turgut Bozan
- Department of Physical Medicine and Rehabilitation, Tunceli Devlet Hastahanesi, Tunceli, Turkey
| | - Aysun Ekinci
- Department of Medical Biochemistry, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Remzi Cevik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Tore NG, Sari F, Sarac DC, Baglan Yentur S, Satis H, Avanoglu Guler A, Haznedaroglu S, Oskay D. Inter-rater reliability of modified hand mobility in scleroderma test. Int J Rheum Dis 2019; 23:203-206. [PMID: 31746119 DOI: 10.1111/1756-185x.13750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022]
Abstract
AIM Systemic sclerosis (SSc) is a chronic autoimmune disease of unknown etiology characterized by excessive collagen production, endothelial cell injury, microvascular obliteration, cutaneous fibrosis and progressive visceral disease. The hands are frequently involved during the progression of the disease, with symmetrical skin thickening as a prominent feature. Modified hand mobility in scleroderma (mHAMIS) test is a measurement method to assess hand mobility in patients with SSc. Knowing the inter-rater reliability of the instrument is important in order for the results from different examiners to be accurately interpreted. The aim of this study was to test inter-rater reliability of the mHAMIS test. METHOD Hand mobility for both hands was assessed in 25 female patients with SSc by 2 physiotherapists who have different years of experience. Patients who had flexion contracture in at least 1 finger and undergone hand surgery in the last year due to any injuries, were excluded from the study since hand mobility was prevented. Inter-rater reliability was determined using intra-class correlation coefficients (ICCs). RESULT The ICCs were excellent between raters for dominant and non-dominant hands. The values were 0.92 and 0.93, respectively. CONCLUSION The inter-rater reliability of the mHAMIS was found to be excellent. This research contributes to the literature by proving that the test can be used without causing bias in clinical trials.
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Affiliation(s)
- Nurten Gizem Tore
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Fulden Sari
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Songul Baglan Yentur
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Firat University, Elazıg, Turkey
| | - Hasan Satis
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Aslihan Avanoglu Guler
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Seminur Haznedaroglu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Forte G, Fadda C, Bocca B, Erre GL, Passiu G, Madeddu R. Association Between Exposure to Heavy Metals and Systemic Sclerosis: the Levels of Al, Cd, Hg, and Pb in Blood and Urine of Patients. Biol Trace Elem Res 2019; 190:1-10. [PMID: 30215191 DOI: 10.1007/s12011-018-1509-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022]
Abstract
Systemic sclerosis (SSc) is a multisystem connective tissue disease; exogenous factors-including heavy metals-may have a role in the disease pathogenesis. In this context, a study on the quantification of Al, Cd, Hg, and Pb in blood and urine of 27 SSc patients and 30 controls was carried out. Main findings were that Al was significantly depleted in blood and increased in urine of SSc patients respect to controls; and Pb was found slightly increased in blood and significantly decreased in SSc group. In addition, higher Hg levels in urine were found in SSc subjects with the higher severity of the disease. Females showed the most marked differences in the levels of blood Al, blood Pb, and urine Cd between patients and controls. Smoking, hobby, ingestion of contaminated food, job exposure may contribute to the bodily levels of Al, Hg, Pb in SSc patients. The results indicated that low, chronic, and multiple exposures to heavy metals-also through habits, diet, and environment-may influence the risk for SSc.
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Affiliation(s)
- Giovanni Forte
- Italian National Institute for Health, Environment and Health Department, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Carlo Fadda
- Department of Biomedical Sciences - Histology, University of Sassari, Sassari, Italy
| | - Beatrice Bocca
- Italian National Institute for Health, Environment and Health Department, Viale Regina Elena, 299, 00161, Rome, Italy.
| | | | - Giuseppe Passiu
- Department of Medical, Surgery and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Roberto Madeddu
- Department of Biomedical Sciences - Histology, University of Sassari, Sassari, Italy
- National Institute of Biostructures and Biosystems, Rome, Italy
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Aguiar R, Pei M, Qureshi AR, Lindholm B. Health-related quality of life in peritoneal dialysis patients: A narrative review. Semin Dial 2018; 32:452-462. [PMID: 30575128 DOI: 10.1111/sdi.12770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Health-related quality of life (HRQOL) is an important aspect of patients´ health that should be an integral part of the evaluation of patient-centered outcomes, not least because HRQOL associates with patients´ morbidity and mortality. This applies also to chronic kidney disease patients, including those dependent on renal replacement therapies, the type of which may influence patients´ perception of HRQOL. Several studies have addressed HRQOL in chronic kidney disease patients undergoing renal replacement therapies, especially transplanted patients and hemodialysis patients, while publications concerning peritoneal dialysis (PD) patients are scarcer. This review describes some of the methods used to assess HRQOL, factors influencing HRQOL in PD patients, HRQOL in PD vs hemodialysis, and the relation between HRQOL and patient outcomes. We conclude that assessment of HRQOL-often neglected at present-should be included as a standard measure of patient-centered outcomes and when monitoring the quality and effectiveness of renal care including PD treatment.
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Affiliation(s)
- Rute Aguiar
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,Nephrology, Hospital Espírito Santo, Évora, Portugal
| | - Ming Pei
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Campus Flemingsberg, Stockholm, Sweden
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Abdulle AE, van Goor H, Mulder DJ. Hydrogen Sulfide: A Therapeutic Option in Systemic Sclerosis. Int J Mol Sci 2018; 19:E4121. [PMID: 30572591 PMCID: PMC6320961 DOI: 10.3390/ijms19124121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022] Open
Abstract
Systemic sclerosis (SSc) is a lethal disease that is characterized by auto-immunity, vascular injury, and progressive fibrosis of multiple organ systems. Despite the fact that the exact etiology of SSc remains unknown, oxidative stress has been associated with a large range of SSc-related complications. In addition to the well-known detrimental properties of reactive oxygen species (ROS), gasotransmitters (e.g., nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H₂S)) are also thought to play an important role in SSc. Accordingly, the diverse physiologic actions of NO and CO and their role in SSc have been previously studied. Recently, multiple studies have also shown the importance of the third gasotransmitter H₂S in both vascular physiology and pathophysiology. Interestingly, homocysteine (which is converted into H₂S through the transsulfuration pathway) is often found to be elevated in SSc patients; suggesting defects in the transsulfuration pathway. Hydrogen sulfide, which is known to have several effects, including a strong antioxidant and vasodilator effect, could potentially play a prominent role in the initiation and progression of vasculopathy. A better understanding of the actions of gasotransmitters, like H₂S, in the development of SSc-related vasculopathy, could help to create early interventions to attenuate the disease course. This paper will review the role of H₂S in vascular (patho-)physiology and potential disturbances in SSc. Moreover, current data from experimental animal studies will be reviewed. Lastly, we will evaluate potential interventional strategies.
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Affiliation(s)
- Amaal Eman Abdulle
- Department of Internal Medicine, Division Vascular Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Harry van Goor
- Department of Pathology and Medical Biology, Section Pathology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Douwe J Mulder
- Department of Internal Medicine, Division Vascular Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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48
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Electrocardiographic Findings in Systemic Sclerosis. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.2478/sjecr-2018-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Systemic sclerosis (SSc) is an autoimmune connective tissue disease which affects various tissues and organs, including skin, lungs, kidneys, gastrointestinal tract and cardiovascular system. Cardiac involvement is the most commonly recognized problem and a significant cause of morbidity. Abnormal ECG is present in 25-75% of patients with SSc and is considered to be an independent predictor of mortality. It is known that the supraventricular arrhythmias are considered as more common in SSc patients, occurring in about two-thirds of the cases, and more often than ventricular tachyarrhythmias. It has been established that right bundle branch block is associated with an increased risk of mortality and that it is an independent predictor of mortality, and should be considered as a marker of the severity of the disease in SSc. Th e prolonged QTc interval is an independent risk factor for a sudden cardiac death reflecting the instability of repolarization and predisposing the onset of cardiac arrhythmias.The prognosis of the disease depends on the SSc subtype and the involvement of internal organs. SSc is a lifelong disease and cannot be cured, but knowing that cardiac dysfunction significantly worsens the prognosis, early detection of cardiac complications and appropriate therapy can influence its progress and improve the patients’ quality of life.
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Li L, Cui Y, Chen S, Zhao Q, Fu T, Ji J, Li L, Gu Z. The impact of systemic sclerosis on health-related quality of life assessed by SF-36: A systematic review and meta-analysis. Int J Rheum Dis 2018; 21:1884-1893. [PMID: 30428506 DOI: 10.1111/1756-185x.13438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/07/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this meta-analysis was to systematically review the literature to evaluate the impact of systemic sclerosis (SSc) on the health-related quality of life (HRQoL) assessed by the Medical Outcomes Short-Form-36 questionnaire (SF-36). METHODS A systematic literature search was performed on PubMed, Web of Science and Embase until April 2017 to obtain eligible studies. Random effect model was performed to summarize the scores of each domain. Scores from the SF-36 questionnaire were used as the outcome measurements, and mean differences with 95% confidence intervals were calculated. RESULTS In total, seven studies were eligible for inclusion criteria, comprising 795 SSc patients and 1154 healthy controls. The SF-36 questionnaire score of each domain (physical function, role physical function, emotional role function, vitality, mental health, social function, body pain, general health) was lower in SSc patients than in healthy controls, meanwhile, physical component scale (PCS) and mental component scale (MCS) scores were all lower in patients with SSc than in healthy controls. Likewise, pooled mean scores of PCS and MCS ranged from 31.20 to 52.80, 37.40 to 68.30, respectively. Additionally, the score of PCS was lower than that of MCS in SSc patients. CONCLUSIONS This meta-analysis showed that SSc patients had lower HRQoL than healthy controls, and SSc had negative influence on the HRQoL of patients. This indicates that clinical workers should pay more attention to SSc patients' HRQoL, so as to improve global health of patients with SSc.
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Affiliation(s)
- Lin Li
- School of Nursing, Nantong University, Nantong, China
| | - Yafei Cui
- School of Nursing, Nantong University, Nantong, China
| | - Shengnan Chen
- School of Nursing, Nantong University, Nantong, China
| | - Qian Zhao
- School of Nursing, Nantong University, Nantong, China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Juan Ji
- Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, China
| | - Liren Li
- School of Nursing, Nantong University, Nantong, China
| | - Zhifeng Gu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
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50
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van Caam A, Vonk M, van den Hoogen F, van Lent P, van der Kraan P. Unraveling SSc Pathophysiology; The Myofibroblast. Front Immunol 2018; 9:2452. [PMID: 30483246 PMCID: PMC6242950 DOI: 10.3389/fimmu.2018.02452] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022] Open
Abstract
Systemic sclerosis (SSc) is a severe auto-immune disease, characterized by vasculopathy and fibrosis of connective tissues. SSc has a high morbidity and mortality and unfortunately no disease modifying therapy is currently available. A key cell in the pathophysiology of SSc is the myofibroblast. Myofibroblasts are fibroblasts with contractile properties that produce a large amount of pro-fibrotic extracellular matrix molecules such as collagen type I. In this narrative review we will discuss the presence, formation, and role of myofibroblasts in SSc, and how these processes are stimulated and mediated by cells of the (innate) immune system such as mast cells and T helper 2 lymphocytes. Furthermore, current novel therapeutic approaches to target myofibroblasts will be highlighted for future perspective.
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Affiliation(s)
- Arjan van Caam
- Experimental Rheumatology, Radboudumc, Nijmegen, Netherlands
| | - Madelon Vonk
- Department of Rheumatology, Radboudumc, Nijmegen, Netherlands
| | | | - Peter van Lent
- Experimental Rheumatology, Radboudumc, Nijmegen, Netherlands
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